Evaluation of New Zealand's high-seas bottom trawl closures using predictive habitat models and quantitative risk assessment.

PubMed

Penney, Andrew J; Guinotte, John M

2013-01-01

United Nations General Assembly Resolution 61/105 on sustainable fisheries (UNGA 2007) establishes three difficult questions for participants in high-seas bottom fisheries to answer: 1) Where are vulnerable marine systems (VMEs) likely to occur?; 2) What is the likelihood of fisheries interaction with these VMEs?; and 3) What might qualify as adequate conservation and management measures to prevent significant adverse impacts? This paper develops an approach to answering these questions for bottom trawling activities in the Convention Area of the South Pacific Regional Fisheries Management Organisation (SPRFMO) within a quantitative risk assessment and cost : benefit analysis framework. The predicted distribution of deep-sea corals from habitat suitability models is used to answer the first question. Distribution of historical bottom trawl effort is used to answer the second, with estimates of seabed areas swept by bottom trawlers being used to develop discounting factors for reduced biodiversity in previously fished areas. These are used in a quantitative ecological risk assessment approach to guide spatial protection planning to address the third question. The coral VME likelihood (average, discounted, predicted coral habitat suitability) of existing spatial closures implemented by New Zealand within the SPRFMO area is evaluated. Historical catch is used as a measure of cost to industry in a cost : benefit analysis of alternative spatial closure scenarios. Results indicate that current closures within the New Zealand SPRFMO area bottom trawl footprint are suboptimal for protection of VMEs. Examples of alternative trawl closure scenarios are provided to illustrate how the approach could be used to optimise protection of VMEs under chosen management objectives, balancing protection of VMEs against economic loss to commercial fishers from closure of historically fished areas.

40 CFR 264.151 - Wording of the instruments.

Code of Federal Regulations, 2013 CFR

2013-07-01

... assurance for closure or post-closure care is demonstrated through the financial test specified in subpart H... parts 264 and 265. The current closure and/or post-closure cost estimates covered by such a test are... CFR parts 264 and 265. The current closure and/or post-closure cost estimate covered by the test are...

40 CFR 264.151 - Wording of the instruments.

Code of Federal Regulations, 2012 CFR

2012-07-01

... assurance for closure or post-closure care is demonstrated through the financial test specified in subpart H... parts 264 and 265. The current closure and/or post-closure cost estimates covered by such a test are... CFR parts 264 and 265. The current closure and/or post-closure cost estimate covered by the test are...

40 CFR 264.151 - Wording of the instruments.

Code of Federal Regulations, 2010 CFR

2010-07-01

... assurance for closure or post-closure care is demonstrated through the financial test specified in subpart H... parts 264 and 265. The current closure and/or post-closure cost estimates covered by such a test are... CFR parts 264 and 265. The current closure and/or post-closure cost estimate covered by the test are...

40 CFR 264.144 - Cost estimate for post-closure care.

Code of Federal Regulations, 2011 CFR

2011-07-01

... § 264.145. For owners or operators using the financial test or corporate guarantee, the post-closure... 40 Protection of Environment 26 2011-07-01 2011-07-01 false Cost estimate for post-closure care... FACILITIES Financial Requirements § 264.144 Cost estimate for post-closure care. (a) The owner or operator of...

40 CFR 264.144 - Cost estimate for post-closure care.

Code of Federal Regulations, 2012 CFR

2012-07-01

... § 264.145. For owners or operators using the financial test or corporate guarantee, the post-closure... 40 Protection of Environment 27 2012-07-01 2012-07-01 false Cost estimate for post-closure care... FACILITIES Financial Requirements § 264.144 Cost estimate for post-closure care. (a) The owner or operator of...

40 CFR 264.144 - Cost estimate for post-closure care.

Code of Federal Regulations, 2013 CFR

2013-07-01

... § 264.145. For owners or operators using the financial test or corporate guarantee, the post-closure... 40 Protection of Environment 27 2013-07-01 2013-07-01 false Cost estimate for post-closure care... FACILITIES Financial Requirements § 264.144 Cost estimate for post-closure care. (a) The owner or operator of...

40 CFR 264.144 - Cost estimate for post-closure care.

Code of Federal Regulations, 2010 CFR

2010-07-01

... § 264.145. For owners or operators using the financial test or corporate guarantee, the post-closure... 40 Protection of Environment 25 2010-07-01 2010-07-01 false Cost estimate for post-closure care... FACILITIES Financial Requirements § 264.144 Cost estimate for post-closure care. (a) The owner or operator of...

Dynamic modelling of costs and health consequences of school closure during an influenza pandemic

PubMed Central

2012-01-01

Background The purpose of this article is to evaluate the cost-effectiveness of school closure during a potential influenza pandemic and to examine the trade-off between costs and health benefits for school closure involving different target groups and different closure durations. Methods We developed two models: a dynamic disease model capturing the spread of influenza and an economic model capturing the costs and benefits of school closure. Decisions were based on quality-adjusted life years gained using incremental cost-effectiveness ratios. The disease model is an age-structured SEIR compartmental model based on the population of Oslo. We studied the costs and benefits of school closure by varying the age targets (kindergarten, primary school, secondary school) and closure durations (1–10 weeks), given pandemics with basic reproductive number of 1.5, 2.0 or 2.5. Results The cost-effectiveness of school closure varies depending on the target group, duration and whether indirect costs are considered. Using a case fatality rate (CFR) of 0.1-0.2% and with current cost-effectiveness threshold for Norway, closing secondary school is the only cost-effective strategy, when indirect costs are included. The most cost-effective strategies would be closing secondary schools for 8 weeks if R0=1.5, 6 weeks if R0=2.0, and 4 weeks if R0= 2.5. For severe pandemics with case fatality rates of 1-2%, similar to the Spanish flu, or when indirect costs are disregarded, the optimal strategy is closing kindergarten, primary and secondary school for extended periods of time. For a pandemic with 2009 H1N1 characteristics (mild severity and low transmissibility), closing schools would not be cost-effective, regardless of the age target of school children. Conclusions School closure has moderate impact on the epidemic’s scope, but the resulting disruption to society imposes a potentially great cost in terms of lost productivity from parents’ work absenteeism. PMID:23140513

Economic evaluation of influenza pandemic mitigation strategies in the us using a stochastic microsimulation transmission model

PubMed Central

Sander, Beate; Nizam, Azhar; Garrison, Louis P.; Postma, Maarten J.; Halloran, M. Elizabeth; Longini, Ira M.

2013-01-01

Objectives To project the potential economic impact of pandemic influenza mitigation strategies from a societal perspective in the United States. Methods We use a stochastic agent-based model to simulate pandemic influenza in the community. We compare 17 strategies: targeted antiviral prophylaxis (TAP) alone and in combination with school closure as well as prevaccination. Results In the absence of intervention, we predict a 50% attack rate with an economic impact of $187 per capita as loss to society. Full TAP is the most effective single strategy, reducing number of cases by 54% at the lowest cost to society ($127 per capita). Prevaccination reduces number of cases by 48% and is the second least costly alternative ($140 per capita). Adding school closure to full TAP or prevaccination further improves health outcomes, but increases total cost to society by approximately $2700 per capita. Conclusion Full targeted antiviral prophylaxis is an effective and cost-saving measure for mitigating pandemic influenza. PMID:18671770

40 CFR 265.1202 - Closure and post-closure care.

Code of Federal Regulations, 2010 CFR

2010-07-01

... post-closure care. (a) At closure of a magazine or unit which stored hazardous waste under this subpart... estimates for closure, and financial responsibility for magazines or units must meet all of the requirements... as long as it remains in service as a munitions or explosives magazine or storage unit. (b) If, after...

