Science.gov

Sample records for advanced planning organizational

  1. Energy Organizational Planning

    SciTech Connect

    Gina C. Paradis; James Yockey; Tracey LeBeau

    2009-04-17

    As the Seneca Nation of Indians (SNI) continues to refine and finalize its Strategic Energy Plan, it became necessary to insure that a sustainable organization structure was developed through which the energy program and its initiatives could be nurtured and managed. To that end, SNI undertook a study to thoroughly evaluate the existing organizational structures and assess the requisite changes and/or additions to that framework that would complement the mission of the Strategic Plan. The goal of this study was to analyze, work with staff and leadership and recommend the most effective plan for the development of an organizational framework within which the Seneca could more effectively exercise energy sovereignty – control and manage their natural resource assets – i.e. develop its own energy resources, meet the current and projected energy needs of their community, and “sit at the table” with other regional energy providers to deal with issues on a peer-to-peer basis.

  2. 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. PMID:26259336

  3. Linking Outcomes to Organizational Planning.

    ERIC Educational Resources Information Center

    Ligon, Glynn; Jackson, Elaine

    Linking Outcomes to Organizational Planning (LOOP) was initiated during the 1984-85 school year in the Austin (Texas) Independent School District. LOOP was designed to ensure that evaluation, research, and informal findings became part of the instructional planning loop; to provide information to the Superintendent on progress toward priorities…

  4. Advance Care Planning

    MedlinePlus

    ... Division of Geriatrics and Clinical Gerontology Division of Neuroscience FAQs Funding Opportunities Intramural Research Program Office of ... Is Advance Care Planning? Advance care planning involves learning about the types of decisions that might need ...

  5. Advance Care Planning.

    PubMed

    Stallworthy, Elizabeth J

    2013-04-16

    Advance care planning should be available to all patients with chronic kidney disease, including end-stage kidney disease on renal replacement therapy. Advance care planning is a process of patient-centred discussion, ideally involving family/significant others, to assist the patient to understand how their illness might affect them, identify their goals and establish how medical treatment might help them to achieve these. An Advance Care Plan is only one useful outcome from the Advance Care Planning process, the education of patient and family around prognosis and treatment options is likely to be beneficial whether or not a plan is written or the individual loses decision making capacity at the end of life. Facilitating Advance Care Planning discussions requires an understanding of their purpose and communication skills which need to be taught. Advance Care Planning needs to be supported by effective systems to enable the discussions and any resulting Plans to be used to aid subsequent decision making. PMID:23586906

  6. The Dynamics of Organizational Culture and Academic Planning

    ERIC Educational Resources Information Center

    Willson, Richard

    2006-01-01

    Planning approaches are in a dynamic relationship with organizational culture. This article uses a case study of academic planning at California State Polytechnic University, Pomona to draw a correspondence between types of organizational culture and planning approaches. The case study shows the differing conceptions of organizational culture held…

  7. Postimplementation Planning and Organizational Structure of Enterprise Resource Planning Systems

    ERIC Educational Resources Information Center

    Wilson, Charmaine V.

    2012-01-01

    Globalization, rapid technological changes, and competitive pressures have resulted in company leaders' worldwide adopting of enterprise resource planning (ERP) systems to improve productivity and business operations and reduce costs in the post-implementation phase. The research addressed organizational leaders' inability to optimize…

  8. Characteristics of Useful and Practical Organizational Strategic Plans

    ERIC Educational Resources Information Center

    Kaufman, Roger

    2014-01-01

    Most organizational strategic plans are not strategic but rather tactical or operational plans masquerading as "strategic." This article identifies the basic elements required in a useful and practical strategic plan and explains why they are important.

  9. Higher Education Futures: Organisational Planning and Organizational Technology Perspectives.

    ERIC Educational Resources Information Center

    Freeman, Andrew R.

    Some possible futures in higher education are explored with an emphasis on organizational planning and organizational technology perspectives. The focus is on "soft" organizational technologies rather than "hard" equipment-based technologies. Attention is directed to the way that the two perspectives could affect higher education organizational…

  10. OSUL2013: Fostering Organizational Change through a Grassroots Planning Process

    ERIC Educational Resources Information Center

    Schlosser, Melanie

    2011-01-01

    This paper provides background on planning and organizational culture change in libraries and describes a grassroots planning process taking place at the Ohio State University Libraries. Now in its third phase, the process aims to create a long-term plan for the organization while fostering a more collaborative, innovative culture.

  11. Increasing Organizational Effectiveness through Better Human Resource Planning and Development

    ERIC Educational Resources Information Center

    Schein, Edgar H.

    1977-01-01

    Discusses the increasing importance of human resource planning and development for organizational effectiveness, and examines how the major components of a human resource planning and development system should be coordinated for maximum effectiveness. Available from Alfred P. Sloan School of Management, Massachusetts Institute of Technology,…

  12. Human Resource Planning: Challenges for Industrial/Organizational Psychologists.

    ERIC Educational Resources Information Center

    Jackson, Susan E.; Schuler, Randall S.

    1990-01-01

    Describes activities that industrial/organizational psychologists engage in as they seek to improve the competitiveness of organizations through effective human resource planning. Presents a model for describing human resource short-term, intermediate-term, and long-term planning. (JS)

  13. Advancement Planning: An Objectives View.

    ERIC Educational Resources Information Center

    Druck, Kalman B.

    1986-01-01

    Planning must revolve around objectives related to students, faculty, money, and political support. When it is understood that all of the institution's advancement activity should help produce these four things, planning is easy. (MLW)

  14. Advanced Production Planning Models

    SciTech Connect

    JONES,DEAN A.; LAWTON,CRAIG R.; KJELDGAARD,EDWIN A.; WRIGHT,STEPHEN TROY; TURNQUIST,MARK A.; NOZICK,LINDA K.; LIST,GEORGE F.

    2000-12-01

    >This report describes the innovative modeling approach developed as a result of a 3-year Laboratory Directed Research and Development project. The overall goal of this project was to provide an effective suite of solvers for advanced production planning at facilities in the nuclear weapons complex (NWC). We focused our development activities on problems related to operations at the DOE's Pantex Plant. These types of scheduling problems appear in many contexts other than Pantex--both within the NWC (e.g., Neutron Generators) and in other commercial manufacturing settings. We successfully developed an innovative and effective solution strategy for these types of problems. We have tested this approach on actual data from Pantex, and from Org. 14000 (Neutron Generator production). This report focuses on the mathematical representation of the modeling approach and presents three representative studies using Pantex data. Results associated with the Neutron Generator facility will be published in a subsequent SAND report. The approach to task-based scheduling described here represents a significant addition to the literature for large-scale, realistic scheduling problems in a variety of production settings.

  15. Coordination of Individual and Organizational Planning for Natural Hazards (Invited)

    NASA Astrophysics Data System (ADS)

    Krantz, D. H.

    2013-12-01

    Decision making consists of constructing or selecting a plan. This is true at many levels of decision making: individuals or households, small groups, larger organizations, and governments. In each case, plans are constructed or selected taking account of the decision maker's prioritized set of active goals and the decision maker's beliefs about the probability or the extent to which each goal will be attained through a given plan. Planning for mitigation of or response to natural hazards can be improved if the plans of the many decision makers at multiple levels are coordinated. Government planning should ideally be informed by knowledge about the plans of businesses and non-profit organizations as well as knowledge about individual, household, and neighborhood plans. Similarly, plans at the individual and organizational levels should be informed by knowledge of others' plans at the same and at higher and lower levels of aggregation. Coordination can be impaired by differences in goals, differences in beliefs about the instrumentality of plans toward given goals, and also by ignorance of others' goals and plans. Good coordination requires incentives that promote sharing of plans, horizontally and vertically, and that alleviate conflicts in goals and conflicts in beliefs that will inevitably surface once plans are shared. Thus, four different kinds of decision aids are needed to improve natural hazard planning: mechanisms that support horizontal dissemination of plans, mechanisms that support vertical dissemination, mechanisms for examining goal conflicts and reducing these through plans that take others' goals into account, and mechanisms for examining belief conflicts.

  16. The impact of gendered organizational systems on women's career advancement.

    PubMed

    O'Neil, Deborah A; Hopkins, Margaret M

    2015-01-01

    In this Perspective article we propose that in order to pave the way for women's career advancement into the senior ranks of organizations, attention must be directed at the systemic norms and structures that drive the gendered nature of the workplace. A focus on individual level issues, i.e., women lacking confidence and women opting out, detracts from the work that must be done at the organizational level in order to dismantle the system of pervasive, structural disadvantage facing women seeking to advance to senior leadership positions. PMID:26175708

  17. Advance Care Planning

    Cancer.gov

    The thirteenth module of the EPEC-O (Education in Palliative and End-of-Life Care for Oncology) Self-Study: Cultural Considerations When Caring for African Americans explores the attitudes and practices of African Americans related to completion of advance directives, and recommends effective strategies to improve decision-making in the setting of serious, life-threatening illness, in ways that augment patient autonomy and support patient-centered goal-setting and decision-making among African American patients and their families.

  18. Planning Ahead: Advanced Heart Failure

    MedlinePlus

    ... Pressure Tools & Resources Stroke More Planning Ahead: Advanced Heart Failure Updated:Aug 24,2016 An important part of ... content was last reviewed on 04/16/2015. Heart Failure • Home • About Heart Failure • Causes and Risks for ...

  19. Consulting to Facilitate Planned Organizational Change in Schools

    ERIC Educational Resources Information Center

    Zins, Joseph E.; Illback, Robert J.

    2007-01-01

    We present an update of our 1984 chapter on organizational interventions in educational settings. Our view of the organizational change process is described, followed by a discussion of the gap between current theory and practice. We describe several examples of promising organizational change initiatives, followed by our observations of future…

  20. Advanced Fuels Campaign Execution Plan

    SciTech Connect

    Kemal Pasamehmetoglu

    2010-10-01

    The purpose of the Advanced Fuels Campaign (AFC) Execution Plan is to communicate the structure and management of research, development, and demonstration (RD&D) activities within the Fuel Cycle Research and Development (FCRD) program. Included in this document is an overview of the FCRD program, a description of the difference between revolutionary and evolutionary approaches to nuclear fuel development, the meaning of science-based development of nuclear fuels, and the “Grand Challenge” for the AFC that would, if achieved, provide a transformational technology to the nuclear industry in the form of a high performance, high reliability nuclear fuel system. The activities that will be conducted by the AFC to achieve success towards this grand challenge are described and the goals and milestones over the next 20 to 40 year period of research and development are established.

  1. Advanced Fuels Campaign Execution Plan

    SciTech Connect

    Kemal Pasamehmetoglu

    2011-09-01

    The purpose of the Advanced Fuels Campaign (AFC) Execution Plan is to communicate the structure and management of research, development, and demonstration (RD&D) activities within the Fuel Cycle Research and Development (FCRD) program. Included in this document is an overview of the FCRD program, a description of the difference between revolutionary and evolutionary approaches to nuclear fuel development, the meaning of science-based development of nuclear fuels, and the 'Grand Challenge' for the AFC that would, if achieved, provide a transformational technology to the nuclear industry in the form of a high performance, high reliability nuclear fuel system. The activities that will be conducted by the AFC to achieve success towards this grand challenge are described and the goals and milestones over the next 20 to 40 year period of research and development are established.

  2. Thinking Globally, Planning Nationally and Acting Locally: Nested Organizational Fields and the Adoption of Environmental Practices

    ERIC Educational Resources Information Center

    Vasi, Ion Bogdan

    2007-01-01

    The study of the adoption of activities to protect the natural environment has tended to focus on the role of organizational fields. This article advances existing research by simultaneously examining conflicting processes that operate in nested organizational fields at local, national and supra-national levels. It examines the recent spread of an…

  3. 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.

  4. Knowledge Management Platform in Advanced Product Quality Planning

    NASA Astrophysics Data System (ADS)

    Chiliban, Bogdan; Baral, Lal Mohan; Kifor, Claudiu

    2014-12-01

    Knowledge is an essential part of organizational competitiveness. This vital resource must be managed correctly within organizations in order to achieve desired performance levels within all undertakings. The process of managing knowledge is a very difficult one due to the illusive nature of the resource itself. Knowledge is stored within every aspect of an organization starting from people and ending with documents and processes. The Knowledge Management Platform is designed as a facilitator for managers and employees in all endeavours knowledge related within the Advanced Product Quality Planning Procedure

  5. Do Values Drive the Plan? Investigating the Nature and Role of Organizational Values in University Strategic Planning

    ERIC Educational Resources Information Center

    Mueller, Robin Alison

    2015-01-01

    Strategic planning is a common practice at higher education institutions. Furthermore, it is assumed that identifying organizational values is an essential part of the planning process. Values are often construed as foundational elements of strategic thinking that serve to "drive the plan". However, there is little conceptual or applied…

  6. 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.

  7. Advance Planning by Same-Sex Couples

    ERIC Educational Resources Information Center

    Riggle, Ellen D. B.; Rostosky, Sharon S.; Prather, Robert A.

    2006-01-01

    The lack of legal recognition of same-sex couples can leave partners vulnerable in a crisis or emergency. Advance planning is one strategy couples can use to establish legal rights. Analyses of data collected from both partners in 131 same-sex couples suggested that executing advance-planning documents (wills, powers of attorney for finance and…

  8. Plans for Advanced LIGO Instruments

    NASA Astrophysics Data System (ADS)

    Wilkinson, Carol

    2005-04-01

    The proposed Advanced LIGO detector will have an increase in sensitivity over initial LIGO by a factor of ten, with an increased bandwidth in the region of highest sensitivity and the ability to tune for specific astrophysical sources. Advanced LIGO will achieve the equivalent of the one-year integrated observation time of initial LIGO in just several hours, allowing observation of astrophysical gravitational waves on a regular basis. The Advanced LIGO detector will replace the existing detector at the LIGO Observatories while retaining the existing building and vacuum system infrastructure. The new instruments build on the initial LIGO Fabry-Perot Michelson Interferometer layout and take advantage of significant advances in technology since the design of initial LIGO in the 1990's. Signal strength/sensitivity will be improved by increasing the laser power, lowering optical absorption, and adding signal recycling to the Fabry-Perot arm cavities. Stray forces on the test masses will be controlled by reducing thermal noise sources in the suspensions and optics and using a multi-staged seismic isolation system with inertial sensing and feedback control. The LIGO laboratory, the LIGO Science Collaboration, and international partners have undertaken a structured program of research and development, including testing of full-scale prototypes in context. Significant progress has been made on several of the detector subsystems. The Advanced LIGO project has been through National Science Foundation peer review and the National Science Board has recommended it for funding. Based on a proposed funding start in 2007, detector installation will begin in 2010, with observations at an advanced level of commissioning in 2013.

  9. The Instructional Planning Team: An Organizational Arrangement To Accomplish Planning, Teaching, and Evaluation in a School. A Pilot Study.

    ERIC Educational Resources Information Center

    Carlisle, David H.; And Others

    The Instructional Planning Team is based on the Research and Instruction Unit of the Wisconsin R & D Center for Cognitive Learning. To determine if the IPT as an organizational arrangement would increase the ability of a group of classroom teachers to use research-based information to improve their instructional program, a pilot test was conducted…

  10. Mega Thinking and Planning: An Introduction to Defining and Delivering Individual and Organizational Success

    ERIC Educational Resources Information Center

    Kaufman, Roger

    2009-01-01

    All organizations are means to societal ends, and thus Mega thinking and planning starts with a primary focus on adding value for all stakeholders, including our shared society. It is pragmatic, realistic, practical, and ethical. Defining and achieving continual organizational success is possible. It relies on three basic elements: (1) a societal…

  11. Power and Influence Styles in Programme Planning: Relationship with Organizational Political Contexts.

    ERIC Educational Resources Information Center

    Yang, Baiyin; Cervero, Ronald M.

    2001-01-01

    Adult educators (n=226) recalled incidents of power and influence behaviors in designing and planning programs. Cluster analysis identified four behaviors: shotgun, tactician, ingratiator, and bystander. These power and influence styles related to organizational contexts. Planners' personal characteristics did not affect choice of style. (SK)

  12. Succession planning in hospitals and the association with organizational performance.

    PubMed

    Kim, Tae Hyun

    2012-01-01

    Effective succession planning is the heart of leadership development and an essential business strategy because it enhances the ability to achieve orderly transitions and maintain productivity levels. The results of this study are consistent with previous studies that exhibit a positive association of previous years' performance with internal succession planning. The key to successful succession planning lies in building a solid foundation of profitability. Having successors ready to fill key vacancies helps improve operational condition and the bottom line, and thus, gives a competitive edge in the market. Preparing successors for leadership may determine which organizations simply survive and which thrive and lead their markets down the road. PMID:22479959

  13. Advancing the Community College Strategic Plan.

    ERIC Educational Resources Information Center

    Herbkersman, Neil; Hibbert-Jones, Karla

    2002-01-01

    Discusses the importance of developing a comprehensive grants development process to advance community college strategic plans, especially in the current economic climate. Details the process as developed and implemented by Sinclair Community College (Ohio). States that colleges that employ methodical processes and effective operating systems to…

  14. Factors Influencing the Selection of the Systems Integration Organizational Model Type for Planning and Implementing Government High-Technology Programs

    NASA Technical Reports Server (NTRS)

    Thomas, Leann; Utley, Dawn

    2006-01-01

    While there has been extensive research in defining project organizational structures for traditional projects, little research exists to support high technology government project s organizational structure definition. High-Technology Government projects differ from traditional projects in that they are non-profit, span across Government-Industry organizations, typically require significant integration effort, and are strongly susceptible to a volatile external environment. Systems Integration implementation has been identified as a major contributor to both project success and failure. The literature research bridges program management organizational planning, systems integration, organizational theory, and independent project reports, in order to assess Systems Integration (SI) organizational structure selection for improving the high-technology government project s probability of success. This paper will describe the methodology used to 1) Identify and assess SI organizational structures and their success rate, and 2) Identify key factors to be used in the selection of these SI organizational structures during the acquisition strategy process.

  15. Planning in Reverse: A Viable Approach to Organizational Leadership

    ERIC Educational Resources Information Center

    Ballantyne, Scott; Berret, Beth; Wells, Mary Ellen

    2011-01-01

    Planning in Reverse is an innovative concept designed to make organizations more successful by altering the perspective utilized in the strategy process. What is needed for organizations to thrive in this new environment of change and uncertainty is a short-term approach for long-term viability. In this book, tools and concepts regarding Planning…

  16. Advance care planning in the elderly.

    PubMed

    Lum, Hillary D; Sudore, Rebecca L; Bekelman, David B

    2015-03-01

    Key components of advance care planning (ACP) for the elderly include choosing a surrogate decision maker, identifying personal values, communicating with surrogates and clinicians, documenting wishes in advance directives, and translating values and preferences for future medical care into medical orders. ACP often involves multiple brief discussions over time. This article outlines common benefits and barriers to ACP in primary care, and provides practical approaches to integrating key ACP components into primary care for older adults. Opportunities for multidisciplinary teams to incorporate ACP into brief clinic visits are highlighted. PMID:25700590

  17. The impact of gendered organizational systems on women’s career advancement

    PubMed Central

    O’Neil, Deborah A.; Hopkins, Margaret M.

    2015-01-01

    In this Perspective article we propose that in order to pave the way for women’s career advancement into the senior ranks of organizations, attention must be directed at the systemic norms and structures that drive the gendered nature of the workplace. A focus on individual level issues, i.e., women lacking confidence and women opting out, detracts from the work that must be done at the organizational level in order to dismantle the system of pervasive, structural disadvantage facing women seeking to advance to senior leadership positions. PMID:26175708

  18. PLANNED CHANGE AND ORGANIZATIONAL HEALTH--FIGURE AND GROUND. CHAPTER 2, CHANGE PROCESSES IN THE PUBLIC SCHOOLS.

    ERIC Educational Resources Information Center

    MILES, MATTHEW B.

    PLANNED CHANGE, CONDITIONED BY THE STATE OF THE SYSTEM IN WHICH IT OCCURS, MUST TAKE THE IMPROVEMENT OF ORGANIZATIONAL HEALTH AS A PRIMARY TARGET. THE HEALTHY SCHOOL SYSTEM IS ABLE TO FUNCTION EFFECTIVELY AND TO DEVELOP INTO A MORE FULLY FUNCTIONING SYSTEM. OF TEN ORGANIZATIONAL HEALTH DIMENSIONS APPLICABLE TO SCHOOLS, THREE ARE TASK CENTERED…

  19. Towards a Natural Systems Theory of Organizational Effectiveness: Integrating Geopolitical, Darwinistic and Strategic Planning Perspectives. ASHE Annual Meeting 1981 Paper.

    ERIC Educational Resources Information Center

    Cope, Robert

    A theory of organizational development is developed from turn-of-the-century geopolitical studies by combining the following: Smithian and Darwinian perspectives; the firmer concepts of management; and strategic planning views. An attempt is made to explore natural organizational processes by considering geopolitical, economic, biological, and…

  20. Local institutional development and organizational change for advancing sustainable urban water futures.

    PubMed

    Brown, Rebekah R

    2008-02-01

    This paper presents the local institutional and organizational development insights from a five-year ongoing interdisciplinary research project focused on advancing the implementation of sustainable urban water management. While it is broadly acknowledged that the inertia associated with administrative systems is possibly the most significant obstacle to advancing sustainable urban water management, contemporary research still largely prioritizes investigations at the technological level. This research is explicitly concerned with critically informing the design of methodologies for mobilizing and overcoming the administrative inertia of traditional urban water management practice. The results of fourteen in-depth case studies of local government organizations across Metropolitan Sydney primarily reveal that (i) the political institutionalization of environmental concern and (ii) the commitment to local leadership and organizational learning are key corporate attributes for enabling sustainable management. A typology of five organizational development phases has been proposed as both a heuristic and capacity benchmarking tool for urban water strategists, policy makers, and decision makers that are focused on improving the level of local implementation of sustainable urban water management activity. While this investigation has focused on local government, these findings do provide guideposts for assessing the development needs of future capacity building programs across a range of different institutional contexts. PMID:18027015

  1. Local Institutional Development and Organizational Change for Advancing Sustainable Urban Water Futures

    NASA Astrophysics Data System (ADS)

    Brown, Rebekah R.

    2008-02-01

    This paper presents the local institutional and organizational development insights from a five-year ongoing interdisciplinary research project focused on advancing the implementation of sustainable urban water management. While it is broadly acknowledged that the inertia associated with administrative systems is possibly the most significant obstacle to advancing sustainable urban water management, contemporary research still largely prioritizes investigations at the technological level. This research is explicitly concerned with critically informing the design of methodologies for mobilizing and overcoming the administrative inertia of traditional urban water management practice. The results of fourteen in-depth case studies of local government organizations across Metropolitan Sydney primarily reveal that (i) the political institutionalization of environmental concern and (ii) the commitment to local leadership and organizational learning are key corporate attributes for enabling sustainable management. A typology of five organizational development phases has been proposed as both a heuristic and capacity benchmarking tool for urban water strategists, policy makers, and decision makers that are focused on improving the level of local implementation of sustainable urban water management activity. While this investigation has focused on local government, these findings do provide guideposts for assessing the development needs of future capacity building programs across a range of different institutional contexts.

  2. 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...

  3. Advanced Directives and Advanced Care Planning for Healthcare Professionals.

    PubMed

    Booth, Adam T; Lehna, Carlee

    2016-01-01

    The purposes of this study were to assess healthcare professionals' need for information on advanced directives and to implement and evaluate an educational plan for change in knowledge and behaviors related to advanced directives. End-of-life (EOL) care is an important topic for patients to discuss with their families and healthcare professionals (HP). Needs assessment data were collected from healthcare providers at an urban trauma intensive care unit (ICU) in Louisville, Kentucky on concepts related to end-of-life. Next, healthcare professionals participated in an educational intervention focused on: knowledge about advanced directives; communication techniques for healthcare professionals to use with patients and their families; awareness of the patient's level of illness in advanced care planning; and specifics about living wills in Kentucky and how to complete one. Pre- and post-test data were collected to evaluate change in knowledge, capability an average of 8.7 years (SD = 9.1; range = 1.9-35 years) in healthcare and worked an average of 8.4 years (SD = 9.3; range = 4 months to 35 years) in their respective ICUs. Eighty-seven percent did not have an AD in place even though their perceived knowledge about AD remained moderate throughout pre- and post-test scores (3.3 to 3.8 on a 5 point scale, respectively). Total post-test scores revealed a 2% improvement in correct responses. These findings point to the need for education of healthcare providers in the ICU to increase early AD and ACP discussions with patients and their families. PMID:27183766

  4. 75 FR 66319 - State Systems Advance Planning Document (APD) Process

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-28

    ... HUMAN SERVICES 45 CFR Part 95 RIN 0970-AC33 State Systems Advance Planning Document (APD) Process AGENCY... Health and Human Services (HHS). ACTION: Final rule. SUMMARY: The Advance Planning Document (APD) process... support programs for children and families. The Advance Planning Document (APD) process governs...

  5. [Advance Care Planning in Cancer Care].

    PubMed

    Kizawa, Yoshiyuki; Yamaguchi, Takashi; Yotani, Nobuyuki

    2016-03-01

    Advance care planning (ACP) is one of the most important issues to consider in providing quality end of life care for cancer patients. ACP has been described as a process whereby a patient, in consultation with health care providers, family members, and important others, makes decisions about his or her future health care, in the event he or she becomes incapable of participating in medical treatment decisions. ACP improves rates of following end of life wishes, increases patient and family satisfaction, and reduces family stress, anxiety, and depression. This article clarifies the differences among ACP, advance directives, and living wills. Additionally, we describe, based on clinical experience, how to introduce ACP most effectively for all stages of cancer care. PMID:27067841

  6. 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.

  7. 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.

  8. Advance care planning for people with dementia.

    PubMed

    2016-05-27

    Advance care planning (ACP) provides a framework for discussing and documenting care preferences in preparation for situations in which a person loses the cognitive capacity to make decisions. It can be particularly valuable in assisting people in the early stages of living with a dementia, supported by their families, to document their preferences for care at the later stages of their illness. While the potential benefits of ACP are widely acknowledged, there remain gaps in the research evidence on ACP and challenges in implementing ACP in practice. The three recently-published studies described below address these issues. PMID:27231079

  9. Not that way: Advance Care Planning

    PubMed Central

    How, Choon How; Koh, Lip Hoe

    2015-01-01

    Advance Care Planning (ACP) is a process of discussion of healthcare decisions with regard to a patient’s future health and personal care, should they become unable to make or communicate their own decisions in the future. ACP can be as simple as a chat about the patient’s end-of-life wishes with their trusted loved ones, and may involve their doctors, organisations and trained facilitators. The process can be documented with available online resources, such as structured tools. Family physicians, with whom patients share unique therapeutic relationships, are in the best position to introduce and start the ACP conversation with their patients. PMID:25640095

  10. 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,…

  11. 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...

  12. 14 CFR 151.111 - Advance planning proposals: General.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 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...

  13. 14 CFR 151.111 - Advance planning proposals: General.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 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...

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

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 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...

  15. 14 CFR 151.111 - Advance planning proposals: General.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 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...

  16. The Effect of Organizational Structure on Planning. A Report of the National Dissemination Project for Community Colleges.

    ERIC Educational Resources Information Center

    Carlson, Dennis; Das, Deb

    Ways in which community college systems might better serve the needs of minority and disadvantaged students through planning are suggested. A number of organizational variables that appeared to affect achievement in 10 previous OEO state planning projects are presented and discussed. The variables are divided into three structural levels: state…

  17. Planning an organizational wellness initiative at a multi-state social service agency.

    PubMed

    Miller, J Jay; Grise-Owens, Erlene; Addison, Donia; Marshall, Midaya; Trabue, Donna; Escobar-Ratliff, Laura

    2016-06-01

    Increasingly, organizations in general, and social service organizations, specifically, are recognizing the importance of planning and evaluating organizational wellness initiatives. Yet, few participatory models for carrying out these aims exist. For this study, researchers utilized concept mapping (CM) to explicate a conceptual framework for planning, and subsequently evaluating, a wellness initiative at a multi-state social service organization. CM is a participatory approach that analyzes qualitative data via multi-dimensional scaling and hierarchical cluster analyses. Outputs include a number of visual depictions that allow researchers to explore complex relationships among sets of the data. Results from this study indicated that participants (N=64), all of whom were employees of the agency, conceptualized organizational wellness via an eight-cluster solution, or Concept Map. Priority areas of this framework, specifically importance and feasibility, were also explored. After a brief review of pertinent literature, this article explicates the CM methodology utilized in this study, describes results, discusses lessons learned, and identifies apt areas for future research. PMID:27003729

  18. 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…

  19. Development of an interactive computer program for advance care planning

    PubMed Central

    Green, Michael J.; Levi, Benjamin H.

    2013-01-01

    Objective To describe the development of an innovative, multimedia decision aid for advance care planning. Background Advance care planning is an important way for people to articulate their wishes for medical care when they are not able to speak for themselves. Living wills and other types of advance directives are the most commonly used tools for advance care planning, but have been criticized for being vague, difficult to interpret, and inconsistent with individuals’ core beliefs and values. Results We developed a multimedia, computer-based decision aid for advance care planning (‘Making Your Wishes Known: Planning Your Medical Future’) to overcome many of the limitations of standard advance directive forms. This computer program guides individuals through the process of advance care planning, and unlike standard advance directives, provides tailored education, values clarification exercises, and a decision-making tool that translates an individual’s values and preferences into a specific medical plan that can be implemented by a health-care team. Pilot testing with 50 adult volunteers recruited from an outpatient primary care clinic showed high levels of satisfaction with the program. Further pilot testing with 34 cancer patients indicated that the program was perceived to be highly accurate at representing patients’ wishes. Conclusions This paper describes the development of an innovative decision aid for advance care planning that was designed to overcome common problems with standard advance directives. Preliminary testing suggests that it is acceptable to users and is accurate. PMID:18823445

  20. 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

  1. The Continuing Seminar on Organizational Planning and Policy Analysis: Implications for Community College Planning Offices.

    ERIC Educational Resources Information Center

    Morrison, James L.

    At the University of North Carolina at Chapel Hill, a seminar on planning and policy analysis is offered for doctoral students who wish to conduct planning and forecasting studies for their doctoral dissertations or who simply wish to learn such techniques. One of the major projects of the seminar is the development of an environmental scanning…

  2. Advance care planning in South Korea: Social work perspective.

    PubMed

    Kwon, Sung Ae; Kolomer, Stacey

    2016-08-01

    As ethical issues arise concerning the continuation of futile medical treatment for dying patients in Korean society, advance directive planning initiatives have been put into place to guide practice. This article describes the awareness and attitudes of social workers in Korea regarding advance care planning and related factors. A total of 246 gerontological/geriatric social workers completed a mailed or in-person survey regarding awareness and attitudes toward advance care planning. Seventy-three percent (n = 180) of the participants reported no knowledge of advance directives. Social workers who emphasized self-determination as a professional value, professed a preference for hospice care, and who were comfortable discussing death were more likely to have a positive attitudes toward advance care planning. This study reinforces the need for the infusion of advance care planning and end-of-life training in social work education in Korea. PMID:27428654

  3. Plan for advanced microelectronics processing technology application

    SciTech Connect

    Goland, A.N.

    1990-10-01

    The ultimate objective of the tasks described in the research agreement was to identify resources primarily, but not exclusively, within New York State that are available for the development of a Center for Advanced Microelectronics Processing (CAMP). Identification of those resources would enable Brookhaven National Laboratory to prepare a program plan for the CAMP. In order to achieve the stated goal, the principal investigators undertook to meet the key personnel in relevant NYS industrial and academic organizations to discuss the potential for economic development that could accompany such a Center and to gauge the extent of participation that could be expected from each interested party. Integrated of these discussions was to be achieved through a workshop convened in the summer of 1990. The culmination of this workshop was to be a report (the final report) outlining a plan for implementing a Center in the state. As events unfolded, it became possible to identify the elements of a major center for x-ray lithography on Lone Island at Brookhaven National Laboratory. The principal investigators were than advised to substitute a working document based upon that concept in place of a report based upon the more general CAMP workshop originally envisioned. Following that suggestion from the New York State Science and Technology Foundation, the principals established a working group consisting of representatives of the Grumman Corporation, Columbia University, the State University of New York at Stony Brook, and Brookhaven National Laboratory. Regular meetings and additional communications between these collaborators have produced a preproposal that constitutes the main body of the final report required by the contract. Other components of this final report include the interim report and a brief description of the activities which followed the establishment of the X-ray Lithography Center working group.

  4. Timeless and Timely Advice: A Commentary on "Consultation to Facilitate Planned Organizational Change in Schools," an Article by Joseph E. Zins and Robert J. Illback

    ERIC Educational Resources Information Center

    Hazel, Cynthia E.

    2007-01-01

    This commentary on Zins and Illback's (1995) article, Consultation to Facilitate Planned Organizational Change in Schools, argues that the authors provided a solid foundation for well-planned, proactive, sustainable, internally-driven systemic change in schools that has yet to be widely realized. Their school organizational change model and more…

  5. Making a Difference in Research and Practice: A Commentary on "Consulting to Facilitate Planned Organizational Change in Schools," an Article by Joseph E. Zins and Robert J. Illback

    ERIC Educational Resources Information Center

    Flaspohler, Paul D.

    2007-01-01

    Zins and Illback observed in 1995 that planned organizational change processes were neglected in practice, training, and research. In the decade following publication of their article, implementation of processes and structures of planned organizational change increased dramatically. Schools and school districts continue to face increased…

  6. 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...

  7. 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...

  8. 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...

  9. 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...

  10. 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...

  11. Understanding the Role of Culture and Communication in Implementing Planned Organizational Change: The Case of Compstat in Police Organizations

    ERIC Educational Resources Information Center

    Yuksel, Yusuf

    2013-01-01

    Despite the popularity of planned change efforts, the failure rates of implementation are as high as 50 to 70 percent (Lewis & Seibold, 1998). While these efforts are affected by technical issues, the organizations' approach to change, structure, technological capabilities, and organizational culture and communication practices are…

  12. 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…

  13. 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…

  14. Integration of Treatment Innovation Planning and Implementation: Strategic Process Models and Organizational Challenges

    PubMed Central

    Lehman, Wayne E. K.; Simpson, D. Dwayne; Knight, Danica K.; Flynn, Patrick M.

    2015-01-01

    Sustained and effective use of evidence-based practices in substance abuse treatment services faces both clinical and contextual challenges. Implementation approaches are reviewed that rely on variations of plan-do-study-act (PDSA) cycles, but most emphasize conceptual identification of core components for system change strategies. A 2-phase procedural approach is therefore presented based on the integration of TCU models and related resources for improving treatment process and program change. Phase 1 focuses on the dynamics of clinical services, including stages of client recovery (cross-linked with targeted assessments and interventions), as the foundations for identifying and planning appropriate innovations to improve efficiency and effectiveness. Phase 2 shifts to the operational and organizational dynamics involved in implementing and sustaining innovations (including the stages of training, adoption, implementation, and practice). A comprehensive system of TCU assessments and interventions for client and program-level needs and functioning are summarized as well, with descriptions and guidelines for applications in practical settings. PMID:21443294

  15. Advance Care Planning in Nursing Homes: Correlates of Capacity and Possession of Advance Directives

    ERIC Educational Resources Information Center

    Allen, Rebecca S.; DeLaine, Shermetra R.; Chaplin, William F.; Marson, Daniel C.; Bourgeois, Michelle S.; Dijkstra, Katinka; Burgio, Louis D.

    2003-01-01

    Purpose: The identification of nursing home residents who can continue to participate in advance care planning about end-of-life care is a critical clinical and bioethical issue. This study uses high quality observational research to identify correlates of advance care planning in nursing homes, including objective measurement of capacity. Design…

  16. Advance Care Planning for Serious Illness

    MedlinePlus

    ... conversations Caring Connections National Hospice and Palliative Care Organization Links to every state’s advance care directive forms http: / / www. caringinfo. org/ i4a/ pages/ index. cfm? ...

  17. Improving patient-centered care through advance care planning.

    PubMed

    Motley, Molly

    2013-06-01

    Advance care planning is crucial for patients confronting incurable, debilitating, or terminal disease. Discussing end-of-life issues can reduce overtreatment and undertreatment as defined by the patient, and improve satisfaction with care. PMID:23805592

  18. Voyager: Perils of advanced planning, 1960 - 1967

    NASA Technical Reports Server (NTRS)

    1984-01-01

    Contract proposals; phased project planning; budgetary problems; Saturn 1 B-Centaur versus Saturn V; mission guidelines and management assignments; and the origins of the Voyager project are discussed.

  19. Promoting perioperative advance care planning: a systematic review of advance care planning decision aids.

    PubMed

    Aslakson, Rebecca A; Schuster, Anne L R; Reardon, Jessica; Lynch, Thomas; Suarez-Cuervo, Catalina; Miller, Judith A; Moldovan, Rita; Johnston, Fabian; Anton, Blair; Weiss, Matthew; Bridges, John F P

    2015-11-01

    This systematic review identifies possible decision aids that promote perioperative advance care planning (ACP) and synthesizes the available evidence regarding their use. Using PubMed, EMBASE, Cochrane, SCOPUS, Web of Science, CINAHL, PsycINFO and Sociological Abstracts, researchers identified and screened articles for eligibility. Data were abstracted and risk of bias assessed for included articles. Thirty-nine of 5327 articles satisfied the eligibility criteria. Primarily completed in outpatient ambulatory populations, studies evaluated a variety of ACP decision aids. None were evaluated in a perioperative population. Fifty unique outcomes were reported with no head-to-head comparisons conducted. Findings are likely generalizable to a perioperative population and can inform development of a perioperative ACP decision aid. Future studies should compare the effectiveness of ACP decision aids. PMID:26346494

  20. 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. PMID:26752396

  1. Plan for an Advanced Turbine Systems Program

    SciTech Connect

    Bajura, R.A.; Webb, H.A.; Parks, W.P.

    1993-03-01

    A draft version of this paper was presented at the Clemson Clean, affordable, and reliable natural gas utilization technologies will play a growing role in meeting future power generation needs in the United States. The US Department of Energy`s (DOE) National Energy Strategy projected that total demand for natural gas will rise from 18.5 trillion cubic feet (tcf) in 1990 to 24.2 tcf by the year 2000. Much of this increase is attributed to the increased use of natural gas as a fuel for electric power generation. Candidate technologies for gas fired power generation include gas turbine and fuel cell systems. The first workshop on research needs for advanced gas turbine systems for power generation was held on April 8-10, 1991 in Greenville, South Carolina. The goals of the Clemson-I Workshop were to identify research needs which would accelerate the development of advanced gas turbines and to consider new approaches to implement this research. The Clemson-I Workshop focused on advanced gas turbine systems which would have a lower cost of electricity or better environmental performance than systems currently under development. The workshop was cosponsored by the DOE`s Morgantown Energy Technology Center (METC), Clemson University, and the South Carolina Energy Research and Development Center. The proceedings from the workshop have been published. The 75 participants in the Clemson-I Workshop represented a broad spectrum of the gas turbine Research & Development (R&D) community as well as potential users of advanced gas turbines. Gas turbine manufacturers, the electric utility industry, the university community, as well as government and private sector R&D sponsors were represented. Participants in the Clemson-I Workshop concluded that it is technically feasible to develop advanced turbine systems and that Government participation would accelerate the developmental effort. Advanced turbine systems could be operated on natural gas or adapted to coal or biomass firing.

  2. Plan for an Advanced Turbine Systems Program

    SciTech Connect

    Bajura, R.A.; Webb, H.A. ); Parks, W.P. )

    1993-01-01

    A draft version of this paper was presented at the Clemson Clean, affordable, and reliable natural gas utilization technologies will play a growing role in meeting future power generation needs in the United States. The US Department of Energy's (DOE) National Energy Strategy projected that total demand for natural gas will rise from 18.5 trillion cubic feet (tcf) in 1990 to 24.2 tcf by the year 2000. Much of this increase is attributed to the increased use of natural gas as a fuel for electric power generation. Candidate technologies for gas fired power generation include gas turbine and fuel cell systems. The first workshop on research needs for advanced gas turbine systems for power generation was held on April 8-10, 1991 in Greenville, South Carolina. The goals of the Clemson-I Workshop were to identify research needs which would accelerate the development of advanced gas turbines and to consider new approaches to implement this research. The Clemson-I Workshop focused on advanced gas turbine systems which would have a lower cost of electricity or better environmental performance than systems currently under development. The workshop was cosponsored by the DOE's Morgantown Energy Technology Center (METC), Clemson University, and the South Carolina Energy Research and Development Center. The proceedings from the workshop have been published. The 75 participants in the Clemson-I Workshop represented a broad spectrum of the gas turbine Research Development (R D) community as well as potential users of advanced gas turbines. Gas turbine manufacturers, the electric utility industry, the university community, as well as government and private sector R D sponsors were represented. Participants in the Clemson-I Workshop concluded that it is technically feasible to develop advanced turbine systems and that Government participation would accelerate the developmental effort. Advanced turbine systems could be operated on natural gas or adapted to coal or biomass firing.

  3. Revised Faculty Compensation, Evaluation, and Advancement Plan. March, 1998.

    ERIC Educational Resources Information Center

    May, Joe

    This report provides the revised faculty compensation, evaluation, and advancement plan for Pueblo Community College (PCC) in Colorado. Section 1 contains the PCC three-level salary plan and discusses guidelines for initial appointment and level placement of faculty, initial salary computations, and minimum initial employment requirements. Section…

  4. Managing the Organizational Vision, Mission, and Planning: Five Steps toward a Successful Leadership Strategy

    ERIC Educational Resources Information Center

    Ricci, Frederick A.

    2011-01-01

    The vision of academic and business leaders often sets a pattern for all activities to follow. Organizational objectives, tasks, performance, and uses of resources are needed to obtain and reach current and future society trends influencing organizational goals. This paper identifies 5 steps leaders need to create a systems approach toward…

  5. 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

  6. Center for Advanced Energy Studies Program Plan

    SciTech Connect

    Kevin Kostelnik

    2005-09-01

    The world is facing critical energy-related challenges regarding world and national energy demands, advanced science and energy technology delivery, nuclear engineering educational shortfalls, and adequately trained technical staff. Resolution of these issues is important for the United States to ensure a secure and affordable energy supply, which is essential for maintaining U.S. national security, continued economic prosperity, and future sustainable development. One way that the U.S. Department of Energy (DOE) is addressing these challenges is by tasking the Battelle Energy Alliance, LLC (BEA) with developing the Center for Advanced Energy Studies (CAES) at the Idaho National Laboratory (INL). By 2015, CAES will be a self-sustaining, world-class, academic and research institution where the INL; DOE; Idaho, regional, and other national universities; and the international community will cooperate to conduct critical energy-related research, classroom instruction, technical training, policy conceptualization, public dialogue, and other events.

  7. Advanced Simulation and Computing Business Plan

    SciTech Connect

    Rummel, E.

    2015-07-09

    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 responsible 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.

  8. Technological iatrogenesis: the manifestation of inadequate organizational planning and the integration of health information technology.