Suitable closure for post-duodenal endoscopic resection taking medical costs into consideration

PubMed Central

Mori, Hirohito; Ayaki, Maki; Kobara, Hideki; Fujihara, Shintaro; Nishiyama, Noriko; Matsunaga, Tae; Yachida, Tatsuo; Masaki, Tsutomu

2015-01-01

AIM: To compare closure methods, closure times and medical costs between two groups of patients who had post-endoscopic resection (ER) artificial ulcer floor closures. METHODS: Nineteen patients with duodenal adenoma, early duodenal cancer, and subepithelial tumors that received ER between September 2009 and September 2014 at Kagawa University Hospital and Ehime Rosai Hospital, an affiliated hospital of Kagawa University, were included in the study. We retrospectively compared two groups of patients who received post-ER artificial ulcer floor closure: the conventional clip group vs the over-the-scope clip (OTSC) group. Delayed bleeding, procedure time of closure, delayed perforation, total number of conventional clips and OTSCs and medical costs were analyzed. RESULTS: Although we observed delayed bleeding in three patients in the conventional clip group, we observed no delayed bleeding in the OTSC group (P = 0.049). We did not observe perforation in either group. The mean procedure times for ulcer closure were 33.26 ± 12.57 min and 9.71 ± 2.92 min, respectively (P = 0.0001). The resection diameters were 18.8 ± 1.30 mm and 22.9 ± 1.21 mm for the conventional clip group and the OTSC group, respectively, with significant difference (P = 0.039). As for medical costs, the costs of all conventional clips were USD $1257 and the costs of OTSCs were $7850 (P = 0.005). If the post-ER ulcer is under 20 mm in diameter, a conventional clip closure may be more suitable with regard to the prevention of delayed perforation and to medical costs. CONCLUSION: If the post-ER ulcer is over 20 mm, the OTSC closure should be selected with regard to safety and reliable closure even if there are high medical costs. PMID:25954101

Suitable closure for post-duodenal endoscopic resection taking medical costs into consideration.

PubMed

Mori, Hirohito; Ayaki, Maki; Kobara, Hideki; Fujihara, Shintaro; Nishiyama, Noriko; Matsunaga, Tae; Yachida, Tatsuo; Masaki, Tsutomu

2015-05-07

To compare closure methods, closure times and medical costs between two groups of patients who had post-endoscopic resection (ER) artificial ulcer floor closures. Nineteen patients with duodenal adenoma, early duodenal cancer, and subepithelial tumors that received ER between September 2009 and September 2014 at Kagawa University Hospital and Ehime Rosai Hospital, an affiliated hospital of Kagawa University, were included in the study. We retrospectively compared two groups of patients who received post-ER artificial ulcer floor closure: the conventional clip group vs the over-the-scope clip (OTSC) group. Delayed bleeding, procedure time of closure, delayed perforation, total number of conventional clips and OTSCs and medical costs were analyzed. Although we observed delayed bleeding in three patients in the conventional clip group, we observed no delayed bleeding in the OTSC group (P = 0.049). We did not observe perforation in either group. The mean procedure times for ulcer closure were 33.26 ± 12.57 min and 9.71 ± 2.92 min, respectively (P = 0.0001). The resection diameters were 18.8 ± 1.30 mm and 22.9 ± 1.21 mm for the conventional clip group and the OTSC group, respectively, with significant difference (P = 0.039). As for medical costs, the costs of all conventional clips were USD $1257 and the costs of OTSCs were $7850 (P = 0.005). If the post-ER ulcer is under 20 mm in diameter, a conventional clip closure may be more suitable with regard to the prevention of delayed perforation and to medical costs. If the post-ER ulcer is over 20 mm, the OTSC closure should be selected with regard to safety and reliable closure even if there are high medical costs.

Travel costs associated with flood closures of state highways near Centralia/Chehalis, Washington.

DOT National Transportation Integrated Search

2014-09-01

This report discusses the travel costs associated with the closure of roads in the greater : Centralia/Chehalis, Washington region due to 100-year flood conditions starting on the Chehalis River. The costs : were computed for roadway closures on I-5,...

40 CFR 264.142 - Cost estimate for closure.

Code of Federal Regulations, 2011 CFR

2011-07-01

... the cost of final closure at the point in the facility's active life when the extent and manner of its... costs for on-site disposal if he can demonstrate that on-site disposal capacity will exist at all times over the life of the facility. (3) The closure cost estimate may not incorporate any salvage value that...

Positive Catch & Economic Benefits of Periodic Octopus Fishery Closures: Do Effective, Narrowly Targeted Actions 'Catalyze' Broader Management?

PubMed

Oliver, Thomas A; Oleson, Kirsten L L; Ratsimbazafy, Hajanaina; Raberinary, Daniel; Benbow, Sophie; Harris, Alasdair

2015-01-01

Eight years of octopus fishery records from southwest Madagascar reveal significant positive impacts from 36 periodic closures on: (a) fishery catches and (b) village fishery income, such that (c) economic benefits from increased landings outweigh costs of foregone catch. Closures covered ~20% of a village's fished area and lasted 2-7 months. Octopus landings and catch per unit effort (CPUE) significantly increased in the 30 days following a closure's reopening, relative to the 30 days before a closure (landings: +718%, p<0.0001; CPUE: +87%, p<0.0001; n = 36). Open-access control sites showed no before/after change when they occurred independently of other management ("no ban", n = 17/36). On the other hand, open-access control sites showed modest catch increases when they extended a 6-week seasonal fishery shutdown ("ban", n = 19/36). The seasonal fishery shutdown affects the entire region, so confound all potential control sites. In villages implementing a closure, octopus fishery income doubled in the 30 days after a closure, relative to 30 days before (+132%, p<0.001, n = 28). Control villages not implementing a closure showed no increase in income after "no ban" closures and modest increases after "ban" closures. Villages did not show a significant decline in income during closure events. Landings in closure sites generated more revenue than simulated landings assuming continued open-access fishing at that site (27/36 show positive net earnings; mean +$305/closure; mean +57.7% monthly). Benefits accrued faster than local fishers' time preferences during 17-27 of the 36 closures. High reported rates of illegal fishing during closures correlated with poor economic performance. We discuss the implications of our findings for broader co-management arrangements, particularly for catalyzing more comprehensive management.

Effectiveness and costs of overland skid trail BMPs

Treesearch

Clay Sawyers; W. Michael Aust; M. Chad Bolding; William A. Lakel III

2012-01-01

Forestry Best Management Practices (BMPs) are designed to protect water quality; however, little data exists comparing the efficacy and costs of different BMP options for skid trail closure. Study objectives were to evaluate erosion control effectiveness and implementation costs of five overland skid trail closure techniques. Closure techniques were: waterbar only (...

Cost-Effectiveness of Percutaneous Closure of the Left Atrial Appendage in Atrial Fibrillation Based on Results From PROTECT AF Versus PREVAIL.

PubMed

Freeman, James V; Hutton, David W; Barnes, Geoffrey D; Zhu, Ruo P; Owens, Douglas K; Garber, Alan M; Go, Alan S; Hlatky, Mark A; Heidenreich, Paul A; Wang, Paul J; Al-Ahmad, Amin; Turakhia, Mintu P

2016-06-01

Randomized trials of left atrial appendage (LAA) closure with the Watchman device have shown varying results, and its cost effectiveness compared with anticoagulation has not been evaluated using all available contemporary trial data. We used a Markov decision model to estimate lifetime quality-adjusted survival, costs, and cost effectiveness of LAA closure with Watchman, compared directly with warfarin and indirectly with dabigatran, using data from the long-term (mean 3.8 year) follow-up of Percutaneous Closure of the Left Atrial Appendage Versus Warfarin Therapy for Prevention of Stroke in Patients With Atrial Fibrillation (PROTECT AF) and Prospective Randomized Evaluation of the Watchman LAA Closure Device in Patients With Atrial Fibrillation (PREVAIL) randomized trials. Using data from PROTECT AF, the incremental cost-effectiveness ratios compared with warfarin and dabigatran were $20 486 and $23 422 per quality-adjusted life year, respectively. Using data from PREVAIL, LAA closure was dominated by warfarin and dabigatran, meaning that it was less effective (8.44, 8.54, and 8.59 quality-adjusted life years, respectively) and more costly. At a willingness-to-pay threshold of $50 000 per quality-adjusted life year, LAA closure was cost effective 90% and 9% of the time under PROTECT AF and PREVAIL assumptions, respectively. These results were sensitive to the rates of ischemic stroke and intracranial hemorrhage for LAA closure and medical anticoagulation. Using data from the PROTECT AF trial, LAA closure with the Watchman device was cost effective; using PREVAIL trial data, Watchman was more costly and less effective than warfarin and dabigatran. PROTECT AF enrolled more patients and has substantially longer follow-up time, allowing greater statistical certainty with the cost-effectiveness results. However, longer-term trial results and postmarketing surveillance of major adverse events will be vital to determining the value of the Watchman in clinical practice. © 2016 American Heart Association, Inc.

Closure of hazardous and mixed radioactive waste management units at DOE facilities. [Contains glossary

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

Not Available

This is document addresses the Federal regulations governing the closure of hazardous and mixed waste units subject to Resource Conservation and Recovery Act (RCRA) requirements. It provides a brief overview of the RCRA permitting program and the extensive RCRA facility design and operating standards. It provides detailed guidance on the procedural requirements for closure and post-closure care of hazardous and mixed waste management units, including guidance on the preparation of closure and post-closure plans that must be submitted with facility permit applications. This document also provides guidance on technical activities that must be conducted both during and after closure ofmore » each of the following hazardous waste management units regulated under RCRA.« less

Comparison of cost-effectiveness and postoperative outcome of device closure and open surgery closure techniques for treatment of patent ductus arteriosus.

PubMed

Ahmadi, Alireza; Sabri, Mohammadreza; Bigdelian, Hamid; Dehghan, Bahar; Gharipour, Mojgan

2014-01-01

Various devices have been recently employed for percutaneous closure of the patent ductus arteriosus (PDA). Although the high effectiveness of device closure techniques has been clearly determined, a few studies have focused on the cost-effectiveness and also postoperative complications of these procedures in comparison with open surgery. The present study aimed to evaluate the clinical outcome and cost-effectiveness of PDA occlusion by Amplatzer and coil device in comparisong with open surgery. In this cross-sectional study, a randomized sample of 201 patients aged 1 month to 16 years (105 patients with device closure and 96 patients with surgical closure) was selected. The ratio of total pulmonary blood flow to total systemic blood flow, the Qp/Qs ratio, was measured using a pulmonary artery catheter. The cost analysis included direct medical care costs associated with device implantation and open surgery, as well as professional fees. All costs were calculated in Iranian Rials and then converted to US dollars. There was no statistical difference in mean Qp/Qs ratio before the procedure between the device closure group and the open surgery group (2.1 ± 0.7 versus 1.7 ± 0.6, P = 0.090). The mean measured costs were overall higher in the device closure group than in open closure group (948.87 ± 548.76 US$ versus 743.70 ± 696.91 US$, P < 0.001). This difference remained significant after adjustment for age and gender (Standardized Beta = 0.160, P = 0.031). PDA closure with the Amplatzer ductal occluder (1053.05 ± 525.73 US$) or with Nit-Occlud coils (PFM) (912.73 ± 565.94 US$, P < 0.001) was more expensive than that via open surgery. However, the Cook detachable spring coils device closure (605.65 ± 194.62 US$, P = 0.650) had a non-significant cost difference with open surgery. No event was observed in the device closure group regarding in-hospital mortality or morbidity; however, in another group, 2 in-hospital deaths occurred, two patients experienced pneumonia and seizure, and one suffered electrolyte abnormalities including hyponatremia and hypocalcemia. Although open surgery seems to be less expensive than device closure technique, because of lower mortality and morbidity, the latter group is more preferable.

40 CFR 265.144 - Cost estimate for post-closure care.

Code of Federal Regulations, 2012 CFR

2012-07-01

... comply with § 265.145. For owners or operators using the financial test or corporate guarantee, the post... 40 Protection of Environment 27 2012-07-01 2012-07-01 false Cost estimate for post-closure care..., STORAGE, AND DISPOSAL FACILITIES Financial Requirements § 265.144 Cost estimate for post-closure care. (a...

40 CFR 265.144 - Cost estimate for post-closure care.

Code of Federal Regulations, 2010 CFR

2010-07-01

... comply with § 265.145. For owners or operators using the financial test or corporate guarantee, the post... 40 Protection of Environment 25 2010-07-01 2010-07-01 false Cost estimate for post-closure care..., STORAGE, AND DISPOSAL FACILITIES Financial Requirements § 265.144 Cost estimate for post-closure care. (a...

40 CFR 265.144 - Cost estimate for post-closure care.

Code of Federal Regulations, 2013 CFR

2013-07-01

... comply with § 265.145. For owners or operators using the financial test or corporate guarantee, the post... 40 Protection of Environment 27 2013-07-01 2013-07-01 false Cost estimate for post-closure care..., STORAGE, AND DISPOSAL FACILITIES Financial Requirements § 265.144 Cost estimate for post-closure care. (a...

40 CFR 265.144 - Cost estimate for post-closure care.

Code of Federal Regulations, 2011 CFR

2011-07-01

... comply with § 265.145. For owners or operators using the financial test or corporate guarantee, the post... 40 Protection of Environment 26 2011-07-01 2011-07-01 false Cost estimate for post-closure care..., STORAGE, AND DISPOSAL FACILITIES Financial Requirements § 265.144 Cost estimate for post-closure care. (a...

40 CFR 265.144 - Cost estimate for post-closure care.

Code of Federal Regulations, 2014 CFR

2014-07-01

... comply with § 265.145. For owners or operators using the financial test or corporate guarantee, the post... 40 Protection of Environment 26 2014-07-01 2014-07-01 false Cost estimate for post-closure care..., STORAGE, AND DISPOSAL FACILITIES Financial Requirements § 265.144 Cost estimate for post-closure care. (a...

Modelling the impact of local reactive school closures on critical care provision during an influenza pandemic

PubMed Central

House, Thomas; Baguelin, Marc; Van Hoek, Albert Jan; White, Peter J.; Sadique, Zia; Eames, Ken; Read, Jonathan M.; Hens, Niel; Melegaro, Alessia; Edmunds, W. John; Keeling, Matt J.

2011-01-01

Despite the fact that the 2009 H1N1 pandemic influenza strain was less severe than had been feared, both seasonal epidemics of influenza-like-illness and future influenza pandemics have the potential to place a serious burden on health services. The closure of schools has been postulated as a means of reducing transmission between children and hence reducing the number of cases at the peak of an epidemic; this is supported by the marked reduction in cases during school holidays observed across the world during the 2009 pandemic. However, a national policy of long-duration school closures could have severe economic costs. Reactive short-duration closure of schools in regions where health services are close to capacity offers a potential compromise, but it is unclear over what spatial scale and time frame closures would need to be made to be effective. Here, using detailed geographical information for England, we assess how localized school closures could alleviate the burden on hospital intensive care units (ICUs) that are reaching capacity. We show that, for a range of epidemiologically plausible assumptions, considerable local coordination of school closures is needed to achieve a substantial reduction in the number of hospitals where capacity is exceeded at the peak of the epidemic. The heterogeneity in demand per hospital ICU bed means that even widespread school closures are unlikely to have an impact on whether demand will exceed capacity for many hospitals. These results support the UK decision not to use localized school closures as a control mechanism, but have far wider international public-health implications. The spatial heterogeneities in both population density and hospital capacity that give rise to our results exist in many developed countries, while our model assumptions are sufficiently general to cover a wide range of pathogens. This leads us to believe that when a pandemic has severe implications for ICU capacity, only widespread school closures (with their associated costs and organizational challenges) are sufficient to mitigate the burden on the worst-affected hospitals. PMID:21288945

Interim Status Closure Plan Open Burning Treatment Unit Technical Area 16-399 Burn Tray

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

Vigil-Holterman, Luciana R.

2012-05-07

This closure plan describes the activities necessary to close one of the interim status hazardous waste open burning treatment units at Technical Area (TA) 16 at the Los Alamos National Laboratory (LANL or the Facility), hereinafter referred to as the 'TA-16-399 Burn Tray' or 'the unit'. The information provided in this closure plan addresses the closure requirements specified in the Code of Federal Regulations (CFR), Title 40, Part 265, Subparts G and P for the thermal treatment units operated at the Facility under the Resource Conservation and Recovery Act (RCRA) and the New Mexico Hazardous Waste Act. Closure of themore » open burning treatment unit will be completed in accordance with Section 4.1 of this closure plan.« less

40 CFR 265.145 - Financial assurance for post-closure care.

Code of Federal Regulations, 2013 CFR

2013-07-01

... of this section in accordance with § 265.145(h). (e) Financial test and corporate guarantee for post... closure and post-closure cost estimates to be covered by the test; (iv) Specify the date ending the owner... Regional Administrator may approve a decrease in the current post-closure cost estimate for which this test...

40 CFR 265.145 - Financial assurance for post-closure care.

Code of Federal Regulations, 2010 CFR

2010-07-01

... of this section in accordance with § 265.145(h). (e) Financial test and corporate guarantee for post... closure and post-closure cost estimates to be covered by the test; (iv) Specify the date ending the owner... Regional Administrator may approve a decrease in the current post-closure cost estimate for which this test...