    PubMed

    Palmieri, Patrick Albert; Peterson, Lori T; Corazzo, Luciano Bedoya

    2011-01-01

    The Institute of Medicine (IOM) views Health Information Technology (HIT) as an essential organizational prerequisite for the delivery of safe, reliable, and cost-effective health services. However, HIT presents the proverbial double-edged sword in generating solutions to improve system performance while facilitating the genesis of novel iatrogenic problems. Incongruent organizational processes give rise to technological iatrogenesis or the unintended consequences to system integrity and the resulting organizational outcomes potentiated by incongruent organizational-technological interfaces. HIT is a disruptive innovation for health services organizations but remains an overlooked organizational development (OD) concern. Recognizing the technology-organizational misalignments that result from HIT adoption is important for leaders seeking to eliminate sources of system instability. The Health Information Technology Iatrogenesis Model (HITIM) provides leaders with a conceptual framework from which to consider HIT as an instrument for organizational development. Complexity and Diffusion of Innovation theories support the framework that suggests each HIT adoption functions as a technological change agent. As such, leaders need to provide operational oversight to managers undertaking system change via HIT implementation. Traditional risk management tools, such as Failure Mode Effect Analysis and Root Cause Analysis, provide proactive pre- and post-implementation appraisals to verify system stability and to enhance system reliability. Reconsidering the use of these tools within the context of a new framework offers leaders guidance when adopting HIT to achieve performance improvement and better outcomes. PMID:21887951

  9. [Depression screening and possible applications of advance care planning].

    PubMed

    Wada, Taizo

    2013-01-01

    Depression screening was conducted to determine the health status of community-dwelling elderly individuals, and the concept of advance care planning was introduced. While depression screening among the elderly often uses the Geriatric Depression Scale, a single question regarding depressive mood also provides a valid measure of depression in elderly persons. Depression is associated with lower activities of daily living, competence, and subjective quality of life among the elderly living in Vietnam and Indonesia, as well as in Japan. Advance care planning is a process of discussion between individuals and their care providers to make decisions about future care preferences and priorities, while they are still capable. If they wish, they may prepare an advance directive to inform others about their decisions and best interests, such as a written advance decision to refuse treatment and/or appointment of a person with lasting powers of attorney. The purpose of advance care planning is to enable elderly persons to receive better end-of-life care. To promote introduction of advance care planning in Japan, voluntary discussion among family members should be encouraged. PMID:23979330

  10. Advanced systems engineering and network planning support

    NASA Technical Reports Server (NTRS)

    Walters, David H.; Barrett, Larry K.; Boyd, Ronald; Bazaj, Suresh; Mitchell, Lionel; Brosi, Fred

    1990-01-01

    The objective of this task was to take a fresh look at the NASA Space Network Control (SNC) element for the Advanced Tracking and Data Relay Satellite System (ATDRSS) such that it can be made more efficient and responsive to the user by introducing new concepts and technologies appropriate for the 1997 timeframe. In particular, it was desired to investigate the technologies and concepts employed in similar systems that may be applicable to the SNC. The recommendations resulting from this study include resource partitioning, on-line access to subsets of the SN schedule, fluid scheduling, increased use of demand access on the MA service, automating Inter-System Control functions using monitor by exception, increase automation for distributed data management and distributed work management, viewing SN operational control in terms of the OSI Management framework, and the introduction of automated interface management.

  11. Advance end-of-life treatment planning. A research review.

    PubMed

    Miles, S H; Koepp, R; Weber, E P

    1996-05-27

    The year 1996 marks the fifth anniversary of the federal Patient Self-Determination Act. The Patient Self-Determination Act required hospitals, nursing homes, and health plans to ask whether patients have advance directives and to incorporate them into the medical record. A "living will" is an advance directive by which a person tells caregivers the circumstances in which life-sustaining treatment is to be provided or forgone if the patient is unable to communicate. A "durable power of attorney for health care" enables one to designate a person to speak on his or her behalf if the author loses decision-making capacity. "Advance planning" is the process of reflection, discussion, and communication of treatment preferences for end-of-life care that precedes and may lead to an advance directive. PMID:8638992

  12. 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. PMID:27150411

  13. DOE planning workshop advanced biomedical technology initiative

    SciTech Connect

    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, 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.

  14. Advanced Hybrid Particulate Collector Project Management Plan

    SciTech Connect

    Miller, S.J.

    1995-11-01

    As the consumption of energy increases, its impact on ambient air quality has become a significant concern. Recent studies indicate that fine particles from coal combustion cause health problems as well as atmospheric visibility impairment. These problems are further compounded by the concentration of hazardous trace elements such as mercury, cadmium, selenium, and arsenic in fine particles. Therefore, a current need exists to develop superior, but economical, methods to control emissions of fine particles. Since most of the toxic metals present in coal will be in particulate form, a high level of fine- particle collection appears to be the best method of overall air toxics control. However, over 50% of mercury and a portion of selenium emissions are in vapor form and cannot be collected in particulate control devices. Therefore, this project will focus on developing technology not only to provide ultrahigh collection efficiency of particulate air toxic emissions, but also to capture vapor- phase trace metals such as mercury and selenium. Currently, the primary state-of-the-art technologies for particulate control are fabric filters (baghouses) and electrostatic precipitators (ESPs). However, they both have limitations that prevent them from achieving ultrahigh collection of fine particulate matter and vapor-phase trace metals. The objective of this project is to develop a highly reliable advanced hybrid particulate collector (AHPC) that can provide > 99.99 % particulate collection efficiency for all particle sizes between 0.01 and 50 14m, is applicable for use with all U.S. coals, and is cost-0443competitive with existing technologies. Phase I of the project is organized into three tasks: Task I - Project Management, Reporting, and Subcontract Consulting Task 2 - Modeling, Design, and Construction of 200-acfm AHPC Model Task 3 - Experimental Testing and Subcontract Consulting

  15. 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)…

  16. 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…

  17. 45 CFR 95.610 - Submission of advance planning documents.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... contained at §§ 1355.54 through 1355.57, § 307.15 and 42 CFR subchapter C, part 433. (c) Advance Planning... considerations including, where appropriate, the use of service-orientated architecture and a transfer of...

  18. 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...

  19. 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...

  20. 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...

  1. 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...

  2. 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...

  3. 45 CFR 1355.54 - Submittal of advance planning documents.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... accordance with procedures specified by 45 CFR part 95, subpart F. ... 45 Public Welfare 4 2011-10-01 2011-10-01 false Submittal of advance planning documents. 1355.54... FAMILIES, FOSTER CARE MAINTENANCE PAYMENTS, ADOPTION ASSISTANCE, AND CHILD AND FAMILY SERVICES...

  4. 45 CFR 1355.54 - Submittal of advance planning documents.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... procedures specified by 45 CFR part 95, subpart F. ... 45 Public Welfare 4 2014-10-01 2014-10-01 false Submittal of advance planning documents. 1355.54... FAMILIES, FOSTER CARE MAINTENANCE PAYMENTS, ADOPTION ASSISTANCE, AND CHILD AND FAMILY SERVICES...

  5. 45 CFR 1355.54 - Submittal of advance planning documents.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... procedures specified by 45 CFR part 95, subpart F. ... 45 Public Welfare 4 2013-10-01 2013-10-01 false Submittal of advance planning documents. 1355.54... FAMILIES, FOSTER CARE MAINTENANCE PAYMENTS, ADOPTION ASSISTANCE, AND CHILD AND FAMILY SERVICES...

  6. 45 CFR 1355.54 - Submittal of advance planning documents.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... accordance with procedures specified by 45 CFR part 95, subpart F. ... 45 Public Welfare 4 2010-10-01 2010-10-01 false Submittal of advance planning documents. 1355.54... FAMILIES, FOSTER CARE MAINTENANCE PAYMENTS, ADOPTION ASSISTANCE, AND CHILD AND FAMILY SERVICES...

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

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... procedures specified by 45 CFR part 95, subpart F. ... 45 Public Welfare 4 2012-10-01 2012-10-01 false Submittal of advance planning documents. 1355.54... FAMILIES, FOSTER CARE MAINTENANCE PAYMENTS, ADOPTION ASSISTANCE, AND CHILD AND FAMILY SERVICES...

  8. An unequivocal good? Acknowledging the complexities of advance care planning.

    PubMed

    Robins-Browne, K; Palmer, V; Komesaroff, P

    2014-10-01

    Over the past few decades advance care planning (ACP) has become the subject of debate, research and legislation in many countries. Encouraging people to express their preference for treatment in advance, ideally in written form, seems a natural way to identify what someone might have wanted when they can no longer participate in decision-making. The notion of ACP as an unequivocal good permeates much of the research and policy work in this area. For example, ACP is now actively encouraged in Australian federal and state government policies and the Victorian Government has recently published a practical ACP strategy for Victorian health services (2014-2018). However, advance care plan is ethically complex and the introduction of the Victorian health services strategy provides an opportunity to reflect on this complexity, particularly on the benefits and risks of ACP. PMID:25302719

  9. SERA - An Advanced Treatment Planning System for Neutron Therapy

    SciTech Connect

    C. A. Wemple; C. L. Albright; D. W. Nigg; D. W. Wessol; F. J. Wheeler; G. J. Harkin; M. B. Rossmeirer; M. T. Cohen; M. W. Frandsen

    1999-06-01

    The technology for computational dosimetry and treatment planning for Boron Neutron Capture Therapy (BNCT) has advanced significantly over the past few years. Because of the more complex nature of the problem, the computational methods that work well for treatment planning in photon radiotherapy are not applicable to BNCT. The necessary methods have, however, been developed and have been successfully employed both for research applications as well as human trials. Computational geometry for BNCT applications can be constructed directly from tomographic medical imagery and computed radiation dose distributions can be readily displayed in formats that are familiar to the radiotherapy community. The SERA system represents a significant advance in several areas for treatment planning. However further improvements in speed and results presentation are still needed for routine clinical applications, particularly when optimizations of dose pattern is required.

  10. Hospital organizational response to the nuclear accident at Three Mile Island: implications for future-oriented disaster planning.

    PubMed Central

    Maxwell, C

    1982-01-01

    The 1979 nuclear accident at Three Mile Island (TMI) near Harrisburg, Pennsylvania, caused severe organizational problems for neighboring health care institutions. Dauphin County, just north of TMI, contained four hospitals ranging in distance from 9.5 to 13.5 miles from the stricken plant. Crash plans put into effect within 48 hours of the initial incident successfully reduced hospital census to below 50 per cent of capacity, but retained bedridden and critically ill patients within the risk-zone. No plans existed for area-wide evacuation of hospitalized patients. Future-oriented disaster planning should include resource files of host institution bed capacity and transportation capabilities for the crash evacuation of hospitalized patients during non-traditional disasters. PMID:7058968

  11. Hospital organizational response to the nuclear accident at Three Mile Island: implications for future-oriented disaster planning.

    PubMed

    Maxwell, C

    1982-03-01

    The 1979 nuclear accident at Three Mile Island (TMI) near Harrisburg, Pennsylvania, caused severe organizational problems for neighboring health care institutions. Dauphin County, just north of TMI, contained four hospitals ranging in distance from 9.5 to 13.5 miles from the stricken plant. Crash plans put into effect within 48 hours of the initial incident successfully reduced hospital census to below 50 per cent of capacity, but retained bedridden and critically ill patients within the risk-zone. No plans existed for area-wide evacuation of hospitalized patients. Future-oriented disaster planning should include resource files of host institution bed capacity and transportation capabilities for the crash evacuation of hospitalized patients during non-traditional disasters. PMID:7058968

  12. AGU governance's decision-making process advances strategic plan

    NASA Astrophysics Data System (ADS)

    McPhaden, Michael; Finn, Carol; McEntee, Chris

    2012-10-01

    A lot has happened in a little more than 2 years, and we want give AGU members an update on how things are working under AGU's strategic plan and governance model. AGU is an organization committed to its strategic plan (http://www.agu.org/about/strategic_plan.shtml), and if you have not read the plan lately, we encourage you to do so. AGU's vision is to be an organization that "galvanizes a community of Earth and space scientists that collaboratively advances and communicates science and its power to ensure a sustainable future." We are excited about the progress we have made under this plan and the future course we have set for the Union. Everything the Board of Directors, Council, and committees put on their agendas is intended to advance AGU's strategic goals and objectives. Together with headquarters staff, these bodies are working in an integrated, effective manner to carry out this plan. The best way to demonstrate the progress made and each group's role is to walk through a recent example: the creation of a new Union-level award (see Figure 1).

  13. 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.

  14. Planning Teacher Professional Development: The Struggles and Successes of an Inter-Organizational Collaboration

    ERIC Educational Resources Information Center

    Frost, Janet Hart; Akmal, Tariq T.; Kingrey, Joan U.

    2010-01-01

    Inter-organizational collaboration is often seen as a means of increasing the potential for bringing about outcomes that none of the organizations could achieve alone. For example, funding agencies that provide grants for teacher professional development often encourage or require collaboration between institutions of higher education and schools.…

  15. Organizational Models for Online Education: District, State, or Charter School? Policy and Planning Series #109

    ERIC Educational Resources Information Center

    Cavalluzzo, Linda

    2004-01-01

    Opportunities for online K-12 education are expanding dramatically throughout the United States. This paper describes some of the organizational models that have been developed to provide online education to public school students, including their key strengths and challenges. The review is intended to help state and local school officials weigh…

  16. Improving Child and Adolescent Psychiatry Education for Medical Students: An Inter-Organizational Collaborative Action Plan

    ERIC Educational Resources Information Center

    Fox, Geraldine S.; Stock, Saundra; Briscoe, Gregory W.; Beck, Gary L.; Horton, Rita; Hunt, Jeffrey I.; Liu, Howard Y.; Rutter, Ashley Partner; Sexson, Sandra; Schlozman, Steven C.; Stubbe, Dorothy E.; Stuber, Margaret L.

    2012-01-01

    Objective: A new Child and Adolescent Psychiatry in Medical Education (CAPME) Task Force, sponsored by the Association for Directors of Medical Student Education in Psychiatry (ADMSEP), has created an inter-organizational partnership between child and adolescent psychiatry (CAP) educators and medical student educators in psychiatry. This paper…

  17. Experiencing the Impact of Organizational Structure on Planning and Visioning Tasks

    ERIC Educational Resources Information Center

    Pennisi, Lisa

    2012-01-01

    The various ways natural resource agencies and programs are structured and how that impacts leadership style and products is an important concept for students to understand. Leadership style and organizational structure determine visions, missions, goals and objectives that set the tone for organizations. This exercise demonstrates organizational…

  18. Advance care planning and palliative medicine in advanced dementia: a literature review.

    PubMed

    Jethwa, Ketan Dipak; Onalaja, Oluwademilade

    2015-04-01

    Aims and method To assess the factors that affect the clinical use of advanced care planning and palliative care interventions in patients with dementia. A literature search of Medline, Embase and PsycINFO was performed to identify themes in advanced care planning and palliative care in dementia. Results In total, 64 articles were found, including 12 reviews, and three key areas emerged: barriers to advanced care planning, raising awareness and fostering communication between professionals and patients, and disease-specific interventions. Clinical implications Most of the studies analysed were carried out in the USA or Continental Europe. This narrative review aims to help guide future primary research, systematic reviews and service development in the UK. PMID:26191437

  19. Advance care planning and palliative medicine in advanced dementia: a literature review

    PubMed Central

    Jethwa, Ketan Dipak; Onalaja, Oluwademilade

    2015-01-01

    Aims and method To assess the factors that affect the clinical use of advanced care planning and palliative care interventions in patients with dementia. A literature search of Medline, Embase and PsycINFO was performed to identify themes in advanced care planning and palliative care in dementia. Results In total, 64 articles were found, including 12 reviews, and three key areas emerged: barriers to advanced care planning, raising awareness and fostering communication between professionals and patients, and disease-specific interventions. Clinical implications Most of the studies analysed were carried out in the USA or Continental Europe. This narrative review aims to help guide future primary research, systematic reviews and service development in the UK. PMID:26191437

  20. Perceptions of Organizational and Political Environments: Results of a National Survey of Institutional Research/Planning Officers at Large Public Universities. AIR Forum 1981 Paper.

    ERIC Educational Resources Information Center

    Storrar, Sandra J.

    The relationship between career orientation of college institutional research/planning officers and perceptions of organizational and political environments was investigated, based on a survey of 154 officers in public doctoral-granting institutions. Of the 106 respondents, 53 percent were directors of institutional research/planning; 26 percent…

  1. Advanced Telescopes and Observatories and Scientific Instruments and Sensors Capability Roadmaps: General Background and Introduction

    NASA Technical Reports Server (NTRS)

    Coulter, Dan; Bankston, Perry

    2005-01-01

    Agency objective are: Strategic Planning Transformation. Advanced Planning Organizational Roles. Public Involvement in Strategic Planning. Strategic Roadmaps and Schedule. Capability Roadmaps and Schedule. Purpose of NRC Review. Capability Roadmap Development (Progress to Date).

  2. 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.

  3. 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

  4. An Investigation of the Knowledge Claims Supporting Goal Based Planning and Organizational Culture as Keys to Excellence in Educational Organizations.

    ERIC Educational Resources Information Center

    Hossler, Don; And Others

    Two independent bodies of organizational theory and research are developing around separate concepts associated with organizational effectiveness: goal-based behavior (intention) and organizational climate (distinction). Although both variables have been found to influence organizational effectiveness, findings have been inconsistent. The term…

  5. Building successful coalitions to promote advance care planning.

    PubMed

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

    2005-01-01

    This qualitative study explored the challenges and successes of an advance care planning (ACP) coalition formed at the University of Wisconsin called Life Planning 2000. Data were obtained from key informant interviews (n = 24) and grounded theory. Major themes included commitment (the need for leadership, recruitment of key persons, and funding); cohesiveness (disparate groups collaborating toward a common purpose); and outcomes (including 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. Results indicate that strong leadership, paid staff adequate funding, and the collaboration of diverse groups working toward a common goal are essential if a coalition promoting end-of-life (EOL) care planning is to be successful. PMID:16323714

  6. [Advance care planning for people with intellectual disability].

    PubMed

    Wagemans, Annemieke M A; van Wijmen, Frans C B

    2014-01-01

    Difficult medical decisions regularly need to be made for people with intellectual disability. They are often unable to play a meaningful role in this and the decisions fall to the family or guardians. A useful aid to proactive medical management is advance care planning. This is a long-term care plan which is centred on the well-being of patients and their quality of life. Ideally it should be a matter for patients and those closest to them, the responsible medical practitioner and those tasked with the day-to-day care of patients. It is important to draw up this plan carefully and to regularly review it in the light of current circumstances. PMID:25424633

  7. Documentation of Advance Care Planning for Community-Dwelling Elders

    PubMed Central

    Yung, Victoria Y.; Walling, Anne M.; Min, Lillian; Wenger, Neil S.

    2010-01-01

    Abstract Background Advance planning for end-of-life care has gained acceptance, but actual end-of-life care is often incongruent with patients' previously stated goals. We assessed the flow of advance care planning information from patients to medical records in a community sample of older adults to better understand why advance care planning is not more successful. Methods Our study used structured interview and medical record data from community-dwelling older patients in two previous studies: Assessing Care of Vulnerable Elders (ACOVE)-1 (245 patients age ≥65 years and screened for high risk of death/functional decline in 1998–1999) and ACOVE-2 (566 patients age ≥75 who screened positive for falls/mobility disorders, incontinence, and/or dementia in 2002–2003). We compared interview data on patients' preferences, advance directives, and surrogate decision-makers with findings from the medical record. Results In ACOVE-1, 38% of surveyed patients had thought about limiting the aggressiveness of medical care; 24% of surveyed patients stated that they had spoken to their doctor about this. The vast majority of patients (88%–93%) preferred to die rather than remain permanently in a coma, on a ventilator, or tube fed. Regardless of patients' specific preferences, 15%–22% of patients had preference information in their medical record. Among patients who reported that they had completed an advance directive and had given it to their health-care provider, 15% (ACOVE-1) and 47% (ACOVE-2) had advance directive information in the medical record. Among patients who had not completed an advance directive but had given surrogate decision-maker information to their provider, 0% (ACOVE-1) and 16% (ACOVE-2) had documentation of a surrogate decision-maker in the medical record. Conclusions Community-dwelling elders' preferences for end-of-life care are not consistent with documentation in their medical records. Electronic health records and standardized data

  8. Adaptive Planning: Understanding Organizational Workload to Capability/ Capacity through Modeling and Simulation

    NASA Technical Reports Server (NTRS)

    Hase, Chris

    2010-01-01

    In August 2003, the Secretary of Defense (SECDEF) established the Adaptive Planning (AP) initiative [1] with an objective of reducing the time necessary to develop and revise Combatant Commander (COCOM) contingency plans and increase SECDEF plan visibility. In addition to reducing the traditional plan development timeline from twenty-four months to less than twelve months (with a goal of six months)[2], AP increased plan visibility to Department of Defense (DoD) leadership through In-Progress Reviews (IPRs). The IPR process, as well as the increased number of campaign and contingency plans COCOMs had to develop, increased the workload while the number of planners remained fixed. Several efforts from collaborative planning tools to streamlined processes were initiated to compensate for the increased workload enabling COCOMS to better meet shorter planning timelines. This paper examines the Joint Strategic Capabilities Plan (JSCP) directed contingency planning and staffing requirements assigned to a combatant commander staff through the lens of modeling and simulation. The dynamics of developing a COCOM plan are captured with an ExtendSim [3] simulation. The resulting analysis provides a quantifiable means by which to measure a combatant commander staffs workload associated with development and staffing JSCP [4] directed contingency plans with COCOM capability/capacity. Modeling and simulation bring significant opportunities in measuring the sensitivity of key variables in the assessment of workload to capability/capacity analysis. Gaining an understanding of the relationship between plan complexity, number of plans, planning processes, and number of planners with time required for plan development provides valuable information to DoD leadership. Through modeling and simulation AP leadership can gain greater insight in making key decisions on knowing where to best allocate scarce resources in an effort to meet DoD planning objectives.

  9. The Development of a Questionnaire for an Organizational Development Program at Los Angeles Southwest College.

    ERIC Educational Resources Information Center

    Hadley, Ollie B.; Andrews, James

    An Organizational Development (OD) questionnaire was designed at Los Angeles Southwest College to enhance planned change in that educational organization. The questionnaire measures attitudes in seven organizational development concept areas: (1) institutional climate indices--opportunity for advancement, general institutional conditions, concern…

  10. 25 CFR 1000.52 - What criteria will the Director use to award advance planning grants?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 25 Indians 2 2010-04-01 2010-04-01 false What criteria will the Director use to award advance... 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...

  11. Advanced High-Level Waste Glass Research and Development Plan

    SciTech Connect

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

    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 for both the low-activity waste (LAW) and high-level waste (HLW) vitrification facilities with an appreciation toward reducing overall mission life. The purpose of this advanced HLW glass research and development plan is to identify the near-, mid-, and longer-term research and development activities required to develop and validate advanced HLW glasses and their associated models to support facility operations at WTP, including both direct feed and full pretreatment flowsheets. This plan also integrates technical support of facility operations and waste qualification activities to show the interdependence of these activities with the advanced waste glass (AWG) program to support the full WTP mission. Figure ES-1 shows these key ORP programmatic activities and their interfaces with both WTP facility operations and qualification needs. The plan is a living document that will be updated to reflect key advancements and mission strategy changes. The research outlined here is motivated by the potential for substantial economic benefits (e.g., significant increases in waste throughput and reductions in glass volumes) that will be realized when advancements in glass formulation continue and models supporting facility operations are implemented. Developing and applying advanced

  12. 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...

  13. Experimental area plans for an advanced hadron facility

    SciTech Connect

    Hoffman, E.W.; Macek, R.J.; Tschalear, C.

    1986-01-01

    A brief overview is presented of the current plans for an experimental area for a new advanced hadron facility for the exploration of nuclear and particle physics. The facility, LAMPF II, is presently visualized as consisting of the LAMPF linac sending 800 MeV protons to a 6 GeV booster ring followed by a 45 GeV main ring. Two experimental areas area planned. The first is intended to provide neutrinos via a pair of pulsed focusing horns. The other is designed to accommodate secondary beams that span the range of useful energies up to GeV/c. Beam specification goals are discussed with respect to source brightness, beam purity, and beam-line acceptance and length. The various beam lines are briefly described. Production cross sections and rates are estimated for antiproton production. Problems of thermal energy deposition in both components and targets and of effectiveness of particle separators are discussed. 9 refs. (LEW)

  14. A Renewal Plan for the Advanced Photon Source

    SciTech Connect

    Fischetti, Robert F.; Fuoss, Paul H.; Gerig, Rodney E.; Maclean, John F.; Mills, Dennis M.; Srajer, George; Keane, Denis T.; Neumann, Dan A.

    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.

  15. 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.

  16. Instituting organizational learning for quality improvement through strategic planning nominal group processes.

    PubMed

    White, D B

    2000-01-01

    Healthcare managers are faced with unprecedented challenges as characterized by managed care constraints, downsizing, increased client needs, and a society demanding more responsive services. Managers must initiate change for quality, efficiency, and survival. This article provides information and strategies for (a) assessing the change readiness of an organization, (b) conducting an organizational diagnosis, (c) instituting a team culture, (d) developing a change strategy, (e) integrating the strategy with a quality improvement process, and (f) identifying the leadership skills to implement organization renewal. Nominal group processes, namely, SWOT and the Search Conference, are described, and case examples are provided. The implementation strategies have been used successfully in a variety of milieus; practical advice for success is described in detail. PMID:11184022

  17. A Multidimensional View of Resistance to Organizational Change: Exploring Cognitive, Emotional, and Intentional Responses to Planned Change across Perceived Change Leadership Strategies

    ERIC Educational Resources Information Center

    Szabla, David B.

    2007-01-01

    In this survey research study, the researcher employed a causal-comparative, or ex post facto, design to explore the relationship between how union employees of a U.S. county government perceived implementation of a new electronic performance appraisal process and how they responded to the planned organizational change along cognitive, emotional,…

  18. Mentoring, Organizational Rank, and Women's Perceptions of Advancement Opportunities in the Workplace

    ERIC Educational Resources Information Center

    Washington, Christa Ellen

    2010-01-01

    The purpose of this study was to examine perceived career barriers of women in entry-level and mid-level positions who were formally and informally mentored. Research studies have found that mentoring can yield positive outcomes; however, there is limited research on how mentoring style impacts career advancement. The primary research questions…

  19. Advance Care Planning among People Living with Dialysis

    PubMed Central

    Elliott, Barbara A.; Gessert, Charles E.

    2016-01-01

    Purpose: Recent nephrology literature focuses on the need for discussions regarding advance care planning (ACP) for people living with dialysis (PWD). PWD and their family members’ attitudes toward ACP and other aspects of late-life decision making were assessed in this qualitative study. Methodology: Thirty-one interviews were completed with 20 PWD over the age of 70 (mean dialysis 34 months) and 11 family members, related to life experiences, making medical decisions, and planning for the future. Interviews were recorded, transcribed and analyzed. Findings: Four themes regarding ACP emerged from this secondary analysis of the interviews: how completing ACP, advance directives (AD), and identifying an agent fit into PWD experiences; PWD understanding of their prognosis; what gives PWD lives meaning and worth; and PWD care preferences when their defined meaning and worth are not part of their experience. These PWD and family members revealed that ACP is ongoing and common among them. They did not seem to think their medical providers needed to be part of these discussions, since family members were well informed. Practical implications: These results suggest that if health care providers and institutions need AD forms completed, it will important to work with both PWD and their family members to assure personal wishes are documented and honored. PMID:27417605

  20. 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. PMID:22512830

  1. 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

  2. Center for Advanced Energy Studies (CAES) Strategic Plan

    SciTech Connect

    Kevin Kostelnik; Keith Perry

    2007-07-01

    Twenty-first century energy challenges include demand growth, national energy security, and global climate protection. The Center for Advanced Energy Studies (CAES) is a public/private partnership between the State of Idaho and its academic research institutions, the federal government through the U.S. Department of Energy (DOE) and the Idaho National Laboratory (INL) managed by the Battelle Energy Alliance (BEA). CAES serves to advance energy security for our nation by expanding the educational opportunities at the Idaho universities in energy-related areas, creating new capabilities within its member institutions, and delivering technological innovations leading to technology-based economic development for the intermountain region. CAES has developed this strategic plan based on the Balanced Scorecard approach. A Strategy Map (Section 7) summarizes the CAES vision, mission, customers, and strategic objectives. Identified strategic objectives encompass specific outcomes related to three main areas: Research, Education, and Policy. Technical capabilities and critical enablers needed to support these objectives are also identified. This CAES strategic plan aligns with and supports the strategic objectives of the four CAES institutions. Implementation actions are also presented which will be used to monitor progress towards fulfilling these objectives.

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

    SciTech Connect

    Moe, Wayne Leland

    2015-05-01

    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, it is also important to remember that certain “minimum” levels of design and safety approach knowledge concerning these technology(s) must be defined and available to an extent that supports appropriate pre-licensing regulatory analysis within the RTDP. Final resolution to advanced reactor licensing issues is most often predicated on the detailed design information and specific safety approach as documented in a facility license application and submitted for licensing review. Because the AdvSMR RTDP is focused on identifying and assessing the potential regulatory implications of DOE-sponsored reactor technology research very early in the pre-license application development phase, the information necessary to support a comprehensive regulatory analysis of a new reactor technology, and the resolution of resulting issues, will generally not be available. As such, the regulatory considerations documented in the RTDP should be considered an initial “first step” in the licensing process which will continue until a license is issued to build and operate the said nuclear facility. Because a facility license application relies heavily on the data and information generated by technology development studies, the anticipated regulatory

  4. A cluster randomized trial of an organizational process improvement intervention for improving the assessment and case planning of offenders: a Study Protocol

    PubMed Central

    Shafer, Michael S; Prendergast, Michael; Melnick, Gerald; Stein, Lynda A; Welsh, Wayne N

    2014-01-01

    Background The Organizational Process Improvement Intervention (OPII), conducted by the NIDA-funded Criminal Justice Drug Abuse Treatment Studies consortium of nine research centers, examined an organizational intervention to improve the processes used in correctional settings to assess substance abusing offenders, develop case plans, transfer this information to community-based treatment agencies, and monitor the services provided by these community based treatment agencies. Methods/Design A multi-site cluster randomized design was used to evaluate an inter-agency organizational process improvement intervention among dyads of correctional agencies and community based treatment agencies. Linked correctional and community based agencies were clustered among nine (9) research centers and randomly assigned to an early or delayed intervention condition. Participants included administrators, managers, and line staff from the participating agencies; some participants served on interagency change teams while other participants performed agency tasks related to offender services. A manualized organizational intervention that includes the use of external organizational coaches was applied to create and support interagency change teams that proceeded through a four-step process over a planned intervention period of 12 months. The primary outcome of the process improvement intervention was to improve processes associated with the assessment, case planning, service referral and service provision processes within the linked organizations. Discussion Providing substance abuse offenders with coordinated treatment and access to community-based services is critical to reducing offender recidivism. Results from this study protocol will provide new and critical information on strategies and processes that improve the assessment and case planning for such offenders as they transition between correctional and community based systems and settings. Further, this study extends current

  5. Impact of Enterprise Resource Planning on Organizational Productivity in an Information Technology Organization

    ERIC Educational Resources Information Center

    Garg, Manoj

    2010-01-01

    Negative consequences follow when an expensive technological implementation fails to accomplish expected benefits and results instead in interrupted business, lost revenues, and dissatisfied and demoralized users. The problem researched in this study was how an organization should introduce advanced technology to system users to optimize…

  6. Integrating Practice and Theory for Advancement

    ERIC Educational Resources Information Center

    Bakewell, Thomas

    2005-01-01

    This is the first installment of a multipart practitioners' guide focused on strategic planning, organizational development, and legal issues. It features practical advice and powerful insights for implementing advancement programs that are organized, productive, and legal--and that generate top results. The author, an organizational development…

  7. Using Action Planning to Build Organizational Capacity for the Prevention of Intimate Partner Violence

    ERIC Educational Resources Information Center

    Schober, Daniel J.; Fawcett, Stephen B.

    2015-01-01

    The DELTA PREP Project aims to reduce risk for intimate partner violence (IPV). It engaged leadership and staff from 19 statewide domestic violence coalitions in building capacity to prevent IPV before it occurs (rather than solely responding to IPV). This article describes the process and outcomes associated with action planning to create…

  8. Responding to Hostility: Evidence-Based Guidance for Communication during Planned Organizational Change

    ERIC Educational Resources Information Center

    Campbell, Kim Sydow; Carmichael, Pierson; Naidoo, Jefrey S.

    2015-01-01

    Hostile challenges to planned organization change are common and challenging to deal with effectively. Little research has explained successful responses to such stakeholder hostility. To address this gap, we use the concept of readiness to characterize the content of hostile challenges. We also use rhetorical strategies based on speech act theory…

  9. Disseminating Information and Soliciting Input during Planned Organizational Change: Implementers' Targets, Sources, and Channels for Communicating.

    ERIC Educational Resources Information Center

    Lewis, Laurie K.

    1999-01-01

    Examines implementers' use of channels to disseminate information to and solicit input from staff members during planned change. Assesses how communication was differently directed to paid and volunteer staff and the degree to which channel use is predictive of implementers' assessments of success of change efforts. Discusses potential…

  10. Succession Planning and Management: A Guide to Organizational Systems and Practices

    ERIC Educational Resources Information Center

    Berke, David

    2005-01-01

    The purpose of succession-related practices is to ensure that there are ready replacements for key positions in an organization so that turnover will not negatively affect the organization's performance. CCL first published an annotated bibliography on succession planning in 1995. That bibliography focused primarily on the link between succession…

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

    NASA Astrophysics Data System (ADS)

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

    1993-05-01

    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.

  12. 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.

  13. 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.

  14. An overview of advance care planning for patients with advanced chronic kidney disease: The basics.

    PubMed

    Wasylynuk, Betty Ann; Davison, Sara N

    2016-01-01

    As the number of Canadians living with end-stage kidney disease (ESKD) continues to grow, even higher numbers are living with advanced chronic kidney disease (CKD). Many of these people will eventually require renal replacement therapy (RRT), either dialysis or transplantation. More than 50% of patients starting RRT today are aged 65 or older, with the fastest growing group being patients 75 years and older. Despite advances to dialysis technology and dialysis care, the mortality rates remain high and dialysis patients' end-of-life care may not align with their preferences or values. Advance care planning (ACP) is an essential component of quality comprehensive kidney care. Kidney care teams develop strong relationships with their patients and are well positioned to integrate ACP into routine kidney care. This article defines ACP, outlines the essential components of ACP, and discusses the benefits, challenges, and special considerations of ACP. By enhancing the kidney care team's understanding of ACP, this article aims to assist in integrating ACP into routine kidney care for patients with advanced CKD. PMID:27215058

  15. Development of Advanced Multi-Modality Radiation Treatment Planning Software

    SciTech Connect

    Nigg, D W; Hartmann Siantar, C

    2002-02-19

    The Idaho National Engineering and Environmental Laboratory (INEEL) has long been active in development of advanced Monte-Carlo based computational dosimetry and treatment planning methods and software for advanced radiotherapy, with a particular focus on Neutron Capture Therapy (NCT) and, to a somewhat lesser extent, Fast-Neutron Therapy. The most recent INEEL software product system of this type is known as SERA, Simulation Environment for Radiotherapy Applications. SERA is at a mature level in its life cycle, it has been licensed for research use worldwide, and it has become well established as a computational tool for research. However, along with its strengths, SERA also has some limitations in its structure and computational methodologies. More specifically, it is optimized only for neutron-based applications. Although photon transport can be computed with SERA, the simplified model that is used is designed primarily for photons produced in the neutron transport process. Thus SERA is not appropriate for applications to, for example, standard external-beam photon radiotherapy, which is by far more commonly used in the clinic than neutron based therapy.

  16. 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. PMID:24493203

  17. Plans for an Upgrade of the Advanced Photon Source

    NASA Astrophysics Data System (ADS)

    Mills, Dennis; APS-U Project Team

    2011-03-01

    We are presently developing plans for an upgrade of the Advanced Photon Source facility. Science has formally issued Critical Decision 0 and approved the Mission Need Statement in April of 2010, authorizing the APS to develop a conceptual design for the APS Upgrade (APS-U) project. The proposed upgrade will include enhancements to the accelerator, beamlines, and facility infrastructure. The high brilliance x-ray beams at high photon energy (e.g. > 25 keV) provided by the APS Upgrade will have strong impact on research in energy, the environment, new or improved materials, and biological studies. High-energy x-rays can penetrate into a wide range of realistic and/or extreme environments and allow imaging of structures and processes in unprecedented detail on picosecond time scales and nanometer length scales. The presentation will include some of the essential goals of the APS-U and proposed strategies to attain those goals. The Advanced Photon Source at Argonne National Laboratory is supported by the U. S. Department of Energy, Office of Science, Office of Basic Energy Sciences, under Contract No. DE-AC02-06CH11357.

  18. Fuel qualification plan for the Advanced Neutron Source Reactor

    SciTech Connect

    Copeland, G.L.

    1995-07-01

    This report describes the development and qualification plan for the fuel for the Advanced Neutron Source. The reference fuel is U{sub 3}Si{sub 2}, dispersed in aluminum and clad in 6061 aluminum. This report was prepared in May 1994, at which time the reference design was for a two-element core containing highly enriched uranium (93% {sup 235}U) . The reactor was in the process of being redesigned to accommodate lowered uranium enrichment and became a three-element core containing a higher volume fraction of uranium enriched to 50% {sup 235}U. Consequently, this report was not issued at that time and would have been revised to reflect the possibly different requirements of the lower-enrichment, higher-volume fraction fuel. Because the reactor is now being canceled, this unrevised report is being issued for archival purposes. The report describes the fabrication and inspection development plan, the irradiation tests and performance modeling to qualify performance, the transient testing that is part of the safety program, and the interactions and interfaces of the fuel development with other tasks.

  19. Advance Care Planning: practicalities, legalities, complexities and controversies.

    PubMed

    Horridge, Karen A

    2015-04-01

    Increasing numbers, complexities and technology dependencies of children and young people with life-limiting conditions require paediatricians to be well prepared to meet their changing needs. Paediatric Advance Care Planning provides a framework for paediatricians, families and their multidisciplinary teams to consider, reflect and record the outcome of their conversations about what might happen in the future in order to optimise quality of clinical care and inform decision-making. For some children and young people this will include discussions about the possibility of death in childhood. This may be unexpected and sudden, in the context of an otherwise active management plan or may be expected and necessitate discussions about the process of dying and attention to symptoms. Decision-making about appropriate levels of intervention must take place within a legal and ethical framework, recognising that the UK Equality Act (2010) protects the rights of disabled children and young people and infants and children of all ages to the same high quality healthcare as anyone else. PMID:25275088

  20. 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.

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

    NASA Technical Reports Server (NTRS)

    Meer, Dave; Oriti, Sal

    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, NASA?s Glenn Research Center (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.

  2. The views of older Malaysians on advanced directive and advanced care planning: a qualitative study.

    PubMed

    Htut, Y; Shahrul, K; Poi, P J H

    2007-01-01

    The provision of optimum care for the ageing population is dependent on the understanding of their views and values on end of life issues. A qualitative descriptive study was conducted to describe views of elderly Malaysians on Advanced Care Planning (henceforth ACP) and Advanced Directives (henceforth AD), and explore factors influencing these views. Fifteen elderly subjects with ages ranging from 65 to 83 years, representing different ethnic and religious groups in Malaysia were selected for in-depth interviews guided by a questionnaire. Five core themes were extracted from the interviews: 1) Considering the future 2) Contingency plans for future illnesses 3) Attitudes towards life prolonging treatment procedures 4) Doctor-patient relationships and 5) Influence of religion on decisions related to future illness. Despite the lack of knowledge on ACP and AD, older respondents were very receptive to their concept. Although the majority agreed on the importance of planning for future medical management and having open discussion on end of life issues with their doctor, they felt it unnecessary to make a formal written AD. Most felt that the future was best left to fate or God, and none had made any contingency plan for severe future illnesses citing religion as reason for this view. Cardiopulmonary resuscitation, mechanical ventilation and dialysis were considered by most to be invasive life prolonging treatments. We suggest that doctors initiate discussions on end of life care with every older patient and their family so as to promote awareness and introduce the concept of ACP/AD to a Malaysian setting. PMID:18330404

  3. Exploring Advance Care Planning from the Nephrology Nurse Perspective: A Literature Review.

    PubMed

    Haras, Mary S; Astroth, Kim S; Woith, Wendy L; Kossman, Susan P

    2015-01-01

    Advance care planning is a process that engages healthcare providers and patients to articulate wishes of patients as their illness progresses. Persons with chronic kidney disease require earlier and more frequent advance care planning conversations because they are faced with increased co-morbidities and a shortened lifespan. This literature review explores the phenomenon of advance care planning and the potential factors affecting nephrology nurse engagement in these discussions. PMID:26290915

  4. Plan for advanced microelectronics processing technology application. Final report

    SciTech Connect

    Goland, A.N.

    1990-10-01

    The ultimate objective of the tasks described in the research agreement was to identify resources primarily, but not exclusively, within New York State that are available for the development of a Center for Advanced Microelectronics Processing (CAMP). Identification of those resources would enable Brookhaven National Laboratory to prepare a program plan for the CAMP. In order to achieve the stated goal, the principal investigators undertook to meet the key personnel in relevant NYS industrial and academic organizations to discuss the potential for economic development that could accompany such a Center and to gauge the extent of participation that could be expected from each interested party. Integrated of these discussions was to be achieved through a workshop convened in the summer of 1990. The culmination of this workshop was to be a report (the final report) outlining a plan for implementing a Center in the state. As events unfolded, it became possible to identify the elements of a major center for x-ray lithography on Lone Island at Brookhaven National Laboratory. The principal investigators were than advised to substitute a working document based upon that concept in place of a report based upon the more general CAMP workshop originally envisioned. Following that suggestion from the New York State Science and Technology Foundation, the principals established a working group consisting of representatives of the Grumman Corporation, Columbia University, the State University of New York at Stony Brook, and Brookhaven National Laboratory. Regular meetings and additional communications between these collaborators have produced a preproposal that constitutes the main body of the final report required by the contract. Other components of this final report include the interim report and a brief description of the activities which followed the establishment of the X-ray Lithography Center working group.

  5. 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

  6. Advancing Design-for-Assembly: The Next Generation in Assembly Planning

    SciTech Connect

    Calton, T.L.

    1998-12-09

    At the 1995 IEEE Symposium on Assembly and Task Planning, Sandia National Laboratories introduced the Archimedes 2 Software Tool [2]. The system was described as a second-generation assembly planning system that allowed preliminmy application of awembly planning for industry, while solidly supporting further research in planning techniques. Sandia has worked closely with indust~ and academia over the last four years. The results of these working relationships have bridged a gap for the next generation in assembly planning. Zke goal of this paper is to share Sandia 's technological advancements in assembly planning over the last four years and the impact these advancements have made on the manufacturing communip.

  7. Intervention thresholds: a conceptual frame for advance care planning choices

    PubMed Central

    2014-01-01

    Background Advance care planning (ACP) provides for decisions in the event of decisional incapacity. Determining ahead of time what a person may want is challenging and limits the utility of ACP. We present empirical evidence for a new approach to ACP: the individual’s “intervention threshold.” The intervention threshold is intuitively understood by clinicians and lay people, but has not been thoroughly described, measured, or analyzed. Methods Using a mixed-methods approach to address the concept of the intervention thresholds, we recruited 52 subjects from a population of chronically ill outpatients for structured telephone interviews assessing knowledge, attitudes, and prior ACP activities. Respondents were presented with 11 interventions for each of four medical scenarios. For each scenario, they were asked whether they would accept each intervention. Data was evaluated by descriptive statistics and chi-squared statistics. Results Complete data were obtained from 52 patients, mean age of 64.5, 34.6% of whom were male. Only 17.3% reported prior ACP discussion with a physician. Rates of accepting and refusing interventions varied by scenario (p < 0.0001) and intervention intensity (p < 0.0001). Conclusions These data provide evidence that people display transitions between wanting or not wanting interventions based on scenarios. Further research is needed to determine effective ways to identify, measure, and represent the components of an individual’s intervention threshold in order to facilitate informed decision making during future incapacity. PMID:24721698

  8. [Study of 4 patients implemented to Advance Care Planning].