40 CFR 265.145 - Financial assurance for post-closure care.

Code of Federal Regulations, 2012 CFR

2012-07-01

... of this section in accordance with § 265.145(h). (e) Financial test and corporate guarantee for post... closure and post-closure cost estimates to be covered by the test; (iv) Specify the date ending the owner... Regional Administrator may approve a decrease in the current post-closure cost estimate for which this test...

40 CFR 265.145 - Financial assurance for post-closure care.

Code of Federal Regulations, 2014 CFR

2014-07-01

... of this section in accordance with § 265.145(h). (e) Financial test and corporate guarantee for post... closure and post-closure cost estimates to be covered by the test; (iv) Specify the date ending the owner... Regional Administrator may approve a decrease in the current post-closure cost estimate for which this test...

40 CFR 265.145 - Financial assurance for post-closure care.

Code of Federal Regulations, 2011 CFR

2011-07-01

... of this section in accordance with § 265.145(h). (e) Financial test and corporate guarantee for post... closure and post-closure cost estimates to be covered by the test; (iv) Specify the date ending the owner... Regional Administrator may approve a decrease in the current post-closure cost estimate for which this test...

Cost-Effectiveness of Percutaneous Closure of the Left Atrial Appendage in Atrial Fibrillation Based on Results from PROTECT AF vs. PREVAIL

PubMed Central

Freeman, James V.; Hutton, David W.; Barnes, Geoffrey D.; Zhu, Ruo P.; Owens, Douglas K.; Garber, Alan M.; Go, Alan S.; Hlatky, Mark A.; Heidenreich, Paul A.; Wang, Paul J.; Al-Ahmad, Amin; Turakhia, Mintu P.

2016-01-01

Background Randomized trials of left atrial appendage (LAA) closure with the Watchman device have shown varying results, and its cost-effectiveness compared to anticoagulation has not been evaluated using all available contemporary trial data. Methods and Results We used a Markov decision model to estimate lifetime quality-adjusted survival, costs, and cost-effectiveness of LAA closure with Watchman, compared directly with warfarin and indirectly with dabigatran, using data from the long-term (mean 3.8 year) follow-up of PROTECT AF and PREVAIL randomized trials. Using data from PROTECT AF, the incremental cost-effectiveness ratios (ICER) compared to warfarin and dabigatran were $20,486 and $23,422 per quality adjusted life year (QALY), respectively. Using data from PREVAIL, LAA closure was dominated by warfarin and dabigatran, meaning that it was less effective (8.44, 8.54, and 8.59 QALYs, respectively) and more costly. At a willingness-to-pay-threshold of $50,000 per QALY, LAA closure was cost-effective 90% and 9% of the time under PROTECT AF and PREVAIL assumptions, respectively. These results were sensitive to the rates of ischemic stroke and intracranial hemorrhage for LAA closure and medical anticoagulation. Conclusions Using data from the PROTECT AF trial, LAA closure with the Watchman device was cost-effective; using PREVAIL trial data, Watchman was more costly and less effective than warfarin and dabigatran. PROTECT AF enrolled more patients and has substantially longer follow-up time, allowing greater statistical certainty with the cost-effectiveness results. However, longer term trial results and post-marketing surveillance of major adverse events will be vital to determining the value of the Watchman in clinical practice. PMID:27307517

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

Willoughby III, O.H.; Lukes, G.C.

EnergySolutions, LLC operates its Mixed Waste Facility at Clive, Utah under the provisions of its State-issued Part B Permit. The facility accepts waste that contains both hazardous and radioactive contaminants. Utah is an EPA Agreement State and therefore the Utah Division of Solid and Hazardous Waste (DSHW) is authorized to regulate the hazardous waste operations at the facility. The radioactive portion of the waste is regulated by the Utah Division of Radiation Control. 40 CFR 264.142 outlines the facility requirements for Closure Costs. The owner or operator must have a detailed written estimate of the cost of closing the facilitymore » in accordance with the rules. For many years the State of Utah had relied on the facility's estimate of closure costs as the amount that needed to be funded. This amount is reviewed annually and adjusted for inflation and for changes at the facility. In 2004 the agency and the facility requested bids from independent contractors to provide their estimate for closure costs. Three engineering firms bid on the project. The facility funded the project and both the agency and the facility chose one of the firms to provide an independent estimate. The engineering firms met with both parties and toured the facility. They were also provided with the current closure cost line items. Each firm provided an estimated cost for closure of the facility at the point in the facility's active life that would make the closure most expensive. Included with the direct costs were indirect line items such as overhead, profit, mobilization, hazardous working conditions and regulatory oversight. The agency and the facility reviewed the independent estimates and negotiated a final Closure and Post-Closure Cost Estimate for the Mixed Waste Facility. There are several mechanisms allowed under the rules to fund the Closure and Post- Closure Care Funds. EnergySolutions has chosen to fund their costs through the use of an insurance policy. Changing mechanisms from an irrevocable trust to an insurance policy required extensive review by the DSHW and the Utah Attorney General's Office. The duration of the Post-Closure Care Period is generally designated as 30 years under the hazardous waste rules. The Legislature of the State of Utah commissioned a review of the need for Perpetual Care Funds for hazardous waste facilities. This fund would provide funds for maintenance and monitoring of facilities following termination of the Post-Closure Permit. The DSHW has recommended to the legislature that a perpetual care fund be created. The legislature will study the recommendation and take appropriate action. (authors)« less

Safety and feasibility of intra-operative device closure of atrial septal defect with transthoracic minimal invasion.

PubMed

Chen, Qiang; Cao, Hua; Zhang, Gui-Can; Chen, Liang-Wan; Chen, Dao-Zhong

2012-01-01

The study aims to evaluate the safety and feasibility of intra-operative device closure of atrial septal defect with transthoracic minimal invasion. From May 2006 to June 2009, 252 patients with secundum-type atrial septal defect closure were enrolled in our institution. The patients were divided into two groups, with 182 patients in group I with intra-operative device closure and 72 in group II with surgical closure. In group I, the patients' age ranged from 3 months to 62 years (mean±standard deviation, 19.0±16.7 years). This approach involved a transthoracic minimal invasion that was performed after full evaluation of the atrial septal defect by transthoracic echocardiography, deploying the device through the delivery sheath to occlude the atrial septal defect. In group I, 180 patients were occluded successfully under this approach. The size of the occluder device implanted ranged from 6 to 48 mm. Minor complications occurred, which included transient arrhythmias (n=23) and pleural effusion (n=15). Two patients with postoperative cardiac arrest were successfully cardiopulmonary resuscitated. Another two patients with occluder dislodged back into the right atrium were turned to surgical repair with cardiopulmonary bypass on the postoperative day. In group II, all patients were occluded successfully, and almost all patients needed blood transfusion and suffered from various minor complications. All discharged patients were followed up for 1-5 years. During this period, we found no recurrence, no thrombosis, even no device failure. In our comparative studies, group II had significantly longer intensive care unit (ICU) stay and hospital stay than group I (p<0.05). The cost for group I was less than group II (p<0.05). Intra-operative device closure of atrial septal defect with transthoracic minimal invasion is a safe and feasible technique. It had the advantages of cost savings, yielding better cosmetic results, and leaving less trauma than surgical closure.

40 CFR 265.117 - Post-closure care and use of property.

Code of Federal Regulations, 2010 CFR

2010-07-01

.... 265.117 Section 265.117 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID.... (a)(1) Post-closure care for each hazardous waste management unit subject to the requirements of... this part. (2) Any time preceding closure of a hazardous waste management unit subject to post-closure...

Positive Catch & Economic Benefits of Periodic Octopus Fishery Closures: Do Effective, Narrowly Targeted Actions ‘Catalyze’ Broader Management?

PubMed Central

Oliver, Thomas A.; Oleson, Kirsten L. L.; Ratsimbazafy, Hajanaina; Raberinary, Daniel; Benbow, Sophie; Harris, Alasdair

2015-01-01

Overview Eight years of octopus fishery records from southwest Madagascar reveal significant positive impacts from 36 periodic closures on: (a) fishery catches and (b) village fishery income, such that (c) economic benefits from increased landings outweigh costs of foregone catch. Closures covered ~20% of a village’s fished area and lasted 2-7 months. Fishery Catches from Each Closed Site Octopus landings and catch per unit effort (CPUE) significantly increased in the 30 days following a closure’s reopening, relative to the 30 days before a closure (landings: +718%, p<0.0001; CPUE: +87%, p<0.0001; n = 36). Open-access control sites showed no before/after change when they occurred independently of other management (“no ban”, n = 17/36). On the other hand, open-access control sites showed modest catch increases when they extended a 6-week seasonal fishery shutdown (“ban”, n = 19/36). The seasonal fishery shutdown affects the entire region, so confound all potential control sites. Fishery Income in Implementing Villages In villages implementing a closure, octopus fishery income doubled in the 30 days after a closure, relative to 30 days before (+132%, p<0.001, n = 28). Control villages not implementing a closure showed no increase in income after “no ban” closures and modest increases after “ban” closures. Villages did not show a significant decline in income during closure events. Net Economic Benefits from Each Closed Site Landings in closure sites generated more revenue than simulated landings assuming continued open-access fishing at that site (27/36 show positive net earnings; mean +$305/closure; mean +57.7% monthly). Benefits accrued faster than local fishers’ time preferences during 17-27 of the 36 closures. High reported rates of illegal fishing during closures correlated with poor economic performance. Broader Co-Management We discuss the implications of our findings for broader co-management arrangements, particularly for catalyzing more comprehensive management. PMID:26083862

40 CFR 264.1202 - Closure and post-closure care.

Code of Federal Regulations, 2010 CFR

2010-07-01

... closure of a magazine or unit which stored hazardous waste under this subpart, the owner or operator must..., and financial responsibility for magazines or units must meet all of the requirements specified in... it remains in service as a munitions or explosives magazine or storage unit. (b) If, after removing...

40 CFR 258.16 - Closure of existing municipal solid waste landfill units.

Code of Federal Regulations, 2011 CFR

2011-07-01

... (CONTINUED) SOLID WASTES CRITERIA FOR MUNICIPAL SOLID WASTE LANDFILLS Location Restrictions § 258.16 Closure of existing municipal solid waste landfill units. (a) Existing MSWLF units that cannot make the... 40 Protection of Environment 25 2011-07-01 2011-07-01 false Closure of existing municipal solid...

40 CFR 258.16 - Closure of existing municipal solid waste landfill units.

Code of Federal Regulations, 2010 CFR

2010-07-01

... (CONTINUED) SOLID WASTES CRITERIA FOR MUNICIPAL SOLID WASTE LANDFILLS Location Restrictions § 258.16 Closure of existing municipal solid waste landfill units. (a) Existing MSWLF units that cannot make the... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Closure of existing municipal solid...

100-D Ponds closure plan. Revision 1

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

Petersen, S.W.

1997-09-01

The 100-D Ponds is a Treatment, Storage, and Disposal (TSD) unit on the Hanford Facility that received both dangerous and nonregulated waste. This Closure Plan (Rev. 1) for the 100-D Ponds TSD unit consists of a RCRA Part A Dangerous Waste Permit Application (Rev. 3), a RCRA Closure Plan, and supporting information contained in the appendices to the plan. The closure plan consists of eight chapters containing facility description, process information, waste characteristics, and groundwater monitoring data. There are also chapters containing the closure strategy and performance standards. The strategy for the closure of the 100-D Ponds TSD unit ismore » clean closure. Appendices A and B of the closure plan demonstrate that soil and groundwater beneath 100-D Ponds are below cleanup limits. All dangerous wastes or dangerous waste constituents or residues associated with the operation of the ponds have been removed, therefore, human health and the environment are protected. Discharges to the 100-D Ponds, which are located in the 100-DR-1 operable unit, were discontinued in June 1994. Contaminated sediment was removed from the ponds in August 1996. Subsequent sampling and analysis demonstrated that there is no contamination remaining in the ponds, therefore, this closure plan is a demonstration of clean closure.« less

Advances in the Surgical Treatment of Gastroschisis.

PubMed

Safavi, Arash; Skarsgard, Erik D

2015-05-01

Gastroschisis (GS) is a structural defect of the anterior abdominal wall, usually diagnosed antenatally, that occurs with a frequency of approximately 4 per 10,000 pregnancies. Babies born with GS require neonatal intensive care and surgical management of the abdominal wall defect soon after birth. Although contemporary survival rates for GS are over 90%, these babies are at risk for significant morbidity, and require 4 to 6 weeks of costly, resource-intensive care in specialized neonatal units. Much consideration has been given to how best to treat the abdominal wall defect of GS. The traditional approach, necessitated by a need to establish enteral feeding as quickly as possible, consists of early postnatal visceral reduction and sutured abdominal closure. Advances in neonatal nutritional support have enabled the development of surgical approaches, which permit gradual visceral reduction and delayed abdominal closure. In cases where early visceral reduction cannot be achieved, delayed closure enabled by the initial placement of a prosthetic silo has been a live-saving alternative. The development of preformed silos has simplified their use and led to an interest in treating all cases with a delayed closure philosophy. Most recently, a sutureless technique of abdominal closure has been reported, which has the benefit of avoiding general anesthesia and offers other outcome improvements over sutured closure of the defect. The debate over primary closure versus silo placement and delayed closure continues to receive much attention. The goal of this article is to review historical aspects of gastroschisis closure, and then focus on current surgical techniques, including the innovative sutureless closure, with an analysis of the comparative clinical effectiveness of these approaches to treatment of the abdominal wall defect in GS.

40 CFR 267.142 - Cost estimate for closure.

Code of Federal Regulations, 2010 CFR

2010-07-01

... that on-site disposal capacity will exist at all times over the life of the facility. (3) The closure...) The owner or operator must keep the following at the facility during the operating life of the... PERMIT Financial Requirements § 267.142 Cost estimate for closure. (a) The owner or operator must have at...

40 CFR 267.142 - Cost estimate for closure.

Code of Federal Regulations, 2011 CFR

2011-07-01

... that on-site disposal capacity will exist at all times over the life of the facility. (3) The closure...) The owner or operator must keep the following at the facility during the operating life of the... PERMIT Financial Requirements § 267.142 Cost estimate for closure. (a) The owner or operator must have at...

Intraoperative device closure of atrial septal defects with inferior vena cava rim deficiency: a safe alternative to surgical repair.

PubMed

Chen, Qiang; Chen, Liang-Wan; Cao, Hua; Zhang, Gui-Can; Chen, Dao-Zhong; Zhang, Hui

2011-03-01

Our objective was to evaluate the safety and feasibility of intraoperative device closure of atrial septal defects with inferior vena cava rim deficiency. From January 2005 to December 2008, we enrolled 65 patients who had a secundum atrial septal defect with inferior vena cava rim deficiency closure in our institution. Patients were divided into 2 groups: 35 patients in group I underwent intraoperative device closure with a right lateral minithoracotomy and 30 in group II underwent open cardiac repair with a right lateral thoracotomy and cardiopulmonary bypass. Intraoperative device closure involved a minimal intercostal incision that was performed after full evaluation of the atrial septal defect by transthoracic echocardiography and the insertion of the device through the delivery sheath to occlude the atrial septal defect. The procedure was successful in all patients. In group I, the diameter of the atrial septal defect ranged from 30 to 44 mm (mean, 35.3 ± 3.9 mm), and the size of the implanted occluder ranged from 34 to 48 mm (mean, 40 ± 2.1 mm). The total occlusion rate was 82.9% immediately after the operation, 97.1% at 3 months, and 100% at 12 and 24 months of follow-up. In group II, all patients had successful closure. A follow-up period of 12 to 24 months was obtained in both groups. During the follow-up, there was no recurrence, thrombosis, or device failure. In our comparative studies, group II had significantly longer operative time, intensive care unit stay, and hospital stay than group I (P < .001). The cost of group I was less than that of group II (20,450.9 ± 840.8 RMB vs 25,884.9 ± 701.8; P < .001). Intraoperative device closure of atrial septal defects with inferior vena cava rim deficiency is a safe and feasible technique. It has the advantages of cost savings, cosmetic results, and less trauma than surgical closure. Early and midterm results are encouraging. Crown Copyright © 2011. Published by Mosby, Inc. All rights reserved.