    PubMed

    Kawabata, Megumi; Fujiwara, Yoko; Kawabata, Hidenobu

    2015-11-01

    This is a study of 4 patients implemented to Advance Care Planning (ACP) reflecting on the health care professionals' role and the outcomes. ACP has been defined as a process of formal decision making that aims to help patients establish their decision about future care that take effect when they lose capacity. For about two years, we tried to engage all patients who were referred to our palliative care team and their families to ACP since their first consultation. We informed their conditions at that time, how their health might change and how treatment might impact on their life goals. We also attempted to help patients' decision making and then fulfill their wishes in cooperation with patients' families and healthcare professionals. We learned three important elements: understanding patients' values and wishes, explaining prediction of the clinical course of the patients and establishing a collaborative healthcare team in order to fulfill the patients' hopes. ACP improved quality of life (QOL) not only for the patients involved, but also for the family members. ACP can play a crucial role in ensuring that patients receive the care they want throughout various stages of their lives. PMID:26742180

  9. Advanced Test Reactor Capabilities and Future Irradiation Plans

    SciTech Connect

    Frances M. Marshall

    2006-10-01

    The Advanced Test Reactor (ATR), located at the Idaho National Laboratory (INL), is one of the most versatile operating research reactors in the Untied States. The ATR has a long history of supporting reactor fuel and material research for the US government and other test sponsors. The INL is owned by the US Department of Energy (DOE) and currently operated by Battelle Energy Alliance (BEA). The ATR is the third generation of test reactors built at the Test Reactor Area, now named the Reactor Technology Complex (RTC), whose mission is to study the effects of intense neutron and gamma radiation on reactor materials and fuels. The current experiments in the ATR are for a variety of customers--US DOE, foreign governments and private researchers, and commercial companies that need neutrons. The ATR has several unique features that enable the reactor to perform diverse simultaneous tests for multiple test sponsors. The ATR has been operating since 1967, and is expected to continue operating for several more decades. The remainder of this paper discusses the ATR design features, testing options, previous experiment programs, future plans for the ATR capabilities and experiments, and some introduction to the INL and DOE's expectations for nuclear research in the future.

  10. Advanced Coal Conversion Process Demonstration Project. Environmental Monitoring Plan

    SciTech Connect

    Not Available

    1992-04-01

    Western Energy Company (WECO) was selected by the Department of Energy (DOE) to demonstrate the Advanced Coal Conversion Process (ACCP) which upgrades low rank coals into high Btu, low sulfur, synthetic bituminous coal. As specified in the Corporate Agreement, RSCP is required to develop an Environmental Monitoring Plan (EMP) which describes in detail the environmental monitoring activities to be performed during the project execution. The purpose of the EMP is to: (1) identify monitoring activities that will be undertaken to show compliance to applicable regulations, (2) confirm the specific environmental impacts predicted in the National Environmental Policy Act documentation, and (3) establish an information base of the assessment of the environmental performance of the technology demonstrated by the project. The EMP specifies the streams to be monitored (e.g. gaseous, aqueous, and solid waste), the parameters to be measured (e.g. temperature, pressure, flow rate), and the species to be analyzed (e.g. sulfur compounds, nitrogen compounds, trace elements) as well as human health and safety exposure levels. The operation and frequency of the monitoring activities is specified, as well as the timing for the monitoring activities related to project phase (e.g. preconstruction, construction, commissioning, operational, post-operational). The EMP is designed to assess the environmental impacts and the environmental improvements resulting from construction and operation of the project.

  11. Proceedings: Advanced motors and drives R D planning forum

    SciTech Connect

    McCleer, P.J. )

    1992-12-01

    With motors consuming nearly 70% of the total US electric power generation, there is a growing need for in-depth user information and comparison data on drive technology. Adjustable-speed drive technology offers opportunities for improving the productivity, energy conservation, and cost-effectiveness of motor operation. Recommendations from an EPRI R D motors and drives forum are organized into an assessment of research needs in areas of circuits, controls, power devices, motor design, and materials. EPRI's Advanced Motors and Drives R D Planning Forum was held June 21--22, 1990, in Monterey, California. More than 110 representatives from relevant economic sectors met in four sessions, each emphasizing a different aspect of motor technology and use. Session 1 reviewed the status of newer motor systems, such as permanent magnet (PM) and reluctance motors as well as associated power electronics. Session 2 reviewed motor and drive requirements in several key application areas such as heating, ventilating, and air conditioning (HVAC); refrigeration; petrochemicals; machine tools and appliances; motion control and robotics; and electric vehicle and automobile systems. Session 3 addressed issues involving motor materials, manufacturing, and marketing. Session 4's open discussions examined other motor and drive application needs and technology issues, while identifying and prioritizing R D areas.

  12. Education and Advance Care Planning in Nursing Homes: The Impact of Ownership Type.

    ERIC Educational Resources Information Center

    Walker, Leslie C.; Bradley, Elizabeth H.

    1998-01-01

    A study of 25 nonprofit and 87 for-profit nursing homes showed both types likely to offer education on advance care planning. However, nonprofits were more likely to have ongoing discussions that covered more than life support decisions and to have ethics committees to support advance care planning. (SK)

  13. 25 CFR 1001.9 - Selection criteria for tribes/consortia seeking advance planning grant funding.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... participate in self-governance. (e) Can tribes/consortia that receive advance planning grants also apply for a..., DEPARTMENT OF THE INTERIOR SELF-GOVERNANCE PROGRAM § 1001.9 Selection criteria for tribes/consortia seeking...-governance tribe and needs advance funding in order to complete the planning phase requirement may...

  14. 25 CFR 1001.9 - Selection criteria for tribes/consortia seeking advance planning grant funding.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... participate in self-governance. (e) Can tribes/consortia that receive advance planning grants also apply for a..., DEPARTMENT OF THE INTERIOR SELF-GOVERNANCE PROGRAM § 1001.9 Selection criteria for tribes/consortia seeking...-governance tribe and needs advance funding in order to complete the planning phase requirement may...

  15. 25 CFR 1001.9 - Selection criteria for tribes/consortia seeking advance planning grant funding.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... participate in self-governance. (e) Can tribes/consortia that receive advance planning grants also apply for a..., DEPARTMENT OF THE INTERIOR SELF-GOVERNANCE PROGRAM § 1001.9 Selection criteria for tribes/consortia seeking...-governance tribe and needs advance funding in order to complete the planning phase requirement may...

  16. 45 CFR 307.20 - Submittal of advance planning documents for computerized support enforcement systems.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... prescribed in 45 CFR part 95, subpart F. ... 45 Public Welfare 2 2011-10-01 2011-10-01 false Submittal of advance planning documents for... § 307.20 Submittal of advance planning documents for computerized support enforcement systems. The...

  17. 45 CFR 307.20 - Submittal of advance planning documents for computerized support enforcement systems.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... prescribed in 45 CFR part 95, subpart F. ... 45 Public Welfare 2 2014-10-01 2012-10-01 true Submittal of advance planning documents for... § 307.20 Submittal of advance planning documents for computerized support enforcement systems. The...

  18. 45 CFR 307.20 - Submittal of advance planning documents for computerized support enforcement systems.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... prescribed in 45 CFR part 95, subpart F. ... 45 Public Welfare 2 2012-10-01 2012-10-01 false Submittal of advance planning documents for... § 307.20 Submittal of advance planning documents for computerized support enforcement systems. The...

  19. 45 CFR 307.20 - Submittal of advance planning documents for computerized support enforcement systems.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... prescribed in 45 CFR part 95, subpart F. ... 45 Public Welfare 2 2010-10-01 2010-10-01 false Submittal of advance planning documents for... § 307.20 Submittal of advance planning documents for computerized support enforcement systems. The...

  20. 45 CFR 307.20 - Submittal of advance planning documents for computerized support enforcement systems.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... prescribed in 45 CFR part 95, subpart F. ... 45 Public Welfare 2 2013-10-01 2012-10-01 true Submittal of advance planning documents for... § 307.20 Submittal of advance planning documents for computerized support enforcement systems. The...

  1. 14 CFR 151.123 - Procedures: Offer; amendment; acceptance; advance planning agreement.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 3 2013-01-01 2013-01-01 false Procedures: Offer; amendment; acceptance; advance planning agreement. 151.123 Section 151.123 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION... Planning and Engineering Proposals § 151.123 Procedures: Offer; amendment; acceptance; advance...

  2. 14 CFR 151.123 - Procedures: Offer; amendment; acceptance; advance planning agreement.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 3 2014-01-01 2014-01-01 false Procedures: Offer; amendment; acceptance; advance planning agreement. 151.123 Section 151.123 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION... Planning and Engineering Proposals § 151.123 Procedures: Offer; amendment; acceptance; advance...

  3. Advanced Education and Technology Business Plan, 2010-13. Highlights

    ERIC Educational Resources Information Center

    Alberta Advanced Education and Technology, 2010

    2010-01-01

    The Ministry of Advanced Education and Technology envisions Alberta's prosperity through innovation and lifelong learning. Advanced Education and Technology's mission is to lead the development of a knowledge-driven future through a dynamic and integrated advanced learning and innovation system. This paper presents the highlights of the business…

  4. Advance planning in end-of-life care: legal and ethical considerations for neurologists.

    PubMed

    Kerrigan, Simon; Ormerod, Ian

    2010-06-01

    Neurological illnesses can leave patients unable to make legally valid decisions about their medical treatment. However, this loss of decision making capacity can often be predicted in advance. The law in the UK now enables patients to make legally binding arrangements to either refuse specific treatments in advance or to appoint others to make decisions on their behalf. This article discusses the mechanics of advance planning under UK law and the role of the neurologist in helping patients to plan ahead. PMID:20498185

  5. Advance care planning: identifying system-specific barriers and facilitators

    PubMed Central

    Hagen, N.A.; Howlett, J.; Sharma, N.C.; Biondo, P.; Holroyd-Leduc, J.; Fassbender, K.; Simon, J.

    2015-01-01

    Background Advance care planning (acp) is an important process in health care today. How to prospectively identify potential local barriers and facilitators to uptake of acp across a complex, multi-sector, publicly funded health care system and how to develop specific mitigating strategies have not been well characterized. Methods We surveyed a convenience sample of clinical and administrative health care opinion leaders across the province of Alberta to characterize system-specific barriers and facilitators to uptake of acp. The survey was based on published literature about the barriers to and facilitators of acp and on the Michie Theoretical Domains Framework. Results Of 88 surveys, 51 (58%) were returned. The survey identified system-specific barriers that could challenge uptake of acp. The factors were categorized into four main domains. Three examples of individual system-specific barriers were “insufficient public engagement and misunderstanding,” “conflict among different provincial health service initiatives,” and “lack of infrastructure.” Local system-specific barriers and facilitators were subsequently explored through a semi-structured informal discussion group involving key informants. The group identified approaches to mitigate specific barriers. Conclusions Uptake of acp is a priority for many health care systems, but bringing about change in multi-sector health care systems is complex. Identifying system-specific barriers and facilitators to the uptake of innovation are important elements of successful knowledge translation. We developed and successfully used a simple and inexpensive process to identify local system-specific barriers and enablers to uptake of acp, and to identify specific mitigating strategies. PMID:26300673

  6. The Era of “E”: The Use of New Technologies in Advance Care Planning

    PubMed Central

    Green, Michael J.; Levi, Benjamin H.

    2012-01-01

    In this paper, we review developments in technology that can help patients, their loved ones, and healthcare providers engage in more effective advance care planning (ACP). We begin with a brief description of ACP and its purpose; then proceed to discuss various electronically available resources for ACP in the U.S.; and finally provide a critical assessment of the achievements, challenges, and future prospects for electronic advance care planning, or “e-planning.” PMID:23141197

  7. Organizational Change as Paradigm Shift.

    ERIC Educational Resources Information Center

    Simsek, Hasan; Louis, Karen Seashore

    1994-01-01

    A model of organizational change is applied to long-term planning at the University of Minnesota. Results suggest that, although planning began in the 1970s, the 1980s saw a model change that increased centralization in strategic orientation and a reduction in size and programs. Implications for organizational research are examined. (Author/MSE)

  8. 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

  9. 48 CFR 2009.570 - NRC organizational conflicts of interest.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true NRC organizational... COMMISSION COMPETITION AND ACQUISITION PLANNING CONTRACTOR QUALIFICATIONS Organizational Conflicts of Interest 2009.570 NRC organizational conflicts of interest....

  10. 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

  11. Advanced Education and Technology Business Plan, 2011-14

    ERIC Educational Resources Information Center

    Alberta Advanced Education and Technology, 2011

    2011-01-01

    Advanced Education and Technology's mission is to lead the development of a knowledge-driven future through a dynamic and integrated advanced learning and innovation system. Its core businesses are to: (1) provide strategic leadership for Campus Alberta and Alberta Innovates; and (2) engage learners, industry and the community in learning…

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

    ERIC Educational Resources Information Center

    Alberta Advanced Education and Technology, 2009

    2009-01-01

    The Ministry of Advanced Education and Technology consists of the following entities for budget purposes: Department of Advanced Education and Technology, the Access to the Future Fund, Alberta Enterprise Corporation, Alberta Research Council Inc., and iCORE Inc. Achieving the Ministry's goals involves the work and coordination of many…

  13. Benefits planning for advanced clinical information systems implementation at Allina hospitals and clinics.

    PubMed

    Thompson, Douglas Ivan; Henry, Sharon; Lockwood, Linda; Anderson, Brian; Atkinson, Susan

    2005-01-01

    Allina Hospitals and Clinics is implementing an enterprise-wide information system with inpatient and ambulatory clinical documentation and orders, clinical decision support, and revenue cycle applications. Allina has adopted a rigorous approach to planning for and realizing the expected clinical and financial benefits from this investment. Allina's strategies include: Forming a benefits realization team with formal responsibility for analysis, education, facilitation, and measurement; Studying system design to consider requirements for benefits realization; Integrating cultural, organizational and process change plans with system implementation plans; Measuring benefits using a measurement framework that matches organizational reporting, enables multi-level sequential analysis and adjusts for bias in quantifying benefits; Assigning accountability for achieving benefits by matching every benefit with an individual and an operational group; system executives, hospital executives, and department managers are held accountable for benefits within their scope of responsibility, and expected financial benefits are part of their yearly budgets. This article describes Allina's approach for benefits planning, contrasting it with the typical provider's approach to benefits realization. It argues that this approach may greatly increase the likelihood of realizing the value of investments in integrated clinical and business IT PMID:15682677

  14. Time Pressure and Phonological Advance Planning in Spoken Production

    ERIC Educational Resources Information Center

    Damian, Markus F.; Dumay, Nicolas

    2007-01-01

    Current accounts of spoken production debate the extent to which speakers plan ahead. Here, we investigated whether the scope of phonological planning is influenced by changes in time pressure constraints. The first experiment used a picture-word interference task and showed that picture naming latencies were shorter when word distractors shared…

  15. 45 CFR 95.610 - Submission of advance planning documents.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 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... administration and operations; (ii) A project management plan that addresses the planning project...

  16. Benefits of advanced software techniques for mission planning systems

    NASA Technical Reports Server (NTRS)

    Gasquet, A.; Parrod, Y.; Desaintvincent, A.

    1994-01-01

    The increasing complexity of modern spacecraft, and the stringent requirement for maximizing their mission return, call for a new generation of Mission Planning Systems (MPS). In this paper, we discuss the requirements for the Space Mission Planning and the benefits which can be expected from Artificial Intelligence techniques through examples of applications developed by Matra Marconi Space.

  17. Pediatric advance care planning from the perspective of health care professionals: A qualitative interview study

    PubMed Central

    Jox, Ralf J; Borasio, Gian Domenico; Führer, Monika

    2015-01-01

    Background: Pediatric advance care planning differs from the adult setting in several aspects, including patients’ diagnoses, minor age, and questionable capacity to consent. So far, research has largely neglected the professionals’ perspective. Aim: We aimed to investigate the attitudes and needs of health care professionals with regard to pediatric advance care planning. Design: This is a qualitative interview study with experts in pediatric end-of-life care. A qualitative content analysis was performed. Setting/participants: We conducted 17 semi-structured interviews with health care professionals caring for severely ill children/adolescents, from different professions, care settings, and institutions. Results: Perceived problems with pediatric advance care planning relate to professionals’ discomfort and uncertainty regarding end-of-life decisions and advance directives. Conflicts may arise between physicians and non-medical care providers because both avoid taking responsibility for treatment limitations according to a minor’s advance directive. Nevertheless, pediatric advance care planning is perceived as helpful by providing an action plan for everyone and ensuring that patient/parent wishes are respected. Important requirements for pediatric advance care planning were identified as follows: repeated discussions and shared decision-making with the family, a qualified facilitator who ensures continuity throughout the whole process, multi-professional conferences, as well as professional education on advance care planning. Conclusion: Despite a perceived need for pediatric advance care planning, several barriers to its implementation were identified. The results remain to be verified in a larger cohort of health care professionals. Future research should focus on developing and testing strategies for overcoming the existing barriers. PMID:25389347

  18. Foreword: planning for the future through advance directive instruments.

    PubMed

    Winick, B J

    1998-09-01

    The Foreword traces the development of advance directive instruments and discusses their legal enforceability and many benefits. Despite their advantages, advance directives remain underused and are frequently ignored by service providers. The contributors to this special issue discuss why this is so and offer and debate a variety of remedial proposals. They analyze the various legal, clinical, ethical, and practical issues presented by the use of advance directives for health and mental health care and examine new directions in their application. The Foreword describes the organization of this special issue, summarizes the articles it contains, and comments on their significance. PMID:12803208

  19. Organizational Epistemology.

    ERIC Educational Resources Information Center

    von Krogh, George; Roos, Johan

    This book is intended to give readers an observational scheme for understanding the process of organizational knowledge development at the individual and social levels. Chapter 1 examines devising a concept of organizational knowledge. In chapter 2, the place of epistemology within philosophy is discussed along with organizational, cognitivist,…

  20. Family Relationships and Advance Care Planning: Do Supportive and Critical Relations Encourage or Hinder Planning?

    PubMed Central

    2013-01-01

    Objectives. The effectiveness of advance care planning (ACP) may depend on family members’ understanding of patient preferences. However, we know of no studies that explore the association between family relationship dynamics and ACP. ACP includes a living will, durable power of attorney for health care (DPAHC) appointment, and discussions. We evaluated the effects of three aspects of family relations—general family functioning, support and criticism from spouse, and support and criticism from children—on both overall ACP and specific DPAHC designations. Method. Using multinomial logistic regression models and data from a sample of 293 older adults, we estimated the effects of family relationship quality on the likelihood of completing ACP and appointing a spouse or adult child as DPAHC. Analyses controlled for demographic and health characteristics. Results. Better overall family functioning increased the odds of ACP. Higher levels of spousal support increased the odds of holding informal discussions, whereas spousal criticism reduced the odds of naming one’s spouse as DPAHC. Both criticism and emotional support from children increased the odds that a child was named as DPAHC. Discussion. Family dynamics affect ACP in complex ways and should be considered when patients and their families discuss end-of-life care and make DPAHC designations. PMID:23286929

  1. 38 CFR 17.32 - Informed consent and advance care planning.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... in 38 CFR Part 16, Protection of Human Subjects. (h) Advance health care planning. Subject to the... damage or sterilization, except as provided in this paragraph (g). Before treatment is initiated,...

  2. 38 CFR 17.32 - Informed consent and advance care planning.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... in 38 CFR Part 16, Protection of Human Subjects. (h) Advance health care planning. Subject to the... unusual or extremely hazardous treatment or procedure, e.g., that which might result in irreversible...

  3. 38 CFR 17.32 - Informed consent and advance care planning.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... in 38 CFR Part 16, Protection of Human Subjects. (h) Advance health care planning. Subject to the... unusual or extremely hazardous treatment or procedure, e.g., that which might result in irreversible...

  4. 38 CFR 17.32 - Informed consent and advance care planning.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... in 38 CFR Part 16, Protection of Human Subjects. (h) Advance health care planning. Subject to the... unusual or extremely hazardous treatment or procedure, e.g., that which might result in irreversible...

  5. 38 CFR 17.32 - Informed consent and advance care planning.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... in 38 CFR Part 16, Protection of Human Subjects. (h) Advance health care planning. Subject to the... unusual or extremely hazardous treatment or procedure, e.g., that which might result in irreversible...

  6. Ready or not: planning for health declines in couples with advanced multiple sclerosis.

    PubMed

    Chen, Hannah; Habermann, Barbara

    2013-02-01

    This study explored how couples living with advanced multiple sclerosis approach planning for health changes together. A qualitative descriptive approach was used, with multiple in-depth interviews. Ten couples were interviewed, consisting of 10 participants with advanced multiple sclerosis and their 10 respective spouses. Interviews were transcribed verbatim and analyzed for themes related to dyad decision making. Particular focus was paid to how or if couples planned for worsening health, including advance care planning. Characteristics of couples who had made plans for worsening health included a desire to make decisions ahead of time, work in a healthcare field, and a life-threatening health event for the care-giving partner. Characteristics of couples who had not discussed plans for worsening health included diminished quality of communication between partners and hoping for a cure. Findings suggest that providers may need to assess quality of communication between partners, because strained communication may negatively affect the process of informed healthcare decision making. PMID:23291870

  7. 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'…

  8. 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…

  9. 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

  10. A Strategic Action Plan for Advancing Math and Science Education in New Mexico 2007-2010

    ERIC Educational Resources Information Center

    New Mexico Public Education Department, 2007

    2007-01-01

    This Strategic Action Plan for Advancing Math and Science Education is an initial outline of strategies, actions, measures of progress, resources needed, timelines, and responsible parties. The Plan focuses on these three main goals: (1) increasing student interest, participation, and achievement in math and science; (2) raising public support and…

  11. HIV, Aging, and Advance Care Planning: Are We Successfully Planning for the Future?

    PubMed Central

    Allshouse, Amanda A.; Duong, Syki; MaWhinney, Samantha; Kohrt, Wendy M.; Campbell, Thomas B.

    2012-01-01

    Abstract Introduction Studies of advance care planning (ACP) completion rates in HIV-infected persons pre-date the “graying” of the HIV epidemic. We sought to examine current ACP completion rates and factors influencing completion among HIV-infected persons. Methods HIV-1-seropositive persons aged 45–65 years on effective antiretroviral therapy for a minimum of 6 months were enrolled in a cross-sectional survey. Likelihood of ACP was assessed by demographic and clinical characteristics, tested with odds ratios (OR) and 95% Wald confidence intervals (CI), and adjusted for gender. Results Of 238 participants, 112 (47%) completed ACP. Persons ≥55 years of age (OR 2.8; CI 1.6,5.0; p<0.001), males (OR 4.1; CI 1.8,9.3; p=0.004), and persons with higher education (OR 2.2; CI 1.3,4.0; p=0.007) were more likely to have completed ACP. Persons with a cardiac event were more likely to have completed ACP (OR 5.5; CI 1.6,25; p=0.03), although this effect was diminished after adjusting for gender (OR 4.5; CI 0.95,21.4; p=0.06). HIV infection diagnosed for greater than 5 years was not associated with ACP completion (OR 1.3; CI 0.7,2.7; p=0.4). Current CD4+ cell counts were similar between those completing and not completing documentation (588 cells/μL and 604 cells/μL, respectively; p=0.7). The likelihood of ACP did not significantly differ with other comorbidities. Discussion Less than 50% of middle-aged patients in HIV care had documented ACP. In particular, women and those with lower education were at greatest risk of non-completion and may need interventions to improve ACP. PMID:22694717

  12. Chemical release and radiation effects experiment advanced planning and coordination

    NASA Technical Reports Server (NTRS)

    Vaughan, William W.; Alzmann, Melanie

    1991-01-01

    The efforts conducted to provide assessments and planning support for the Chemical Release and Radiation Effects Satellite (CRRES) Experiments are summarized. Included are activities regarding scientific working group and workshop development including the preparation of descriptive information on the CRRES Project.

  13. Plan of advanced satellite communication experiments using ETS-6

    NASA Technical Reports Server (NTRS)

    Ikegami, Tetsushi

    1989-01-01

    In 1992, an Engineering Test Satellite 6 is scheduled to be launched by an H-2 rocket. The missions of ETS-6 are to establish basic technologies of inter-satellite communications using S-band, millimeter waves and optical beams and of fixed and mobile satellite communications using multibeam antenna on board the satellite. A plan of the experiments is introduced.

  14. Advanced Simulation in Undergraduate Pilot Training (ASUPT) Facility Utilization Plan.

    ERIC Educational Resources Information Center

    Hagin, William V.; Smith, James F.

    The capabilities of a flight simulation research facility located at Williams AFB, Arizona are described. Research philosophy to be applied is discussed. Long range and short range objectives are identified. A time phased plan for long range research accomplishment is described. In addition, some examples of near term research efforts which will…

  15. Chemical release and radiation effects experiment advanced planned

    NASA Technical Reports Server (NTRS)

    Vaughan, William W.; Alzmann, Melanie

    1990-01-01

    A summary of the efforts conducted to provide assessments and planning support for the Chemical Release and Radiation Experiment Satellite (CRRES) is reported. Included are activities regarding scientific working group and workshop development including the preparation of descriptive information on the CRRES project.

  16. Planning alternative organizational frameworks for a large scale educational telecommunications system served by fixed/broadcast satellites

    NASA Technical Reports Server (NTRS)

    Walkmeyer, J.

    1973-01-01

    This memorandum explores a host of considerations meriting attention from those who are concerned with designing organizational structures for development and control of a large scale educational telecommunications system using satellites. Part of a broader investigation at Washington University into the potential uses of fixed/broadcast satellites in U.S. education, this study lays ground work for a later effort to spell out a small number of hypothetical organizational blueprints for such a system and for assessment of potential short and long term impacts. The memorandum consists of two main parts. Part A deals with subjects of system-wide concern, while Part B deals with matters related to specific system components.

  17. 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

  18. Development of Advanced Multi-Modality Radiation Treatment Planning Software for Neutron Radiotherapy and Beyond

    SciTech Connect

    Nigg, D; Wessol, D; Wemple, C; Harkin, G; Hartmann-Siantar, C

    2002-08-20

    The Idaho National Engineering and Environmental Laboratory (INEEL) has long been active in development of advanced Monte-Carlo based computational dosimetry and treatment planning methods and software for advanced radiotherapy, with a particular focus on Neutron Capture Therapy (NCT) and, to a somewhat lesser extent, Fast-Neutron Therapy. The most recent INEEL software system of this type is known as SERA, Simulation Environment for Radiotherapy Applications. As a logical next step in the development of modern radiotherapy planning tools to support the most advanced research, INEEL and Lawrence Livermore National Laboratory (LLNL), the developers of the PEREGRTNE computational engine for radiotherapy treatment planning applications, have recently launched a new project to collaborate in the development of a ''next-generation'' multi-modality treatment planning software system that will be useful for all modern forms of radiotherapy.

  19. Advancement of remote technology: past perspectives and future plans

    SciTech Connect

    Feldman, M J; Hamel, W R

    1984-01-01

    In the Consolidated Fuel Reprocessing Program at the Oak Ridge National Laboratory, a comprehensive remote systems development program has existed for the past five years. The new remote technology under development is expected to significantly improve remote operations by extending the range of admissible remote tasks and increasing remote work efficiency. The motivation and justification for the program are discussed by surveying the 40 years of remote operating experience which exists and considering the essential features of various old and new philosophies which have been, or are being, used in remote engineering. A future direction based upon the Remotex concept is explained, and recent progress in the development of an advanced servomanipulator-based maintenance concept is summarized to show that a new generation of remote systems capability is feasible through advanced technology. 20 references, 10 figures, 1 table.

  20. Advancement of remote systems technology: past perspectives and future plans

    SciTech Connect

    Feldman, M.J.; Hamel, W.R.

    1984-01-01

    In the Fuel Recycle Division, Consolidated Fuel Reprocessing Program, at the Oak Ridge National Laboratory, a comprehensive remote systems development program has existed for the past five years. The new remote technology under development is expected to significantly improve remote operations by extending the range of admissible remote tasks and increasing remote work efficiency. The motivation and justification for the program are discussed by surveying the 40 years of remote operating experience which exists and considering the essential features of various old and new philosophies which have been, or are being, used in remote engineering. A future direction based upon the Teletec concept is explained, and recent progress in the development of an advanced servomanipulator-based maintenance concept is summarized to show that a new generation of remote systems capability is feasible through advanced technology. 20 references, 9 figures, 1 table.

  1. Advancement of remote technology: past perspectives and future plans

    SciTech Connect

    Feldman, M.J.; Hamel, W.R.

    1984-01-01

    In the Consolidated Fuel Reprocessing Program at the Oak Ridge National Laboratory, a comprehensive remote systems development program has existed for the past five years. The new remote technology under development is expected to significantly improve remote operations by extending the range of admissible remote tasks and increasing remote work efficiency. The motivation and justification for the program are discussed by surveying the 40 years of remote operating experience which exists and considering the essential features of various old and new philosophies which have been, or are being, used in remote engineering. A future direction based upon the Remotex concept is explained, and recent progress in the development of an advanced servomanipulator-based maintenance concept is summarized to show that a new generation of remote systems capability is feasible through advanced technology. 20 references, 9 figures, 1 table.

  2. Advancement of remote systems technology: past perspectives and future plans

    SciTech Connect

    Feldman, M.J.; Hamel, W.R.

    1984-01-01

    In the Consolidated Fuel Reprocessing Program at the Oak Ridge National Laboratory, a comprehensive remote systems development program has existed for the past five years. The new remote technology under development is expected to significantly improve remote operations by extending the range of admissible remote tasks and increasing remote work efficiency. The motivation and justification for the program are discussed by surveying the 40 years of remote operating experience which exists and considering the essential features of various old and new philosophies which have been, or are being, used in remote engineering. A future direction based upon the Remotex concept is explained, and recent progress in the development of an advanced servomanipulator-based maintenance concept is summarized to show that a new generation of remote systems capability is feasible through advanced technology. 9 references, 5 figures.

  3. Waste Management Planned for the Advanced Fuel Cycle Facility

    SciTech Connect

    Soelberg

    2007-09-01

    The U.S. Department of Energy (DOE) Global Nuclear Energy Partnership (GNEP) program has been proposed to develop and employ advanced technologies to increase the proliferation resistance of spent nuclear fuels, recover and reuse nuclear fuel resources, and reduce the amount of wastes requiring permanent geological disposal. In the initial GNEP fuel cycle concept, spent nuclear fuel is to be reprocessed to separate re-useable transuranic elements and uranium from waste fission products, for fabricating new fuel for fast reactors. The separated wastes would be converted to robust waste forms for disposal. The Advanced Fuel Cycle Facility (AFCF) is proposed by DOE for developing and demonstrating spent nuclear fuel recycling technologies and systems. The AFCF will include capabilities for receiving and reprocessing spent fuel and fabricating new nuclear fuel from the reprocessed spent fuel. Reprocessing and fuel fabrication activities will generate a variety of radioactive and mixed waste streams. Some of these waste streams are unique and unprecedented. The GNEP vision challenges traditional U.S. radioactive waste policies and regulations. Product and waste streams have been identified during conceptual design. Waste treatment technologies have been proposed based on the characteristics of the waste streams and the expected requirements for the final waste forms. Results of AFCF operations will advance new technologies that will contribute to safe and economical commercial spent fuel reprocessing facilities needed to meet the GNEP vision. As conceptual design work and research and design continues, the waste management strategies for the AFCF are expected to also evolve.

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

    PubMed Central

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

    2013-01-01

    Objectives 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. Design 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. Participants and setting 19 selected RACFs (managed by 12 aged care organisations) in metropolitan and regional areas of Victoria. Results 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. Conclusions Standardised procedures and documentation are needed to improve the quality of processes, documents and outcomes of ACP in the residential aged care sector. PMID:23626906

  5. Advanced type placement and geonames database: comprehensive coordination plan

    SciTech Connect

    Barnes, A.E.; Gough, E.C.; Brown, R.M.; Zied, A.

    1983-01-01

    This paper presents a preliminary comprehensive coordination plan for the technical development and integration of an automated names database capture and management of an overall automated cartographic system, for the Defense Mapping Agency. It broadly covers the technical issues associated with system and associated subsystems functional requirements, inter-subsystem interaction common technologies in hardware, software, database, and artificial intelligence. The 3-phase RandD cycles for each and all subsystems are also outlined.

  6. Engaging Chinese American Adults in Advance Care Planning: A Community-Based, Culturally Sensitive Seminar.

    PubMed

    Lee, Mei Ching; Hinderer, Katherine A; Friedmann, Erika

    2015-08-01

    Ethnic minority groups are less engaged than Caucasian American adults in advance care planning (ACP). Knowledge deficits, language, and culture are barriers to ACP. Limited research exists on ACP and advance directives in the Chinese American adult population. Using a pre-posttest, repeated measures design, the current study explored the effectiveness of a nurseled, culturally sensitive ACP seminar for Chinese American adults on (a) knowledge, completion, and discussion of advance directives; and (b) the relationship between demographic variables, advance directive completion, and ACP discussions. A convenience sample of 72 urban, community-dwelling Chinese American adults (mean age=61 years) was included. Knowledge, advance directive completion, and ACP discussions increased significantly after attending the nurse-led seminar (p<0.01). Increased age correlated with advance directive completion and ACP discussions; female gender correlated with ACP discussions. Nursing education in a community setting increased advance directive knowledge and ACP engagement in Chinese American adults. PMID:25912237

  7. Recent advances in surgical planning & navigation for tumor biopsy and resection.

    PubMed

    Wang, Defeng; Ma, Diya; Wong, Matthew Lun; Wáng, Yì Xiáng J

    2015-10-01

    This paper highlights recent advancements in imaging technologies for surgical planning and navigation in tumor biopsy and resection which need high-precision in detection and characterization of lesion margin in preoperative planning and intraoperative navigation. Multimodality image-guided surgery platforms brought great benefits in surgical planning and operation accuracy via registration of various data sets with information on morphology [X-ray, magnetic resonance (MR), computed tomography (CT)], function connectivity [functional magnetic resonance imaging (fMRI), diffusion tensor imaging (DTI), rest-status fMRI], or molecular activity [positron emission tomography (PET)]. These image-guided platforms provide a correspondence between the pre-operative surgical planning and intra-operative procedure. We envisage that the combination of advanced multimodal imaging, three-dimensional (3D) printing, and cloud computing will play increasingly important roles in planning and navigation of surgery for tumor biopsy and resection in the coming years. PMID:26682133

  8. Recent advances in surgical planning & navigation for tumor biopsy and resection

    PubMed Central

    Ma, Diya; Wong, Matthew Lun; Wáng, Yì Xiáng J.

    2015-01-01

    This paper highlights recent advancements in imaging technologies for surgical planning and navigation in tumor biopsy and resection which need high-precision in detection and characterization of lesion margin in preoperative planning and intraoperative navigation. Multimodality image-guided surgery platforms brought great benefits in surgical planning and operation accuracy via registration of various data sets with information on morphology [X-ray, magnetic resonance (MR), computed tomography (CT)], function connectivity [functional magnetic resonance imaging (fMRI), diffusion tensor imaging (DTI), rest-status fMRI], or molecular activity [positron emission tomography (PET)]. These image-guided platforms provide a correspondence between the pre-operative surgical planning and intra-operative procedure. We envisage that the combination of advanced multimodal imaging, three-dimensional (3D) printing, and cloud computing will play increasingly important roles in planning and navigation of surgery for tumor biopsy and resection in the coming years. PMID:26682133

  9. It's just too hard! Australian health care practitioner perspectives on barriers to advance care planning.

    PubMed

    Boddy, Jennifer; Chenoweth, Lesley; McLennan, Vanette; Daly, Michelle

    2013-01-01

    This article presents findings from six focus groups with health care practitioners in an Australian hospital during 2010, which sought to elicit their perspectives on the barriers for people to plan their future health care should they become unwell. Such knowledge is invaluable in overcoming the barriers associated with advance care planning and enhancing the uptake of advance directives and the appointment of an enduring power of attorney for people of all ages. A person's rights to self-determination in health care, including decision making about their wishes for future care in the event they lose cognitive capacity, should not be overlooked against the backdrop of increasing pressure on health care systems. Findings suggest that multiple barriers exist, from practitioners' perspectives, which can be divided into three major categories, namely: patient-centred, practitioner-centred and system-centred barriers. Specifically, patient-centred barriers include lack of knowledge, accessibility concerns, the small 'window of opportunity' to discuss advance care planning, emotional reactions and avoidance when considering one's mortality, and demographic influences. At the practitioner level, barriers relate to a lack of knowledge and uncertainty around advance care planning processes. Systemically, legislative barriers (including a lack of a central registry and conflicting state legislation), procedural issues (particularly in relation to assessing cognitive capacity and making decisions ad hoc) and questions about delegation, roles and responsibilities further compound the barriers to advance care planning. PMID:22951247

  10. Advanced Environmental Monitoring and Control Program: Strategic Plan

    NASA Technical Reports Server (NTRS)

    Schmidt, Gregory

    1996-01-01

    Human missions in space, from short-duration shuttle missions lasting no more than several days to the medium-to-long-duration missions planned for the International Space Station, face a number of hazards that must be understood and mitigated for the mission to be carried out safely. Among these hazards are those posed by the internal environment of the spacecraft itself; through outgassing of toxic vapors from plastics and other items, failures or off-nominal operations of spacecraft environmental control systems, accidental exposure to hazardous compounds used in experiments: all present potential hazards that while small, may accumulate and pose a danger to crew health. The first step toward mitigating the dangers of these hazards is understanding the internal environment of the spacecraft and the compounds contained within it. Future spacecraft will have integrated networks of redundant sensors which will not only inform the crew of hazards, but will pinpoint the problem location and, through analysis by intelligent systems, recommend and even implement a course of action to stop the problem. This strategic plan details strategies to determine NASA's requirements for environmental monitoring and control systems for future spacecraft, and goals and objectives for a program to answer these needs.

  11. Plan of advanced satellite communications experiment using ETS-VI

    NASA Technical Reports Server (NTRS)

    Shiomi, Tadashi

    1988-01-01

    Communications Research Laboratory (CRL, Ministry of Posts and Telecommunications, Japan) has been engaged in development of three advanced satellite communication payloads aiming at experiments by Japan's 2-ton class Engineering Test Satellite VI (ETS-VI) which is to be launched in H-II rocket by NASDA in August 1992. CRL's three experimental systems are: (1) S-band inter-satellite communications; (2) millimeter-wave inter-satellite and personal-satellite communications; and (3) optical inter-satellite communications. CRL develops experimental optical communication system with telescope of 75 mm diameter which has gimbal mirror beam pointing/tracking mechanism. The onboard system has fundamental optical communication functions with laser diode transmitter of wavelength 0.83 micron, laser beam point-ahead mechanism, receiver of wavelength 0.51 micron, modulation/demodulation subsystem, and so on.

  12. The advanced neutron source research and development plan

    SciTech Connect

    Selby, D.L.

    1995-08-01

    The Advanced Neutron Source (ANS) is being designed as a user-oriented neutron research laboratory centered around the most intense continuous beams of thermal and subthermal neutrons in the world (an order of magnitude more intense than beams available from the most advanced existing reactors). The ANS will be built around a new research reactor of 330-MW fission power, producing an unprecedented peak thermal flux of >7 {center_dot} 10{sup 19} {center_dot} m{sup -2} {center_dot} s{sup -1}. Primarily a research facility, the ANS will accommodate more than 1000 academic, industrial, and government researchers each year. They will conduct basic research in all branches of science as well as applied research leading to better understanding of new materials, including high temperature super conductors, plastics, and thin films. Some 48 neutron beam stations will be set up in the ANS beam rooms and the neutron guide hall for neutron scattering and for fundamental and nuclear physics research. There also will be extensive facilities for materials irradiation, isotope production, and analytical chemistry. The top level work breakdown structure (WBS) for the project. As noted in this figure, one component of the project is a research and development (R&D) program (WBS 1.1). This program interfaces with all of the other project level two WBS activities. Because one of the project guidelines is to meet minimum performance goals without relying on new inventions, this R&D activity is not intended to produce new concepts to allow the project to meet minimum performance goals. Instead, the R&D program will focus on the four objectives described.

  13. Organizational Management Handbook.

    ERIC Educational Resources Information Center

    Haendle, Connie

    A handbook on the organizational structure and management practices of the Literacy Volunteers of America, Inc. (LVA), is presented. An outline of LVA's structure and policies is presented as basic training for leaders before they begin the planning and operational phases. The activity of starting an affiliate is described with respect to interim…

  14. The Competitive Advantage of Organizational Learning.

    ERIC Educational Resources Information Center

    Appelbaum, Steven H.; Gallagher, John

    2000-01-01

    Explores theories of organizational learning and identifies the implications of the following for learning organizations: the new economy, strategic planning, management practices, and communication. (Contains 32 references.) (SK)

  15. Advanced Seismic Probabilistic Risk Assessment Demonstration Project Plan

    SciTech Connect

    Justin Coleman

    2014-09-01

    Idaho National Laboratories (INL) has an ongoing research and development (R&D) project to remove excess conservatism from seismic probabilistic risk assessments (SPRA) calculations. These risk calculations should focus on providing best estimate results, and associated insights, for evaluation and decision-making. This report presents a plan for improving our current traditional SPRA process using a seismic event recorded at a nuclear power plant site, with known outcomes, to improve the decision making process. SPRAs are intended to provide best estimates of the various combinations of structural and equipment failures that can lead to a seismic induced core damage event. However, in general this approach has been conservative, and potentially masks other important events (for instance, it was not the seismic motions that caused the Fukushima core melt events, but the tsunami ingress into the facility).

  16. Advances in imaging technologies for planning breast reconstruction

    PubMed Central

    Mohan, Anita T.

    2016-01-01

    The role and choice of preoperative imaging for planning in breast reconstruction is still a disputed topic in the reconstructive community, with varying opinion on the necessity, the ideal imaging modality, costs and impact on patient outcomes. Since the advent of perforator flaps their use in microsurgical breast reconstruction has grown. Perforator based flaps afford lower donor morbidity by sparing the underlying muscle provide durable results, superior cosmesis to create a natural looking new breast, and are preferred in the context of radiation therapy. However these surgeries are complex; more technically challenging that implant based reconstruction, and leaves little room for error. The role of imaging in breast reconstruction can assist the surgeon in exploring or confirming flap choices based on donor site characteristics and presence of suitable perforators. Vascular anatomical studies in the lab have provided the surgeon a foundation of knowledge on location and vascular territories of individual perforators to improve our understanding for flap design and safe flap harvest. The creation of a presurgical map in patients can highlight any abnormal or individual anatomical variance to optimize flap design, intraoperative decision-making and execution of flap harvest with greater predictability and efficiency. This article highlights the role and techniques for preoperative planning using the newer technologies that have been adopted in reconstructive clinical practice: computed tomographic angiography (CTA), magnetic resonance angiography (MRA), laser-assisted indocyanine green fluorescence angiography (LA-ICGFA) and dynamic infrared thermography (DIRT). The primary focus of this paper is on the application of CTA and MRA imaging modalities. PMID:27047790

  17. Advances in imaging technologies for planning breast reconstruction.

    PubMed

    Mohan, Anita T; Saint-Cyr, Michel

    2016-04-01

    The role and choice of preoperative imaging for planning in breast reconstruction is still a disputed topic in the reconstructive community, with varying opinion on the necessity, the ideal imaging modality, costs and impact on patient outcomes. Since the advent of perforator flaps their use in microsurgical breast reconstruction has grown. Perforator based flaps afford lower donor morbidity by sparing the underlying muscle provide durable results, superior cosmesis to create a natural looking new breast, and are preferred in the context of radiation therapy. However these surgeries are complex; more technically challenging that implant based reconstruction, and leaves little room for error. The role of imaging in breast reconstruction can assist the surgeon in exploring or confirming flap choices based on donor site characteristics and presence of suitable perforators. Vascular anatomical studies in the lab have provided the surgeon a foundation of knowledge on location and vascular territories of individual perforators to improve our understanding for flap design and safe flap harvest. The creation of a presurgical map in patients can highlight any abnormal or individual anatomical variance to optimize flap design, intraoperative decision-making and execution of flap harvest with greater predictability and efficiency. This article highlights the role and techniques for preoperative planning using the newer technologies that have been adopted in reconstructive clinical practice: computed tomographic angiography (CTA), magnetic resonance angiography (MRA), laser-assisted indocyanine green fluorescence angiography (LA-ICGFA) and dynamic infrared thermography (DIRT). The primary focus of this paper is on the application of CTA and MRA imaging modalities. PMID:27047790

  18. Assessing Advance Care Planning: Examining Autonomous Selections in an Advance Directive.

    PubMed

    Klugman, Craig M; Tolwin, Nicole M

    2015-01-01

    We examined the management of completed advance directives including why participants completed a document, what procedures and values they chose, with whom they held end-of-life conversations, and where they stored their document. Participants elected to complete a SurveyMonkey survey that was made available to individuals who wrote an advance directive through TexasLivingWill.org; 491 individuals elected to fill out the survey, aged 19 to 94 years. The survey asked multiple questions about why participants completed an advance directive, where they would store it, and with whom they had conversations about their end-of-life wishes. A list of procedures and values allowed participants to indicate what they refused or requested in their advance directive. Advance directives are most often completed to allow patients to prepare and control the healthcare they wish to receive when dying. One-half to two-thirds of individuals refuse common end-of-life medical procedures, and the rest request the procedures. We found a correlation between the choice to refuse or request a procedure and the age of the participant. Participants reported that their end-of-life conversations most often occurred with their spouse. Respondents often reported that their advance directive was stored with their physician and power of attorney for healthcare, conversations with those individuals rarely happened. Advance directives document patients' requests for and refusals of end-of-life care. Physicians and surrogates need to be better educated so that the documents are part of a meaningful conversation with the patient. Because patients' choices change over their lifespan, these documents need to be revisited regularly and not completed as a onetime event. PMID:26399671

  19. Organizational Justice

    ERIC Educational Resources Information Center

    Burns, Travis

    2013-01-01

    Helping principals understand the importance of organizational justice is the first step in enhancing learning outcomes for all learners, regardless of their social class, race, abilities, sex, or gender. In schools, organizational justice may be defined as teachers' perceptions of fairness, respect, and equity that relate to their…

  20. Organizational Science

    ERIC Educational Resources Information Center

    Beriwal, Madhu; Clegg, Stewart; Collopy, Fred; McDaniel, Reuben, Jr.; Morgan, Gareth; Sutcliffe, Kathleen; Kaufman, Roger; Marker, Anthony; Selwyn, Neil

    2013-01-01

    Scholars representing the field of organizational science, broadly defined as including many fields--organizational behavior and development, management, workplace performance, and so on--were asked to identify what they considered to be the most exciting and imaginative work currently being done in their field, as well as how that work might…

  1. Decision aids for advance care planning: an overview of the state of the science.

    PubMed

    Butler, Mary; Ratner, Edward; McCreedy, Ellen; Shippee, Nathan; Kane, Robert L

    2014-09-16

    Advance care planning honors patients' goals and preferences for future care by creating a plan for when illness or injury impedes the ability to think or communicate about health decisions. Fewer than 50% of severely or terminally ill patients have an advance directive in their medical record, and physicians are accurate only about 65% of the time when predicting patient preferences for intensive care. Decision aids can support the advance care planning process by providing a structured approach to informing patients about care options and prompting them to document and communicate their preferences. This review, commissioned as a technical brief by the Agency for Healthcare Research and Quality Effective Health Care Program, provides a broad overview of current use of and research related to decision aids for adult advance care planning. Using interviews of key informants and a search of the gray and published literature from January 1990 to May 2014, the authors found that many decision aids are widely available but are not assessed in the empirical literature. The 16 published studies testing decision aids as interventions for adult advance care planning found that most are proprietary or not publicly available. Some are constructed for the general population, whereas others address disease-specific conditions that have more predictable end-of-life scenarios and, therefore, more discrete choices. New decision aids should be designed that are responsive to diverse philosophical perspectives and flexible enough to change as patients gain experience with their personal illness courses. Future efforts should include further research, training of advance care planning facilitators, dissemination and access, and tapping potential opportunities in social media or other technologies. PMID:25069709

  2. The Advanced Neutron Source research and development plan

    SciTech Connect

    Selby, D.L.

    1992-11-30

    The Advanced Neutron Source (ANS) is being designed as a user-oriented neutron research laboratory centered around the most intense continuous beams of thermal and subthermal neutrons in the world. The ANS will be built around a new research reactor of [approximately] 330 MW fission power, producing an unprecedented peak thermal flux of > 7 [times] 10[sup 19] M[sup [minus]2] [center dot] S[sup [minus]1]. Primarily a research facility, the ANS will accommodate more than 1000 academic, industrial, and government researchers each year. They will conduct basic research in all branches of science-as well as applied research-leading to better understanding of new materials, including high temperature super conductors, plastics, and thin films. Some 48 neutron beam stations will be set up in the ANS beam rooms and the neutron guide hall for neutron scattering and for fundamental and nuclear physics research. There also will be extensive facilities for materials irradiation, isotope production, and analytical chemistry. The R D program will focus on the four objectives: Address feasibility issues; provide analysis support; evaluate options for improvement in performance beyond minimum requirements; and provide prototype demonstrations for unique facilities. The remainder of this report presents (1) the process by which the R D activities are controlled and (2) a discussion of the individual tasks that have been identified for the R D program, including their justification, schedule and costs. The activities discussed in this report will be performed by Martin Marietta Energy Systems, Inc. (MMES) through the Oak Ridge National Laboratory (ORNL) and through subcontracts with industry, universities, and other national laboratories. It should be noted that in general a success path has been assumed for all tasks.

  3. The Advanced Neutron Source research and development plan

    SciTech Connect

    Selby, D.L.

    1992-11-30

    The Advanced Neutron Source (ANS) is being designed as a user-oriented neutron research laboratory centered around the most intense continuous beams of thermal and subthermal neutrons in the world. The ANS will be built around a new research reactor of {approximately} 330 MW fission power, producing an unprecedented peak thermal flux of > 7 {times} 10{sup 19} M{sup {minus}2} {center_dot} S{sup {minus}1}. Primarily a research facility, the ANS will accommodate more than 1000 academic, industrial, and government researchers each year. They will conduct basic research in all branches of science-as well as applied research-leading to better understanding of new materials, including high temperature super conductors, plastics, and thin films. Some 48 neutron beam stations will be set up in the ANS beam rooms and the neutron guide hall for neutron scattering and for fundamental and nuclear physics research. There also will be extensive facilities for materials irradiation, isotope production, and analytical chemistry. The R&D program will focus on the four objectives: Address feasibility issues; provide analysis support; evaluate options for improvement in performance beyond minimum requirements; and provide prototype demonstrations for unique facilities. The remainder of this report presents (1) the process by which the R&D activities are controlled and (2) a discussion of the individual tasks that have been identified for the R&D program, including their justification, schedule and costs. The activities discussed in this report will be performed by Martin Marietta Energy Systems, Inc. (MMES) through the Oak Ridge National Laboratory (ORNL) and through subcontracts with industry, universities, and other national laboratories. It should be noted that in general a success path has been assumed for all tasks.

  4. Advanced Materials Development Program: Ceramic Technology for Advanced Heat Engines program plan, 1983--1993

    SciTech Connect

    Not Available

    1990-07-01

    The purpose of the Ceramic Technology for Advanced Heat Engines (CTAHE) Project is the development of an industrial technology base capable of providing reliable and cost-effective high temperature ceramic components for application in advanced heat engines. There is a deliberate emphasis on industrial'' in the purpose statement. The project is intended to support the US ceramic and engine industries by providing the needed ceramic materials technology. The heat engine programs have goals of component development and proof-of-concept. The CTAHE Project is aimed at developing generic basic ceramic technology and does not involve specific engine designs and components. The materials research and development efforts in the CTAHE Project are focused on the needs and general requirements of the advanced gas turbine and low heat rejection diesel engines. The CTAHE Project supports the DOE Office of Transportation Systems' heat engine programs, Advanced Turbine Technology Applications (ATTAP) and Heavy Duty Transport (HDT) by providing the basic technology required for development of reliable and cost-effective ceramic components. The heat engine programs provide the iterative component design, fabrication, and test development logic. 103 refs., 18 figs., 11 tabs.

  5. End-of-life communication in Korean older adults: With focus on advance care planning and advance directives.

    PubMed

    Shin, Dong Wook; Lee, Ji Eun; Cho, BeLong; Yoo, Sang Ho; Kim, SangYun; Yoo, Jun-Hyun

    2016-04-01

    The present article aimed to provide a comprehensive review of current status of end-of-life (EOL) care and sociocultural considerations in Korea, with focus on the EOL communication and use of advance directives (AD) in elderly Koreans. Through literature review, we discuss the current status of EOL care and sociocultural considerations in Korea, and provide a look-ahead. In Korea, patients often receive life-sustaining treatment until the very end of life. Advance care planning is rare, and most do-not-resuscitate decisions are made between the family and physician at the very end of patient's life. Koreans, influenced mainly by Confucian tradition, prefer a natural death and discontinuation of life-sustaining treatment. Although Koreans generally believe that death is natural and unavoidable, they tend not to think about or discuss death, and regard preparation for death as unnecessary. As a result, AD are completed by just 4.7% of the general adult population. This situation can be explained by several sociocultural characteristics including opting for natural death, wish not to burden others, preference for family involvement and trust in doctor, avoidance of talking about death, and filial piety. Patients often receive life-sustaining treatment until the very EOL, advance care planning and the use of AD is not common in Korea. This was related to unique sociocultural characteristics of Korea. A more active role of physicians, development of a more deliberate EOL discussion process, development of culturally appropriate AD and promotion of advance care planning might be required to provide good EOL care in Korea. PMID:26459613

  6. 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

  7. Ministry of Advanced Education and Labour Market Development 2008/09 Annual Service Plan Report

    ERIC Educational Resources Information Center

    Ministry of Advanced Education and Labour Market Development, 2009

    2009-01-01

    This Service Plan Report reflects the Ministry of Advanced Education and Labour Market Development's success in achieving the overall priorities of the Government of British Columbia, in the current economic conditions and other relevant external factors related to the strategic direction and operations of this Ministry. This paper also highlights…

  8. 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...

  9. 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...

  10. 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...

  11. 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...

  12. 15 CFR 714.3 - Advance declaration requirements for additionally planned production of Schedule 3 chemicals.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... COMMERCE CHEMICAL WEAPONS CONVENTION REGULATIONS ACTIVITIES INVOLVING SCHEDULE 3 CHEMICALS § 714.3 Advance... a Schedule 3 chemical above the declaration threshold; (ii) You plan to produce at a plant declared under § 714.1(a)(1)(ii) of the CWCR an additional Schedule 3 chemical above the declaration...

  13. 15 CFR 714.3 - Advance declaration requirements for additionally planned production of Schedule 3 chemicals.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 15 Commerce and Foreign Trade 2 2011-01-01 2011-01-01 false Advance declaration requirements for 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...

  14. 15 CFR 714.3 - Advance declaration requirements for additionally planned production of Schedule 3 chemicals.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... COMMERCE CHEMICAL WEAPONS CONVENTION REGULATIONS ACTIVITIES INVOLVING SCHEDULE 3 CHEMICALS § 714.3 Advance... a Schedule 3 chemical above the declaration threshold; (ii) You plan to produce at a plant declared under § 714.1(a)(1)(ii) of the CWCR an additional Schedule 3 chemical above the declaration...

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

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... COMMERCE CHEMICAL WEAPONS CONVENTION REGULATIONS ACTIVITIES INVOLVING SCHEDULE 3 CHEMICALS § 714.3 Advance... a Schedule 3 chemical above the declaration threshold; (ii) You plan to produce at a plant declared under § 714.1(a)(1)(ii) of the CWCR an additional Schedule 3 chemical above the declaration...

  16. 15 CFR 713.4 - Advance declaration requirements for additionally planned production, processing, or consumption...

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 15 Commerce and Foreign Trade 2 2011-01-01 2011-01-01 false Advance declaration requirements for additionally planned production, processing, or consumption of Schedule 2 chemicals. 713.4 Section 713.4 Commerce and Foreign Trade Regulations Relating to Commerce and Foreign Trade (Continued) BUREAU OF INDUSTRY AND SECURITY, DEPARTMENT OF...

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

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... COMMERCE CHEMICAL WEAPONS CONVENTION REGULATIONS ACTIVITIES INVOLVING SCHEDULE 3 CHEMICALS § 714.3 Advance... a Schedule 3 chemical above the declaration threshold; (ii) You plan to produce at a plant declared under § 714.1(a)(1)(ii) of the CWCR an additional Schedule 3 chemical above the declaration...

  18. 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…

  19. 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...

  20. 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…

  1. Advanced reactors transition fiscal year 1995 multi-year program plan WBS 7.3

    SciTech Connect

    Loika, E.F.

    1994-09-22

    This document describes in detail the work to be accomplished in FY-1995 and the out years for the Advanced Reactors Transition (WBS 7.3). This document describes specific milestones and funding profiles. Based upon the Fiscal Year 1995 Multi-Year Program Plan, DOE will provide authorization to perform the work outlined in the FY 1995 MYPP. Following direction given by the US Department of Energy (DOE) on December 15, 1993, Advanced Reactors Transition (ART), previously known as Advanced Reactors, will provide the planning and perform the necessary activities for placing the Fast Flux Test Facility (FFTF) in a radiologically and industrially safe shutdown condition. The DOE goal is to accomplish the shutdown in approximately five years. The Advanced Reactors Transition Multi-Year Program Plan, and the supporting documents; i.e., the FFTF Shutdown Program Plan and the FFTF Shutdown Project Resource Loaded Schedule (RLS), are defined for the life of the Program. During the transition period to achieve the Shutdown end-state, the facilities and systems will continue to be maintained in a safe and environmentally sound condition. Additionally, facilities that were associated with the Office of Nuclear Energy (NE) Programs, and are no longer required to support the Liquid Metal Reactor Program will be deactivated and transferred to an alternate sponsor or the Decontamination and Decommissioning (D and D) Program for final disposition, as appropriate.

  2. 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, what is…

  3. Ministry of Advanced Education and Labour Market Development 2009/10-2011/12 Service Plan Update

    ERIC Educational Resources Information Center

    Ministry of Advanced Education and Labour Market Development, 2009

    2009-01-01

    The Ministry of Advanced Education and Labour Market Development's overarching purpose is to position British Columbia to meet the competitive challenges of the twenty-first century through better aligning labour market supply and demand. In the six months since the Ministry issued its February 2009 service plan and the subsequent re-election of…

  4. Beta Test Plan for Advanced Inverters Interconnecting Distributed Resources with Electric Power Systems

    SciTech Connect

    Hoke, A.; Chakraborty, S.; Basso, T.; Coddington, M.

    2014-01-01

    This document provides a preliminary (beta) test plan for grid interconnection systems of advanced inverter-based DERs. It follows the format and methodology/approach established by IEEE Std 1547.1, while incorporating: 1. Upgraded tests for responses to abnormal voltage and frequency, and also including ride-through. 2. A newly developed test for voltage regulation, including dynamic response testing. 3. Modified tests for unintentional islanding, open phase, and harmonics to include testing with the advanced voltage and frequency response functions enabled. Two advanced inverters, one single-phase and one three-phase, were tested under the beta test plan. These tests confirmed the importance of including tests for inverter dynamic response, which varies widely from one inverter to the next.

  5. 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. PMID:25900977

  6. 45 CFR 307.40 - Suspension of approval of advance planning documents for computerized support enforcement systems.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 2 2011-10-01 2011-10-01 false Suspension of approval of advance planning documents for computerized support enforcement systems. 307.40 Section 307.40 Public Welfare Regulations... ENFORCEMENT SYSTEMS § 307.40 Suspension of approval of advance planning documents for computerized...

  7. Implementation: The Glue of Organizational Change.

    ERIC Educational Resources Information Center

    Addison, Roger M.; Lloyd, Clayton R.

    1999-01-01

    Discussion of organizational change and performance improvement programs focuses on 10 guidelines for developing successful implementation plans. Highlights include defining a vision and mission; cultural considerations; forming a team; contingency plans; communication; employee education; monitoring mechanisms; and rewarding and recognizing…

  8. Lewin's Theory of Planned Change as a strategic resource.

    PubMed

    Shirey, Maria R

    2013-02-01

    This department highlights change management strategies that may be successful in strategically planning and executing organizational change initiatives. With the goal of presenting practical approaches helpful to nurse leaders advancing organizational change, content includes evidence-based projects, tools, and resources that mobilize and sustain organizational change initiatives. In this article, the author explores the use of the Lewin's Theory of Planned Change as a strategic resource to mobilize the people side of change. An overview of the theory is provided along with a discussion of its strengths, limitations, and targeted application. PMID:23343723

  9. Advancements in integrating DSM and distributed generation and storage into T&D planning: Proceedings from the Third Annual Workshop

    SciTech Connect

    Not Available

    1994-09-01

    This third in a series of annual EPRI workshops focused on integrating demand-side management and distributed generation an into transmission and distribution planning. The workshop included utility case studies on integrated planning, results from utility pilot projects, analytical developments, and cross-departmental planning and implementation. In addition, the workshop featured information on advancements in area-specific planning and costing methods along with EPRI products that support utility integrated planning efforts.

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

    PubMed Central

    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' medical records. Using data from a survey of more than 5,000 white Wisconsin high school graduates in their mid-60s, we found that participants who were living in the La Crosse area were significantly less likely than their peers living elsewhere to have executed a living will or appointed a health care power of attorney. This pattern may reflect psychological reactance, where individuals reject a message or lesson when they perceive compliance as a threat to their autonomy. There was no evidence of social diffusion effects; participants who lived in the La Crosse region themselves or who had social network members residing in the area were no more likely than those with no known ties to the region to have engaged in advance care planning. Future studies should explore the processes through which individuals learn and share with others their knowledge of advance care planning. PMID:24567988

  11. Effects of MPH-OROS on the Organizational, Time Management, and Planning Behaviors of Children with ADHD

    ERIC Educational Resources Information Center

    Abikoff, Howard; Nissley-Tsiopinis, Jenelle; Gallagher, Richard; Zambenedetti, Maurizio; Seyffert, Michael; Boorady, Roy; McCarthy, John

    2009-01-01

    A double-blind, placebo-controlled, crossover design study was done to evaluate the effects of methylphenidate-osmotic-release oral systems (MPH-OROS) on the organization, time management, and planning (OTMP) of children with attention deficit hyperactivity disorder (ADHD). Results show significant improvements on the OTMP of children with ADHD in…

  12. Media Selection during the Implementation of Planned Organizational Change: A Predictive Framework Based on Implementation Approach and Phase.

    ERIC Educational Resources Information Center

    Timmerman, C. Erik

    2003-01-01

    Integrates literature that addresses implementation approaches and phases with media selection research to provide a descriptive framework for understanding and predicting media use during planned change implementation. Concludes by synthesizing the findings that emerge from the integration of these bodies of literature and describing implications…

  13. A Review of Qualitative Data Gathering Methods and Their Applications To Support Organizational Strategic Planning Processes. Study Number Six.

    ERIC Educational Resources Information Center

    Wright, Phillip C.; Geroy, Gary D.

    Exploring existing methodologies to determine whether they can be adapted or adopted to support strategic goal setting, this paper focuses on information gathering techniques as they relate to the human resource development professional's input into strategic planning processes. The information gathering techniques are all qualitative methods and…

  14. 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

  15. 45 CFR 302.12 - Single and separate organizational unit.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 2 2010-10-01 2010-10-01 false Single and separate organizational unit. 302.12... HUMAN SERVICES STATE PLAN REQUIREMENTS § 302.12 Single and separate organizational unit. (a) The State plan shall provide for the establishment or designation of a single and separate organizational unit...

  16. 45 CFR 302.12 - Single and separate organizational unit.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 2 2011-10-01 2011-10-01 false Single and separate organizational unit. 302.12... HUMAN SERVICES STATE PLAN REQUIREMENTS § 302.12 Single and separate organizational unit. (a) The State plan shall provide for the establishment or designation of a single and separate organizational unit...

  17. 45 CFR 302.12 - Single and separate organizational unit.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 2 2014-10-01 2012-10-01 true Single and separate organizational unit. 302.12... HUMAN SERVICES STATE PLAN REQUIREMENTS § 302.12 Single and separate organizational unit. (a) The State plan shall provide for the establishment or designation of a single and separate organizational unit...

  18. 45 CFR 302.12 - Single and separate organizational unit.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 2 2012-10-01 2012-10-01 false Single and separate organizational unit. 302.12... HUMAN SERVICES STATE PLAN REQUIREMENTS § 302.12 Single and separate organizational unit. (a) The State plan shall provide for the establishment or designation of a single and separate organizational unit...

  19. 45 CFR 302.12 - Single and separate organizational unit.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 2 2013-10-01 2012-10-01 true Single and separate organizational unit. 302.12... HUMAN SERVICES STATE PLAN REQUIREMENTS § 302.12 Single and separate organizational unit. (a) The State plan shall provide for the establishment or designation of a single and separate organizational unit...

  20. Advanced Metering Plan for Monitoring Energy and Potable Water Use in PNNL EMS4 Buildings

    SciTech Connect

    Pope, Jason E.; Olson, Norman J.; Berman, Marc J.; Schielke, Dale R.

    2011-08-17

    This updated Advanced Metering Plan for monitoring whole building energy use in Pacific Northwest National Laboratory (PNNL) EMS4 buildings on the PNNL campus has been prepared in accordance with the requirements of the Energy Policy Act of 2005 (EPAct 2005), Section 103, U.S. Department of Energy (DOE) Order 430.2B, and Metering Best Practices, A Guide to Achieving Utility Resource Efficiency, Federal Energy Management Program, October 2007 (Sullivan et al. 2007). The initial PNNL plan was developed in July 2007 (Olson 2007), updated in September 2008 (Olson et al. 2008), updated in September 2009 (Olson et al. 2009), and updated again in August 2010 (Olson et al. 2010).

  1. Advanced reactors transition FY 1997 multi-year work plan WBS 7.3

    SciTech Connect

    Hulvey, R.K.

    1996-09-27

    This document describes in detail the work to be accomplised in FY 1997 and the out-years for the Advanced Reactors Transition (WBS 7.3) under the management of the Babcock & Wilcox Hanford Company. This document also includes specific milestones and funding profiles. Based upon the Fiscal Year 1997 Multi-Year Work Plan, the Department of Energy will provide authorization to perform the work described.

  2. 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

  3. 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

  4. The COMP-Ident Find-Screen Planning Package. A Descriptive Manual And Organizational Guide for Planning and Conducting Child Find/Screen Efforts in Rural Areas.

    ERIC Educational Resources Information Center

    Laub, Karen W.; And Others

    In order to comply with Public Law 94-142, Education for All Handicapped Children Act, procedures for planning and conducting screening (identification) and assessment of preschool handicapped children in rural areas were developed. Screening was accomplished by public awareness campaigns, health screening, or school census analysis. In the HICOMP…

  5. Cultures of engagement: The organizational foundations of advancing health in immigrant and low-income communities of color.

    PubMed

    Bloemraad, Irene; Terriquez, Veronica

    2016-09-01

    A rich civic infrastructure of community-based organizations (CBOs) can help generate, diffuse and maintain a culture of engagement and health that benefits marginalized populations most at risk for illness, disability, and poor health. Attention to CBOs advances "meso-level" frameworks for understanding health cultures and outcomes by going beyond attention to social networks and social identities. We focus on three mechanisms: CBOs can (1) empower individuals by developing civic capacity and personal efficacy; (2) foster solidarity by building networks, social identities and a shared commitment to collective well-being; and (3) mobilize people to have a voice in health-related policies and programming, thereby affecting community well-being. We draw on theory and research in sociology, political science and psychology, and we illustrate the utility of a CBO approach by examining survey and semi-structured interview data from participants in youth civic groups in 13 low-income, predominantly immigrant communities in California. Interview data illustrate the ways in which CBOs enhance members' civic capacities, provide a sense of empowerment and efficacy to engage in healthy behaviors, develop solidarity among diverse participants, and elaborate networks among those committed to community well-being. We also discuss CBO-led campaigns in which youth mobilized for change in policies and practices of local institutions to illustrate possible community-wide health consequences of CBO engagement. CBOs can thus generate individual-level well-being effects, and reduce structural barriers to good health through changes in the broader environment. PMID:26898114

  6. Utilizing Organizational Culture to Predict Responses to Planned Change in a Public School: A Test of the OC[superscript 3] Model

    ERIC Educational Resources Information Center

    Sandberg, Eric Christian

    2012-01-01

    The primary purpose of this research was to test the capability of the Organizational Change in Cultural Context (OC[superscript 3]) Model (Latta, 2009, 2011) to predict responses to change. According to Latta, predictions of resistance to or facilitation of change can be predicted by utilizing organizational culture and its alignment with the…

  7. Accuracy of a Decision Aid for Advance Care Planning: Simulated End-of-Life Decision Making

    PubMed Central

    Levi, Benjamin H.; Heverley, Steven R.; Green, Michael J.

    2013-01-01

    Purpose Advance directives have been criticized for failing to help physicians make decisions consistent with patients’ wishes. This pilot study sought to determine if an interactive, computer-based decision aid that generates an advance directive can help physicians accurately translate patients’ wishes into treatment decisions. Methods We recruited 19 patient-participants who had each previously created an advance directive using a computer-based decision aid, and 14 physicians who had no prior knowledge of the patient-participants. For each advance directive, three physicians were randomly assigned to review the advance directive and make five to six treatment decisions for each of six (potentially) end-of-life clinical scenarios. From the three individual physicians’ responses, a “consensus physician response” was generated for each treatment decision (total decisions = 32). This consensus response was shared with the patient whose advance directive had been reviewed, and she/he was then asked to indicate how well the physician translated his/her wishes into clinical decisions. Results Patient-participants agreed with the consensus physician responses 84 percent (508/608) of the time, including 82 percent agreement on whether to provide mechanical ventilation, and 75 percent on decisions about cardiopulmonary resuscitation (CPR). Across the six vignettes, patient-participants’ rating of how well physicians translated their advance directive into medical decisions was 8.4 (range = 6.5–10, where 1 = extremely poorly, and 10 = extremely well). Physicians’ overall rating of their confidence at accurately translating patients’ wishes into clinical decisions was 7.8 (range = 6.1–9.3, 1 = not at all confident, 10 = extremely confident). Conclusion For simulated cases, a computer-based decision aid for advance care planning can help physicians more confidently make end-of-life decisions that patients will endorse. PMID:22167985

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

    SciTech Connect

    Stewart, Emma; Kiliccote, Sila; McParland, Charles; Roberts, Ciaran

    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. 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

  9. Advanced Test Reactor -- Testing Capabilities and Plans AND Advanced Test Reactor National Scientific User Facility -- Partnerships and Networks

    SciTech Connect

    Frances M. Marshall

    2008-07-01

    The Advanced Test Reactor (ATR), at the Idaho National Laboratory (INL), is one of the world’s premier test reactors for providing the capability for studying the effects of intense neutron and gamma radiation on reactor materials and fuels. The physical configuration of the ATR, a 4-leaf clover shape, allows the reactor to be operated at different power levels in the corner “lobes” to allow for different testing conditions for multiple simultaneous experiments. The combination of high flux (maximum thermal neutron fluxes of 1E15 neutrons per square centimeter per second and maximum fast [E>1.0 MeV] neutron fluxes of 5E14 neutrons per square centimeter per second) and large test volumes (up to 122 cm long and 12.7 cm diameter) provide unique testing opportunities. For future research, some ATR modifications and enhancements are currently planned. In 2007 the US Department of Energy designated the ATR as a National Scientific User Facility (NSUF) to facilitate greater access to the ATR for material testing research by a broader user community. This paper provides more details on some of the ATR capabilities, key design features, experiments, and plans for the NSUF.

  10. 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. PMID:27490070

  11. Organizational Culture and Safety

    NASA Technical Reports Server (NTRS)

    Adams, Catherine A.

    2003-01-01

    '..only a fool perseveres in error.' Cicero. Humans will break the most advanced technological devices and override safety and security systems if they are given the latitude. Within the workplace, the operator may be just one of several factors in causing accidents or making risky decisions. Other variables considered for their involvement in the negative and often catastrophic outcomes include the organizational context and culture. Many organizations have constructed and implemented safety programs to be assimilated into their culture to assure employee commitment and understanding of the importance of everyday safety. The purpose of this paper is to examine literature on organizational safety cultures and programs that attempt to combat vulnerability, risk taking behavior and decisions and identify the role of training in attempting to mitigate unsafe acts.

  12. 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. PMID:27053406

  13. 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

  14. Overview of recent advances in treatment planning for ion beam radiotherapy

    NASA Astrophysics Data System (ADS)

    Krämer, Michael; Scifoni, Emanuele; Schmitz, Frederike; Sokol, Olga; Durante, Marco

    2014-10-01

    To achieve practical calculations of dose delivery in ion beam radiotherapy, the physical models of beam propagation need to be properly implemented and supplemented by models describing the complex mechanisms of radiation damage in the biological tissues. TRiP98 is the first and most advanced treatment planning system for particles, in which physical and biological models have been incorporated to develop a clinically applicable tool for dose optimization and delivery. We report our recent advances in TRiP98 code development, in particular towards hypoxia-driven and multi-modal dose optimization. We also discuss the present needs and possible extensions of our models for which input from nanoscale physics is required. Contribution to the Topical Issue "Nano-scale Insights into Ion-beam Cancer Therapy", edited by Andrey V. Solov'yov, Nigel Mason, Paulo Limão-Vieira and Malgorzata Smialek-Telega.

  15. 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.

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

    NASA Astrophysics Data System (ADS)

    Miller, Glenn E.

    1994-10-01

    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.

  17. A Two Stage Solution Procedure for Production Planning System with Advance Demand Information

    NASA Astrophysics Data System (ADS)

    Ueno, Nobuyuki; Kadomoto, Kiyotaka; Hasuike, Takashi; Okuhara, Koji

    We model for ‘Naiji System’ which is a unique corporation technique between a manufacturer and suppliers in Japan. We propose a two stage solution procedure for a production planning problem with advance demand information, which is called ‘Naiji’. Under demand uncertainty, this model is formulated as a nonlinear stochastic programming problem which minimizes the sum of production cost and inventory holding cost subject to a probabilistic constraint and some linear production constraints. By the convexity and the special structure of correlation matrix in the problem where inventory for different periods is not independent, we propose a solution procedure with two stages which are named Mass Customization Production Planning & Management System (MCPS) and Variable Mesh Neighborhood Search (VMNS) based on meta-heuristics. It is shown that the proposed solution procedure is available to get a near optimal solution efficiently and practical for making a good master production schedule in the suppliers.

  18. Development plan for an advanced drilling system with real-time diagnostics (Diagnostics-While-Drilling)

    SciTech Connect

    FINGER,JOHN T.; MANSURE,ARTHUR J.; PRAIRIE,MICHAEL R.; GLOWKA,D.A.

    2000-02-01

    This proposal provides the rationale for an advanced system called Diagnostics-while-drilling (DWD) and describes its benefits, preliminary configuration, and essential characteristics. The central concept is a closed data circuit in which downhole sensors collect information and send it to the surface via a high-speed data link, where it is combined with surface measurements and processed through drilling advisory software. The driller then uses this information to adjust the drilling process, sending control signals back downhole with real-time knowledge of their effects on performance. The report presents background of related previous work, and defines a Program Plan for US Department of Energy (DOE), university, and industry cooperation.

  19. Wild Orangutan Males Plan and Communicate Their Travel Direction One Day in Advance

    PubMed Central

    van Schaik, Carel P.; Damerius, Laura; Isler, Karin

    2013-01-01

    The ability to plan for the future beyond immediate needs would be adaptive to many animal species, but is widely thought to be uniquely human. Although studies in captivity have shown that great apes are capable of planning for future needs, it is unknown whether and how they use this ability in the wild. Flanged male Sumatran orangutans (Pongo abelii) emit long calls, which females use to maintain earshot associations with them. We tested whether long calls serve to communicate a male's ever-changing predominant travel direction to facilitate maintaining these associations. We found that the direction in which a flanged male emits his long calls predicts his subsequent travel direction for many hours, and that a new call indicates a change in his main travel direction. Long calls given at or near the night nest indicate travel direction better than random until late afternoon on the next day. These results show that male orangutans make their travel plans well in advance and announce them to conspecifics. We suggest that such a planning ability is likely to be adaptive for great apes, as well as in other taxa. PMID:24040357

  20. 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. PMID:24550866

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

    PubMed Central

    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. PMID:24550866

  2. Typologizing Organizational Amnesia

    ERIC Educational Resources Information Center

    Othman, Rozhan; Hashim, Noor Azuan

    2004-01-01

    This article proposes that a major problem limiting an organization's ability to develop organizational learning capacity is of organizational amnesia. To understand organizational amnesia, it is necessary to look at the various ways that organizational learning is defined. Organizational learning is not merely the process of acquiring knowledge.…

  3. "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…

  4. Ontario Basic Skills. Career Planning. A Thematic Unit for Integrated Curriculum: Advanced Level. [Student Workbook and] Teacher's Manual.

    ERIC Educational Resources Information Center

    Anderson, Marcia; And Others

    This set of publications, consisting of a student workbook and teacher's manual, is designed for use by adult learners registered in the advanced level of the career planning course of the Ontario (Canada) Basic Skills program. The student workbook contains units on the following topics: introduction to career planning, self-assessment for…

  5. Organizational Climate Changes over Time

    ERIC Educational Resources Information Center

    Walden, John C.; Taylor, Thomas N.; Watkins, J. Foster

    1975-01-01

    As the basis for his doctoral dissertation, Taylor explored some of the conjectures advanced by Halpin and Croft relative to the possible directional changes in the organizational climate of schools over time. Taylor limited his study to elementary school based upon the question raised by Watkins in his dissertation relative to the validity of the…

  6. Cinematic Perspectives on Organizational Mentoring

    ERIC Educational Resources Information Center

    Boyd, David P.

    2009-01-01

    Properly conceived and conducted, organizational mentoring can bestow benefits on the suppliant, the mentor and the firm. If prospective protégés assess the context of a mentoring relationship before they enter into one, they can enjoy a bonding experience that facilitates psychological satisfaction and furthers professional advancement. The movie…

  7. Organizational Change.

    ERIC Educational Resources Information Center

    Woodard, Dudley B., Jr.; Love, Patrick; Komives, Susan R.

    2000-01-01

    Management of student affairs is a complex and unpredictable task that requires thoughtful planning and sensitivity. Managers who set priorities in a planned way, act strategically to implement plans, and make adjustments based on changing conditions can make a difference. Managers must work collaboratively to achieve mutual purposes through…

  8. Advance Care Planning and HIV Infection in the Era of Antiretroviral Therapy: A Review.

    PubMed

    Sangarlangkarn, Aroonsiri; Merlin, Jessica S; Tucker, Rodney O; Kelley, Amy S

    In the era of antiretroviral therapy, HIV infection has become a chronic illness with associated multimorbidity, and practitioners are faced with an emerging population of HIV-infected patients with evolving needs for advance care planning (ACP), defined as communication between individuals and their proxies to plan for future health care decisions. This article provides a review of original research studies on ACP in HIV-infected adults in the era of antiretroviral therapy (1996-present) from PubMed, EMBASE, and PsycINFO. Eleven studies conducted between 1996 and 2015 met the selection criteria, with study sizes ranging from 9 to 2864 participants. Most studies consisted of white men in outpatient settings and had poorly defined definitions of ACP. Prevalence of ACP was variable (36%-54% had end-of-life communication, 8%-47% had advance directives). Lack of ACP was most commonly associated with low income, followed by lower severity of illness, low education level, black or Hispanic race, female sex, younger age, injection drug use, and social isolation. Practitioners reported limited time or energy and inadequate preparation or training as barriers to ACP. Existing literature on ACP in the era of antiretroviral therapy is limited, but shows that ACP prevalence in HIV-infected individuals is variable depending on socioeconomic factors, severity of illness, and practitioner resources and training. More research is needed to increase ACP among HIV-infected individuals. PMID:27398771

  9. National Research Council Dialogue to Assess Progress on NASA's Advanced Modeling, Simulation and Analysis Capability and Systems Engineering Capability Roadmap Development

    NASA Technical Reports Server (NTRS)

    Aikins, Jan

    2005-01-01

    Contents include the following: General Background and Introduction of Capability Roadmaps. Agency Objective. Strategic Planning Transformation. Advanced Planning Organizational Roles. Public Involvement in Strategic Planning. Strategic Roadmaps and Schedule. Capability Roadmaps and Schedule. Purpose of NRC Review. Capability Roadmap Development (Progress to Date).

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

    SciTech Connect

    Peeler, David K.; Kim, Dong-Sang; Vienna, John D.; Schweiger, Michael J.; Piepel, Gregory F.

    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, key 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 throughout

  11. Advance care planning: A systematic review of randomised controlled trials conducted with older adults.

    PubMed

    Weathers, Elizabeth; O'Caoimh, Rónán; Cornally, Nicola; Fitzgerald, Carol; Kearns, Tara; Coffey, Alice; Daly, Edel; O'Sullivan, Ronan; McGlade, Ciara; Molloy, D William

    2016-09-01

    Advance care planning (ACP), involving discussions between patients, families and healthcare professionals on future healthcare decisions, in advance of anticipated impairment in decision-making capacity, improves satisfaction and end-of-life care while respecting patient autonomy. It usually results in the creation of a written advanced care directive (ACD). This systematic review examines the impact of ACP on several outcomes (including symptom management, quality of care and healthcare utilisation) in older adults (>65years) across all healthcare settings. Nine randomised controlled trials (RCTs) were identified by searches of the CINAHL, PubMed and Cochrane databases. A total of 3646 older adults were included (range 72-88 years). Seven studies were conducted with community dwellers and the other two RCTs were conducted in nursing homes. Most studies did not implement a standardised ACD, or measure the impact on quality of end-of-life care or on the death and dying experience. All studies had some risk of bias, with most scoring poorly on the Oxford Quality Scale. While ACP interventions are well received by older adults and generally have positive effects on outcomes, this review highlights the need for well-designed RCTs that examine the economic impact of ACP and its effect on quality of care in nursing homes and other sectors. PMID:27451328

  12. 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

  13. Advance care planning in stroke: influence of time on engagement in the process

    PubMed Central

    Green, Theresa; Gandhi, Shreyas; Kleissen, Tessa; Simon, Jessica; Raffin-Bouchal, Shelley; Ryckborst, Karla

    2014-01-01

    Purpose Individuals who experience stroke have a higher likelihood of subsequent stroke events, making it imperative to plan for future medical care. In the event of a further serious health event, engaging in the process of advanced care planning (ACP) can help family members and health care professionals (HCPs) make medical decisions for individuals who have lost the capacity to do so. Few studies have explored the views and experiences of patients with stroke about discussing their wishes and preferences for future medical events, and the extent to which stroke HCPs engage in conversations around planning for such events. In this study, we sought to understand how the process of ACP unfolded between HCPs and patients post-stroke. Patients and methods Using grounded theory (GT) methodology, we engaged in direct observation of HCP and patient interactions on an acute stroke unit and two stroke rehabilitation units. Using semi-structured interviews, 14 patients and four HCPs were interviewed directly about the ACP process. Results We found that open and continual ACP conversations were not taking place, patients experienced an apparent lack of urgency to engage in ACP, and HCPs were uncomfortable initiating ACP conversations due to the sensitive nature of the topic. Conclusion In this study, we identified lack of engagement in ACP post-stroke, attributable to patient and HCP factors. This encourages us to look further into the process of ACP in order to develop open communication between the patient with stroke, their families, and stroke HCPs. PMID:24493922

  14. 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.

  15. Organizational Communication: ERIC Report.

    ERIC Educational Resources Information Center

    Boileau, Don M.

    1984-01-01

    Presents abstracts from "Resources in Education" on (1) teaching about women in organizational communication; (2) communication as part of job satisfaction; and (3) research in organizational communication. (PD)

  16. Technology Alignment and Portfolio Prioritization (TAPP): Advanced Methods in Strategic Analysis, Technology Forecasting and Long Term Planning for Human Exploration and Operations, Advanced Exploration Systems and Advanced Concepts

    NASA Technical Reports Server (NTRS)

    Funaro, Gregory V.; Alexander, Reginald A.

    2015-01-01

    The Advanced Concepts Office (ACO) at NASA, Marshall Space Flight Center is expanding its current technology assessment methodologies. ACO is developing a framework called TAPP that uses a variety of methods, such as association mining and rule learning from data mining, structure development using a Technological Innovation System (TIS), and social network modeling to measure structural relationships. The role of ACO is to 1) produce a broad spectrum of ideas and alternatives for a variety of NASA's missions, 2) determine mission architecture feasibility and appropriateness to NASA's strategic plans, and 3) define a project in enough detail to establish an initial baseline capable of meeting mission objectives ACO's role supports the decision­-making process associated with the maturation of concepts for traveling through, living in, and understanding space. ACO performs concept studies and technology assessments to determine the degree of alignment between mission objectives and new technologies. The first step in technology assessment is to identify the current technology maturity in terms of a technology readiness level (TRL). The second step is to determine the difficulty associated with advancing a technology from one state to the next state. NASA has used TRLs since 1970 and ACO formalized them in 1995. The DoD, ESA, Oil & Gas, and DoE have adopted TRLs as a means to assess technology maturity. However, "with the emergence of more complex systems and system of systems, it has been increasingly recognized that TRL assessments have limitations, especially when considering [the] integration of complex systems." When performing the second step in a technology assessment, NASA requires that an Advancement Degree of Difficulty (AD2) method be utilized. NASA has used and developed or used a variety of methods to perform this step: Expert Opinion or Delphi Approach, Value Engineering or Value Stream, Analytical Hierarchy Process (AHP), Technique for the Order of

  17. Organizational Commitment through Organizational Socialization Tactics

    ERIC Educational Resources Information Center

    Filstad, Cathrine

    2011-01-01

    Purpose: The aim of this paper is to investigate how organizational socialization tactics affect newcomers' organizational commitment and learning processes. Design/methodology/approach: A survey was conducted using a measurement tool based on Van Maanen and Schein's theory on organizational socialization tactics and Kuvaas' measurement tools of…

  18. 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

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

    SciTech Connect

    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 individual work activities within the scope of work. Contractors may not deviate from this plan without a revised WA or subsequent IP.