Deformable Bullnose Energy Absorbing System (BEAS). Report 2: Head-On Impact with a Deformable BEAS and Introducing a Collapsible Arch

DTIC Science & Technology

2011-07-01

gate operations at Belleville Locks and Dam. ........................... 105 Figure 5.20 The non-linear costs for full closure of the locks and dam...Super Cone Fender Front Arch Results ................................................. 96 Table 5.3 Costs Over Time for Full Closure at Particular Corps...Corps Navigation Economics PDT tabulation of costs over time for full closure at the Corps lock and dam structures. Bob Willis also supplied the

Early intervention of negative pressure wound therapy using Vacuum-Assisted Closure in trauma patients: impact on hospital length of stay and cost.

PubMed

Kaplan, Mark; Daly, Darron; Stemkowski, Stephen

2009-03-01

The cost of treating complex traumatic wounds is substantial because of trauma severity, potential for infection, and delayed closure. Negative pressure wound therapy using reticulated open cell foam (NPWT/ROCF) as delivered by Vacuum-Assisted Closure* (KCI Licensing, Inc, San Antonio, Texas) is an established, viable option for treating traumatic wounds. The authors used retrospective data to study the clinical and cost-effective benefits of using NPWT/ROCF early on day 1 or day 2 of treatment for traumatic wounds as compared with using it late (on day 3 or later). Hospital data records from trauma wound patients treated with NPWT/ROCF were retrospectively analyzed. Data were subdivided into 2 groups based on start of treatment. The group of patients treated on day 1 or 2 of their hospital stay was referred to as the early group, and that composed of patients treated on day 3 or later as the late group. Clinical and cost-effective metrics were compared between the 2 groups. For the early group, 518 patient records were included; 1000 records were reviewed for the late group. Early-group patients had fewer hospital inpatient days (10.6 vs 20.6 days; P < .0001), fewer treatment days (5.1 vs 6.0 days; P = .0498), shorter intensive care unit (ICU) stays (5.3 vs 12.4 days; P < .0001), and higher ICU admission rates (51.5 vs 44.5%; P = .0091) than the late group. Compared with late-group patients, early-group patients had lower total and variable costs per patient discharge ($43,956 vs $32,175; P < .0001 and $22,891 vs $15,805; P < .0001, respectively). Acute-care trauma wound patients receiving early NPWT/ROCF demonstrated significant reductions in length of stay, treatment days, and ICU stay, which resulted in significant reduced patient treatment costs. These results indicate that early intervention with NPWT/ROCF has potential clinical and cost-effective benefits for the treatment of traumatic wounds.

Simulating school closure policies for cost effective pandemic decision making

PubMed Central

2012-01-01

Background Around the globe, school closures were used sporadically to mitigate the 2009 H1N1 influenza pandemic. However, such closures can detrimentally impact economic and social life. Methods Here, we couple a decision analytic approach with a mathematical model of influenza transmission to estimate the impact of school closures in terms of epidemiological and cost effectiveness. Our method assumes that the transmissibility and the severity of the disease are uncertain, and evaluates several closure and reopening strategies that cover a range of thresholds in school-aged prevalence (SAP) and closure durations. Results Assuming a willingness to pay per quality adjusted life-year (QALY) threshold equal to the US per capita GDP ($46,000), we found that the cost effectiveness of these strategies is highly dependent on the severity and on a willingness to pay per QALY. For severe pandemics, the preferred strategy couples the earliest closure trigger (0.5% SAP) with the longest duration closure (24 weeks) considered. For milder pandemics, the preferred strategies also involve the earliest closure trigger, but are shorter duration (12 weeks for low transmission rates and variable length for high transmission rates). Conclusions These findings highlight the importance of obtaining early estimates of pandemic severity and provide guidance to public health decision-makers for effectively tailoring school closures strategies in response to a newly emergent influenza pandemic. PMID:22713694

Cost savings associated with prevention of recurrent lumbar disc herniation with a novel annular closure device: a multicenter prospective cohort study.

PubMed

Parker, Scott L; Grahovac, Gordan; Vukas, Duje; Ledic, Darko; Vilendecic, Milorad; McGirt, Matthew J

2013-09-01

Same-level recurrent disc herniation is a well-defined complication following lumbar discectomy. Reherniation results in increased morbidity and health care costs. Techniques to reduce these consequences may improve outcomes and reduce cost after lumbar discectomy. In a prospective cohort study, we set out to evaluate the cost associated with surgical management of recurrent, same-level lumbar disc herniation following primary discectomy. Forty-six consecutive European patients undergoing lumbar discectomy for a single-level herniated disc at two institutions were prospectively followed with clinical and radiographic evaluations. A second consecutive cohort of 30 patients undergoing 31 lumbar discectomies with implantation of an annular closure device was followed at the same hospitals and same follow-up intervals. Cost estimates for reherniation were modeled on Medicare national allowable payment amounts (direct cost) and patient work-day losses (indirect cost). Annular closure and control cohorts were matched at baseline. By 2 years follow-up, symptomatic recurrent same-level disc herniation occurred in three (6.5%) patients in the control cohort versus zero (0%) patients in the annular closure cohort. For patients experiencing recurrent disc herniation, mean estimated direct and indirect cost of management of recurrent disc herniation was $34,242 and $3,778, respectively. Use of an annular closure device potentially results in a cost savings of $222,573 per 100 primary discectomy procedures performed (or $2,226 per discectomy), based solely on the reduction of reoperated reherniations when modeled on U.S. Medicare costs. Recurrent disc herniation did not occur in any patients after annular closure within the 12-month follow-up. The reduction in the incidence of reherniation was associated with potentially significant cost savings. Development of novel techniques to prevent recurrent lumbar disc herniation is warranted to decrease the associated morbidity and health care costs associated with this complication. Georg Thieme Verlag KG Stuttgart · New York.

40 CFR 261.151 - Wording of the instruments.

Code of Federal Regulations, 2013 CFR

2013-07-01

... assurance for closure or post-closure care is demonstrated through the financial test specified in subpart H... parts 264 and 265. The current closure and/or post-closure cost estimates covered by such a test are... financial test specified in subpart H of 40 CFR parts 264 and 265. The current closure and/or post-closure...

CRP - VD Tube & Closure -  Unit Non-Reclosable Packaging Rigid

EPA Pesticide Factsheets

This is a unit-dose non-reclosable rigid package. The package consists of a tube and a closure that is permanently attached to the tube neck. The package is opened by pushing down on the closure and simultaneously turning it counterclockwise.

Resection of the metatarsal head for diabetic foot ulcers.

PubMed

Wieman, T J; Mercke, Y K; Cerrito, P B; Taber, S W

1998-11-01

Diabetic foot ulceration is a worldwide health problem. Approximately 15% of the 10 million diabetic patients in the United States will develop a foot ulceration at some time in their lives. The presence of a foot ulcer in this population is extremely debilitating and dramatically increases the risk of lower extremity amputation, accounting for approximately 67,000 lost limbs each year. Additionally, the costs associated with treating foot ulcers in diabetic patients is a major expense in the overall care of this patient group. An 11-year retrospective study was conducted to evaluate 101 consecutive patients with diabetic ulcers of the forefoot who were treated using resection of the metatarsal head as the primary means of obtaining wound closure. The results indicate that 88% of the ulcers were healed by using this technique, and relatively more rapidly than would be expected when compared with historical norms. Resection of the metatarsal head is a safe and relatively inexpensive procedure that facilitates closure of the lesion, helps to control infection, and prevents countless and costly amputations.

Resource Conservation and Recovery Act closure report: Area 2 Bitcutter and Postshot Containment Shops Injection Wells, Correction Action Unit 90

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

NONE

This Closure Report provides documentation of the activities conducted during the Resource Conservation and Recovery Act (RCRA) closure of the Bitcutter and Postshot Containment Shops Injection Wells located in Area 2 of the Nevada Test Site (NTS), Oak Spring Quadrangle (USGS, 1986), Township 10 South, Range 53 East, Nye County, Nevada. This report discusses the Bitcutter Shop Inside Injection Well (CAU 90-A) closure-in-place and the Bitcutter Shop Outside Injection Well (CAU 90-B) and Postshot Containment Shop Injection Well (CAU 90-C) clean closures. This Closure Report provides background information about the unit, the results of the characterization activities and actions conductedmore » to determine the closure design. It also provides a discussion of the drainage analysis, preliminary closure activities, final closure activities, waste management activities, and the Post-Closure Care requirements.« less

40 CFR 258.75 - Discounting.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES CRITERIA FOR MUNICIPAL... State may allow discounting of closure cost estimates in § 258.71(a), post-closure cost estimates in § 258.72(a), and/or corrective action costs in § 258.73(a) up to the rate of return for essentially risk...