  20. Exploring the district nurse role in facilitating individualised advance care planning.

    PubMed

    Boot, Michelle

    2016-03-01

    Health-care policy recognises the importance of engaging people in making decisions related to the management of their health. Advance care planning (ACP) offers a framework for decision making on end-of-life care. There are positive indicators that ACP enables health professionals to meet people's preferences. However, there are reports of insensitive attempts to engage people in end-of-life care decision making. District nurses are in the ideal position to facilitate ACP, as they have the opportunity to build relationships with the people they are caring for--an antecedent to sensitive ACP--and in recognising and fulfilling this role, they could ameliorate the risk of insensitive ACP. Distric nurse leaders also have a role to play in ensuring that organisational and environmental factors support appropriate ACP facilitation including: training, fostering a team culture that empowers district nurses to recognise and meet their ACP role, and advocating for appropriate ACP evaluation outcome measures. PMID:26940617

  1. Trends in Engagement in Advance Care Planning Behaviors and the Role of Socioeconomic Status.

    PubMed

    Khosla, Nidhi; Curl, Angela L; Washington, Karla T

    2016-08-01

    We investigated the trends in advance care planning (ACP) between 2002 and 2010 and whether socioeconomic status explained such trends. We conducted a pooled regression analysis of Health and Retirement Study data from 6052 proxies of deceased individuals. We studied 3 ACP behaviors, discussing end-of-life (EOL) care preferences, providing written EOL care instructions, and appointing a durable power of attorney for health care (DPAHC). ACP increased by 12% to 23% every 2 years from 2002 to 2010. Higher household income increased the odds of having a DPAHC. Education was not associated with ACP. Socioeconomic status alone appears to play a very limited role in predicting ACP. Engagement in ACP likely depends on a constellation of many social and contextual factors. PMID:25900854

  2. Coping Styles, Health Status and Advance Care Planning in Patients with Hematologic Malignancies

    PubMed Central

    Loberiza, Fausto R; Swore-Flecther, Barbara A.; Block, Susan D.; Back, Anthony L.; Goldman, Roberta E.; Tulsky, James A.; Lee, Stephanie J.

    2014-01-01

    This study evaluated if measures of psychological well-being, including coping style are associated with advance care planning (ACP). Data were from the HEMA-COMM study, a prospective observational study of physician-patient communication in patients with hematologic malignancies. ACP was defined as having a living will, having a health care proxy, discussing life support with family or friends, and discussing life support with a doctor or nurse. 293 patients participated: only 45 (15%) had all the elements of ACP, 215 (73%) had at least 1 element of ACP, while 33 (11%) did not engage in ACP. In multivariate analysis, specific coping styles but not other measures of psychosocial well being were associated with having written ACP. Verbal ACP was associated with patient-reported health and physician estimate of life expectancy. Our study suggests that tailoring ACP discussions to a patient’s coping style may increase engagement in ACP. PMID:21851220

  3. Mass Customization Production Planning System by Advance Demand Information Based on Unfulfilled-order-rate

    NASA Astrophysics Data System (ADS)

    Ueno, Nobuyuki; Kawasaki, Masaya; Okuhara, Koji

    In this paper, we try to model for ‘Naiji System’ which is a unique corporation between a maker and suppliers in Japan. We propose Mass Customization Production Planning & Management System (MCPS) based on unfulfilled-order-rate by using Advance Demand Information, which is called ‘Naiji’. This model is formulated as a nonlinear stochastic programming problem which minimizes the sum of production cost and inventory holding cost subject to the set of probabilistic constraint and some linear production constraints. We propose the new upper bound SOn (ρmin) to estimate the unfulfilled-order-rate more strictly. The procedure to find a good solution is developed by solving the linear programming problem repeatedly on the basic solution strategy that is ‘relaxation’. A computational load to obtain a solution by the proposed indicator is shown to be very small. Finally, an availability of the procedure is shown.

  4. Lessons learned from New York's community approach to advance care planning and MOLAT.

    PubMed

    Bomba, Patricia A; Orem, Katie

    2015-01-01

    This article reviews the lessons learned from the development and implementation of New York's community approach to advance care planning (ACP) as a wellness initiative and the key components of the complementary programs: Community Conversations on Compassionate Care (CCCC) and Medical Orders for Life-Sustaining Treatment (MOLST). Shared, informed medical decision-making is a patient-centered process that is critical to ensuring patient preferences for care are honored at the end of life. Providers must be trained, qualified, and comfortable with the discussions needed for effective shared, informed medical decision-making. Development, implementation, outcomes, lessons learned and sustainability of the CCCC and MOLST programs highlight the success of a healthcare and community collaborative initiative focused on improving care at the end of life. Community data support the value of implementing the CCCC and New York's MOLST throughout the country. PMID:25813415

  5. [Timing of Advance Care Planning in frail elderly patients: when to start?].

    PubMed

    Ott, Brenda; van Thiel, Ghislaine J M W; de Ruiter, Corinne M; van Delden, Hans J J M

    2015-01-01

    Advance Care Planning (ACP) is the process of discussing and recording patient preferences concerning goals for end-of-life care and to facilitate decision-making. ACP is an essential element of care for frail elderly patients because frailty increases the risks of negative health outcomes and loss of function. In this article, we present three patient cases to illustrate how general practitioners (GPs) can perform ACP and to demonstrate the importance of early and iterative end-of-life discussions with frail elderly patients. Good timing is decisive for the success of the intervention. GPs are in a key position to identify and discuss ACP matters at an early stage, supported by the geriatrician if necessary. Posing the 'surprise question' has proved helpful to determine timing. Complex ACP interventions contribute to care which is better adapted to the needs of frail elderly patients. PMID:25650032

  6. ADVANCED MR IMAGING METHODS FOR PLANNING AND MONITORING RADIATION THERAPY IN PATIENTS WITH HIGH GRADE GLIOMA

    PubMed Central

    Lupo, Janine M.; Nelson, Sarah J.

    2016-01-01

    This review explores how the integration of advanced imaging methods with high quality anatomic images significantly improves the characterization, target definition, assessment of response to therapy, and overall management of patients with high-grade glioma. Metrics derived from diffusion, perfusion, and susceptibility weighted MR imaging in conjunction with MR spectroscopic imaging, allows us to characterize regions of edema, hypoxia, increased cellularity, and necrosis within heterogeneous tumor and surrounding brain tissue. Quantification of such measures may provide a more reliable initial representation of tumor delineation and response to therapy than changes in the contrast enhancing or T2 lesion alone and have a significant impact on targeting resection, planning radiation, and assessing treatment effectiveness. In the long-term, implementation of these imaging methodologies can also aid in the identification of recurrent tumor and its differentiation from treatment-related confounds and facilitate the detection of radiation-induced vascular injury in otherwise normal appearing brain tissue. PMID:25219809

  7. Quality of advance care planning policy and practice in residential aged care facilities in Australia

    PubMed Central

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

    2013-01-01

    Objectives To assess existing advance care planning (ACP) practices in residential aged care facilities (RACFs) in Victoria, Australia before a systematic intervention; to assess RACF staff experience, understanding of and attitudes towards ACP. Design Surveys of participating organisations concerning ACP-related policies and procedures, review of existing ACP-related documentation, and pre-intervention survey of RACF staff covering their role, experiences and attitudes towards ACP-related procedures. Setting 19 selected RACFs in Victoria. Participants 12 aged care organisations (representing 19 RACFs) who provided existing ACP-related documentation for review, 12 RACFs who completed an organisational survey and 45 staff (from 19 RACFs) who completed a pre-intervention survey of knowledge, attitudes and behaviour. Results Findings suggested that some ACP-related practices were already occurring in RACFs; however, these activities were inconsistent and variable in quality. Six of the 12 responding RACFs had written policies and procedures for ACP; however, none of the ACP-related documents submitted covered all information required to meet ACP best practice. Surveyed staff had limited experience of ACP, and discrepancies between self reported comfort, and levels of knowledge and confidence to undertake ACP-related activities, indicated a need for training and ongoing organisational support. Conclusions Surveyed organisations â policies and procedures related to ACP were limited and the quality of existing documentation was poor. RACF staff had relatively limited experience in developing advance care plans with facility residents, although attitudes were positive. A systematic approach to the implementation of ACP in residential aged care settings is required to ensure best practice is implemented and sustained. PMID:24644755

  8. The Reciprocal Influence of Organizational Culture and Training and Development Programs: Building the Case for a Culture Analysis within Program Planning

    ERIC Educational Resources Information Center

    Kissack, Heather C.; Callahan, Jamie L.

    2010-01-01

    Purpose: The purpose of this paper is to demonstrate that training designers can, and should, account for organizational culture during training needs assessments. Design/methodology/approach: Utilizing the approach and arguments in Giddens' structuration theory, the paper conceptually applies these tenets to training and development programs…

  9. Using Corporate Tools for Organizational Development to Affect Cultural and Structural Change in the Academy: Gallup Impact Planning at the University of Nebraska-Lincoln

    ERIC Educational Resources Information Center

    Latta, Gail F.

    2006-01-01

    External pressures have transformed academic life, shattering the roles and relationships that created a sense of community. Increasingly the challenges of fostering an engaged workforce in these institutions mirror the corporate world. Leaders at UNL have adapted Gallup's organizational development strategy to improve faculty engagement and…

  10. How Do General Practitioners Conceptualise Advance Care Planning in Their Practice? A Qualitative Study

    PubMed Central

    De Vleminck, Aline; Pardon, Koen; Beernaert, Kim; Houttekier, Dirk; Vander Stichele, Robert; Deliens, Luc

    2016-01-01

    Objectives To explore how GPs conceptualise advance care planning (ACP), based on their experiences with ACP in their practice. Methods Five focus groups were held with 36 GPs. Discussions were analysed using a constant comparative method. Results Four overarching themes in the conceptualisations of ACP were discerned: (1) the organisation of professional care required to meet patients’ needs, (2) the process of preparing for death and discussing palliative care options, (3) the discussion of care goals and treatment decisions, (4) the completion of advance directives. Within these themes, ACP was both conceptualised in terms of content of ACP and/or in terms of tasks for the GP. A specific task that was mentioned throughout the discussion of the four different themes was (5) the task of actively initiating ACP by the GP versus passively waiting for patients’ initiation. Conclusions This study illustrates that GPs have varying conceptualisations of ACP, of which some are more limited to specific aspects of ACP. A shared conceptualisation and agreement on the purpose and goals of ACP is needed to ensure successful implementation, as well as a systematic integration of ACP in routine practice that could lead to a better uptake of all the important elements of ACP. PMID:27096846

  11. Honoring Choices Minnesota: Preliminary Data from a Community-Wide Advance Care Planning Model

    PubMed Central

    Wilson, Kent S; Kottke, Thomas E; Schettle, Sue

    2014-01-01

    Advance care planning (ACP) increases the likelihood that individuals who are dying receive the care that they prefer. It also reduces depression and anxiety in family members and increases family satisfaction with the process of care. Honoring Choices Minnesota is an ACP program based on the Respecting Choices model of La Crosse, Wisconsin. The objective of this report is to describe the process, which began in 2008, of implementing Honoring Choices Minnesota in a large, diverse metropolitan area. All eight large healthcare systems in the metropolitan area agreed to participate in the project, and as of April 30, 2013, the proportion of hospitalized individuals 65 and older with advance care directives in the electronic medical record was 12.1% to 65.6%. The proportion of outpatients aged 65 and older was 11.6% to 31.7%. Organizations that had sponsored recruitment initiatives had the highest proportions of records containing healthcare directives. It was concluded that it is possible to reduce redundancy by recruiting all healthcare systems in a metropolitan area to endorse the same ACP model, although significantly increasing the proportion of individuals with a healthcare directive in their medical record requires a campaign with recruitment of organizations and individuals. PMID:25516036

  12. Redefining the “Planning” in Advance Care Planning: Preparing for End-of-Life Decision Making

    PubMed Central

    Sudore, Rebecca L.; Fried, Terri R.

    2010-01-01

    The traditional objective of advance care planning has been to have patients make treatment decisions in advance in an attempt to provide care consistent with their goals. We argue that the objective for advance care planning ought to be the preparation of patients and surrogates to participate with clinicians in making the best possible in-the-moment medical decisions. We provide practical steps for clinicians to help patients and surrogate decision makers achieve this objective in the outpatient setting. Preparation for in-the-moment decision making shifts the focus from having patients make premature decisions based on incomplete information to preparing patients and their surrogates for the types of decisions and conflicts they may encounter when they do have to engage in in-the-moment decision making. This approach does not preclude the completion of advance directives, but acknowledges that they are but one piece of information to be used at the time of decision making. PMID:20713793

  13. Ares First Stage "Systemology" - Combining Advanced Systems Engineering and Planning Tools to Assure Mission Success

    NASA Technical Reports Server (NTRS)

    Seiler, James; Brasfield, Fred; Cannon, Scott

    2008-01-01

    Ares is an integral part of NASA s Constellation architecture that will provide crew and cargo access to the International Space Station as well as low earth orbit support for lunar missions. Ares replaces the Space Shuttle in the post 2010 time frame. Ares I is an in-line, two-stage rocket topped by the Orion Crew Exploration Vehicle, its service module, and a launch abort system. The Ares I first stage is a single, five-segment reusable solid rocket booster derived from the Space Shuttle Program's reusable solid rocket motor. The Ares second or upper stage is propelled by a J-2X main engine fueled with liquid oxygen and liquid hydrogen. This paper describes the advanced systems engineering and planning tools being utilized for the design, test, and qualification of the Ares I first stage element. Included are descriptions of the current first stage design, the milestone schedule requirements, and the marriage of systems engineering, detailed planning efforts, and roadmapping employed to achieve these goals.

  14. Mass Customization Production Planning System by Advance Demand Information Based on Unfulfilled-order-rate II

    NASA Astrophysics Data System (ADS)

    Ueno, Nobuyuki; Kadomoto, Kiyotaka; Okuhara, Koji

    In the previous paper, we proposed Mass Customization Production Planning & Management System (MCPS) based on unfulfilled-order-rate by using Advance Demand Information which is called ‘Naiji System’ as an unique corporation between a maker and suppliers in Japan, and 3 indicators to estimate the unfulfilled-order-rate. Applying these indicators to the model, we investigated the behavior of unfulfilled-order-rate at the final period in the planning horizon. In this paper, we propose a new model for purchasing, and investigate the unfulfilled-order-rate at each period and the impact to the total inventory. We find that the total inventories become 5.9%-20.0% decreases by using SOn rather than by using SOn(0). And we enhance a base-stock policy to a new one with multi-period. We prove that the MCPS model for purchasing by using SOn(0) is equivalent to the base-stock policy with multi-period under the specified condition. Under this condition, the proposed model by using SOn decreases inventories more than the base-stock policy with multi-period.

  15. Advance care planning knowledge and documentation in a hospitalized cancer population

    PubMed Central

    Barakat, Ayman; Barnes, Sunni A.; Casanova, Mark A.; Stone, Marvin J.; Shuey, Kathleen M.

    2013-01-01

    To have a better understanding of our patients’ knowledge of advance directive planning and execution, as well as communication with their oncologists regarding their wishes, we conducted a survey on our inpatient hematology-oncology services. A total of 68 unique hospitalized patients with a diagnosis of cancer completed surveys. Surveys were given to all oncology patients regardless of their reason for admission. Overall, 29% of the patients reported having had a discussion with their oncologist regarding their wishes if they became seriously ill or near death. Of those who did have this conversation, the majority said that they, rather than their physician, initiated it. Although the vast majority of patients (97%) knew what a living will was, only 54% had one in place. Twenty patients had a discussion with their oncologist, and 14 of them (70%) had a living will. This percentage was higher than in the group that did not have a conversation with their physician (48%; 23 of 48 patients), but the difference was not statistically significant. Most cancer patients admitted to an inpatient oncology unit either did not have or did not recall having a discussion with their oncologist regarding end-of-life issues. This study gives us a baseline of information in evaluating future interventions directed to improve the quality of patient-physician communication regarding end-of-life planning. PMID:24082411

  16. Mission planning and scheduling concept for the Advanced X-ray Astrophysics Facility (AXAF)

    NASA Technical Reports Server (NTRS)

    Newhouse, M.; Guffin, O. T.

    1994-01-01

    Projected for launch in the latter part of 1998, the Advanced X-ray Astrophysics Facility (AXAF), the third satellite in the Great Observatory series, promises to dramatically open the x-ray sky as the Hubble and Compton observatories have done in their respective realms. Unlike its companions, however, AXAF will be placed in a high altitude, highly elliptical orbit (10,000 x 100,000 km), and will therefore be subject to its own unique environment, spacecraft and science instrument constraints and communication network interactions. In support of this mission, ground operations personnel have embarked on the development of the AXAF Offline System (OFLS), a body of software divided into four basic functional elements: (1) Mission Planning and Scheduling, (2) Command Management, (3) Altitude Determination and Sensor Calibration and (4) Spacecraft Support and Engineering Analysis. This paper presents an overview concept for one of these major elements, the Mission Planning and Scheduling subsystem (MPS). The derivation of this concept is described in terms of requirements driven by spacecraft and science instrument characteristics, orbital environment and ground system capabilities. The flowdown of these requirements through the systems analysis process and the definition of MPS interfaces has resulted in the modular grouping of functional subelements depicted in the design implementation approach. The rationale for this design solution is explained and capabilities for the initial prototype system are proposed from the user perspective.

  17. Advances in 4D Treatment Planning for Scanned Particle Beam Therapy — Report of Dedicated Workshops

    PubMed Central

    Bert, Christoph; Graeff, Christian; Riboldi, Marco; Nill, Simeon; Baroni, Guido; Knopf, Antje-Christin

    2014-01-01

    We report on recent progress in the field of mobile tumor treatment with scanned particle beams, as discussed in the latest editions of the 4D treatment planning workshop. The workshop series started in 2009, with about 20 people from 4 research institutes involved, all actively working on particle therapy delivery and development. The first workshop resulted in a summary of recommendations for the treatment of mobile targets, along with a list of requirements to apply these guidelines clinically. The increased interest in the treatment of mobile tumors led to a continuously growing number of attendees: the 2012 edition counted more than 60 participants from 20 institutions and commercial vendors. The focus of research discussions among workshop participants progressively moved from 4D treatment planning to complete 4D treatments, aiming at effective and safe treatment delivery. Current research perspectives on 4D treatments include all critical aspects of time resolved delivery, such as in-room imaging, motion detection, beam application, and quality assurance techniques. This was motivated by the start of first clinical treatments of hepato cellular tumors with a scanned particle beam, relying on gating or abdominal compression for motion mitigation. Up to date research activities emphasize significant efforts in investigating advanced motion mitigation techniques, with a specific interest in the development of dedicated tools for experimental validation. Potential improvements will be made possible in the near future through 4D optimized treatment plans that require upgrades of the currently established therapy control systems for time resolved delivery. But since also these novel optimization techniques rely on the validity of the 4DCT, research focusing on alternative 4D imaging technique, such as MRI based 4DCT generation will continue. PMID:24354749

  18. Economic Impact of an Advanced Illness Consultation Program within a Medicare Advantage Plan Population

    PubMed Central

    Colaberdino, Vincent; Marshall, Colleen; DuBose, Paul; Daitz, Mitchell

    2016-01-01

    Abstract Background: In the United States the quality and cost associated with medical treatment for individuals experiencing an advanced illness is highly variable and is often misaligned with the patient's and family's quality of life values and priorities. Many of the obstacles that stand in the way of aligning the care that an individual receives with their priorities are well understood in the context of behavioral science. Through employing behavioral based approaches to improve the quality of communication and shared decision making processes among patients, providers and families it is possible to enhance the efficiency of delivering care which is also more highly aligned with the individual's preferences. Objectives: The study objectives were to measure the economic impact of a proprietary advanced illness behavioral consultation program, the Vital Decisions Living Well Consultation Program (LWCP), on the cost of care delivered during the last six and three months of life for enrolled members in a Medicare Advantage plan. Study design: Retrospective matched case control analysis examined medical, pharmaceutical, and capitation expenses after an offset by premium revenue. Methods: The treatment population consisted of participating members of the LWCP who died between October 1, 2011 and March 31, 2013 (N = 1755). The control population consisted of plan members who died between July 1, 2008 and June 1, 2011, prior to the introduction of the LWCP (N = 5560). Criteria used to match treatment subjects with one or more control subjects were diagnosis, age at death, and health care costs incurred prior to the time under examination. A paired t-test evaluated the significance of differences between the matched treatment and control members. Results: The mean cost reduction during the last six months of life for treatment members compared to matched control group members was $13,956 (p < 0.001) during the last six months of life and $9,285 (p < 0

  19. Inverse Planned High-Dose-Rate Brachytherapy for Locoregionally Advanced Cervical Cancer: 4-Year Outcomes

    SciTech Connect

    Tinkle, Christopher L.; Weinberg, Vivian; Chen, Lee-May; Littell, Ramey; Cunha, J. Adam M.; Sethi, Rajni A.; Chan, John K.; Hsu, I-Chow

    2015-08-01

    Purpose: Evaluate the efficacy and toxicity of image guided brachytherapy using inverse planning simulated annealing (IPSA) high-dose-rate brachytherapy (HDRB) boost for locoregionally advanced cervical cancer. Methods and Materials: From December 2003 through September 2009, 111 patients with primary cervical cancer were treated definitively with IPSA-planned HDRB boost (28 Gy in 4 fractions) after external radiation at our institution. We performed a retrospective review of our experience using image guided brachytherapy. Of the patients, 70% had a tumor size >4 cm, 38% had regional nodal disease, and 15% had clinically evident distant metastasis, including nonregional nodal disease, at the time of diagnosis. Surgical staging involving pelvic lymph node dissection was performed in 15% of patients, and 93% received concurrent cisplatin-based chemotherapy. Toxicities are reported according to the Common Terminology Criteria for Adverse Events version 4.0 guidelines. Results: With a median follow-up time of 42 months (range, 3-84 months), no acute or late toxicities of grade 4 or higher were observed, and grade 3 toxicities (both acute and late) developed in 8 patients (1 constitutional, 1 hematologic, 2 genitourinary, 4 gastrointestinal). The 4-year Kaplan-Meier estimate of late grade 3 toxicity was 8%. Local recurrence developed in 5 patients (4 to 9 months after HDRB), regional recurrence in 3 (6, 16, and 72 months after HDRB), and locoregional recurrence in 1 (4 months after HDR boost). The 4-year estimates of local, locoregional, and distant control of disease were 94.0%, 91.9%, and 69.1%, respectively. The overall and disease-free survival rates at 4 years were 64.3% (95% confidence interval [CI] of 54%-73%) and 61.0% (95% CI, 51%-70%), respectively. Conclusions: Definitive radiation by use of inverse planned HDRB boost for locoregionally advanced cervical cancer is well tolerated and achieves excellent local control of disease. However, overall

  20. Multicriteria Optimization in Intensity-Modulated Radiation Therapy Treatment Planning for Locally Advanced Cancer of the Pancreatic Head

    SciTech Connect

    Hong, Theodore S. Craft, David L.; Carlsson, Fredrik; Bortfeld, Thomas R.

    2008-11-15

    Purpose: Intensity-modulated radiation therapy (IMRT) affords the potential to decrease radiation therapy-associated toxicity by creating highly conformal dose distributions. However, the inverse planning process can create a suboptimal plan despite meeting all constraints. Multicriteria optimization (MCO) may reduce the time-consuming iteration loop necessary to develop a satisfactory plan while providing information regarding trade-offs between different treatment planning goals. In this exploratory study, we examine the feasibility and utility of MCO in physician plan selection in patients with locally advanced pancreatic cancer (LAPC). Methods and Materials: The first 10 consecutive patients with LAPC treated with IMRT were evaluated. A database of plans (Pareto surface) was created that met the inverse planning goals. The physician then navigated to an 'optimal' plan from the point on the Pareto surface at which kidney dose was minimized. Results: Pareto surfaces were created for all 10 patients. A physician was able to select a plan from the Pareto surface within 10 minutes for all cases. Compared with the original (treated) IMRT plans, the plan selected from the Pareto surface had a lower stomach mean dose in 9 of 10 patients, although often at the expense of higher kidney dose than with the treated plan. Conclusion: The MCO is feasible in patients with LAPC and allows the physician to choose a satisfactory plan quickly. Generally, when given the opportunity, the physician will choose a plan with a lower stomach dose. The MCO enables a physician to provide greater active clinical input into the IMRT planning process.

  1. 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.

  2. Scenario Planning: A Phenomenological Examination of Influence on Organizational Learning and Decision-Making in a K-12 Public Education System

    ERIC Educational Resources Information Center

    Deklotz, Patricia F.

    2013-01-01

    Organizations commonly engage in long range planning to direct decisions. Scenario planning, one method of private sector planning, is recognized as useful when organizations are facing uncertainty. Scenario planning engages the organization in a process that produces plausible stories, called scenarios, describing the organization in several…

  3. On the Flexibility of Grammatical Advance Planning during Sentence Production: Effects of Cognitive Load on Multiple Lexical Access

    ERIC Educational Resources Information Center

    Wagner, Valentin; Jescheniak, Jorg D.; Schriefers, Herbert

    2010-01-01

    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…

  4. The Power of Advance Care Planning in Promoting Hospice and Out-of-Hospital Death in a Dialysis Unit

    PubMed Central

    Weaner, Barbara B.; Long, Dustin

    2015-01-01

    Abstract Background: Despite mortality rates that exceed those of most cancers, hospice remains underutilized in patients with end-stage renal disease (ESRD) on dialysis and nearly half of all dialysis patients die in the hospital. Objective: To review the impact of advance care planning on withdrawal from dialysis, use of hospice, and location of death. Design: Retrospective review. Setting: A rural outpatient dialysis unit. Participants: Former dialysis patients who died over a 5-year period. Exposure: Advance care planning, the use of physician orders for life-sustaining therapy program (POLST). Main Outcome and Measure: Use of hospice among patients withdrawing from dialysis, location of death. Results: Advance care planning was associated with a low incidence of in-hospital death and among those who withdrew, a high use of hospice. Conclusions and Relevance: Comprehensive and systematic advance care planning among patients with ESRD on dialysis promotes greater hospice utilization and may facilitate the chance that death will occur out of hospital. PMID:25006866

  5. 45 CFR 307.40 - Suspension of approval of advance planning documents for computerized support enforcement systems.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 2 2010-10-01 2010-10-01 false Suspension of approval of advance planning documents for computerized support enforcement systems. 307.40 Section 307.40 Public Welfare Regulations Relating to Public Welfare OFFICE OF CHILD SUPPORT ENFORCEMENT (CHILD SUPPORT ENFORCEMENT...

  6. 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.

  7. A Status of the Advanced Space Transportation Program from Planning to Action

    NASA Technical Reports Server (NTRS)

    Lyles, Garry; Griner, Carolyn

    1998-01-01

    A Technology Plan for Enabling Commercial Space Business was presented at the 48th International Astronautical Congress in Turin, Italy. This paper presents a status of the program's accomplishments. Technology demonstrations have progressed in each of the four elements of the program; (1) Low Cost Technology, (2) Advanced Reusable Technology, (3) Space Transfer Technology and (4) Space Transportation Research. The Low Cost Technology program element is primarily focused at reducing development and acquisition costs of aerospace hardware using a "design to cost" philosophy with robust margins, adapting commercial manufacturing processes and commercial off-the-shelf hardware. The attributes of this philosophy for small payload launch are being demonstrated at the component, sub-system, and system level. The X-34 "Fastrac" engine has progressed through major component and subsystem demonstrations. A propulsion system test bed has been implemented for system-level demonstration of component and subsystem technologies; including propellant tankage and feedlines, controls, pressurization, and engine systems. Low cost turbopump designs, commercial valves and a controller are demonstrating the potential for a ten-fold reduction in engine and propulsion system costs. The Advanced Reusable Technology program element is focused on increasing life through high strength-to-weight structures and propulsion components, highly integrated propellant tanks, automated checkout and health management and increased propulsion system performance. The validation of rocket based combined cycle (RBCC) propulsion is pro,-,ressing through component and subsystem testing. RBCC propulsion has the potential to provide performance margin over an all rocket system that could result in lower gross liftoff weight, a lower propellant mass fraction or a higher payload mass fraction. The Space Transfer Technology element of the program is pursuing technology that can improve performance and

  8. Planned preoperative radiation therapy for advanced laryngeal carcinoma. [/sup 60/Co

    SciTech Connect

    Kazem, I.; van den Broek, P.; Huygen, P.L.M.

    1982-09-01

    One hundred ten patients with predominantly advanced laryngeal carcinoma were treated in the period 1969-1978 with planned preoperative radiation therapy followed by surgery. Site distribution was: 63 supraglottic, 26 glottic, 15 transglottic and 6 subglottic. There were 4 Stage II patients, 66 Stage III and 40 Stage IV. Preoperative radiation therapy consisted of Telecobalt irradiation to a total dose of 25 Gy given to a target volume encompassing the larynx and regional neck nodes, given in 5 equal daily fractions of 5 Gy in 5 consecutive days. Surgery was performed 2 days later. Total laryngectomy was performed on 48 patients, total laryngectomy with neck dissection on 55 patients, supraglottic laryngectomy on 5 and supraglottic laryngectomy with neck dissection on 2 patients. Crude actuarial 5 and 10 year survival probability for the whole group is 71 and 61%, respectively. The corrected 5 and 10 year survival is 75%. For patients with T/sub 3/-T/sub 4/-N/sub 0/ tumors 5 and 10 year survival probability is: crude 65 and 58%, and corrected 70% respectively. For T/sub 3/-T/sub 4/-N/sub +/ crude: 75 and 60% and corrected: 78%. Of 110 patients, one died postoperative, three died of intercurrent disease, five died as a result of second malignancy, and 23 died of their larynx carcinoma: 12/23 because of locoregional failure, and 11/23 because of distant metastasis. We concluded that short intensive preoperative radiation therapy and surgery offer a high cure rate in the treatment of advanced resectable laryngeal carcinoma. The merits of this technique are outlined in the text.

  9. RISMC advanced safety analysis working plan: FY2015 - FY2019. Light Water Reactor Sustainability Program

    SciTech Connect

    Szilard, Ronaldo H; Smith, Curtis L

    2014-09-01

    In this report, the Advanced Safety Analysis Program (ASAP) objectives and value proposition is described. ASAP focuses on modernization of nuclear power safety analysis (tools, methods and data); implementing state-of-the-art modeling techniques (which include, for example, enabling incorporation of more detailed physics as they become available); taking advantage of modern computing hardware; and combining probabilistic and mechanistic analyses to enable a risk informed safety analysis process. The modernized tools will maintain the current high level of safety in our nuclear power plant fleet, while providing an improved understanding of safety margins and the critical parameters that affect them. Thus, the set of tools will provide information to inform decisions on plant modifications, refurbishments, and surveillance programs, while improving economics. The set of tools will also benefit the design of new reactors, enhancing safety per unit cost of a nuclear plant. As part of the discussion, we have identified three sets of stakeholders, the nuclear industry, the Department of Energy (DOE), and associated oversight organizations. These three groups would benefit from ASAP in different ways. For example, within the DOE complex, the possible applications that are seen include the safety of experimental reactors, facility life extension, safety-by-design in future generation advanced reactors, and managing security for the storage of nuclear material. This report provides information in five areas: (1) A value proposition (“why is this important?”) that will make the case for stakeholder’s use of the ASAP research and development (R&D) products; (2) An identification of likely end users and pathway to adoption of enhanced tools by the end-users; (3) A proposed set of practical and achievable “use case” demonstrations; (4) A proposed plan to address ASAP verification and validation (V&V) needs; and (5) A proposed schedule for the multi-year ASAP.

  10. Measuring engagement in advance care planning: a cross-sectional multicentre feasibility study

    PubMed Central

    Howard, Michelle; Bonham, Aaron J; Heyland, Daren K; Sudore, Rebecca; Fassbender, Konrad; Robinson, Carole A; McKenzie, Michael; Elston, Dawn; You, John J

    2016-01-01

    Objectives To assess the feasibility, acceptability and clinical sensibility of a novel survey, the advance care planning (ACP) Engagement Survey, in various healthcare settings. Setting A target sample of 50 patients from each of primary care, hospital, cancer care and dialysis care settings. Participants A convenience sample of patients without cognitive impairment who could speak and read English was recruited. Patients 50 and older were eligible in primary care; patients 80 and older or 55 and older with clinical markers of advanced chronic disease were recruited in hospital; patients aged 19 and older were recruited in cancer and renal dialysis centres. Outcomes We assessed feasibility, acceptability and clinical sensibility of the ACP Engagement Survey using a 6-point scale. The ACP Engagement Survey measures ACP processes (knowledge, contemplation, self-efficacy and readiness) on 5-point Likert scales and actions (yes/no). Results 196 patients (38–96 years old, 50.5% women) participated. Mean (±SD) time to administer was 48.8±19.6 min. Mean acceptability scores ranged from 3.2±1.3 in hospital to 4.7±0.9 in primary care, and mean relevance ranged from 3.5±1.0 in hospital to 4.9±0.9 in dialysis centres (p<0.001 for both). The mean process score was 3.1±0.6 and the mean action score was 11.2±5.6 (of a possible 25). Conclusions The ACP Engagement Survey demonstrated feasibility and acceptability in outpatient settings but was less feasible and acceptable among hospitalised patients due to length. A shorter version may improve feasibility. Engagement in ACP was low to moderate. PMID:27338877

  11. Early experience with digital advance care planning and directives, a novel consumer-driven program

    PubMed Central

    Yang, Zhiyong; Spivey, Christy; Boardman, Bonnie; Courtney, Maureen

    2016-01-01

    Barriers to traditional advance care planning (ACP) and advance directive (AD) creation have limited the promise of ACP/AD for individuals and families, the healthcare team, and society. Our objectives were to determine the results of a digital ACP/AD through which consumers create, store, locate, and retrieve their ACP/AD at no charge and with minimal physician involvement, and the ACP/AD can be integrated into the electronic health record. The authors chose 900 users of MyDirectives, a digital ACP/AD tool, to achieve proportional representation of all 50 states by population size and then reviewed their responses. The 900 participants had an average age of 50.8 years (SD = 16.6); 84% of the men and 91% of the women were in self-reported good health when signing their ADs. Among the respondents, 94% wanted their physicians to consult a supportive and palliative care team if they were seriously ill; nearly 85% preferred cessation of life-sustaining treatments during their final days; 76% preferred to spend their final days at home or in a hospice; and 70% would accept attempted cardiopulmonary resuscitation in limited circumstances. Most respondents wanted an autopsy under certain conditions, and 62% wished to donate their organs. In conclusion, analysis of early experience with this ACP/AD platform demonstrates that individuals of different ages and conditions can engage in an interrogatory process about values, develop ADs that are more nuanced than traditional paper-based ADs in reflecting those values, and easily make changes to their ADs. Online ADs have the potential to remove barriers to ACP/AD and thus further improve patient-centered end-of-life care. PMID:27365867

  12. Early experience with digital advance care planning and directives, a novel consumer-driven program.

    PubMed

    Fine, Robert L; Yang, Zhiyong; Spivey, Christy; Boardman, Bonnie; Courtney, Maureen

    2016-07-01

    Barriers to traditional advance care planning (ACP) and advance directive (AD) creation have limited the promise of ACP/AD for individuals and families, the healthcare team, and society. Our objectives were to determine the results of a digital ACP/AD through which consumers create, store, locate, and retrieve their ACP/AD at no charge and with minimal physician involvement, and the ACP/AD can be integrated into the electronic health record. The authors chose 900 users of MyDirectives, a digital ACP/AD tool, to achieve proportional representation of all 50 states by population size and then reviewed their responses. The 900 participants had an average age of 50.8 years (SD = 16.6); 84% of the men and 91% of the women were in self-reported good health when signing their ADs. Among the respondents, 94% wanted their physicians to consult a supportive and palliative care team if they were seriously ill; nearly 85% preferred cessation of life-sustaining treatments during their final days; 76% preferred to spend their final days at home or in a hospice; and 70% would accept attempted cardiopulmonary resuscitation in limited circumstances. Most respondents wanted an autopsy under certain conditions, and 62% wished to donate their organs. In conclusion, analysis of early experience with this ACP/AD platform demonstrates that individuals of different ages and conditions can engage in an interrogatory process about values, develop ADs that are more nuanced than traditional paper-based ADs in reflecting those values, and easily make changes to their ADs. Online ADs have the potential to remove barriers to ACP/AD and thus further improve patient-centered end-of-life care. PMID:27365867

  13. Estimating the Effect of Palliative Care Interventions and Advance Care Planning on ICU Utilization: A Systematic Review

    PubMed Central

    Khandelwal, Nita; Kross, Erin K.; Engelberg, Ruth A.; Coe, Norma B.; Long, Ann C.; Curtis, J. Randall

    2015-01-01

    Objective We conducted a systematic review to answer three questions: 1) Do advance care planning and palliative care interventions lead to a reduction in ICU admissions for adult patients with life-limiting illnesses? 2) Do these interventions reduce ICU length of stay? and 3) Is it possible to provide estimates of the magnitude of these effects? Data Sources We searched MEDLINE, EMBASE, Cochrane Controlled Clinical Trials, and Cumulative Index to Nursing and Allied Health Literature databases from 1995 through March 2014. Study Selection We included studies that reported controlled trials (randomized and nonrandomized) assessing the impact of advance care planning and both primary and specialty palliative care interventions on ICU admissions and ICU length of stay for critically ill adult patients. Data Extraction Nine randomized controlled trials and 13 nonrandomized controlled trials were selected from 216 references. Data Synthesis Nineteen of these studies were used to provide estimates of the magnitude of effect of palliative care interventions and advance care planning on ICU admission and length of stay. Three studies reporting on ICU admissions suggest that advance care planning interventions reduce the relative risk of ICU admission for patients at high risk of death by 37% (sd, 23%). For trials evaluating palliative care interventions in the ICU setting, we found a 26% (sd, 23%) relative risk reduction in length of stay with these interventions. Conclusions Despite wide variation in study type and quality, patients who received advance care planning or palliative care interventions consistently showed a pattern toward decreased ICU admissions and reduced ICU length of stay. Although sds are wide and study quality varied, the magnitude of the effect is possible to estimate and provides a basis for modeling impact on healthcare costs. PMID:25574794

  14. Advanced treatment planning methods for efficient radiation therapy with laser accelerated proton and ion beams

    SciTech Connect

    Schell, Stefan; Wilkens, Jan J.

    2010-10-15

    lateral clustering and reduce the number of particles that have to be blocked in the beam delivery system. Furthermore, the optimization routine can be adjusted to reduce the number of dose spots and laser shots. The authors implemented these methods into a research treatment planning system for laser accelerated particles. Results: The authors' proposed methods can decrease the amount of secondary radiation produced when blocking particles with wrong energies or when reducing the total number of particles from one laser shot. Additionally, caused by the efficient use of the beam, the treatment time is reduced considerably. Both improvements can be achieved without extensively changing the quality of the treatment plan since conventional intensity modulated particle therapy usually includes a certain amount of unused degrees of freedom which can be used to adapt to laser specific properties. Conclusions: The advanced beam delivery and treatment planning methods reduce the need to have a perfect laser-based accelerator reproducing the properties of conventional accelerators that might not be possible without increasing treatment time and secondary radiation to the patient. The authors show how some of the differences to conventional beams can be overcome and efficiently used for radiation treatment.

  15. Diagnostic Systems Plan for the Advanced Light Source Top-OffUpgrade

    SciTech Connect

    Barry, Walter; Chin, Mike; Robin, David; Sannibale, Fernando; Scarvie, Tom; Steier, Christoph

    2005-05-10

    The Advanced Light Source (ALS) will soon be upgraded to enable top-off operations [1], in which electrons are quasi-continuously injected to produce constant stored beam current. The upgrade is structured in two phases. First, we will upgrade our injector from 1.5 GeV to 1.9 GeV to allow full energy injection and will start top-off operations. In the second phase, we will upgrade the Booster Ring (BR) with a bunch cleaning system to allow high bunch purity top-off injection. A diagnostics upgrade will be crucial for success in both phases of the top-off project, and our plan for it is described in this paper. New booster ring diagnostics will include updated beam position monitor (BPM) electronics, a tune monitoring system, and a new scraper. Two new synchrotron light monitors and a beam stop will be added to the booster-to-storage ring transfer line (BTS), and all the existing beam current monitors along the accelerator chain will be integrated into a single injection efficiency monitoring application. A dedicated bunch purity monitor will be installed in the storage ring (SR). Together, these diagnostic upgrades will enable smooth commissioning of the full energy injector and a quick transition to high quality top-off operation at the ALS.

  16. Advance Care Planning in Norwegian nursing homes-Who is it for?

    PubMed

    Thoresen, Lisbeth; Ahlzén, Rolf; Solbrække, Kari Nyheim

    2016-08-01

    Advance care planning (ACP) is an international concept for improving patient autonomy and communication in the context of anticipated deterioration and end-of-life care. In a preparatory conversation, health care professionals facilitate one or more conversations where nursing home residents are invited to reflect on, and articulate wishes and preferences concerning future medical treatment and end-of-life care. Our aim with this study was to increase knowledge of existing ACP practices in Norwegian nursing homes. We wanted to know how nursing home residents, relatives and nursing home staff take part in the conversations, and to what extent these conversations can be regarded as promoting autonomy, legal rights and individual needs for the residents. We conducted participant observation of seven preparatory conversations, followed by interviews with health care staff (together) and resident and relative (together). In the result section, we present an informative case example of an ACP conversation where common and important characteristics running through our data are present. These are further elaborated under the following headings: Life critical questions, Residents' quiet participation in the conversations, the Dying phase - a clinical issue, Nurses and physicians; different domains and Timing. We find that nursing home staff in our study wants to contribute to open awareness, autonomy and a good death, but there are little reflections about the purpose and content of the conversations, how they should be carried out and when, and what frail nursing home residents are able to understand and express in ACP conversations. PMID:27531449

  17. Agreement between Older Persons and their Surrogate Decision Makers Regarding Participation in Advance Care Planning

    PubMed Central

    Fried, Terri R.; Redding, Colleen A.; Robbins, Mark L.; O'Leary, John R.; Iannone, Lynne

    2014-01-01

    Objectives To examine agreement between older persons and their surrogates regarding participation in advance care planning (ACP). Design Observational cohort study. Setting Community Participants Persons age ≥ 65 and the individual they identified as most likely to make treatment decisions on their behalf. Measurements Older persons were asked about participation in four activities: 1. Completion of living will; 2. Completion of health care proxy; 3. Communication regarding views about life-sustaining treatment; 4. Communication regarding views about quality versus quantity of life. Surrogates were asked whether they believed the older person had completed these activities. Results Of 216 pairs, 81% agreed about whether a living will had been completed [k = .61, 95% confidence interval (CI) .51, .72]. Only 68% of pairs agreed about whether a health care proxy had been completed (k = .39, 95% CI .29, .50), 64% agreed about whether they had communicated regarding life-sustaining treatment (k = .22, 95% CI .09, .35), and 62% agreed about whether they had communicated regarding quality versus quantity of life (k = .23, 95% CI .11, .35). Conclusions While agreement between older persons and their surrogates regarding living will completion was good, agreement about participation in other aspects of ACP was fair to poor. Additional study is necessary to determine who is providing the most accurate report of objective ACP components and whether agreement regarding participation in ACP is associated with greater shared understanding of patients’ preferences. PMID:21649619

  18. Advance Care Planning Among Hematopoietic Cell Transplant Patients and Bereaved Caregivers

    PubMed Central

    Loggers, Elizabeth Trice; Lee, Stephanie; Chilson, Kate; Back, Anthony L.; Block, Susan; Loberiza, Fausto R.

    2014-01-01

    Younger, healthier patients contemplating high-risk (but potentially curative) hematopoietic cell transplants (HCT) may not consider advance care planning (ACP). We investigated the effect of pre-transplant ACP in surviving HCT patients and bereaved caregivers using retrospective, audiotaped telephone surveys. Subjects were identified between 2001–2003 via databases at two high-volume HCT centers. Transcripts were coded by 2 investigators, with differences resolved by consensus. HCT survivors (n=18) were interviewed a median of 13 months after HCT for acute leukemia (7), lymphoma (5), or other (6); 50% had living wills, 72% had a formal proxy. Twelve (67%) had discussed mortality risk pre-HCT with the medical team. Of those, 92% felt their hope and perception of the medical team's truthfulness was increased or unchanged (I/U) by the conversation, while all felt clinician commitment to transplant was I/U. Bereaved caregivers (n=11) were interviewed a median of 10 months post-death (median 31 days post-HCT, range 13–152). Nine (82%) had discussed mortality risk pre-HCT with the medical team; 7 (78%) felt hope was I/U, all felt clinician commitment to transplant and truthfulness was I/U, and most felt ACP reduced burden (67%). ACP discussions with patients and caregivers pre-HCT did not affect hope and supported confidence in medical teams. PMID:25068417

  19. Consensus views on advance care planning for dementia: a Delphi study.

    PubMed

    Sinclair, James B; Oyebode, Jan R; Owens, R Glynn

    2016-03-01

    The uptake of advance care planning (ACP) is particularly low among people with dementia. This may reflect barriers to communication between professionals, patients and families in the face of lack of consensus about the process. This study aimed to methodically investigate consensus views of how ACP should be explained and carried out with people with dementia. A three-round Delphi study explored views of how and when ACP should be addressed, what should be covered, who should be involved and why rates of ACP are low. Seventeen participants took part comprising family members, old age psychiatrists and policy makers. Thirty-two items reached consensus. The panel agreed on 11 different areas for discussion. They concurred that ACP was best addressed after the person has come to terms with the diagnosis when the individual feels ready to do so. There was a consensus view that the process should be couched in terms of 'certain possibilities'. Consensus items emphasised personal choice and autonomy, while also prioritising the need to discuss financial aspects and to include spouses. There was no consensus that professionals should be involved, although the panel viewed them as carrying some responsibility for low uptake. It is suggested that ACP should include general discussion of values as well as coverage of specific points. Professionals need to offer discussion and information on ACP, but also make clear that the patient has the right to choose whether to pursue ACP or not. PMID:25684278

  20. Sweet potato in a vegetarian menu plan for NASA's Advanced Life Support Program.

    PubMed

    Wilson, C D; Pace, R D; Bromfield, E; Jones, G; Lu, J Y

    1998-01-01

    Sweet potato has been selected as one of the crops for NASA's Advanced Life Support Program. Sweet potato primarily provides carbohydrate--an important energy source, beta-carotene, and ascorbic acid to a space diet. This study focuses on menus incorporating two sets of sweet potato recipes developed at Tuskegee University. One set includes recipes for 10 vegetarian products containing fom 6% to 20% sweet potato on a dry weight basis (pancakes, waffles, tortillas, bread, pie, pound cake, pasta, vegetable patties, doughnuts, and pretzels) that have been formulated, subjected to sensory evaluation, and determined to be acceptable. These recipes and the other set of recipes, not tested organoleptically, were substituted in a 10-day vegetarian menu plan developed by the American Institute of Biological Sciences (AIBS) Kennedy Space Center Biomass Processing Technical Panel. At least one recipe containing sweet potato was included in each meal. An analysis of the nutritional quality of this menu compared to the original AIBS menu found improved beta-carotene content (p<0.05). All other nutrients, except vitamin B6, and calories were equal and in some instances greater than those listed for NASA's Controlled Ecological Life Support Systems RDA. These results suggest that sweet potato products can be used successfully in menus developed for space with the added benefit of increased nutrient value and dietary variety. PMID:11876202

  1. Barriers and facilitators for general practitioners to engage in advance care planning: A systematic review

    PubMed Central

    2013-01-01

    Abstract Objective The aim of this systematic review is to identify the perceived factors hindering or facilitating GPs in engaging in advance care planning (ACP) with their patients about care at the end of life. Design Studies from 1990 to 2011 were found in four electronic databases (PubMed, CINAHL, EMBASE, PsycINFO); by contacting first authors of included studies and key experts; and searching through relevant journals and reference lists. Studies were screened, graded for quality, and analysed independently by two authors; those reporting the perception by GPs of barriers and facilitators to engagement in ACP were included. Results Eight qualitative studies and seven cross-sectional studies were included for data extraction. All barriers and facilitators identified were categorized as GP characteristics, perceived patient factors, or health care system characteristics. Stronger evidence was found for the following barriers: lack of skills to deal with patients’ vague requests, difficulties with defining the right moment, the attitude that it is the patient who should initiate ACP, and fear of depriving patients of hope. Stronger evidence was found for the following facilitators: accumulated skills, the ability to foresee health problems in the future, skills to respond to a patient's initiation of ACP, personal convictions about who to involve in ACP, and a longstanding patient–GP relationship and the home setting. Conclusion Initiation of ACP in general practice may be improved by targeting the GPs’ skills, attitudes, and beliefs but changes in health care organization and financing could also contribute. PMID:24299046

  2. SU-E-T-617: A Feasibility Study of Navigation Based Multi Criteria Optimization for Advanced Cervical Cancer IMRT Planning

    SciTech Connect

    Ma, C

    2014-06-01

    Purpose: This study aims to validate multi-criteria optimization (MCO) against standard intensity modulated radiation therapy (IMRT) optimization for advanced cervical cancer in RayStation (v2.4, RaySearch Laboratories, Sweden). Methods: 10 advanced cervical cancer patients IMRT plans were randomly selected, these plans were designed with step and shoot optimization, new plans were then designed with MCO based on these plans,while keeping optimization conditions unchanged,comparison was made between both kinds of plans including the dose volume histogram parameters of PTV and OAR,and were analysed by pairing-t test. Results: We normalize the plan so that 95% volume of PTV achieved the prescribed dose(50Gy). The volume of radiation 10, 20, 30, and 40 Gy of the rectum were reduced by 14.7%,26.8%,21.1%,10.5% respectively(P≥0.05). The mean dose of rectum were reduced by 7.2Gy(P≤0.05). There were no significant differences for the dosimetric parameters for the bladder. Conclusion: In comparision with standard IMRT optimization, MCO reduces the dose of organs at risk with the same PTV coverage,but the result needs further clinical evalution.

  3. Approaches to Teaching Organizational Communication.

    ERIC Educational Resources Information Center

    Applebaum, Ronald L.

    1998-01-01

    Discusses fundamental problems in selecting an approach to organizational communications; the purpose of an organizational communication course; the structure and content of organizational communication coursework; and teaching strategies used in the basic course in organizational communication. (RS)

  4. Patterns of Organizational Conflict

    ERIC Educational Resources Information Center

    Corwin, Ronald G.

    1969-01-01

    Patterns of relationships were identified between indices of organizational conflict and several measures of each of five organizational variables. The measures were adapted from 1500 questionnaires and 600 interviews in 28 public high schools. (Author)

  5. Defining Advancement Career Paths and Succession Plans: Critical Human Capital Retention Strategies for High-Performing Advancement Divisions

    ERIC Educational Resources Information Center

    Croteau, Jon Derek; Wolk, Holly Gordon

    2010-01-01

    There are many factors that can influence whether a highly talented staff member will build a career within an institution or use it as a stepping stone. This article defines and explores the notions of developing career paths and succession planning and why they are critical human capital investment strategies in retaining the highest performers…

  6. Advanced energy design and operation technologies research: Recommendations for a US Department of Energy multiyear program plan

    SciTech Connect

    Brambley, M.R.; Crawley, D.B.; Hostetler, D.D.; Stratton, R.C.; Addision, M.S.; Deringer, J.J.; Hall, J.D.; Selkowitz, S.E.

    1988-12-01

    This document describes recommendations for a multiyear plan developed for the US Department of Energy (DOE) as part of the Advanced Energy Design and Operation Technologies (AEDOT) project. The plan is an outgrowth of earlier planning activities conducted for DOE as part of design process research under the Building System Integration Program (BSIP). The proposed research will produce intelligent computer-based design and operation technologies for commercial buildings. In this document, the concept is explained, the need for these new computer-based environments is discussed, the benefits are described, and a plan for developing the AEDOT technologies is presented for the 9-year period beginning FY 1989. 45 refs., 37 figs., 9 tabs.

  7. Efficacy of a self-management plan in exacerbations for patients with advanced COPD

    PubMed Central

    Sánchez-Nieto, Juan Miguel; Andújar-Espinosa, Rubén; Bernabeu-Mora, Roberto; Hu, Chunshao; Gálvez-Martínez, Beatriz; Carrillo-Alcaraz, Andrés; Álvarez-Miranda, Carlos Federico; Meca-Birlanga, Olga; Abad-Corpa, Eva

    2016-01-01

    Background Self-management interventions improve different outcome variables in various chronic diseases. Their role in COPD has not been clearly established. We assessed the efficacy of an intervention called the self-management program on the need for hospital care due to disease exacerbation in patients with advanced COPD. Methods Multicenter, randomized study in two hospitals with follow-up of 1 year. All the patients had severe or very severe COPD, and had gone to either an accident and emergency (A&E) department or had been admitted to a hospital at least once in the previous year due to exacerbation of COPD. The intervention consisted of a group education session on the main characteristics of the disease, an individual training session on inhalation techniques, at the start and during the 3rd month, and a written action plan containing instructions for physical activity and treatment for stable phases and exacerbations. We determined the combined number of COPD-related hospitalizations and emergency visits per patient per year. Secondary endpoints were number of patients with visits to A&E and the number of patients hospitalized because of exacerbations, use of antibiotics and corticosteroids, length of hospital stay, and all-cause mortality. Results After 1 year, the rate of COPD exacerbations with visits to A&E or hospitalization had decreased from 1.37 to 0.89 (P=0.04) and the number of exacerbations dropped from 52 to 42 in the group of patients who received the intervention. The numbers of patients hospitalized, at 19 (40.4%) versus 20 (52.6%) (P=0.26), and those who went to A&E, at 9 (19.1%) versus 14 (36.8%) (P=0.06), due to exacerbation of COPD were also lower in this group. Intake of antibiotics was higher in the intervention group, whereas use of glucocorticoids was slightly lower, though there were no significant differences (P=0.30). There were also no differences between groups in the length of hospital stay (P=0.154) or overall mortality (P=0

  8. Dimensionality of Organizational Trust

    ERIC Educational Resources Information Center

    Adams, Samuel H.; Wiswell, Albert K.

    2007-01-01

    Trust facilitates individual and organizational learning, and is often misunderstood by organizations although they must continuously learn in order to attain organizational goals and survive. Leaders of organizations often view trust defensively and their reactions may impede organizational learning This paper builds on prior research concerning…

  9. Emerging Organizational Structures.

    ERIC Educational Resources Information Center

    Carchidi, Daniel M.; Peterson, Marvin W.

    2000-01-01

    Discussion of emerging higher educational organizational structures focuses on the increasing importance of distance education. Considers the emerging organizational landscape, three types of network organizations, six organization archetypes, organizational forms that support distance education, and implications for higher education planners. (DB)

  10. The Organizational Learning Audit.

    ERIC Educational Resources Information Center

    Pace, R. Wayne

    2002-01-01

    Notes that organizational communication and organizational learning share a common focus on how message processing occurs in institutional settings and how they affect and are affected by people and relationships. Proposes that the assessment of organizational learning represents an assessment of a subset of communication processes in an…

  11. 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

  12. Advance Care Planning: A Qualitative Study of Dialysis Patients and Families

    PubMed Central

    Eneanya, Nwamaka D.; Feinberg, Rebecca; Germain, Michael J.; Marr, Lisa; Berzoff, Joan; Cohen, Lewis M.; Unruh, Mark

    2015-01-01

    Background and objectives More than 90,000 patients with ESRD die annually in the United States, yet advance care planning (ACP) is underutilized. Understanding patients’ and families’ diverse needs can strengthen systematic efforts to improve ACP. Design, setting, participants, & measurements In-depth interviews were conducted with a purposive sample of patients and family/friends from dialysis units at two study sites. Applying grounded theory, interviews were audiotaped, professionally transcribed, and analyzed in an iterative process. Emergent themes were identified, discussed, and organized into major themes and subthemes. Results Thirteen patients and nine family/friends participated in interviews. The mean patient age was 63 years (SD 14) and five patients were women. Participants identified as black (n=1), Hispanic (n=4), Native American (n=4), Pacific Islander (n=1), white (n=11), and mixed (n=1). Three major themes with associated subthemes were identified. The first theme, “Prior experiences with ACP,” revealed that these discussions rarely occur, yet most patients desire them. A potential role for the primary care physician was broached. The second theme, “Factors that may affect perspectives on ACP,” included a desire for more of a connection with the nephrologist, positive and negative experiences with the dialysis team, disenfranchisement, life experiences, personality traits, patient-family/friend relationships, and power differentials. The third theme, “Recommendations for discussing ACP,” included thoughts on who should lead discussions, where and when discussions should take place, what should be discussed and how. Conclusions Many participants desired better communication with their nephrologist and/or their dialysis team. A number expressed feelings of disenfranchisement that could negatively impact ACP discussions through diminished trust. Life experiences, personality traits, and relationships with family and friends may

  13. Research Infrastructure for the Advancement of Hydrologic Science: Planning Highlights and Update

    NASA Astrophysics Data System (ADS)

    Bales, R. C.

    2001-12-01

    In response to the need for research infrastructure in hydrologic sciences, a group of over 35 universities has formed a Consortium of Universities for the Advancement of Hydrologic Science, Inc. (CUAHSI). With support from the U.S. National Science Foundation, CUAHSI has initiated a science planning process aimed at building research infrastructure in three main areas: i) Long Term Hydrologic Observatories, to provide the consistent, integrated, long-term information from point to continental scales ii) a Hydrologic Information System program, to support the data, information, and analysis requirements of the community and iii) a Hydrologic Measurement Technology program to develop and operate state-of-the-art systems and provide support services for hydrologic research. Scientifically, this infrastructure initiative aims to support research to provide new understanding about priority questions in hydrologic and related sciences, including: i) spatial and temporal properties of precipitation and snow processes, ii) surface water generation and transport at scales from hectares to continental-scale basins, iii) linked water, carbon and other chemical cycles, and changes in response to varying temperature, precipitation and land-use patterns, iii) environmental stresses on aquatic and riparian ecosystems related to groundwater pumping and other perturbations, iv) basin-scale subsurface water and solute movement, particularly as related to patterns of precipitation, evapotranspiration and recharge, and v) feedback between regional evaporation and transpiration and patterns of precipitation and humidity. It has become apparent that the science infrastructure in hydrologic and related sciences is currently inadequate to meet many of these priority science questions and societal needs. Specifically, investments are needed to: i) maintain, supplement and upgrade existing field facilities, ii) establish measurement programs that can deliver consistent data over the long

  14. The impact of advance care planning of place of death, a hospice retrospective cohort study

    PubMed Central

    Abel, Julian; Pring, Andy; Rich, Alison; Malik, Tariq; Verne, Julia

    2013-01-01

    Objectives There is limited evidence of the impact of advance care planning (ACP) on outcomes. We conducted a retrospective cohort study on deaths of all patients known to a hospice in a 2.5-year period to see if use of ACP affected actual place of death, hospital use and cost of hospital care in the last year. Results 969 patients were included. 550 (57%) people completed ACP. 414 (75%) achieved their choice of place of death. For those who chose home, 34 (11.3%) died in hospital; a care home 2 (1.7%) died in hospital; a hospice 14 (11.2%) died in hospital and 6 (86%) who chose to die in hospital did so. 112 (26.5%) of people without ACP died in hospital. Mean number of days in hospital in the last year of life was 18.1 in the ACP group and 26.5 in the non-ACP group(p<0.001). Mean cost of hospital treatment during the last year of life for those who died in hospital was £11,299, those dying outside of hospital £7,730 (p<0.001). Mean number of emergency admissions for those who died in hospital was 2.2 and who died elsewhere was 1.7 (p<0.001). Conclusions ACP can be used routinely in a hospice setting. Those who used ACP spent less time in hospital in their last year. ACP is associated with a reduction in the number of days in hospital in the last year of life with less hospital costs, supporting the assumptions made in the End of Life Care Strategy 2008. PMID:23626905

  15. Stages of Change for the Component Behaviors of Advance Care Planning

    PubMed Central

    Fried, Terri R.; Redding, Colleen; Robbins, Mark; Paiva, Andrea; O’Leary, John R.; Iannone, Lynne

    2010-01-01

    Objectives 1) To develop stages of change measures for advance care planning (ACP), conceptualized as a group of interrelated but separate behaviors. 2) To use these measures to characterize older persons’ engagement in and factors associated with readiness to participate in ACP. Design Observational cohort study. Setting Community. Participants Persons age ≥ 65 recruited from physician offices and a senior center. Measurements Stages of change for six ACP behaviors: completion of a living will and health care proxy, communication with loved ones regarding use of life-sustaining treatments and quantity versus quality of life (QOL), and communication with physicians about these same issues. Results Readiness to participate in ACP varied widely across behaviors. Whereas between approximately 50–60% of participants were in the action or maintenance stage for communicating with loved ones and completing a living will, 40% were in the precontemplation stage for communicating with loved ones about quantity versus QOL, and 70–75% were in the precontemplation stage for communicating with physicians. Participants were frequently in different stages for the different behaviors. Relatively few sociodemographic, health, or psychosocial factors were associated with stages of change for completing a living will, but a broader range of factors was associated with stages of change for communication with loved ones about quantity versus QOL. Conclusion Older persons show a range of readiness to engage in different aspects of ACP. Individualized assessment and interventions targeted to stage of behavior change for each component of ACP may be an effective strategy to increase participation in ACP. PMID:21143441

  16. Impact of a Disease-Specific Advance Care Planning Intervention on End-of-life Care

    PubMed Central

    Kirchhoff, Karin T.; Hammes, Bernard J.; Kehl, Karen A.; Briggs, Linda A.; Brown, Roger L.

    2012-01-01

    Background/Objectives Advance Care Planning (ACP) allows patients to state preferences for their end of life care but these preferences are frequently ignored. Following a Patient-Centered ACP interview (PC-ACP), patients’ preferences were compared to care received at end of life. Design A randomized controlled trial was conducted with patients with Congestive Heart Failure or End-stage Renal Disease and their surrogates who were randomized to receive either PC-ACP or usual care. Setting Two centers in Wisconsin with associated clinics/dialysis units provided patients. Participants Of the 313 patients and their surrogates who completed entry data, 110 died. Intervention During PC-ACP the trained facilitator assessed the patient and surrogate understanding of and experiences with the illness, provided information about disease-specific treatment options and their benefits and burden, assisted in documentation of patient treatment preferences, and assisted the surrogates in understanding the patient’s preferences and their role. Measurements Preferences were documented and then compared to the care received at end of life determined by surrogate interviews or medical charts. Results Patients (74%) frequently continued to make their own decisions about care to the end. The experimental group had fewer (1/62) but not significantly so cases where the patients could not get their wishes met about CPR than control (6/48). Significantly more experimental patients withdrew from dialysis than control. Conclusions Patients and their surrogates were generally willing to discuss preferences with a trained facilitator. Most patients received the care they desired at end of life or altered their preferences to be in accord with the care they could receive. A larger sample with surrogate decision makers is needed to detect significance. PMID:22458336

  17. Implementing advance care planning: a qualitative study of community nurses' views and experiences

    PubMed Central

    2010-01-01

    Background Advance care planning (ACP) is a process of discussion about goals of care and a means of setting on record preferences for care of patients who may lose capacity or communication ability in the future. Implementation of ACP is widely promoted by policy makers. This study examined how community palliative care nurses in England understand ACP and their roles within ACP. It sought to identify factors surrounding community nurses' implementation of ACP and nurses' educational needs. Methods An action research strategy was employed. 23 community nurses from two cancer networks in England were recruited to 6 focus group discussions and three follow up workshops. Data were analysed using a constant comparison approach. Findings Nurses understood ACP to be an important part of practice and to have the potential to be a celebration of good nursing care. Nurses saw their roles in ACP as engaging with patients to elicit care preferences, facilitate family communication and enable a shift of care focus towards palliative care. They perceived challenges to ACP including: timing, how to effect team working in ACP, the policy focus on instructional directives which related poorly to patients' concerns; managing differences in patients' and families' views. Perceived barriers included: lack of resources; lack of public awareness about ACP; difficulties in talking about death. Nurses recommended the following to be included in education programmes: design of realistic scenarios; design of a flow chart; practical advice about communication and documentation; insights into the need for clinical supervision for ACP practice. Conclusions Nurses working in the community are centrally involved with patients with palliative care needs who may wish to set on record their views about future care and treatment. This study reveals some important areas for practice and educational development to enhance nurses' use and understanding of ACP. PMID:20377876

  18. Peer education for advance care planning: volunteers’ perspectives on training and community engagement activities

    PubMed Central

    Seymour, Jane E; Almack, Kathryn; Kennedy, Sheila; Froggatt, Katherine

    2013-01-01

    Background Peer education by volunteers may aid attitudinal change, but there is little understanding of factors assisting the preparation of peer educators. This study contributes to conceptual understandings of how volunteers may be prepared to work as peer educators by drawing on an evaluation of a training programme for peer education for advance care planning (ACP). Objectives To report on volunteers’ perspectives on the peer education training programme, their feelings about assuming the role of volunteer peer educators and the community engagement activities with which they engaged during the year after training. To examine broader implications for peer education. Design Participatory action research employing mixed methods of data collection. Participants Twenty-four older volunteers and eight health and social care staff. Data collection methods Evaluative data were gathered from information provided during and at the end of training, a follow-up survey 4 months post-training; interviews and focus groups 6 and 12 months post-training. Findings Volunteers’ personal aims ranged from working within their communities to using what they had learnt within their own families. The personal impact of peer education was considerable. Two-thirds of volunteers reported community peer education activities 1 year after the training. Those who identified strongly with a community group had the most success. Conclusion We reflect on the extent to which the programme aided the development of ‘critical consciousness’ among the volunteers: a key factor in successful peer education programmes. More research is needed about the impact on uptake of ACP in communities. PMID:21615641

  19. Stress: How Does It Affect Your Life? Advance Guidance (Individual Quest), Lesson Plan No. 2.

    ERIC Educational Resources Information Center

    Kawamata, Pauline

    This lesson plan focuses on the definition, kinds, and causes of stress, and explores some ways of coping with stress. The lesson plan begins with information on the course for which the plan was developed; equipment and audio-visual aids needed; requirements for student materials; course objectives; bibliographic references; and special remarks…

  20. Conservative Management and Planned Surgery for Periviable Advanced Extrauterine Abdominal Pregnancy with Favorable Outcome: Report of Two Cases

    PubMed Central

    Harirah, Hassan M.; Smith, J. Michael; Dixon, C. Luke; Hankins, Gary D. V.

    2016-01-01

    Advanced abdominal pregnancy is an extremely rare condition that poses diagnostic and management challenges. A high index of suspicion and careful assessment of the patient's symptoms, supplemented with obstetric ultrasound, and magnetic resonance imaging, are crucial for timely diagnosis and management to prevent life-threatening complications. The presence of periviable fetuses in advanced abdominal pregnancies increases the challenge to achieve a balance between maternal and fetal benefits and risks. Early diagnosis and management decisions via a multidisciplinary approach and planned delivery are of paramount importance to minimize complications and achieve favorable maternal and fetal outcomes. Even in the setting of oligohydramnios and suspected preterm premature rupture of membranes, in-patient conservative management and an individualized planned surgical approach that includes removing or leaving the placenta in place are appropriate for managing the periviable abdominal pregnancy. PMID:27595049

  1. Conservative Management and Planned Surgery for Periviable Advanced Extrauterine Abdominal Pregnancy with Favorable Outcome: Report of Two Cases.

    PubMed

    Harirah, Hassan M; Smith, J Michael; Dixon, C Luke; Hankins, Gary D V

    2016-07-01

    Advanced abdominal pregnancy is an extremely rare condition that poses diagnostic and management challenges. A high index of suspicion and careful assessment of the patient's symptoms, supplemented with obstetric ultrasound, and magnetic resonance imaging, are crucial for timely diagnosis and management to prevent life-threatening complications. The presence of periviable fetuses in advanced abdominal pregnancies increases the challenge to achieve a balance between maternal and fetal benefits and risks. Early diagnosis and management decisions via a multidisciplinary approach and planned delivery are of paramount importance to minimize complications and achieve favorable maternal and fetal outcomes. Even in the setting of oligohydramnios and suspected preterm premature rupture of membranes, in-patient conservative management and an individualized planned surgical approach that includes removing or leaving the placenta in place are appropriate for managing the periviable abdominal pregnancy. PMID:27595049

  2. 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

    2016-03-01

    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. [Res Gerontol Nurs. 2016; 9(2):72-80.]. PMID:26020579

  3. Family Planning Supply Environment in Kinshasa, DRC: Survey Findings and Their Value in Advancing Family Planning Programming

    PubMed Central

    Kayembe, Patrick; Babazadeh, Saleh; Dikamba, Nelly; Akilimali, Pierre; Hernandez, Julie; Binanga, Arsene; Bertrand, Jane T

    2015-01-01

    Background: Modern contraceptive prevalence was 14.1% in 2007 in Kinshasa, the capital city of the Democratic Republic of the Congo (DRC). Yet virtually nothing was known about the family planning supply environment. Methods: Three surveys of health facilities were conducted in 2012, 2013, and 2014 to determine the number, spatial distribution, and attributes of sites providing family planning services. The 2012 and 2013 surveys aimed to identify the universe of family planning facilities while obtaining a limited set of data on “readiness” to provide family planning services (defined as having at least 3 modern methods, at least 1 person training in family planning in the last 3 years, and an information system to track distribution of products to clients) and output (measured by couple-years of protection, or CYP). In contrast, the 2014 survey, conducted under the umbrella of the Performance Monitoring and Accountability 2020 (PMA2020) project, was based on 2-stage cluster sampling. This article provides detailed analysis of the 2012 and 2013 surveys, including bivariate and multivariate analysis of correlates of readiness to provide services and of output. Results: We identified 184 health facilities that reported providing at least 1 contraceptive method in 2012 and 395 facilities in 2013. The percentage of sites defined as “ready” to provide services increased from 44.1% in 2012 to 63.3% in 2013. For the 3-month period between January and March 2013, facilities distributed between 0 and 879.2 CYP (mean, 39.7). Nearly half (49%) of the CYP was attributable to implants, followed by IUDs (24%), CycleBeads (11%), and injectables (8%). In 2013, facilities supported by PEPFAR (n = 121) were more likely than other facilities to be rated as ready to provide services (P<.0001); however, PEPFAR-supported sites generated less CYP on average than sites supported by family planning implementing agencies (P<.0001). Multivariate analysis showed 3 variables were

  4. Accelerating tomorrow's opto-electronic technologies: a comprehensive introduction to advanced optoelectronic materials and devices in the National Hi-Tech R&D Plan (863-Plan)

    NASA Astrophysics Data System (ADS)

    Jiang, Shan; Chen, Haoming; Ren, Xiaomin; Wang, Zhigong; Qian, Longsheng; Zhang, Rong; Feng, Songlin; Yang, Hui; Xu, Ningsheng

    2004-05-01

    The National Hi-Tech R&D Program (the 863-Program) is to enhance China's international competitiveness and improve China's overall capability of R&D in high technology and to bridge the gap between the laboratory and the marketplace. Advanced Optoelectronic Materials and Devices are one of the technology areas strategically important to China's information industry. It has been one of the major priority research fields funded by the 863 Program even since 1987 when the plan was first initiated. From the viewpoint of Priority Expert Group (PEG), this paper will give a comprehensive introduction to advanced optoelectronic materials and devices in the national 863-Program during the current five years period (up to 2005) which includes the main aims and goals and especially the main content of each subject.

  5. The Process of Advance Care Planning in HCT Candidates and Proxies: Self-Efficacy, Locus of Control, and Anxiety Levels

    PubMed Central

    Duckworth, Katharine E.; Forti, Allison M.; Russell, Gregory B.; Naik, Seema; Hurd, David; McQuellon, Richard P.

    2013-01-01

    The purpose of this study was to examine the relationship between hematopoietic cell transplant candidate and proxy advance care planning (ACP) behavior and attitudes. A total of 49 candidates and 44 proxies completed the Advance Directive Attitudes Survey, Multidimensional Health Locus of Control Scale, Family Decision Making Self-Efficacy Scale, and the State-Trait Anxiety Inventory. In all, 45% of candidates reported completing an advance directive (AD), while only 26% had ADs on file; 80% of candidates discussed ACP wishes with their loved ones and 15% discussed ACP wishes with their medical team. The AD completers were significantly (1) older, (2) more positive about ADs, and (3) were less likely to believe that health events happen by chance. Discrepancies between reported ACP behavior and communication with health care practitioners have implications for end-of-life care. PMID:23946253

  6. The process of advance care planning in HCT candidates and proxies: self-efficacy, locus of control, and anxiety levels.

    PubMed

    Duckworth, Katharine E; Forti, Allison M; Russell, Gregory B; Naik, Seema; Hurd, David; McQuellon, Richard P

    2014-11-01

    The purpose of this study was to examine the relationship between hematopoietic cell transplant candidate and proxy advance care planning (ACP) behavior and attitudes. A total of 49 candidates and 44 proxies completed the Advance Directive Attitudes Survey, Multidimensional Health Locus of Control Scale, Family Decision Making Self-Efficacy Scale, and the State-Trait Anxiety Inventory. In all, 45% of candidates reported completing an advance directive (AD), while only 26% had ADs on file; 80% of candidates discussed ACP wishes with their loved ones and 15% discussed ACP wishes with their medical team. The AD completers were significantly (1) older, (2) more positive about ADs, and (3) were less likely to believe that health events happen by chance. Discrepancies between reported ACP behavior and communication with health care practitioners have implications for end-of-life care. PMID:23946253

  7. Building an advanced climate model: Program plan for the CHAMMP (Computer Hardware, Advanced Mathematics, and Model Physics) Climate Modeling Program

    SciTech Connect

    Not Available

    1990-12-01

    The issue of global warming and related climatic changes from increasing concentrations of greenhouse gases in the atmosphere has received prominent attention during the past few years. The Computer Hardware, Advanced Mathematics, and Model Physics (CHAMMP) Climate Modeling Program is designed to contribute directly to this rapid improvement. The goal of the CHAMMP Climate Modeling Program is to develop, verify, and apply a new generation of climate models within a coordinated framework that incorporates the best available scientific and numerical approaches to represent physical, biogeochemical, and ecological processes, that fully utilizes the hardware and software capabilities of new computer architectures, that probes the limits of climate predictability, and finally that can be used to address the challenging problem of understanding the greenhouse climate issue through the ability of the models to simulate time-dependent climatic changes over extended times and with regional resolution.

  8. A review of advance care planning programs in long-term care homes: are they dementia friendly?

    PubMed

    Wickson-Griffiths, Abigail; Kaasalainen, Sharon; Ploeg, Jenny; McAiney, Carrie

    2014-01-01

    Background. Persons living with dementia in the long-term care home (LTCH) setting have a number of unique needs, including those related to planning for their futures. It is therefore important to understand the advance care planning (ACP) programs that have been developed and their impact in order for LTCH settings to select a program that best suits residents' needs. Methods. Four electronic databases were searched from 1990 to 2013, for studies that evaluated the impact of advance care planning programs implemented in the LTCH setting. Studies were critically reviewed according to rigour, impact, and the consideration of the values of residents with dementia and their family members according to the Dementia Policy Lens Toolkit. Results and Conclusion. Six ACP programs were included in the review, five of which could be considered more "dementia friendly." The programs indicated a variety of positive impacts in the planning and provision of end-of-life care for residents and their family members, most notably, increased ACP discussion and documentation. In moving forward, it will be important to evaluate the incorporation of residents with dementia's values when designing or implementing ACP interventions in the LTCH settings. PMID:24757563

  9. A Review of Advance Care Planning Programs in Long-Term Care Homes: Are They Dementia Friendly?

    PubMed Central

    Wickson-Griffiths, Abigail; Kaasalainen, Sharon; McAiney, Carrie

    2014-01-01

    Background. Persons living with dementia in the long-term care home (LTCH) setting have a number of unique needs, including those related to planning for their futures. It is therefore important to understand the advance care planning (ACP) programs that have been developed and their impact in order for LTCH settings to select a program that best suits residents' needs. Methods. Four electronic databases were searched from 1990 to 2013, for studies that evaluated the impact of advance care planning programs implemented in the LTCH setting. Studies were critically reviewed according to rigour, impact, and the consideration of the values of residents with dementia and their family members according to the Dementia Policy Lens Toolkit. Results and Conclusion. Six ACP programs were included in the review, five of which could be considered more “dementia friendly.” The programs indicated a variety of positive impacts in the planning and provision of end-of-life care for residents and their family members, most notably, increased ACP discussion and documentation. In moving forward, it will be important to evaluate the incorporation of residents with dementia's values when designing or implementing ACP interventions in the LTCH settings. PMID:24757563

  10. Planned Use of Pulsed Crab Cavities for Short X-Ray Pulse Generation at the Advanced Photon Source

    SciTech Connect

    Borland, Michael; Carwardine, J.; Chae, Y.; Emery, L.; Den Hartog, Patric; Harkay, K.C.; Lumpkin, A.H.; Nassiri, A.; Sajaev, V.; Sereno, Nicholas S.; Waldschmidt, G.; Yang, B.X.; Dolgashev, V.; /SLAC

    2007-11-06

    Recently, we have explored application to the Advanced Photon Source (APS) of Zholents'[1] crab cavity scheme for production of short x-ray pulses. We assumed use of superconducting (SC) cavities in order to have a continuous stream of crabbed bunches and flexibility of operating modes. The challenges of the SC approach are related to the size, cost, and development time of the cavities and associated systems. A good case can be made [2] for a pulsed system using room-temperature cavities. APS has elected to pursue such a system in the near term, with the SC-based system planned for a later date. This paper describes the motivation for the pulsed system and gives an overview of the planned implementation and issues. Among these are overall configuration options and constraints, cavity design options, frequency choice, cavity design challenges, tolerances, instabilities, and diagnostics plans.

  11. 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

  12. Video decision aids to assist with advance care planning: a systematic review and meta-analysis

    PubMed Central

    Jain, Ashu; Corriveau, Sophie; Quinn, Kathleen; Gardhouse, Amanda; Vegas, Daniel Brandt; You, John J

    2015-01-01

    Objective Advance care planning (ACP) can result in end-of-life care that is more congruent with patients’ values and preferences. There is increasing interest in video decision aids to assist with ACP. The objective of this study was to evaluate the impact of video decision aids on patients’ preferences regarding life-sustaining treatments (primary outcome). Design Systematic review and meta-analysis of randomised controlled trials. Data sources MEDLINE, EMBASE, PsycInfo, CINAHL, AMED and CENTRAL, between 1980 and February 2014, and correspondence with authors. Eligibility criteria for selecting studies Randomised controlled trials of adult patients that compared a video decision aid to a non-video-based intervention to assist with choices about use of life-sustaining treatments and reported at least one ACP-related outcome. Data extraction Reviewers worked independently and in pairs to screen potentially eligible articles, and to extract data regarding risk of bias, population, intervention, comparator and outcomes. Reviewers assessed quality of evidence (confidence in effect estimates) for each outcome using the Grading of Recommendations Assessment, Development and Evaluation framework. Results 10 trials enrolling 2220 patients were included. Low-quality evidence suggests that patients who use a video decision aid are less likely to indicate a preference for cardiopulmonary resuscitation (pooled risk ratio, 0.50 (95% CI 0.27 to 0.95); I2=65%). Moderate-quality evidence suggests that video decision aids result in greater knowledge related to ACP (standardised mean difference, 0.58 (95% CI 0.38 to 0.77); I2=0%). No study reported on the congruence of end-of-life treatments with patients’ wishes. No study evaluated the effect of video decision aids when integrated into clinical care. Conclusions Video decision aids may improve some ACP-related outcomes. Before recommending their use in clinical practice, more evidence is needed to confirm these findings and

  13. 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. PMID:25443161

  14. RapidArc Planning and Delivery in Patients With Locally Advanced Head-and-Neck Cancer Undergoing Chemoradiotherapy

    SciTech Connect

    Doornaert, Patricia; Verbakel, Wilko F.A.R.; Bieker, Michael; Slotman, Ben J.; Senan, Suresh

    2011-02-01

    Purpose: Volumetric modulated arc therapy (RapidArc, Varian Medical Systems) permits the delivery of highly conformal dose distributions. We studied planning and delivery in patients who underwent RapidArc for locally advanced head-and-neck cancer (HNC). Methods and Materials: A total of 35 consecutive patients who completed RapidArc with concurrent chemotherapy for Stages III-IV tumors of the oro- and hypopharynx/larynx in our center were identified. All underwent bilateral neck irradiation and 21 patients had at least N2 disease. A simultaneous integrated boost (SIB) delivered 70 Gy (in 2 Gy/fraction) to the planning target volume (PTV){sub boost} and elective nodal regions (PTV{sub elect}) received 57.75 Gy. A standard planning constraint set was used and constraints for parotid glands were individually adapted. Treatments were delivered using two arcs after all plans were verified in a solid water phantom using GafChromic External Beam Therapy films. Results: RapidArc planning generally took 1.5-2 h, which was faster than with our previous seven-field intensity-modulated radiotherapy sliding window technique. Film dosimetry revealed that 0.6% of films exceeded a combination of dose differences {>=}3% or distance to agreement {>=}2 mm. More than 99% of both PTVs received {>=}95% of the prescription dose. Average plan conformity index was 1.13 and mean dose to ipsilateral and contralateral parotid glands were 31.4 Gy and 26.1 Gy, respectively. The mean beam-on time was <3 min and mean number of monitor units was 426. Conclusions: RapidArc achieved excellent target coverage and normal tissue sparing, with delivery completed in less than 3 min. RA is currently our standard intensity-modulated radiotherapy approach for advanced HNC.

  15. A novel test of planning ability: great apes can plan step-by-step but not in advance of action.

    PubMed

    Tecwyn, Emma C; Thorpe, Susannah K S; Chappell, Jackie

    2013-11-01

    The ability to identify an appropriate sequence of actions or to consider alternative possible action sequences might be particularly useful during problem solving in the physical domain. We developed a new 'paddle-box' task to test the ability of different ape species to plan an appropriate sequence of physical actions (rotating paddles) to retrieve a reward from a goal location. The task had an adjustable difficulty level and was not dependent on species-specific behaviours (e.g. complex tool use). We investigated the planning abilities of captive orangutans (Pongo pygmaeus) and bonobos (Pan paniscus) using the paddle-box. In experiment 1, subjects had to rotate one or two paddles before rotating the paddle with the reward on. Subjects of both species performed poorly, though orangutans rotated more non-food paddles, which may be related to their greater exploratory tendencies and bolder temperament compared with bonobos. In experiment 2 subjects could always rotate the paddle with the reward on first and still succeed, and most subjects of both species performed appropriate sequences of up to three paddle rotations to retrieve the reward. Poor performance in experiment 1 may have been related to subjects' difficulty in inhibiting the prepotent response to act on the reward immediately. PMID:24153327

  16. Competencies in Organizational E-Learning: Concepts and Tools

    ERIC Educational Resources Information Center

    Sicilia, Miguel-Angel, Ed.

    2007-01-01

    "Competencies in Organizational E-Learning: Concepts and Tools" provides a comprehensive view of the way competencies can be used to drive organizational e-learning, including the main conceptual elements, competency gap analysis, advanced related computing topics, the application of semantic Web technologies, and the integration of competencies…

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

    NASA Technical Reports Server (NTRS)

    Cavanaugh, J.

    1994-01-01

    This plan describes methods and procedures Aerojet will follow in the implementation of configuration control for each established baseline. The plan is written in response to the GSFC EOS CM Plan 420-02-02, dated January 1990, and also meets he requirements specified in DOD-STD-480, DOD-D 1000B, MIL-STD-483A, and MIL-STD-490B. The plan establishes the configuration management process to be used for the deliverable hardware, software, and firmware of the EOS/AMSU-A during development, design, fabrication, test, and delivery. This revision includes minor updates to reflect Aerojet's CM policies.

  18. 45 CFR 307.15 - Approval of advance planning documents for computerized support enforcement systems.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... capacity planning services. (F) Develop performance metrics which allow tracking project completion against... CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES COMPUTERIZED SUPPORT ENFORCEMENT...

  19. 45 CFR 307.15 - Approval of advance planning documents for computerized support enforcement systems.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... capacity planning services. (F) Develop performance metrics which allow tracking project completion against... CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES COMPUTERIZED SUPPORT ENFORCEMENT...

  20. Predicting Organizational Commitment from Organizational Culture in Turkish Primary Schools

    ERIC Educational Resources Information Center

    Ipek, Cemalettin

    2010-01-01

    This study aims to describe organizational culture and commitment and to predict organizational commitment from organizational culture in Turkish primary schools. Organizational Culture Scale (Ipek "1999") and Organizational Commitment Scale (Balay "2000") were used in the data gathering process. The data were collected from 415 primary teachers…

  1. Investigation of the Relationship between Organizational Trust and Organizational Commitment

    ERIC Educational Resources Information Center

    Bastug, Gülsüm; Pala, Adem; Kumartasli, Mehmet; Günel, Ilker; Duyan, Mehdi

    2016-01-01

    Organizational trust and organizational commitment are considered as the most important entraining factors for organizational success. The most important factor in the formation of organizational commitment is trust that employees have in their organizations. In this study, the relationship between organizational trust and organizational…

  2. Comprehensive Interpretive Planning.

    ERIC Educational Resources Information Center

    Kohen, Richard; Sikoryak, Kim

    1999-01-01

    Discusses interpretive planning and provides information on how to maximize a sense of ownership shared by managers, staff, and other organizational shareholders. Presents practical and effective plans for providing interpretive services. (CCM)

  3. Advanced Monitoring Is Associated with Fewer Alarm Events During Planned Moderate Procedure-Related Sedation: A 2-Part Pilot Trial

    PubMed Central

    Lenart, John; Malkin, Mathew; Meineke, Minhthy N.; Qoshlli, Silvana; Neumann, Monica; Jacobson, J. Paul; Kruger, Alison; Ching, Jeffrey; Hassanian, Mohammad; Um, Michael

    2016-01-01

    BACKGROUND: Diagnostic and interventional procedures are often facilitated by moderate procedure-related sedation. Many studies support the overall safety of this sedation; however, adverse cardiovascular and respiratory events are reported in up to 70% of these procedures, more frequently in very young, very old, or sicker patients. Monitoring with pulse oximetry may underreport hypoventilation during sedation, particularly if supplemental oxygen is provided. Capnometry may result in false alarms during sedation when patients mouth breathe or displace sampling devices. Advanced monitor use during sedation may allow event detection before complications develop. This 2-part pilot study used advanced monitors during planned moderate sedation to (1) determine incidences of desaturation, low respiratory rate, and deeper than intended sedation alarm events; and (2) determine whether advanced monitor use is associated with fewer alarm events. METHODS: Adult patients undergoing scheduled gastroenterology or interventional radiology procedures with planned moderate sedation given by dedicated sedation nurses under the direction of procedural physicians (procedural sedation team) were monitored per standard protocols (electrocardiography blood pressure, pulse oximetry, and capnometry) and advanced monitors (acoustic respiratory monitoring and processed electroencephalograpy). Data were collected to computers for analysis. Advanced monitor parameters were not visible to teams in part 1 (standard) but were visible to teams in part 2 (advanced). Alarm events were defined as desaturation—Spo2 ≤92%; respiratory depression, acoustic respiratory rate ≤8 breaths per minute, and deeper than intended sedation, indicated by processed electroencephalograpy. The number of alarm events was compared. RESULTS: Of 100 patients enrolled, 10 were excluded for data collection computer malfunction or consent withdrawal. Data were analyzed from 90 patients (44 standard and 46 advanced

  4. Attitudes on end-of-life care and advance care planning in the lesbian and gay community.

    PubMed

    Stein, G L; Bonuck, K A

    2001-01-01

    Gay men and lesbians have special interests in documenting their preferences regarding advance care planning and end-of-life care. A 64-item survey instrument was developed to ascertain the preferences of this community regarding approaches to end-of-life care, viewpoints on physician-assisted suicide (PAS) and euthanasia, and practices regarding advance care planning. The survey was completed by 575 participants recruited through community-based health care and social service organizations serving the lesbian and gay community, primarily in the New York metropolitan area. Respondents represent a diverse group of women (36%) and men (63%) from various age, racial/ethnic, and religious/spiritual backgrounds; 10% were human immunodeficiency virus (HIV)-positive. Respondents' perspectives on end-of-life care are generally consistent with findings from other attitudinal studies of U.S. adults: a majority supported legalization of PAS and preferred a palliative approach to end-of-life care. However, the gay community sample revealed even stronger support for assisted suicide and palliative care. Although respondents completed advance directives at a higher rate than adults generally, the legal importance for gay men and lesbians to execute directives should encourage health care providers and community organizations to assume a larger educational role on advance care planning. Results confirm other reports on the need to address provider communication skills. It is speculated that the HIV epidemic was a major influence behind these results because of the overwhelming personal impact of the epidemic on most gay men and lesbians during the past two decades. PMID:11441626

  5. Selected Research, Development and Organizational Needs of the Hearing Impaired.

    ERIC Educational Resources Information Center

    Garrett, Charles W., Ed.