A prospective study of two methods of closing surgical scalp wounds.

PubMed

Adeolu, A A; Olabanji, J K; Komolafe, E O; Ademuyiwa, A O; Awe, A O; Oladele, A O

2012-02-01

Scalp wounds are commonly closed in two layers, although single layer closure is feasible. This study prospectively compared the two methods of closing scalp wounds. Patients with non-traumatic scalp wounds were allocated to either the single layer closure group or the multilayer closure group. We obtained relevant data from the patients. The primary outcome measures were wound edge related complications, rate of suturing and cost of sutures used for suturing. Thirty-one wounds were in the single layer closure group and 30 were in the multilayer closure group. Age range was 1-80 years. The most common indication for making a scalp incision was subdural hematoma, representing 27.8% of all the indications. The most common surgery was burr hole drainage of subdural hematoma. Polyglactin acid suture was used for the inner layer and polyamide -00- for the final layer in the multilayer closure group. Only the latter suture was used for the single layer closure method. Total cost of suturing per wound in the single layer closure group was N= 100 (0.70USD) and N= 800 (5.30USD) in the multilayer group. The mean rate of closure was 0.39 ± 1.89 mm/sec for single layer closure and 0.23 ± 0.89 mm/sec in multilayer closure. The difference was statistically significant. Wound edge related complication rate was 19.35% in the single layer closure group and 16.67% in the multilayer closure method group. The difference was not statistically significant (z: 0.00, p value: 1.000; Pearson chi-squared (DF = 1)= 0.0075, p = 0.0785). The study shows that closing the scalp in one layer is much faster and more cost effective compared to the multilayer closure method. We did not observe significant difference in the complication rates in the two methods of closure. Long-term outcome, especially cosmetic outcome, remains to be determined in this preliminary study.

40 CFR 264.117 - Post-closure care and use of property.

Code of Federal Regulations, 2010 CFR

2010-07-01

.... 264.117 Section 264.117 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID... for each hazardous waste management unit subject to the requirements of §§ 264.117 through 264.120... preceding partial closure of a hazardous waste management unit subject to post-closure care requirements or...

300 Area waste acid treatment system closure plan

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

LUKE, S.N.

1999-05-17

The Hanford Facility Dangerous Waste Permit Application is considered to be a single application organized into a General Information Portion (document number DOERL-91-28) and a Unit-Specific Portion. The scope of the Unit-Specific Portion includes closure plan documentation submitted for individual, treatment, storage, and/or disposal units undergoing closure, such as the 300 Area Waste Acid Treatment System. Documentation contained in the General Information Portion is broader in nature and could be used by multiple treatment, storage, and/or disposal units (e.g., the glossary provided in the General Information Portion). Whenever appropriate, 300 Area Waste Acid Treatment System documentation makes cross-reference to themore » General Information Portion, rather than duplicating text. This 300 Area Waste Acid Treatment System Closure Plan (Revision 2) includes a Hanford Facility Dangerous Waste Permit Application, Part A, Form 3. Information provided in this closure plan is current as of April 1999.« less

Corrective Action Decision Document/Corrective Action Plan for the 92-Acre Area and Corrective Action Unit 111: Area 5 WMD Retired Mixed Waste Pits, Nevada National Security Site, Nevada

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

NSTec Environmental Restoration

This Corrective Action Decision Document/Corrective Action Plan (CADD/CAP) has been prepared for the 92-Acre Area, the southeast quadrant of the Radioactive Waste Management Site, located in Area 5 of the Nevada National Security Site (NNSS). The 92-Acre Area includes Corrective Action Unit (CAU) 111, 'Area 5 WMD Retired Mixed Waste Pits.' Data Quality Objectives (DQOs) were developed for the 92-Acre Area, which includes CAU 111. The result of the DQO process was that the 92-Acre Area is sufficiently characterized to provide the input data necessary to evaluate corrective action alternatives (CAAs) without the collection of additional data. The DQOs aremore » included as Appendix A of this document. This CADD/CAP identifies and provides the rationale for the recommended CAA for the 92-Acre Area, provides the plan for implementing the CAA, and details the post-closure plan. When approved, this CADD/CAP will supersede the existing Pit 3 (P03) Closure Plan, which was developed in accordance with Title 40 Code of Federal Regulations (CFR) Part 265, 'Interim Status Standards for Owners and Operators of Hazardous Waste Treatment, Storage, and Disposal Facilities.' This document will also serve as the Closure Plan and the Post-Closure Plan, which are required by 40 CFR 265, for the 92-Acre Area. After closure activities are complete, a request for the modification of the Resource Conservation and Recovery Act Permit that governs waste management activities at the NNSS will be submitted to the Nevada Division of Environmental Protection to incorporate the requirements for post-closure monitoring. Four CAAs, ranging from No Further Action to Clean Closure, were evaluated for the 92-Acre Area. The CAAs were evaluated on technical merit focusing on performance, reliability, feasibility, safety, and cost. Based on the evaluation of the data used to develop the conceptual site model; a review of past, current, and future operations at the site; and the detailed and comparative analysis of the potential CAAs, Closure in Place with Administrative Controls is the preferred CAA for the 92-Acre Area. Closure activities will include the following: (1) Constructing an engineered evapotranspiration cover over the 92-Acre Area; (2) Installing use restriction (UR) warning signs, concrete monuments, and subsidence survey monuments; (3) Establishing vegetation on the cover; (4) Implementing a UR; and (5) Implementing post-closure inspections and monitoring. The Closure in Place with Administrative Controls alternative meets all requirements for the technical components evaluated, fulfills all applicable federal and state regulations for closure of the site, and will minimize potential future exposure pathways to the buried waste at the site.« less

Corrective Action Decision Document/Corrective Action Plan for the 92-Acre Area and Corrective Action Unit 111: Area 5 WMD Retired Mixed Waste Pits, Nevada Test Site, Nevada

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

NSTec Environmental Restoration

2009-07-31

This Corrective Action Decision Document/Corrective Action Plan (CADD/CAP) has been prepared for the 92-Acre Area, the southeast quadrant of the Radioactive Waste Management Site, located in Area 5 of the Nevada Test Site (NTS). The 92-Acre Area includes Corrective Action Unit (CAU) 111, 'Area 5 WMD Retired Mixed Waste Pits.' Data Quality Objectives (DQOs) were developed for the 92-Acre Area, which includes CAU 111. The result of the DQO process was that the 92-Acre Area is sufficiently characterized to provide the input data necessary to evaluate corrective action alternatives (CAAs) without the collection of additional data. The DQOs are includedmore » as Appendix A of this document. This CADD/CAP identifies and provides the rationale for the recommended CAA for the 92-Acre Area, provides the plan for implementing the CAA, and details the post-closure plan. When approved, this CADD/CAP will supersede the existing Pit 3 (P03) Closure Plan, which was developed in accordance with Title 40 Code of Federal Regulations (CFR) Part 265, 'Interim Status Standards for Owners and Operators of Hazardous Waste Treatment, Storage, and Disposal Facilities.' This document will also serve as the Closure Plan and the Post-Closure Plan, which are required by 40 CFR 265, for the 92-Acre Area. After closure activities are complete, a request for the modification of the Resource Conservation and Recovery Act Permit that governs waste management activities at the NTS will be submitted to the Nevada Division of Environmental Protection to incorporate the requirements for post-closure monitoring. Four CAAs, ranging from No Further Action to Clean Closure, were evaluated for the 92-Acre Area. The CAAs were evaluated on technical merit focusing on performance, reliability, feasibility, safety, and cost. Based on the evaluation of the data used to develop the conceptual site model; a review of past, current, and future operations at the site; and the detailed and comparative analysis of the potential CAAs, Closure in Place with Administrative Controls is the preferred CAA for the 92-Acre Area. Closure activities will include the following: (1) Constructing an engineered evapotranspiration cover over the 92-Acre Area; (2) Installing use restriction (UR) warning signs, concrete monuments, and subsidence survey monuments; (3) Establishing vegetation on the cover; (4) Implementing a UR; and (5) Implementing post-closure inspections and monitoring. The Closure in Place with Administrative Controls alternative meets all requirements for the technical components evaluated, fulfills all applicable federal and state regulations for closure of the site, and will minimize potential future exposure pathways to the buried waste at the site.« less

Cost effectiveness of left atrial appendage closure with the Watchman device for atrial fibrillation patients with absolute contraindications to warfarin

PubMed Central

Reddy, Vivek Y.; Akehurst, Ronald L.; Armstrong, Shannon O.; Amorosi, Stacey L.; Brereton, Nic; Hertz, Deanna S.; Holmes, David R.