    Identified are research, development, and organizational needs regarding sensory aids for the hearing impaired. Discussion of the present status of sensory aids focuses on acoustic and nonacoustic aids and points out that practical long-term utility has been extremely limited. Described are organizational and planning needs such as demographic…

  6. Tools for the Improvement of Organizational Learning Processes in Innovation.

    ERIC Educational Resources Information Center

    de Weerd-Nederhof, Petra C.; Pacitti, Bernice J.; da Silva Gomes, Jorge F.; Pearson, Alan W.

    2002-01-01

    From case studies of organizational learning in research and development companies, learning tools or mechanisms were identified: job rotation, innovation process planning, and product innovation project review. Organizational learning involved parallel rather than linear processes of information acquisition, distribution, and interpretation and…

  7. Personality and organizational influences on aerospace human performance

    NASA Technical Reports Server (NTRS)

    Helmreich, Robert L.

    1989-01-01

    Individual and organizational influences on performance in aerospace environments are discussed. A model of personality with demonstrated validity is described along with reasons why personality's effects on performance have been underestimated. Organizational forces including intergroup conflict and coercive pressures are also described. It is suggested that basic and applied research in analog situations is needed to provide necessary guidance for planning future space missions.

  8. 25 CFR 1001.9 - Selection criteria for tribes/consortia seeking advance planning grant funding.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    .... Tribes/consortia that have received a planning grant within 3 years preceding the date of the latest... describes the tribe's/consortium's plans to conduct: (i) Legal and budgetary research, and (ii) Internal... of tribal resources to total resources as indicated in the latest A-128 audit. We will give...

  9. IRS Ruling Advances Mich. Tuition Plan but Could Quash Other States' Programs.

    ERIC Educational Resources Information Center

    Jaschik, Scott

    1988-01-01

    Governor Blanchard of Michigan announced that the IRS planned to allow parents to participate in the state's prepaid-tuition program without paying additional federal income tax. A broader ruling will take additional time to formulate. The federal government is considering a national plan to allow tax breaks for college savings. (MLW)

  10. Sandia National Laboratories Advanced Simulation and Computing (ASC) software quality plan : ASC software quality engineering practices Version 3.0.

    SciTech Connect

    Turgeon, Jennifer L.; Minana, Molly A.; Hackney, Patricia; Pilch, Martin M.

    2009-01-01

    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 the US Department of Energy/National Nuclear Security Agency (DOE/NNSA) Quality Criteria, Revision 10 (QC-1) as 'conformance to customer requirements and expectations'. This quality plan defines the SNL ASC Program software quality engineering (SQE) practices and provides a mapping of these practices to the SNL Corporate Process Requirement (CPR) 001.3.6; 'Corporate Software Engineering Excellence'. This plan also identifies ASC management's and the software project teams responsibilities in implementing the software quality practices and in assessing progress towards achieving their software quality goals. This SNL ASC Software Quality Plan establishes the signatories commitments to improving software products by applying cost-effective SQE practices. This plan enumerates the SQE practices that comprise the development of SNL ASC's software products and explains the project teams opportunities for tailoring and implementing the practices.

  11. Organizational change tactics: the evidence base in the literature.

    PubMed

    Packard, Thomas; Shih, Amber

    2014-01-01

    Planned organizational change processes can be used to address the many challenges facing human service organizations (HSOs) and improve organizational outcomes. There is massive literature on organizational change, ranging from popular management books to academic research on specific aspects of change. Regarding HSOs, there is a growing literature, including increasing attention to implementation science and evidence-based practices. However, research which offers generalizable, evidence-based guidelines for implementing change is not common. The purpose of the authors was to assess the evidence base in this organizational change literature to lay the groundwork for more systematic knowledge development in this important field. PMID:25491004

  12. Technology Development and Advanced Planning for Curation of Returned Mars Samples

    NASA Technical Reports Server (NTRS)

    Lindstrom, David J.; Allen, Carlton C.

    2002-01-01

    NASA Johnson Space Center (JSC) curates extraterrestrial samples, providing the international science community with lunar rock and soil returned by the Apollo astronauts, meteorites collected in Antarctica, cosmic dust collected in the stratosphere, and hardware exposed to the space environment. Curation comprises initial characterization of new samples, preparation and allocation of samples for research, and clean, secure long-term storage. The foundations of this effort are the specialized cleanrooms (class 10 to 10,000) for each of the four types of materials, the supporting facilities, and the people, many of whom have been doing detailed work in clean environments for decades. JSC is also preparing to curate the next generation of extraterrestrial samples. These include samples collected from the solar wind, a comet, and an asteroid. Early planning and R\\&D are underway to support post-mission sample handling and curation of samples returned from Mars. One of the strong scientific reasons for returning samples from Mars is to search for evidence of current or past life in the samples. Because of the remote possibility that the samples may contain life forms that are hazardous to the terrestrial biosphere, the National Research Council has recommended that all samples returned from Mars be kept under strict biological containment until tests show that they can safely be released to other laboratories. It is possible that Mars samples may contain only scarce or subtle traces of life or prebiotic chemistry that could readily be overwhelmed by terrestrial contamination . Thus, the facilities used to contain, process, and analyze samples from Mars must have a combination of high-level biocontainment and organic / inorganic chemical cleanliness that is unprecedented. JSC has been conducting feasibility studies and developing designs for a sample receiving facility that would offer biocontainment at least the equivalent of current maximum containment BSL-4 (Bio

  13. Organizational Theory, Organizational Communication, Organizational Knowledge, and Problematic Integration.

    ERIC Educational Resources Information Center

    McPhee, Robert D.; Zaug, Pamela

    2001-01-01

    Argues that three traditions of theory about organizational communication have special relevance to the ideas of problematic integration theory. Indicates the implications of theoretic currents and notes that the main implication is that problematic integration looks very different in the context of a complex communication system. (SG)

  14. Electronic Creativity Techniques for Organizational Innovation.

    ERIC Educational Resources Information Center

    Siau, Keng L.

    1996-01-01

    Discusses using advanced electronic and communication technology to improve organizational innovation. Group creativity techniques, such as electronic brainstorming, PMI (a brainstorming approach involving plus, minus, and interesting points), synectics, and their verbal counterparts are compared. Electronic PMI and synectics are found to be…

  15. Advancing the Guánica Bay (Puerto Rico) Watershed Management Plan

    EPA Science Inventory

    Consideration of stakeholder values in watershed planning and management is a necessity, but sufficiently eliciting, understanding, and organizing those values can be daunting. Many studies have demonstrated the usefulness of formal decision analysis to integrate expert knowledge...

  16. Space station systems technology study (add-on task). Volume 3: Technology advancement program plan

    NASA Technical Reports Server (NTRS)

    1985-01-01

    Program plans are given for an integrating controller for space station autonomy as well as for controls and displays. The technical approach, facility requirements and candidate facilities, development schedules, and resource requirements estimates are given.

  17. Integrated Advanced Sounding Unit-A (AMSU-A). Configuration Management Plan

    NASA Technical Reports Server (NTRS)

    Cavanaugh, J.

    1996-01-01

    The purpose of this plan is to identify the baseline to be established during the development life cycle of the integrated AMSU-A, and define the methods and procedures which Aerojet will follow in the implementation of configuration control for each established baseline. Also this plan establishes the Configuration Management process to be used for the deliverable hardware, software, and firmware of the Integrated AMSU-A during development, design, fabrication, test, and delivery.

  18. Clarifying the Consultant-Client Role Relationship through an Organizational Needs Model.

    ERIC Educational Resources Information Center

    Tubbs, Stewart L.; Baird, John W.

    An organizational need hierarchy can be used by consultants as a model for diagnosing organizational problems, after which an intervention plan can be made. The need hierarchy, which approximates Abraham Maslow's individual need hierarchy, is composed of five ascending levels related to organizational needs in the areas of survival of the…

  19. Adaptability of Organizational Innovations as a Function of Eco-System Management.

    ERIC Educational Resources Information Center

    Kurpius, DeWayne J.

    Research in organizational development and ecological psychology has demonstrated the importance of viewing organizations from a systems perspective. Organizational innovations are planned, designed, and implemented in increasingly complex and dynamic ecosystems. This paper presents a model of organizational change which was developed using a…

  20. Advances and Future Directions for Tuberous Sclerosis Complex Research: Recommendations From the 2015 Strategic Planning Conference.

    PubMed

    Sahin, Mustafa; Henske, Elizabeth P; Manning, Brendan D; Ess, Kevin C; Bissler, John J; Klann, Eric; Kwiatkowski, David J; Roberds, Steven L; Silva, Alcino J; Hillaire-Clarke, Coryse St; Young, Lisa R; Zervas, Mark; Mamounas, Laura A

    2016-07-01

    On March 10 to March 12, 2015, the National Institute of Neurological Disorders and Stroke and the Tuberous Sclerosis Alliance sponsored a workshop in Bethesda, Maryland, to assess progress and new opportunities for research in tuberous sclerosis complex with the goal of updating the 2003 Research Plan for Tuberous Sclerosis (http://www.ninds.nih.gov/about_ninds/plans/tscler_research_plan.htm). In addition to the National Institute of Neurological Disorders and Stroke and Tuberous Sclerosis Alliance, participants in the strategic planning effort and workshop included representatives from six other Institutes of the National Institutes of Health, the Department of Defense Tuberous Sclerosis Complex Research Program, and a broad cross-section of basic scientists and clinicians with expertise in tuberous sclerosis complex along with representatives from the pharmaceutical industry. Here we summarize the outcomes from the extensive premeeting deliberations and final workshop recommendations, including (1) progress in the field since publication of the initial 2003 research plan for tuberous sclerosis complex, (2) the key gaps, needs, and challenges that hinder progress in tuberous sclerosis complex research, and (3) a new set of research priorities along with specific recommendations for addressing the major challenges in each priority area. The new research plan is organized around both short-term and long-term goals with the expectation that progress toward specific objectives can be achieved within a five to ten year time frame. PMID:27267556

  1. Building an ethical organizational culture.

    PubMed

    Nelson, William A; Taylor, Emily; Walsh, Thom

    2014-01-01

    The success of a health care institution-as defined by delivering high-quality, high-value care, positive patient outcomes, and financial solvency-is inextricably tied to the culture within that organization. The ability to achieve and sustain alignment between its mission, values, and everyday practices defines a positive organizational culture. An institution that has a diminished organizational culture, reflected in the failure to consistently align management and clinical decisions and practices with its mission and values, will struggle. The presence of misalignment or of ethics gaps affects the quality of care being delivered, the morale of the staff, and the organization's image in the community. Transforming an organizational culture will provide a foundation for success and a framework for daily ethics-grounded operations in any organization. However, building an ethics-grounded organization is a challenging process requiring strong organization leadership and planning. Using a case study, the authors provide a multiyear, continuous step-by-step strategy consisting of identifying ethics culture gaps, establishing an ethics taskforce, clarifying and prioritizing the problems, developing strategy for change, implementing the strategy, and evaluating outcomes. This process will assist organizations in aligning its actions with its mission and values, to find success on all fronts. PMID:24776835

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

    PubMed Central

    Horsley, Helen L; Shepherd, Kate; Brown, Heather; Carey, Irene; Matthews, Beverley; O’Donoghue, Donal; Vinen, Katie; Murtagh, Felicity EM

    2015-01-01

    Background: 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. Aim: 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. Study design: Semi-structured qualitative interview study of people receiving haemodialysis. Interviews were analysed using thematic analysis. Recruitment ceased once data saturation was achieved. Setting/participants: A total of 20 patients at two UK National Health Service hospitals, purposively sampled by age, time on haemodialysis and symptom burden. Results: 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. Conclusion: 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. PMID:25527527

  3. AN ORGANIZATIONAL GUIDE TO POLLUTION PREVENTION WORKSHOPS

    EPA Science Inventory

    This three-day workshop focuses on the new EPA publication, An Organizational Guide to Pollution Prevention (EPA/625/R-01/003). This new Guide presents three well-publicized approaches to environmental planning for organizations desiring to start, revitalize, or promote pollutio...

  4. Houston A+ Challenge: An Organizational Review

    ERIC Educational Resources Information Center

    Farr, Beverly; Medrich, Elliott

    2008-01-01

    The purpose of this organizational review, undertaken by MPR Associates, Inc. at the request of Houston A+ Challenge (HA+C), is to enable the organization to take stock of its contribution to school reform in the Houston area after a decade of work and to examine its weaknesses and strengths as it makes plans for the future. To do this, MPR staff…

  5. 16 CFR 1000.12 - Organizational structure.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 1000.12 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION GENERAL COMMISSION ORGANIZATION AND FUNCTIONS § 1000.12 Organizational structure. The Consumer Product Safety Commission is composed of the...) Office of Financial Management, Planning and Evaluation; (2) Office of Hazard Identification...

  6. 16 CFR 1000.12 - Organizational structure.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 1000.12 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION GENERAL COMMISSION ORGANIZATION AND FUNCTIONS § 1000.12 Organizational structure. The Consumer Product Safety Commission is composed of the...) Office of Financial Management, Planning and Evaluation; (2) Office of Hazard Identification...

  7. 16 CFR 1000.12 - Organizational structure.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 1000.12 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION GENERAL COMMISSION ORGANIZATION AND FUNCTIONS § 1000.12 Organizational structure. The Consumer Product Safety Commission is composed of the...) Office of Financial Management, Planning and Evaluation; (2) Office of Hazard Identification...

  8. 16 CFR 1000.12 - Organizational structure.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 1000.12 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION GENERAL COMMISSION ORGANIZATION AND FUNCTIONS § 1000.12 Organizational structure. The Consumer Product Safety Commission is composed of the...) Office of Financial Management, Planning and Evaluation; (2) Office of Hazard Identification...

  9. ORGANIZATIONAL GOALS--A SYSTEMS APPROACH.

    ERIC Educational Resources Information Center

    OHM, ROBERT E.

    CONTEMPORARY SYSTEMS THEORISTS HAVE PROVIDED A HELPFUL VIEW OF THE WAY GOAL-STRUCTURE MAY SHAPE ADMINISTRATIVE BEHAVIOR IN EDUCATIONAL ORGANIZATIONS. THE "TRADITIONALIST" VIEW ASSIGNED ORGANIZATIONAL GOALS THE FUNCTIONS OF FORECASTING AND PLANNING. THE "EMERGING MODEL" VIEWED GOALS AS UNDEFINED ELEMENTS REQUIRING LITTLE SYSTEMATIC TREATMENT IN A…

  10. Appreciative Inquiry as an Organizational Development Tool.

    ERIC Educational Resources Information Center

    Martinetz, Charles F.

    2002-01-01

    Defines appreciative inquiry as a change model that uses traditional organizational development processes (team building, strategic planning, business process redesign, management audits) in a new way, both as a philosophy and as a process. Emphasizes collaboration, participation of all voices, and changing the organization rather than the people.…

  11. Advance Care Planning and Goals of Care Communication in Older Adults with Cardiovascular Disease and Multi-Morbidity.

    PubMed

    Lum, Hillary D; Sudore, Rebecca L

    2016-05-01

    This article provides an approach to advance care planning (ACP) and goals of care communication in older adults with cardiovascular disease and multi-morbidity. The goal of ACP is to ensure that the medical care patients receive is aligned with their values and preferences. In this article, the authors outline common benefits and challenges to ACP for older adults with cardiovascular disease and multimorbidity. Recognizing that these patients experience diverse disease trajectories and receive care in multiple health care settings, the authors provide practical steps for multidisciplinary teams to integrate ACP into brief clinic encounters. PMID:27113144

  12. Organizational Paradigm Shifts.

    ERIC Educational Resources Information Center

    National Association of College and University Business Officers, Washington, DC.

    This collection of essays explores a new paradigm of higher education. The first essay, "Beyond Re-engineering: Changing the Organizational Paradigm" (L. Edwin Coate), suggests a model of quality process management and a structure for managing organizational change. "Thinking About Consortia" (Mary Jo Maydew) discusses cooperative effort and…

  13. Managing Organizational Change.

    ERIC Educational Resources Information Center

    Watwood, Britt; And Others

    Based on studies comparing leadership in two rural community colleges undergoing change and examining the management of change at Maryland's Allegany College, this paper presents a conceptual framework and model for managing organizational change. First, a framework for understanding the community college chair's role in organizational change is…

  14. Changing Organizational Forms.

    ERIC Educational Resources Information Center

    1997

    This document contains three papers from a symposium on changing organizational forms. "Goal Integration in a Multi-divisional Organization" (Richard J. Torraco, Mary Finnegan), reports on a study that examined how goals are integrated into organizational activities once they have been identified, proposes a model of goal integration, and develops…

  15. Preliminary design study of advanced composite blade and hub and nonmechanical control system for the tilt-rotor aircraft. Volume 2: Project planning data

    NASA Technical Reports Server (NTRS)

    1980-01-01

    Project planning data for a rotor and control system procurement and testing program for modifications to the XV-15 tilt-rotor research demonstrator aircraft is presented. The design, fabrication, and installation of advanced composite blades compatible with the existing hub, an advanced composite hub, and a nonmechanical control system are required.

  16. Advances in Distributed Operations and Mission Activity Planning for Mars Surface Exploration

    NASA Technical Reports Server (NTRS)

    Fox, Jason M.; Norris, Jeffrey S.; Powell, Mark W.; Rabe, Kenneth J.; Shams, Khawaja

    2006-01-01

    A centralized mission activity planning system for any long-term mission, such as the Mars Exploration Rover Mission (MER), is completely infeasible due to budget and geographic constraints. A distributed operations system is key to addressing these constraints; therefore, future system and software engineers must focus on the problem of how to provide a secure, reliable, and distributed mission activity planning system. We will explain how Maestro, the next generation mission activity planning system, with its heavy emphasis on portability and distributed operations has been able to meet these design challenges. MER has been an excellent proving ground for Maestro's new approach to distributed operations. The backend that has been developed for Maestro could benefit many future missions by reducing the cost of centralized operations system architecture.

  17. Integrated computer aided planning and manufacture of advanced technology jet engines

    NASA Astrophysics Data System (ADS)

    Subhas, B. K.; George, Chacko; Arul Raj, A.

    1987-10-01

    This paper highlights an attempt at evolving a computer aided manufacturing system on a personal computer. A case study of an advanced technology jet engine component is included to illustrate various outputs from the system. The proposed system could be an alternate solution to sophisticated and expensive CAD/CAM workstations.

  18. 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. PMID:21398263

  19. 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.

  20. Integrated Application of Active Controls (IAAC) Technology to an Advanced Subsonic Transport: Project Plan

    NASA Technical Reports Server (NTRS)

    1981-01-01

    The state of the art of active controls technology (ACT) and a recommended ACT development program plan are reviewed. The performance benefits and cost of ownership of an integrated application of ACT to civil transport aircraft is to be assessed along with the risk and laboratory and/or flight experiments designed to reduce the technical risks to a commercially acceptable level.

  1. Advanced software development workstation: Object-oriented methodologies and applications for flight planning and mission operations

    NASA Technical Reports Server (NTRS)

    Izygon, Michel

    1993-01-01

    The work accomplished during the past nine months in order to help three different organizations involved in Flight Planning and in Mission Operations systems, to transition to Object-Oriented Technology, by adopting one of the currently most widely used Object-Oriented analysis and Design Methodology is summarized.

  2. Advancing mission in the marketplace. Integrated strategic planning and budgeting helps a system remain accountable.

    PubMed

    Smessaert, A H

    1992-10-01

    In the late 1980s Holy Cross Health System (HCHS), South Bend, IN, began to implement a revised strategic planning and budgeting process to effectively link the system's mission with its day-to-day operations. Leaders wanted a process that would help system employees internalize and act on the four major elements articulated in the HCHS mission statement: fidelity, excellence, empowerment, and stewardship. Representatives from mission, strategic planning, and finance from the corporate office and subsidiaries examined planning and budgeting methods. From the beginning, HCHS leaders decided that the process should be implemented gradually, with each step focusing on refining methodology and improving mission integration. As the process evolved. HCHS developed a sequence in which planning preceded budgeting. The system also developed a variety of educational and collaborative initiatives to help system employees adapt to the organization's change of direction. One critical aspect of HCHS's ongoing education is an ethical reflection process that helps participants balance ethical considerations by viewing an issue from three perspectives: social vision, multiple responsibility, and self-interest. PMID:10121477

  3. An Exploratory Study of Spirituality in HIV Infected Adolescents and their Families: FAmily CEntered Advance Care Planning and Medication Adherence

    PubMed Central

    Lyon, Maureen E.; Garvie, Patricia A.; Kao, Ellin; Briggs, Linda; He, Jianping; Malow, Robert; D’Angelo, Lawrence J.; McCarter, Robert

    2010-01-01

    Purpose To explore the impact of spirituality and religious beliefs on FAmily CEntered (FACE) Advance Care Planning and medication adherence in HIV+ adolescents and their surrogate decision-makers. Methods A sample of HIV+ adolescents (n=40) and their surrogates, age 21 or older, (n=40) was randomized to an active Healthy Living Control group or the FACE Advance Care Planning intervention, guided by transactional stress and coping theory. Adolescents’ spirituality was assessed at baseline and 3 months post-intervention, using the FACIT-SP-4-EX, as was the belief that HIV is a punishment from God. Results Control adolescents increased faith and meaning/purpose more so than FACE adolescents (p=0.02). At baseline more behaviorally (16%) vs. perinatally (8%) infected adolescents believed HIV was a punishment from God, but not at 3-months post-intervention. Adolescents endorsing HIV was a punishment scored lower on spirituality (p=.05) and adherence to HAART (p= .04). Surrogates were more spiritual than adolescents (p=<.0001). Conclusion Providing family support in a friendly, facilitated, environment enhanced adolescents’ spirituality. Facilitated family conversations had an especially positive effect on behaviorally infected adolescents’ medication adherence and spiritual beliefs. PMID:21575826

  4. Advance Care Planning Discussions: Why They Should Happen, Why They Don't, and How We Can Facilitate the Process.

    PubMed

    Norals, Taira Everett; Smith, Thomas J

    2015-08-01

    Recent data suggest that we are not successfully getting the message across about the importance of advance care planning for patients who have a life-ending illness. Half to three-quarters of patients with incurable cancer think that they might be cured by chemotherapy, radiation, or surgery. The source of this denial may lie with them, it may be traceable to their physicians, or it may be a combination of the two. This avoidance has consequences, since those patients with "prognostic awareness" have end-of-life care pathways that involve little use of the hospital, ICU, end-of-life chemo, or "codes" with almost no chance of success, and much more dying at home with hospice care. If we can successfully initiate advance care planning discussions with our patients and families, their end-of-life processes will improve, resulting in better care, less use of the hospital, and more honoring of newly discerned choices. We show how this can be done in regular oncology practice by introducing the Johns Hopkins "Palliative Care Temporary Tattoo" and by providing some ways to discuss cardiopulmonary resuscitation in settings where it will not be helpful. PMID:26281841

  5. Intensity-Modulated Radiotherapy of Pelvic Lymph Nodes in Locally Advanced Prostate Cancer: Planning Procedures and Early Experiences

    SciTech Connect

    Muren, Ludvig Paul Wasbo, Ellen; Helle, Svein Inge; Hysing, Liv Bolstad; Karlsdottir, Asa; Odland, Odd Harald; Valen, Harald; Ekerold, Randi; Johannessen, Dag Clement

    2008-07-15

    Purpose: We present planning and early clinical outcomes of a study of intensity-modulated radiotherapy (IMRT) for locally advanced prostate cancer. Methods and Materials: A total of 43 patients initially treated with an IMRT plan delivering 50 Gy to the prostate, seminal vesicles, and pelvic lymph nodes, followed by a conformal radiotherapy (CRT) plan delivering 20 Gy to the prostate and seminal vesicles, were studied. Dose-volume histogram (DVH) data for the added plans were compared with dose-volume histogram data for the sum of two CRT plans for 15 cases. Gastrointestinal (GI) and genitourinary (GU) toxicity, based on the Radiation Therapy Oncology Group scoring system, was recorded weekly throughout treatment as well as 3 to 18 months after treatment and are presented. Results: Treatment with IMRT both reduced normal tissue doses and increased the minimum target doses. Intestine volumes receiving more than 40 and 50 Gy were significantly reduced (e.g., at 50 Gy, from 81 to 19 cm{sup 3}; p = 0.026), as were bladder volumes above 40, 50, and 60 Gy, rectum volumes above 30, 50, and 60 Gy, and hip joint muscle volumes above 20, 30, and 40 Gy. During treatment, Grade 2 GI toxicity was reported by 12 of 43 patients (28%), and Grade 2 to 4 GU toxicity was also observed among 12 patients (28%). With 6 to 18 months of follow-up, 2 patients (5%) experienced Grade 2 GI effects and 7 patients (16%) experienced Grade 2 GU effects. Conclusions: Use of IMRT for pelvic irradiation in prostate cancer reduces normal tissue doses, improves target coverage, and has a promising toxicity profile.

  6. IOOC Organizational Network (ION) Project

    NASA Astrophysics Data System (ADS)

    Dean, H.

    2013-12-01

    In order to meet the growing need for ocean information, research communities at the national and international levels have responded most recently by developing organizational frameworks that can help to integrate information across systems of existing networks and standardize methods of data gathering, management, and processing that facilitate integration. To address recommendations and identified challenges related to the need for a better understanding of ocean observing networks, members of the U.S. Interagency Ocean Observation Committee (IOOC) supported pursuing a project that came to be titled the IOOC Organizational Network (ION). The ION tool employs network mapping approaches which mirror approaches developed in academic literature aimed at understanding political networks. Researchers gathered data on the list of global ocean observing organizations included in the Framework for Ocean Observing (FOO), developed in 2012 by the international Task Team for an Integrated Framework for Sustained Ocean Observing. At the international scale, researchers reviewed organizational research plans and documents, websites, and formal international agreement documents. At the U.S. national scale, researchers analyzed legislation, formal inter-agency agreements, work plans, charters, and policy documents. Researchers based analysis of relationships among global organizations and national federal organizations on four broad relationship categories: Communications, Data, Infrastructure, and Human Resources. In addition to the four broad relationship categories, researchers also gathered data on relationship instrument types, strength of relationships, and (at the global level) ocean observing variables. Using network visualization software, researchers then developed a series of dynamic webpages. Researchers used the tool to address questions identified by the ocean observing community, including identifying gaps in global relationships and the types of tools used to

  7. A methodology for evaluating the economic and organizational impact of information technology

    SciTech Connect

    Nirenberg, L.M. ); Colley, R.W. )

    1992-01-01

    Information management and communications technology, called information technology - IT in this paper, continues to revolutionize the way in which businesses operate. Information technology can increase both the congruity of the information for an activity and the velocity of the information, i.e., it can get the right information, to the right person in a timely manner for analysis, decision making and action. This paper reports that the transfer to an end user of an IT system by the developer/vendor, and the subsequent utilization by the end user is likely to cause substantial changes to the user's organization. As the interim report makes clear, these changes are not only hard to predict, but can cause organizational conflict. Further, as cited, IT systems tend to produce disappointing value to the firm because the investment process tends to ignore valuable intangible benefits. Thus, requirements are not specified in advance to achieve these intangibles. Consequently, much of the potential value of the information technology system is not realized. Accordingly, effective economic and organizational planning is required to gain the most value. This planning calls for new approaches to economic evaluation and management of organizational change.

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

    SciTech Connect

    Kruger, A. A.; Peeler, D. K.; Kim, D. S.; Vienna, J. D.; Piepel, G. F.; Schweiger, M. J.

    2015-11-23

    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, key 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.

  9. Organizational climate and culture.

    PubMed

    Schneider, Benjamin; Ehrhart, Mark G; Macey, William H

    2013-01-01

    Organizational climate and organizational culture theory and research are reviewed. The article is first framed with definitions of the constructs, and preliminary thoughts on their interrelationships are noted. Organizational climate is briefly defined as the meanings people attach to interrelated bundles of experiences they have at work. Organizational culture is briefly defined as the basic assumptions about the world and the values that guide life in organizations. A brief history of climate research is presented, followed by the major accomplishments in research on the topic with regard to levels issues, the foci of climate research, and studies of climate strength. A brief overview of the more recent study of organizational culture is then introduced, followed by samples of important thinking and research on the roles of leadership and national culture in understanding organizational culture and performance and culture as a moderator variable in research in organizational behavior. The final section of the article proposes an integration of climate and culture thinking and research and concludes with practical implications for the management of effective contemporary organizations. Throughout, recommendations are made for additional thinking and research. PMID:22856467

  10. FY05-FY06 Advanced Simulation and Computing Implementation Plan, Volume 2

    SciTech Connect

    Baron, A L

    2004-07-19

    The Stockpile Stewardship Program (SSP) is a single, highly integrated technical program for maintaining the safety and reliability of the U.S. nuclear stockpile. The SSP uses past nuclear test data along with future non-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 will require the continued use of current facilities and programs along with new experimental facilities and computational enhancements to support these programs. The Advanced Simulation and Computing program (ASC) is a cornerstone of the SSP, providing simulation capabilities and computational resources to support the annual stockpile assessment and certification, to study advanced nuclear weapon design and manufacturing processes, to analyze accident scenarios and weapons aging, and to provide the tools to enable stockpile life extension programs and the resolution of significant finding investigations (SFIs). This requires a balanced system of technical staff, hardware, simulation software, and computer science solutions.

  11. Development and pilot of an advance care planning website for women with ovarian cancer: A randomized controlled trial

    PubMed Central

    Vogel, Rachel Isaksson; Petzel, Sue V.; Cragg, Julie; McClellan, Molly; Chan, Daniel; Dickson, Elizabeth; Jacko, Julie A.; Sainfort, François; Geller, Melissa A.

    2015-01-01

    Objective Few available tools facilitate cancer patients and physicians' discussions of quality of life and end-of-life. Our objective was to develop a web-based tool to promote advance care planning for women with ovarian cancer. Methods Women with ovarian cancer, their families, clinicians and researchers met to identify ways to improve cancer care. A prototype website was created to address advance care planning, focusing on advance healthcare directives (AHD) and palliative care consultation. Patients were recruited from a gynecologic oncology clinic for a pilot randomized controlled trial. Primary outcomes included completion of an AHD and palliative care consultation. Results At study completion, 53 women with ovarian cancer were enrolled and 35 completed the study. The mean age at enrollment was 57.9 ± 9.5 years; most were newly diagnosed or at first recurrence. There were no statistical differences in completion of AHD (p = 0.220) or palliative care consultation (p = 0.440) between intervention and control groups. However, women in the intervention group showed evidence of moving toward decision making regarding AHD and palliative care and lower decisional conflict. Women assigned to the intervention, compared to control website, were highly satisfied with the amount (p = 0.054) and quality (p = 0.119) of information and when they accessed the website, used it longer (p = 0.049). Overall website use was lower than expected, resulting from several patient-related and design barriers. Conclusions A website providing information and decisional support for women with ovarian cancer is feasible. Increasing frequency of website use requires future research. PMID:23988413

  12. [Advance Care Planning and Decisions to limit treatment at the end of life - the view from medical ethics and psychooncology].

    PubMed

    Winkler, Eva C; Heußner, Pia

    2016-03-01

    Decisions to limit treatment are important in order to avoid overtreatment at the end of life. They proceed more than half of expected deaths in Europe and the US, but are not always communicated with the patient in advance. One reason for non-involvement is that conversations that prepare patients for end-of-life decisions and work out their preferences do not take place on a regular basis. At the same time there is growing evidence that such communication improves patients' quality of life, reduces anxiety and depression and allows patients to develop a realistic understanding of their situation - which in turn is a prerequisite for shared decision making about limiting treatment. In this paper we define "treatment limitation" and explain the medical ethics perspective. The main focus, however, is on the causes that hinder advanced care planning and conversations about limiting treatment in the care of patients with advanced disease. Finally the evidence for approaches to improve the situation is presented with concrete suggestions for solutions. PMID:26983109

  13. Advanced software development workstation: Effectiveness of constraint-checking. [spaceflight simulation and planning

    NASA Technical Reports Server (NTRS)

    Izygon, Michel

    1992-01-01

    This report summarizes the findings and lessons learned from the development of an intelligent user interface for a space flight planning simulation program, in the specific area related to constraint-checking. The different functionalities of the Graphical User Interface part and of the rule-based part of the system have been identified. Their respective domain of applicability for error prevention and error checking have been specified.

  14. Earth Observing System (EOS) Advanced Microwave Sounding Unit-A (AMSU-A) Spares Program Plan

    NASA Technical Reports Server (NTRS)

    Chapman, Weldon

    1994-01-01

    This plan specifies the spare components to be provided for the EOS/AMSU-A instrument and the general spares philosophy for their procurement. It also address key components not recommended for spares, as well as the schedule and method for obtaining the spares. The selected spares list was generated based on component criticality, reliability, repairability, and availability. An alternative spares list is also proposed based on more stringent fiscal constraints.

  15. Improved Test Planning and Analysis Through the Use of Advanced Statistical Methods

    NASA Technical Reports Server (NTRS)

    Green, Lawrence L.; Maxwell, Katherine A.; Glass, David E.; Vaughn, Wallace L.; Barger, Weston; Cook, Mylan

    2016-01-01

    The goal of this work is, through computational simulations, to provide statistically-based evidence to convince the testing community that a distributed testing approach is superior to a clustered testing approach for most situations. For clustered testing, numerous, repeated test points are acquired at a limited number of test conditions. For distributed testing, only one or a few test points are requested at many different conditions. The statistical techniques of Analysis of Variance (ANOVA), Design of Experiments (DOE) and Response Surface Methods (RSM) are applied to enable distributed test planning, data analysis and test augmentation. The D-Optimal class of DOE is used to plan an optimally efficient single- and multi-factor test. The resulting simulated test data are analyzed via ANOVA and a parametric model is constructed using RSM. Finally, ANOVA can be used to plan a second round of testing to augment the existing data set with new data points. The use of these techniques is demonstrated through several illustrative examples. To date, many thousands of comparisons have been performed and the results strongly support the conclusion that the distributed testing approach outperforms the clustered testing approach.

  16. Advance Care Planning Norms May Contribute to Hospital Variation in End-of-life ICU Use: A Simulation Study

    PubMed Central

    Barnato, Amber E.; Mohan, Deepika; Lane, Rondall K.; Huang, Yue Ming; Angus, Derek C.; Farris, Coreen; Arnold, Robert M.

    2014-01-01

    Background There is wide variation in end-of-life (EOL) intensive care unit (ICU) use among academic medical centers (AMCs). Objective To develop hypotheses regarding medical decision-making factors underlying this variation. Design High-fidelity simulation experiment involving a critically and terminally ill elder, followed by a survey and debriefing cognitive interview and evaluated using triangulated quantitative-qualitative comparative analysis. Setting 2 AMCs in the same state and health care system with disparate EOL ICU use. Subjects Hospital-based physicians responsible for ICU admission decisions. Measurements Treatment plan, prognosis, diagnosis, qualitative case perceptions and clinical reasoning. Main Results Sixty-seven of 111 (60%) eligible physicians agreed to participate; 48 (72%) could be scheduled. There were no significant between-AMC differences in 3-month prognosis or treatment plan, but there were systematic differences in perceptions of the case. Case perceptions at the low-intensity AMC seemed to be influenced by the absence of a DNR order in the context of norms of universal code status discussion and documentation upon admission, whereas case perceptions at the high-intensity AMC seemed to be influenced by the patient’s known metastatic gastric cancer in the context of norms of oncologists’ avoiding code status discussions. Conclusions In this simulation study of 2 AMCs, hospital-based physicians had different perceptions of an identical case. We hypothesize that different advance care planning norms may have influenced their decision-making heuristics. PMID:24615275

  17. Comparison of CT and PET-CT based planning of radiation therapy in locally advanced pancreatic carcinoma

    PubMed Central

    Topkan, Erkan; Yavuz, Ali A; Aydin, Mehmet; Onal, Cem; Yapar, Fuat; Yavuz, Melek N

    2008-01-01

    Background To compare computed tomography (CT) with co-registered positron emission tomography-computed tomography (PET-CT) as the basis for delineating gross tumor volume (GTV) in unresectable, locally advanced pancreatic carcinoma (LAPC). Methods Fourteen patients with unresectable LAPC had both CT and PET images acquired. For each patient, two three-dimensional conformal plans were made using the CT and PET-CT fusion data sets. We analyzed differences in treatment plans and doses of radiation to primary tumors and critical organs. Results Changes in GTV delineation were necessary in 5 patients based on PET-CT information. In these patients, the average increase in GTV was 29.7%, due to the incorporation of additional lymph node metastases and extension of the primary tumor beyond that defined by CT. For all patients, the GTVCT versus GTVPET-CT was 92.5 ± 32.3 cm3 versus 104.5 ± 32.6 cm3 (p = 0.009). Toxicity analysis revealed no clinically significant differences between two plans with regard to doses to critical organs. Conclusion Co-registration of PET and CT information in unresectable LAPC may improve the delineation of GTV and theoretically reduce the likelihood of geographic misses. PMID:18808725

  18. Impact of a Care Directives Activity Tab in the Electronic Health Record on Documentation of Advance Care Planning

    PubMed Central

    Turley, Marianne; Wang, Susan; Meng, Di; Kanter, Michael; Garrido, Terhilda

    2016-01-01

    Context: To ensure patient-centered end-of-life care, advance care planning (ACP) must be documented in the medical record and readily retrieved across care settings. Objective: To describe use of the Care Directives Activity tab (CDA), a single-location feature in the electronic health record for collecting and viewing ACP documentation in inpatient and ambulatory care settings, and to assess its association with ACP documentation rates. Design: Retrospective pre- and postimplementation analysis in 2012 and 2013 at Kaiser Permanente Southern California among 113,309 patients aged 65 years and older with ACP opportunities during outpatient or inpatient encounters. Main Outcome Measures: Providers’ CDA use rates and documentation rates of advance directives and physician orders for life-sustaining treatments stratified by CDA use. Results: Documentation rates of advance directives and physician orders for life-sustaining treatments among patients with outpatient and inpatient encounters were 3.5 to 9.6 percentage points higher for patients with CDA use vs those without it. The greatest differences were for orders for life-sustaining treatments among patients with inpatient encounters and for advance directives among patients with outpatient encounters; both were 9.6 percentage points higher among those with CDA use than those without it. All differences were significant after controlling for yearly variation (p < 0.001). Conclusion: Statistically significant differences in documentation rates between patients with and without CDA use suggest the potential of a standardized location in the electronic health record to improve ACP documentation. Further research is required to understand effects of CDA use on retrieval of preferences and end-of-life care. PMID:27057820

  19. Advanced Reactors Transition program fiscal year 1998 multi-year work plan

    SciTech Connect

    Gantt, D.A.

    1997-09-25

    The mission of the Advanced Reactors Transition program is two-fold. First, the program is to maintain the Fast Flux Test Facility (FFTF) and the Fuels and Materials Examination Facility (FMEF) in Standby to support a possible future role in the tritium production strategy. Secondly, the program is to continue deactivation activities which do not conflict with the Standby directive. On-going deactivation activities include the processing of non-usable, irradiated, FFTF components for storage or disposal; deactivation of Nuclear Energy legacy test facilities; and deactivation of the Plutonium Recycle Test Reactor (PRTR) facility, 309 Building.

  20. Planned High-brightness Channeling Radiation Experiment at Fermilab's Advanced Superconducting Test Accelerator

    SciTech Connect

    Blomberg, Ben; Mihalcea, Daniel; Panuganti, Harsha; Piot, Philippe; Brau, Charles; Choi, Bo; Gabella, William; Ivanov, Borislav; Mendenhall, Marcus; Lynn, Christopher; Sen, Tanaji; Wagner, Wolfgang

    2014-07-01

    In this contribution we describe the technical details and experimental setup of our study aimed at producing high-brightness channeling radiation (CR) at Fermilab’s new user facility the Advanced Superconducting Test Accelerator (ASTA). In the ASTA photoinjector area electrons are accelerated up to 40-MeV and focused to a sub-micron spot on a ~40 micron thick carbon diamond, the electrons channel through the crystal and emit CR up to 80-KeV. Our study utilizes ASTA’s long pulse train capabilities and ability to preserve ultra-low emittance, to produce the desired high average brightness.

  1. Advanced biochemical processes for geothermal brines FY 1998 annual operating plan

    SciTech Connect

    1997-10-01

    As part of the overall Geothermal Energy Research which is aimed at the development of economical geothermal resources production systems, the aim of the Advanced Biochemical Processes for Geothermal Brines (ABPGB) effort is the development of economic and environmentally acceptable methods for disposal of geothermal wastes and conversion of by-products to useful forms. Methods are being developed for dissolution, separation and immobilization of geothermal wastes suitable for disposal, usable in inert construction materials, suitable for reinjection into the reservoir formation, or used for recovery of valuable metals.

  2. Confirmation of ETI: initial organizational response

    NASA Astrophysics Data System (ADS)

    Harrison, Albert A.

    2003-08-01

    Perhaps the most crucial responses to the confirmation of extraterrestrial intelligence will come from organizations, rather than from individual people. Among the key organizations that will help shape humanity's response are political institutions such as the US Congress, administrative bodies such as the US Department of State, security agencies, the military, professional societies, and the media. Although popular culture and individual beliefs will affect organizational performance, organizational reactions will depend also on organizational cultures and traditions, administrative structures, communication patterns, decision-making processes, and the actions of other organizations. Prompt and effective responses may be blocked by sociopolitical constraints, jurisdictional disputes, cumbersome structures and procedures, stresses that frequently slow and distort information processing, and potentially counterproductive efforts to maintain positive organizational images. Efforts undertaken by governmental agencies will be hampered by public perceptions of low credibility. Foresight and advance preparation are among the steps that organizations may take to prepare for contact, but conservative values, skepticism towards SETI, and competing organizational priorities make serious preparation unlikely.

  3. Grassroots Organizational Battles

    ERIC Educational Resources Information Center

    Silver, Michael

    1976-01-01

    The author presents these three ground rules for engaging in organizational conflict: (1) take the offensive; (2) take the cue for the second move from the opponent's defensive response; and (3) know when to execute a "strategic retreat." (HMV)

  4. Varieties of Organizational Conflict

    ERIC Educational Resources Information Center

    Pondy, Louis R.

    1969-01-01

    The viewpoints and findings of the seven empirical studies of organizational conflict contained in this issue are compared and contrasted. A distinction is made between conflict within a stable organization structure and conflict aimed at changing the organization structure. (Author)

  5. Evolving to organizational learning.

    PubMed

    Bechtold, B L

    2000-02-01

    To transform in stride with the business changes, organizations need to think of development as "organizational learning" rather than "training." Companies need to manage learning as a strategic competitive advantage for current and future business rather than as a perk for individuals. To position themselves for success in a dynamic business environment, companies need to reframe their concept of learning and development to a mindset of organizational learning. PMID:11184906

  6. Preliminary calibration plan for the Advanced Particles and Field Observatory (APAFO) magnetometer experiment

    NASA Technical Reports Server (NTRS)

    Voorhies, C. V.; Langel, R. A.; Slavin, J.; Lancaster, E. R.; Jones, S.

    1991-01-01

    Prelaunch and postlaunch calibration plans for the APAFO magnetometer experiment are presented. A study of tradeoffs between boom length and spacecraft field is described; the results are summarized. The prelaunch plan includes: calibration of the Vector Fluxgate Magnetometer (VFM), Star Sensors, and Scalar Helium Magnetometer (SHM); optical bench integration; and acquisition of basic spacecraft field data. Postlaunch calibration has two phases. In phase one, SHM data are used to calibrate the VFM, total vector magnetic field data are used to calibrate a physical model of the spacecraft field, and both calibrations are refined by iteration. In phase two, corrected vector data are transformed into geocentric coordinates, previously undetected spacecraft fields are isolated, and initial geomagnetic field models are computed. Provided the SHM is accurate to the required 1.0 nT and can be used to calibrate the VFM to the required 3.0- nT accuracy, the tradeoff study indicates that a 12 m boom and a spacecraft field model uncertainty of 5 percent together allow the 1.0 nT spacecraft field error requirement to be met.

  7. Advanced Simulation and Computing FY10-11 Implementation Plan Volume 2, Rev. 0

    SciTech Connect

    Carnes, B

    2009-06-08

    The Stockpile Stewardship Program (SSP) is a single, highly integrated technical program for maintaining the surety and reliability of the U.S. nuclear stockpile. The SSP uses past nuclear test data along with current and future non-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 current facilities and programs along with new experimental facilities and computational enhancements to support these programs. The Advanced Simulation and Computing Program (ASC) is a cornerstone of the SSP, providing simulation capabilities and computational resources to support the annual stockpile assessment and certification, to study advanced nuclear weapons design and manufacturing processes, to analyze accident scenarios and weapons aging, and to provide the tools to enable stockpile Life Extension Programs (LEPs) and the resolution of Significant Finding Investigations (SFIs). This requires a balanced resource, including technical staff, hardware, simulation software, and computer science solutions. In its first decade, the ASC strategy focused on demonstrating simulation capabilities of unprecedented scale in three spatial dimensions. In its second decade, ASC is focused on increasing its predictive capabilities in a three-dimensional simulation environment while maintaining support to the SSP. The program continues to improve its unique tools for solving progressively more difficult stockpile problems (focused on sufficient resolution, dimensionality and scientific details); to quantify critical margins and uncertainties (QMU); and to resolve increasingly difficult analyses needed for the SSP. Moreover, ASC has restructured its business model from one that

  8. Advanced Simulation & Computing FY09-FY10 Implementation Plan Volume 2, Rev. 0

    SciTech Connect

    Meisner, R; Perry, J; McCoy, M; Hopson, J

    2008-04-30

    The Stockpile Stewardship Program (SSP) is a single, highly integrated technical program for maintaining the safety and reliability of the U.S. nuclear stockpile. The SSP uses past nuclear test data along with current and future nonnuclear 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 current facilities and programs along with new experimental facilities and computational enhancements to support these programs. The Advanced Simulation and Computing Program (ASC)1 is a cornerstone of the SSP, providing simulation capabilities and computational resources to support the annual stockpile assessment and certification, to study advanced nuclear-weapons design and manufacturing processes, to analyze accident scenarios and weapons aging, and to provide the tools to enable Stockpile Life Extension Programs (SLEPs) and the resolution of Significant Finding Investigations (SFIs). This requires a balanced resource, including technical staff, hardware, simulation software, and computer science solutions. In its first decade, the ASC strategy focused on demonstrating simulation capabilities of unprecedented scale in three spatial dimensions. In its second decade, ASC is focused on increasing its predictive capabilities in a three-dimensional simulation environment while maintaining the support to the SSP. The program continues to improve its unique tools for solving progressively more difficult stockpile problems (focused on sufficient resolution, dimensionality and scientific details); to quantify critical margins and uncertainties (QMU); and to resolve increasingly difficult analyses needed for the SSP. Moreover, ASC has restructured its business model from one

  9. Strategic Plan for Nuclear Energy -- Knowledge Base for Advanced Modeling and Simulation (NE-KAMS)

    SciTech Connect

    Kimberlyn C. Mousseau

    2011-10-01

    The Nuclear Energy Computational Fluid Dynamics Advanced Modeling and Simulation (NE-CAMS) system is being developed at the Idaho National Laboratory (INL) in collaboration with Bettis Laboratory, Sandia National Laboratory (SNL), Argonne National Laboratory (ANL), Utah State University (USU), and other interested parties with the objective of developing and implementing a comprehensive and readily accessible data and information management system for computational fluid dynamics (CFD) verification and validation (V&V) in support of nuclear energy systems design and safety analysis. The two key objectives of the NE-CAMS effort are to identify, collect, assess, store and maintain high resolution and high quality experimental data and related expert knowledge (metadata) for use in CFD V&V assessments specific to the nuclear energy field and to establish a working relationship with the U.S. Nuclear Regulatory Commission (NRC) to develop a CFD V&V database, including benchmark cases, that addresses and supports the associated NRC regulations and policies on the use of CFD analysis. In particular, the NE-CAMS system will support the Department of Energy Office of Nuclear Energy Advanced Modeling and Simulation (NEAMS) Program, which aims to develop and deploy advanced modeling and simulation methods and computational tools for reliable numerical simulation of nuclear reactor systems for design and safety analysis. Primary NE-CAMS Elements There are four primary elements of the NE-CAMS knowledge base designed to support computer modeling and simulation in the nuclear energy arena as listed below. Element 1. The database will contain experimental data that can be used for CFD validation that is relevant to nuclear reactor and plant processes, particularly those important to the nuclear industry and the NRC. Element 2. Qualification standards for data evaluation and classification will be incorporated and applied such that validation data sets will result in well

  10. Advanced Simulation and Computing Fiscal Year 2011-2012 Implementation Plan, Revision 0

    SciTech Connect

    McCoy, M; Phillips, J; Hpson, J; Meisner, R

    2010-04-22

    The Stockpile Stewardship Program (SSP) is a single, highly integrated technical program for maintaining the surety and reliability of the U.S. nuclear stockpile. The SSP uses past nuclear test data along with current and future non-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 (D&E) programs, and an appropriately scaled production capability to support stockpile requirements. This integrated national program requires the continued use of current facilities and programs along with new experimental facilities and computational enhancements to support these programs. The Advanced Simulation and Computing Program (ASC) is a cornerstone of the SSP, providing simulation capabilities and computational resources to support the annual stockpile assessment and certification, to study advanced nuclear weapons design and manufacturing processes, to analyze accident scenarios and weapons aging, and to provide the tools to enable stockpile Life Extension Programs (LEPs) and the resolution of Significant Finding Investigations (SFIs). This requires a balanced resource, including technical staff, hardware, simulation software, and computer science solutions. In its first decade, the ASC strategy focused on demonstrating simulation capabilities of unprecedented scale in three spatial dimensions. In its second decade, ASC is focused on increasing its predictive capabilities in a three-dimensional (3D) simulation environment while maintaining support to the SSP. The program continues to improve its unique tools for solving progressively more difficult stockpile problems (focused on sufficient resolution, dimensionality and scientific details); to quantify critical margins and uncertainties (QMU); and to resolve increasingly difficult analyses needed for the SSP. Moreover, ASC has restructured its business model

  11. Advanced Simulation and Computing FY08-09 Implementation Plan Volume 2 Revision 0

    SciTech Connect

    McCoy, M; Kusnezov, D; Bikkel, T; Hopson, J

    2007-04-25

    The Stockpile Stewardship Program (SSP) is a single, highly integrated technical program for maintaining the safety and reliability of the U.S. nuclear stockpile. The SSP uses past nuclear test data along with current and future nonnuclear 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 current facilities and programs along with new experimental facilities and computational enhancements to support these programs. The Advanced Simulation and Computing Program (ASC) is a cornerstone of the SSP, providing simulation capabilities and computational resources to support the annual stockpile assessment and certification, to study advanced nuclear-weapons design and manufacturing processes, to analyze accident scenarios and weapons aging, and to provide the tools to enable Stockpile Life Extension Programs (SLEPs) and the resolution of Significant Finding Investigations (SFIs). This requires a balanced resource, including technical staff, hardware, simulation software, and computer science solutions. In its first decade, the ASC strategy focused on demonstrating simulation capabilities of unprecedented scale in three spatial dimensions. In its second decade, ASC is focused on increasing its predictive capabilities in a three-dimensional simulation environment while maintaining the support to the SSP. The program continues to improve its unique tools for solving progressively more difficult stockpile problems (focused on sufficient resolution, dimensionality and scientific details); to quantify critical margins and uncertainties (QMU); and to resolve increasingly difficult analyses needed for the SSP. Moreover, ASC has restructured its business model from one

  12. Advanced Simulation and Computing FY09-FY10 Implementation Plan Volume 2, Rev. 1

    SciTech Connect

    Kissel, L

    2009-04-01

    The Stockpile Stewardship Program (SSP) is a single, highly integrated technical program for maintaining the surety and reliability of the U.S. nuclear stockpile. The SSP uses past nuclear test data along with current and future non-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 current facilities and programs along with new experimental facilities and computational enhancements to support these programs. The Advanced Simulation and Computing Program (ASC) is a cornerstone of the SSP, providing simulation capabilities and computational resources to support the annual stockpile assessment and certification, to study advanced nuclear weapons design and manufacturing processes, to analyze accident scenarios and weapons aging, and to provide the tools to enable stockpile Life Extension Programs (LEPs) and the resolution of Significant Finding Investigations (SFIs). This requires a balanced resource, including technical staff, hardware, simulation software, and computer science solutions. In its first decade, the ASC strategy focused on demonstrating simulation capabilities of unprecedented scale in three spatial dimensions. In its second decade, ASC is focused on increasing its predictive capabilities in a three-dimensional simulation environment while maintaining support to the SSP. The program continues to improve its unique tools for solving progressively more difficult stockpile problems (focused on sufficient resolution, dimensionality and scientific details); to quantify critical margins and uncertainties (QMU); and to resolve increasingly difficult analyses needed for the SSP. Moreover, ASC has restructured its business model from one that

  13. Advanced Simulation and Computing FY09-FY10 Implementation Plan, Volume 2, Revision 0.5

    SciTech Connect

    Meisner, R; Hopson, J; Peery, J; McCoy, M

    2008-10-07

    The Stockpile Stewardship Program (SSP) is a single, highly integrated technical program for maintaining the surety and reliability of the U.S. nuclear stockpile. The SSP uses past nuclear test data along with current and future non-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 current facilities and programs along with new experimental facilities and computational enhancements to support these programs. The Advanced Simulation and Computing Program (ASC)1 is a cornerstone of the SSP, providing simulation capabilities and computational resources to support the annual stockpile assessment and certification, to study advanced nuclear weapons design and manufacturing processes, to analyze accident scenarios and weapons aging, and to provide the tools to enable stockpile Life Extension Programs (LEPs) and the resolution of Significant Finding Investigations (SFIs). This requires a balanced resource, including technical staff, hardware, simulation software, and computer science solutions. In its first decade, the ASC strategy focused on demonstrating simulation capabilities of unprecedented scale in three spatial dimensions. In its second decade, ASC is focused on increasing its predictive capabilities in a three-dimensional simulation environment while maintaining support to the SSP. The program continues to improve its unique tools for solving progressively more difficult stockpile problems (focused on sufficient resolution, dimensionality and scientific details); to quantify critical margins and uncertainties (QMU); and to resolve increasingly difficult analyses needed for the SSP. Moreover, ASC has restructured its business model from one

  14. Advanced Simulation and Computing FY08-09 Implementation Plan, Volume 2, Revision 0.5

    SciTech Connect

    Kusnezov, D; Bickel, T; McCoy, M; Hopson, J

    2007-09-13

    The Stockpile Stewardship Program (SSP) is a single, highly integrated technical program for maintaining the surety and reliability of the U.S. nuclear stockpile. The SSP uses past nuclear test data along with current and future non-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 current facilities and programs along with new experimental facilities and computational enhancements to support these programs. The Advanced Simulation and Computing Program (ASC)1 is a cornerstone of the SSP, providing simulation capabilities and computational resources to support the annual stockpile assessment and certification, to study advanced nuclear-weapons design and manufacturing processes, to analyze accident scenarios and weapons aging, and to provide the tools to enable Stockpile Life Extension Programs (SLEPs) and the resolution of Significant Finding Investigations (SFIs). This requires a balanced resource, including technical staff, hardware, simulation software, and computer science solutions. In its first decade, the ASC strategy focused on demonstrating simulation capabilities of unprecedented scale in three spatial dimensions. In its second decade, ASC is focused on increasing its predictive capabilities in a three-dimensional simulation environment while maintaining the support to the SSP. The program continues to improve its unique tools for solving progressively more difficult stockpile problems (focused on sufficient resolution, dimensionality and scientific details); to quantify critical margins and uncertainties (QMU); and to resolve increasingly difficult analyses needed for the SSP. Moreover, ASC has restructured its business model from

  15. Advanced Simulation and Computing FY10-FY11 Implementation Plan Volume 2, Rev. 0.5

    SciTech Connect

    Meisner, R; Peery, J; McCoy, M; Hopson, J

    2009-09-08

    The Stockpile Stewardship Program (SSP) is a single, highly integrated technical program for maintaining the surety and reliability of the U.S. nuclear stockpile. The SSP uses past nuclear test data along with current and future non-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 (D&E) programs, and an appropriately scaled production capability to support stockpile requirements. This integrated national program requires the continued use of current facilities and programs along with new experimental facilities and computational enhancements to support these programs. The Advanced Simulation and Computing Program (ASC) is a cornerstone of the SSP, providing simulation capabilities and computational resources to support the annual stockpile assessment and certification, to study advanced nuclear weapons design and manufacturing processes, to analyze accident scenarios and weapons aging, and to provide the tools to enable stockpile Life Extension Programs (LEPs) and the resolution of Significant Finding Investigations (SFIs). This requires a balanced resource, including technical staff, hardware, simulation software, and computer science solutions. In its first decade, the ASC strategy focused on demonstrating simulation capabilities of unprecedented scale in three spatial dimensions. In its second decade, ASC is focused on increasing its predictive capabilities in a three-dimensional (3D) simulation environment while maintaining support to the SSP. The program continues to improve its unique tools for solving progressively more difficult stockpile problems (focused on sufficient resolution, dimensionality and scientific details); to quantify critical margins and uncertainties (QMU); and to resolve increasingly difficult analyses needed for the SSP. Moreover, ASC has restructured its business model

  16. Advanced Simulation and Computing FY07-08 Implementation Plan Volume 2

    SciTech Connect

    Kusnezov, D; Hale, A; McCoy, M; Hopson, J

    2006-06-22

    The Stockpile Stewardship Program (SSP) is a single, highly integrated technical program for maintaining the safety and reliability of the U.S. nuclear stockpile. The SSP uses past nuclear test data along with current and future nonnuclear 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 will require the continued use of current facilities and programs along with new experimental facilities and computational enhancements to support these programs. The Advanced Simulation and Computing Program (ASC) is a cornerstone of the SSP, providing simulation capabilities and computational resources to support the annual stockpile assessment and certification, to study advanced nuclear-weapons design and manufacturing processes, to analyze accident scenarios and weapons aging, and to provide the tools to enable Stockpile Life Extension Programs (SLEPs) and the resolution of Significant Finding Investigations (SFIs). This requires a balanced resource, including technical staff, hardware, simulation software, and computer science solutions. In its first decade, the ASC strategy focused on demonstrating simulation capabilities of unprecedented scale in three spatial dimensions. In its second decade, ASC is focused on increasing its predictive capabilities in a three-dimensional simulation environment while maintaining the support to the SSP. The program continues to improve its unique tools for solving progressively more difficult stockpile problems (focused on sufficient resolution, dimensionality and scientific details); to quantify critical margins and uncertainties (QMU); and to resolve increasingly difficult analyses needed for the SSP. Moreover, ASC has restructured its business model from

  17. Fiscal year 1999 multi-year work plan, advanced reactors transition program

    SciTech Connect

    Gantt, D.A.

    1998-09-17

    The Advanced Reactors Transition (ART) has two missions. One, funded by DOE-EM is to transition assigned, surplus facilities to a safe and compliant, low-cost stable, deactivated condition (requiring minimal surveillance and maintenance) pending eventual reuse or D and D. Facilities to be transitioned include the 309 Building/Plutonium Recycle Test Reactor (PRTR) and Nuclear Energy (NE) Legacy Facilities. The second mission, funded by DOE-NE, is to maintain the Fast Flux Test Facility (FFTF) and affiliated 400 Area buildings in a safe and compliant standby condition. The condition of the plant hardware, software and personnel is to be preserved in a manner not to preclude a plant restart.

  18. A Plan for Advanced Guidance and Control Technology for 2nd Generation Reusable Launch Vehicles

    NASA Technical Reports Server (NTRS)

    Hanson, John M.; Fogle, Frank (Technical Monitor)

    2002-01-01

    Advanced guidance and control (AG&C) technologies are critical for meeting safety/reliability and cost requirements for the next generation of reusable launch vehicle (RLV). This becomes clear upon examining the number of expendable launch vehicle failures in the recent past where AG&C technologies would have saved a RLV with the same failure mode, the additional vehicle problems where this technology applies, and the costs associated with mission design with or without all these failure issues. The state-of-the-art in guidance and control technology, as well as in computing technology, is at the point where we can took to the possibility of being able to safely return a RLV in any situation where it can physically be recovered. This paper outlines reasons for AG&C, current technology efforts, and the additional work needed for making this goal a reality.

  19. The intention of advanced practice registered nurses to remain in positions at family planning clinics serving low-income women.

    PubMed

    Cheng, An-Lin; Kelly, Patricia J; Carlson, Kimberly; Witt, Jacki

    2014-01-01

    Federally funded Title X Family Planning Clinics are critical safety nets for reproductive health services in which advanced practice nurses (APRNs) provide the majority of care. The goal of this study was to identify factors affecting APRN's intention to remain in positions at these clinics. An Internet-administered survey was completed by 406 APRNs working in Title X clinics. The survey, based on a causal model of retention adapted for APRN practice, included 10 factors. Factor significance and model selection criteria were used to determine model fit. Intention to remain in current positions was associated with greater family responsibilities and lower levels of involvement in professional associations. Less routinization, more integration, and a greater sense of distributive justice were significant causal paths to job satisfaction (a significant mediator for intention to remain). Results provide Title X administrators information that can guide them in policy development to maximize APRN retention. PMID:24503318

  20. Planned preoperative radiation therapy vs. definitive radiotherapy for advanced laryngeal carcinoma

    SciTech Connect

    Kazem, I.; van den Broek, P.

    1984-10-01

    In the period 1970-1980 inclusive, 191 patients with T3T4 laryngeal carcinoma (glottic: 63 and supraglottic: 128) received either definitive radiation therapy (RT) (60-65 Gy in 6-7 weeks) or planned preoperative radiation therapy (25 Gy in 5 equal daily fractions of 5 Gy) followed by laryngectomy with or without neck dissection (RT + S). Selection for RT vs. RT + S was based on medical operability and/or patient's refusal to undergo surgery. All patients are evaluable with minimum of 2 years observation. Crude 5 and 10-year survival probability for 32 patients with glottic localization who received RT is 55% and 38% vs. 65% and 65% respectively for 31 treated with RT + S. For 52 patients with supraglottic site who received RT, the 5 and 10-year survival is 44% and 44% vs. 82% and 60% for 76 patients treated with RT + S.

  1. A Broadly Adaptive Array of Dose-Constraint Templates for Planning of Intensity-Modulated Radiation Therapy for Advanced T-Stage Nasopharyngeal Carcinoma

    SciTech Connect

    Chau, R.M.-C. Leung, S.-F.; Kam, M.K.-M.; Cheung, K.-Y.; Kwan, W.-H.; Yu, K.-H.; Chiu, K.-W.; Cheung, M.L.-M.; Chan, A.T.-C.

    2009-05-01

    Purpose: To develop and validate adaptive dose-constraint templates in intensity-modulated radiotherapy (IMRT) planning for advanced T-stage nasopharyngeal carcinoma (NPC). Method and Materials: Dose-volume histograms of clinically approved plans for 20 patients with advanced T-stage NPC were analyzed, and the pattern of distribution in relation to the degree of overlap between targets and organs at risk (OARs) was explored. An adaptive dose constraint template (ADCT) was developed based on the degree of overlap. Another set of 10 patients with advanced T-stage NPC was selected for validation. Results of the manual arm optimization protocol and the ADCT optimization protocol were compared with respect to dose optimization time, conformity indices, multiple-dose end points, tumor control probability, and normal tissue complication probability. Results: For the ADCT protocol, average time required to achieve an acceptable plan was 9 minutes, with one optimization compared with 94 minutes with more than two optimizations of the manual arm protocol. Target coverage was similar between the manual arm and ADCT plans. A more desirable dose distribution in the region of overlap between planning target volume and OARs was achieved in the ADCT plan. Dose end points of OARs were similar between the manual arm and ADCT plans. Conclusions: With the developed ADCT, IMRT treatment planning becomes more efficient and less dependent on the planner's experience on dose optimization. The developed ADCT is applicable to a wide range of advanced T-stage NPC treatment and has the potential to be applied in a broader context to IMRT planning for other cancer sites.

  2. Barriers to Advance Care Planning at the End of Life: An Explanatory Systematic Review of Implementation Studies

    PubMed Central

    Lund, Susi; Richardson, Alison; May, Carl

    2015-01-01

    Context Advance Care Plans (ACPs) enable patients to discuss and negotiate their preferences for the future including treatment options at the end of life. Their implementation poses significant challenges. Objective To investigate barriers and facilitators to the implementation of ACPs, focusing on their workability and integration in clinical practice. Design An explanatory systematic review of qualitative implementation studies. Data sources Empirical studies that reported interventions designed to support ACP in healthcare. Web of Knowledge, Ovid MEDLINE, CINAHL, PsycINFO, British Nursing Index and PubMed databases were searched. Methods Direct content analysis, using Normalization Process Theory, to identify and characterise relevant components of implementation processes. Results 13 papers identified from 166 abstracts were included in the review. Key factors facilitating implementation were: specially prepared staff utilizing a structured approach to interactions around ACPs. Barriers to implementation were competing demands of other work, the emotional and interactional nature of patient-professional interactions around ACPs, problems in sharing decisions and preferences within and between healthcare organizations. Conclusions This review demonstrates that doing more of the things that facilitate delivery of ACPs will not reduce the effects of those things that undermine them. Structured tools are only likely to be partially effective and the creation of a specialist cadre of ACP facilitators is unlikely to be a sustainable solution. The findings underscore both the challenge and need to find ways to routinely incorporate ACPs in clinical settings where multiple and competing demands impact on practice. Interventions most likely to meet with success are those that make elements of Advance Care Planning workable within complex and time pressured clinical workflows. PMID:25679395

  3. Strategic Plan for Nuclear Energy -- Knowledge Base for Advanced Modeling and Simulation (NE-KAMS)

    SciTech Connect

    Rich Johnson; Kimberlyn C. Mousseau; Hyung Lee

    2011-09-01

    NE-KAMS knowledge base will assist computational analysts, physics model developers, experimentalists, nuclear reactor designers, and federal regulators by: (1) Establishing accepted standards, requirements and best practices for V&V and UQ of computational models and simulations, (2) Establishing accepted standards and procedures for qualifying and classifying experimental and numerical benchmark data, (3) Providing readily accessible databases for nuclear energy related experimental and numerical benchmark data that can be used in V&V assessments and computational methods development, (4) Providing a searchable knowledge base of information, documents and data on V&V and UQ, and (5) Providing web-enabled applications, tools and utilities for V&V and UQ activities, data assessment and processing, and information and data searches. From its inception, NE-KAMS will directly support nuclear energy research, development and demonstration programs within the U.S. Department of Energy (DOE), including the Consortium for Advanced Simulation of Light Water Reactors (CASL), the Nuclear Energy Advanced Modeling and Simulation (NEAMS), the Light Water Reactor Sustainability (LWRS), the Small Modular Reactors (SMR), and the Next Generation Nuclear Power Plant (NGNP) programs. These programs all involve computational modeling and simulation (M&S) of nuclear reactor systems, components and processes, and it is envisioned that NE-KAMS will help to coordinate and facilitate collaboration and sharing of resources and expertise for V&V and UQ across these programs. In addition, from the outset, NE-KAMS will support the use of computational M&S in the nuclear industry by developing guidelines and recommended practices aimed at quantifying the uncertainty and assessing the applicability of existing analysis models and methods. The NE-KAMS effort will initially focus on supporting the use of computational fluid dynamics (CFD) and thermal hydraulics (T/H) analysis for M&S of nuclear

  4. Advanced satellite workstation: An integrated workstation environment for operational support of satellite system planning and analysis

    NASA Technical Reports Server (NTRS)

    Sutton, Stewart A.

    1992-01-01

    A prototype integrated environment, the Advanced Satellite Workstation (ASW), is described that has been developed and delivered for evaluation and operator feedback in an operational satellite control center. The current ASW hardware consists of a Sun Workstation and Macintosh II Workstation connected via an ethernet Network Hardware and Software, Laser Disk System, Optical Storage System, and Telemetry Data File Interface. The central mission of ASW is to provide an intelligent decision support and training environment for operator/analysts of complex systems such as satellites. There have been many workstation implementations recently which incorporate graphical telemetry displays and expert systems. ASW is a considerably broader look at intelligent, integrated environments for decision support, based upon the premise that the central features of such an environment are intelligent data access and integrated toolsets. A variety of tools have been constructed in support of this prototype environment including: an automated pass planner for scheduling vehicle support activities, architectural modeler for hierarchical simulation and analysis of satellite vehicle subsystems, multimedia-based information systems that provide an intuitive and easily accessible interface to Orbit Operations Handbook and other relevant support documentation, and a data analysis architecture that integrates user modifiable telemetry display systems, expert systems for background data analysis, and interfaces to the multimedia system via inter-process communication.

  5. DOE Advanced Controls R&D Planning Workshop, June 11, 2003, Washington DC: Workshop Results

    SciTech Connect

    Brambley, Michael R.; Haves, Philip; McDonald, Sean C.; Torcellini, Paul; Hansen, David G.; Holmberg, David; Roth, Kurt

    2005-04-13

    On June 11, 2003, representatives from universities, federal and state government agencies, Department of Energy national laboratories, and the private sector attended a one-day workshop in Washington, DC. The objective of the workshop was to review and provide input into DOE's assessment of the market for advanced sensors and controls technology and potential R&D pathways to enhance their success in the buildings market place. The workshop consisted of two sessions. During the morning session, participants were given an overview on the following topics: market assessment, current applications and strategies for new applications, sensors and controls, networking, security, and protocols and standards, and automated diagnostics, performance measurement, commissioning and optimal control and tools. In the sessions, workshop participants were asked to review the potential R&D pathways, identify high priority activities, and outline a five year path for each of these activities. Priorities were as follows: largest and quickest impact; best use of finite resources; greatest likelihood for market penetration; and ability to replicate results. The participants identified several promising R&D opportunities.

  6. Comparative study of four advanced 3d-conformal radiation therapy treatment planning techniques for head and neck cancer

    PubMed Central

    Herrassi, Mohamed Yassine; Bentayeb, Farida; Malisan, Maria Rosa

    2013-01-01

    For the head-and-neck cancer bilateral irradiation, intensity-modulated radiation therapy (IMRT) is the most reported technique as it enables both target dose coverage and organ-at-risk (OAR) sparing. However, during the last 20 years, three-dimensional conformal radiotherapy (3DCRT) techniques have been introduced, which are tailored to improve the classic shrinking field technique, as regards both planning target volume (PTV) dose conformality and sparing of OAR’s, such as parotid glands and spinal cord. In this study, we tested experimentally in a sample of 13 patients, four of these advanced 3DCRT techniques, all using photon beams only and a unique isocentre, namely Bellinzona, Forward-Planned Multisegments (FPMS), ConPas, and field-in-field (FIF) techniques. Statistical analysis of the main dosimetric parameters of PTV and OAR’s DVH’s as well as of homogeneity and conformity indexes was carried out in order to compare the performance of each technique. The results show that the PTV dose coverage is adequate for all the techniques, with the FPMS techniques providing the highest value for D95%; on the other hand, the best sparing of parotid glands is achieved using the FIF and ConPas techniques, with a mean dose of 26 Gy to parotid glands for a PTV prescription dose of 54 Gy. After taking into account both PTV coverage and parotid sparing, the best global performance was achieved by the FIF technique with results comparable to that of IMRT plans. This technique can be proposed as a valid alternative when IMRT equipment is not available or patient is not suitable for IMRT treatment. PMID:23776314

  7. Intensity-Modulated Radiotherapy for Locally Advanced Non-Small-Cell Lung Cancer: A Dose-Escalation Planning Study

    SciTech Connect

    Lievens, Yolande; Nulens, An; Gaber, Mousa Amr; Defraene, Gilles; De Wever, Walter; Stroobants, Sigrid; Van den Heuvel, Frank

    2011-05-01

    Purpose: To evaluate the potential for dose escalation with intensity-modulated radiotherapy (IMRT) in positron emission tomography-based radiotherapy planning for locally advanced non-small-cell lung cancer (LA-NSCLC). Methods and Materials: For 35 LA-NSCLC patients, three-dimensional conformal radiotherapy and IMRT plans were made to a prescription dose (PD) of 66 Gy in 2-Gy fractions. Dose escalation was performed toward the maximal PD using secondary endpoint constraints for the lung, spinal cord, and heart, with de-escalation according to defined esophageal tolerance. Dose calculation was performed using the Eclipse pencil beam algorithm, and all plans were recalculated using a collapsed cone algorithm. The normal tissue complication probabilities were calculated for the lung (Grade 2 pneumonitis) and esophagus (acute toxicity, grade 2 or greater, and late toxicity). Results: IMRT resulted in statistically significant decreases in the mean lung (p <.0001) and maximal spinal cord (p = .002 and 0005) doses, allowing an average increase in the PD of 8.6-14.2 Gy (p {<=}.0001). This advantage was lost after de-escalation within the defined esophageal dose limits. The lung normal tissue complication probabilities were significantly lower for IMRT (p <.0001), even after dose escalation. For esophageal toxicity, IMRT significantly decreased the acute NTCP values at the low dose levels (p = .0009 and p <.0001). After maximal dose escalation, late esophageal tolerance became critical (p <.0001), especially when using IMRT, owing to the parallel increases in the esophageal dose and PD. Conclusion: In LA-NSCLC, IMRT offers the potential to significantly escalate the PD, dependent on the lung and spinal cord tolerance. However, parallel increases in the esophageal dose abolished the advantage, even when using collapsed cone algorithms. This is important to consider in the context of concomitant chemoradiotherapy schedules using IMRT.

  8. Replacement of Cross-Site Transfer System Startup Plan

    SciTech Connect

    Gerken, M.D.

    1996-01-01

    This Startup Plan provides a discussion of organizational responsibilities, work planning, quality assurance (QA), personnel qualifications, and testing requirements for the Cross-Site Transfer System.

  9. Building on Individual, State, and Federal Initiatives for Advance Care Planning, an Integral Component of Palliative and End-of-Life Cancer Care

    PubMed Central

    Epstein, Andrew S.; Volandes, Angelo E.; O'Reilly, Eileen M.

    2011-01-01

    Federal and state provisions for advance care planning—the process by which patients, families, and medical professionals plan for future and, in particular, end-of-life care—continue to receive attention. Such planning remains an integral component of palliative care, complementing the recognition and treatment of pain and other symptoms that patients with advanced malignancies and their families encounter. Historically, advance care planning interventions (particularly those involving advance directives) have been unable to consistently demonstrate positive outcomes for patients with life-threatening illnesses. However, more recent literature, including that on patients with cancer, illustrates that both patients and caregivers report improved quality of life and less distress after discussions with their health care teams about end-of-life care. Herein, we discuss recent federal and state public policy that focuses on advance care planning, suggesting the promise for care delivery improvements and the means by which existing barriers might be surmounted. These care delivery issues apply to several disease states but are particularly pertinent to the adult oncology setting. PMID:22379415

  10. Using 3D printed models for planning and guidance during endovascular intervention: a technical advance

    PubMed Central

    Itagaki, Michael W.

    2015-01-01

    Three-dimensional (3D) printing applications in medicine have been limited due to high cost and technical difficulty of creating 3D printed objects. It is not known whether patient-specific, hollow, small-caliber vascular models can be manufactured with 3D printing, and used for small vessel endoluminal testing of devices. Manufacture of anatomically accurate, patient-specific, small-caliber arterial models was attempted using data from a patient’s CT scan, free open-source software, and low-cost Internet 3D printing services. Prior to endovascular treatment of a patient with multiple splenic artery aneurysms, a 3D printed model was used preoperatively to test catheter equipment and practice the procedure. A second model was used intraoperatively as a reference. Full-scale plastic models were successfully produced. Testing determined the optimal puncture site for catheter positioning. A guide catheter, base catheter, and microcatheter combination selected during testing was used intraoperatively with success, and the need for repeat angiograms to optimize image orientation was minimized. A difficult and unconventional procedure was successful in treating the aneurysms while preserving splenic function. We conclude that creation of small-caliber vascular models with 3D printing is possible. Free software and low-cost printing services make creation of these models affordable and practical. Models are useful in preoperative planning and intraoperative guidance. PMID:26027767

  11. Using 3D printed models for planning and guidance during endovascular intervention: a technical advance.

    PubMed

    Itagaki, Michael W

    2015-01-01

    Three-dimensional (3D) printing applications in medicine have been limited due to high cost and technical difficulty of creating 3D printed objects. It is not known whether patient-specific, hollow, small-caliber vascular models can be manufactured with 3D printing, and used for small vessel endoluminal testing of devices. Manufacture of anatomically accurate, patient-specific, small-caliber arterial models was attempted using data from a patient's CT scan, free open-source software, and low-cost Internet 3D printing services. Prior to endovascular treatment of a patient with multiple splenic artery aneurysms, a 3D printed model was used preoperatively to test catheter equipment and practice the procedure. A second model was used intraoperatively as a reference. Full-scale plastic models were successfully produced. Testing determined the optimal puncture site for catheter positioning. A guide catheter, base catheter, and microcatheter combination selected during testing was used intraoperatively with success, and the need for repeat angiograms to optimize image orientation was minimized. A difficult and unconventional procedure was successful in treating the aneurysms while preserving splenic function. We conclude that creation of small-caliber vascular models with 3D printing is possible. Free software and low-cost printing services make creation of these models affordable and practical. Models are useful in preoperative planning and intraoperative guidance. PMID:26027767

  12. DOE Advanced Scientific Computing Advisory Committee (ASCAC) Report: Exascale Computing Initiative Review

    SciTech Connect

    Reed, Daniel; Berzins, Martin; Pennington, Robert; Sarkar, Vivek; Taylor, Valerie

    2015-08-01

    On November 19, 2014, the Advanced Scientific Computing Advisory Committee (ASCAC) was charged with reviewing the Department of Energy’s conceptual design for the Exascale Computing Initiative (ECI). In particular, this included assessing whether there are significant gaps in the ECI plan or areas that need to be given priority or extra management attention. Given the breadth and depth of previous reviews of the technical challenges inherent in exascale system design and deployment, the subcommittee focused its assessment on organizational and management issues, considering technical issues only as they informed organizational or management priorities and structures. This report presents the observations and recommendations of the subcommittee.

  13. Research Models of the Future for Industrial and Organizational Psychology.

    ERIC Educational Resources Information Center

    Barrett, Gerald V.

    This paper presents three different aspects of research in industrial and organizational psychology. First, characteristics of major advances in science, and in the social and behavioral sciences are given, including: (1) team research is more common for major advances; and (2) young men under 35 are responsible for many major contributions.…

  14. Organizational Considerations for Advanced Manufacturing Technology

    ERIC Educational Resources Information Center

    DeRuntz, Bruce D.; Turner, Roger M.

    2003-01-01

    In the last several decades, the United States has experienced a decline in productivity, while the world has seen a maturation of the global marketplace. Nations have moved manufacturing strategy and process technology issues to the top of management priority lists. The issues surrounding manufacturing technologies and their implementations have…

  15. Organizational change theory: implications for health promotion practice.

    PubMed

    Batras, Dimitri; Duff, Cameron; Smith, Ben J

    2016-03-01

    Sophisticated understandings of organizational dynamics and processes of organizational change are crucial for the development and success of health promotion initiatives. Theory has a valuable contribution to make in understanding organizational change, for identifying influential factors that should be the focus of change efforts and for selecting the strategies that can be applied to promote change. This article reviews select organizational change models to identify the most pertinent insights for health promotion practitioners. Theoretically derived considerations for practitioners who seek to foster organizational change include the extent to which the initiative is modifiable to fit with the internal context; the amount of time that is allocated to truly institutionalize change; the ability of the agents of change to build short-term success deliberately into their implementation plan; whether or not the shared group experience of action for change is positive or negative and the degree to which agencies that are the intended recipients of change are resourced to focus on internal factors. In reviewing theories of organizational change, the article also addresses strategies for facilitating the adoption of key theoretical insights into the design and implementation of health promotion initiatives in diverse organizational settings. If nothing else, aligning health promotion with organizational change theory promises insights into what it is that health promoters do and the time that it can take to do it effectively. PMID:25398838

  16. Organizational-skills interventions in the treatment of ADHD.

    PubMed

    Langberg, Joshua M; Epstein, Jeffery N; Graham, Amanda J

    2008-10-01

    Children with attention-deficit/hyperactivity disorder (ADHD) often experience problems with temporal and materials organization. These difficulties remain prominent throughout development. For children, organizational problems are most apparent in the school setting and result in impairments such as lost and forgotten homework assignments and inadequate planning for tests. Temporal aspects of organization tend to be most salient for adults with ADHD and manifest as procrastination and missed appointments and deadlines. Skills and strategy training interventions have been developed to address the organizational problems of children and adults with ADHD. Patients are taught systems for managing their time and materials more effectively. Contingency management is often used in conjunction with organizational skills training to promote the use of organizational skills and their generalization. Organizational skills interventions have been evaluated as standalone interventions and part of multicomponent interventions for children, adolescents and adults with ADHD. These interventions are associated with significant improvements in the organization of materials, homework management, time management and planning. There is also some evidence to suggest that organizational improvements lead to reductions in ADHD symptoms and gains in academic functioning. Additional research using randomized controlled research designs and long-term follow-up evaluation is necessary before organizational interventions may be considered established evidence-based interventions for patients with ADHD. PMID:18928347

  17. The Impact of Training Interventions on Organizational Readiness to Support Innovations in Juvenile Justice Offices

    PubMed Central

    Taxman, Faye S.; Henderson, Craig; Young, Doug; Farrell, Jill

    2012-01-01

    OBJECTIVE Clinical trials on technology transfer models are rare, even with the interest in advancing the uptake of evidence-based practices in social service agencies. This article presents the results from a trial examining different transfer strategies to assist juvenile justice caseworkers in using screening, assessment, and case planning practices to address mental health and substance use needs. Study findings examine factors that promote organizational readiness. METHODS A clinical trial was conducted examining the mpact of three post-training strategies: an external coach to build the social network of the justice office (build social climate), an external coach to educate staff (build skills and knowledge), and a control condition consisting of traditional management directives (directives to staff of agency priorities). All groups were exposed to a one day refresher course in motivational interviewing. The social network and skill building groups also attended an intensive three-day training followed by three on-site booster sessions over a 12 month period of time. Twelve juvenile justice offices (with their 231 juvenile justice staff) were assigned to one of three conditions. The study examined the impact of different transfer conditions on organizational readiness to implement the innovation of screening, assessment, and referral strategies. RESULTS External coaching targeting the social climate of the justice office to support innovations improved organizational readiness to change, regardless of office size. Coaching that targeted either the social climate or staff knowledge and skills both improved organizational readiness for change compared to management directives, but social climate coaching resulted in greater improvements in receptivity to change. No individual level features of case workers (e.g., age, gender, years of experience) significantly predicted organizational readiness to change. Unexpectedly, the skill and knowledge building

  18. The impact of training interventions on organizational readiness to support innovations in juvenile justice offices.

    PubMed

    Taxman, Faye S; Henderson, Craig; Young, Doug; Farrell, Jill

    2014-03-01

    Clinical trials on technology transfer models are rare, even with the interest in advancing the uptake of evidence-based practices in social service agencies. This article presents the results from a trial examining different transfer strategies to assist juvenile justice caseworkers in using screening, assessment, and case planning practices to address mental health and substance use needs. Study findings examine factors that promote organizational readiness. A clinical trial was conducted examining the impact of three post-training strategies: an external coach to build the social network of the justice office (build social climate), an external coach to educate staff (build skills and knowledge), and a control condition consisting of traditional management directives (directives to staff of agency priorities). All groups were exposed to a 1 day refresher course in motivational interviewing. The social network and skill building groups also attended an intensive 3-day training followed by three on-site booster sessions over a 12 month period of time. Twelve juvenile justice offices (with their 231 juvenile justice staff) were assigned to one of three conditions. The study examined the impact of different transfer conditions on organizational readiness to implement the innovation of screening, assessment, and referral strategies. External coaching targeting the social climate of the justice office to support innovations improved organizational readiness to change, regardless of office size. Coaching that targeted either the social climate or staff knowledge and skills both improved organizational readiness for change compared to management directives, but social climate coaching resulted in greater improvements in receptivity to change. No individual level features of case workers (e.g., age, gender, years of experience) significantly predicted organizational readiness to change. Unexpectedly, the skill and knowledge building approach did not perform any better

  19. Does Organizational Forgetting Matter? Organizational Survival for Life Coaching Companies

    ERIC Educational Resources Information Center

    Aydin, Erhan; Gormus, Alparslan Sahin

    2015-01-01

    Purpose: The purposes of this paper are to determine the role of organizational forgetting in different type of coaching companies and to determine organizational survival based on both knowledge structure of coaching companies and organizational forgetting with core features of organizations. Design/methodology/approach: Within the context of…

  20. Organizational Citizenship and Organizational Justice in Turkish Primary Schools

    ERIC Educational Resources Information Center

    Yilmaz, Kursad; Tasdan, Murat

    2009-01-01

    Purpose: The purpose of this study is to determine primary school teachers' perceptions regarding organizational citizenship and organizational justice. The study also aims to determine whether such perceptions vary depending on the variables of gender, field of study and seniority, and whether organizational citizenship behaviors and…