2016-01-01

Abstract Aims Atrial fibrillation (AF) patients with contraindications to oral anticoagulation have had few options for stroke prevention. Recently, a novel oral anticoagulant, apixaban, and percutaneous left atrial appendage closure (LAAC) have emerged as safe and effective therapies for stroke risk reduction in these patients. This analysis assessed the cost effectiveness of LAAC with the Watchman device relative to apixaban and aspirin therapy in patients with non-valvular AF and contraindications to warfarin therapy. Methods and results A cost-effectiveness model was constructed using data from three studies on stroke prevention in patients with contraindications: the ASAP study evaluating the Watchman device, the ACTIVE A trial of aspirin and clopidogrel, and the AVERROES trial evaluating apixaban. The cost-effectiveness analysis was conducted from a German healthcare payer perspective over a 20-year time horizon. Left atrial appendage closure yielded more quality-adjusted life years (QALYs) than aspirin and apixaban by 2 and 4 years, respectively. At 5 years, LAAC was cost effective compared with aspirin with an incremental cost-effectiveness ratio (ICER) of €16 971. Left atrial appendage closure was cost effective compared with apixaban at 7 years with an ICER of €9040. Left atrial appendage closure was cost saving and more effective than aspirin and apixaban at 8 years and remained so throughout the 20-year time horizon. Conclusions This analysis demonstrates that LAAC with the Watchman device is a cost-effective and cost-saving solution for stroke risk reduction in patients with non-valvular AF who are at risk for stroke but have contraindications to warfarin. PMID:26838691

Impact of radiofrequency ablation for patients with varicose veins on the budget of the German statutory health insurance system

PubMed Central

2013-01-01

Objectives In contrast to other countries, surgery still represents the common invasive treatment for varicose veins in Germany. However, radiofrequency ablation, e.g. ClosureFast, becomes more and more popular in other countries due to potential better results and reduced side effects. This treatment option may cause less follow-up costs and is a more convenient procedure for patients, which could justify an introduction in the statutory benefits catalogue. Therefore, we aim at calculating the budget impact of a general reimbursement of ClosureFast in Germany. Methods To assess the budget impact of including ClosureFast in the German statutory benefits catalogue, we developed a multi-cohort Markov model and compared the costs of a “World with ClosureFast” with a “World without ClosureFast” over a time horizon of five years. To address the uncertainty of input parameters, we conducted three different types of sensitivity analysis (one-way, scenario, probabilistic). Results In the Base Case scenario, the introduction of the ClosureFast system for the treatment of varicose veins saves costs of about 19.1 Mio. € over a time horizon of five years in Germany. However, the results scatter in the sensitivity analyses due to limited evidence of some key input parameters. Conclusions Results of the budget impact analysis indicate that a general reimbursement of ClosureFast has the potential to be cost-saving in the German Statutory Health Insurance. PMID:23551943

40 CFR 264.1202 - Closure and post-closure care.

Code of Federal Regulations, 2014 CFR

2014-07-01

... FACILITIES Hazardous Waste Munitions and Explosives Storage § 264.1202 Closure and post-closure care. (a) At... it remains in service as a munitions or explosives magazine or storage unit. (b) If, after removing...

40 CFR 264.1202 - Closure and post-closure care.

Code of Federal Regulations, 2011 CFR

2011-07-01

... FACILITIES Hazardous Waste Munitions and Explosives Storage § 264.1202 Closure and post-closure care. (a) At... it remains in service as a munitions or explosives magazine or storage unit. (b) If, after removing...

40 CFR 264.1202 - Closure and post-closure care.

Code of Federal Regulations, 2013 CFR

2013-07-01

... FACILITIES Hazardous Waste Munitions and Explosives Storage § 264.1202 Closure and post-closure care. (a) At... it remains in service as a munitions or explosives magazine or storage unit. (b) If, after removing...

40 CFR 264.1202 - Closure and post-closure care.

Code of Federal Regulations, 2012 CFR

2012-07-01

... FACILITIES Hazardous Waste Munitions and Explosives Storage § 264.1202 Closure and post-closure care. (a) At... it remains in service as a munitions or explosives magazine or storage unit. (b) If, after removing...

Corrective Action Decision Document/Closure Report for Corrective Action Unit 105: Area 2 Yucca Flat Atmospheric Test Sites, Nevada National Security Site, Nevada, Revision 0

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

Matthews, Patrick

2013-09-01

This Corrective Action Decision Document/Closure Report presents information supporting the closure of Corrective Action Unit (CAU) 105: Area 2 Yucca Flat Atmospheric Test Sites, Nevada National Security Site, Nevada. CAU 105 comprises the following five corrective action sites (CASs): -02-23-04 Atmospheric Test Site - Whitney Closure In Place -02-23-05 Atmospheric Test Site T-2A Closure In Place -02-23-06 Atmospheric Test Site T-2B Clean Closure -02-23-08 Atmospheric Test Site T-2 Closure In Place -02-23-09 Atmospheric Test Site - Turk Closure In Place The purpose of this Corrective Action Decision Document/Closure Report is to provide justification and documentation supporting the recommendation that nomore » further corrective action is needed for CAU 105 based on the implementation of the corrective actions. Corrective action investigation (CAI) activities were performed from October 22, 2012, through May 23, 2013, as set forth in the Corrective Action Investigation Plan for Corrective Action Unit 105: Area 2 Yucca Flat Atmospheric Test Sites; and in accordance with the Soils Activity Quality Assurance Plan, which establishes requirements, technical planning, and general quality practices.« less

Closure report for Corrective Action Unit 211, Area 15 EPA Farm waste sites, Nevada Test Site, Nevada

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

NONE

1998-04-01

This Closure Report summarizes the corrective actions which were completed at the Corrective Action Sites within Corrective Action Unit 211 Area 15 Farm Waste Sties at the Nevada Test Site. Current site descriptions, observations and identification of wastes removed are included on FFACO Corrective Action Site housekeeping closure verification forms.

Carbapenemase-producing Acinetobacter baumannii: An outbreak report with special highlights on economic burden.

PubMed

Gagnaire, J; Gagneux-Brunon, A; Pouvaret, A; Grattard, F; Carricajo, A; Favier, H; Mattei, A; Pozzetto, B; Nuti, C; Lucht, F; Berthelot, P; Botelho-Nevers, E

2017-06-01

We aimed to describe the management of a carbapenemase-producing Acinetobacter baumannii (CP-AB) outbreak using the Outbreak Reports and Intervention Studies of Nosocomial Infection (ORION) statement. We also aimed to evaluate the cost of the outbreak and simulate costs if a dedicated unit to manage such outbreak had been set-up. We performed a prospective epidemiological study. Multiple interventions were implemented including cohorting measures and limitation of admissions. Cost estimation was performed using administrative local data. Five patients were colonized with CP-AB and hospitalized in the neurosurgery ward. The index case was a patient who had been previously hospitalized in Portugal. Four secondary colonized patients were further observed within the unit. The strains of A. baumannii were shown to belong to the same clone and all of them produced an OXA-23 carbapenemase. The closure of the ward associated with the discharge of the five patients in a cohorting area of the Infectious Diseases Unit with dedicated staff put a stop to the outbreak. The estimated cost of this 17-week outbreak was $474,474. If patients had been managed in a dedicated unit - including specific area for cohorting of patients and dedicated staff - at the beginning of the outbreak, the estimated cost would have been $189,046. Controlling hospital outbreaks involving multidrug-resistant bacteria requires a rapid cohorting of patients. Using simulation, we highlighted cost gain when using a dedicated cohorting unit strategy for such an outbreak. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Military Base Realignments and Closures: DOD has Improved Environmental Cleanup Reporting but Should Obtain and Share More Information

DTIC Science & Technology

2017-01-01

Defense (DOD) has captured and reported more comprehensive cost information in its environmental cost reporting for installations closed under the...Letter 1 Background 4 DOD’s Latest Report to Congress Captures More- Comprehensive Environmental Cleanup Cost Information, but Omits Emerging...22 Abbreviations BRAC Base Realignment and Closure CERCLA Comprehensive Environmental Response, Compensation, and

The economics of potential reduction of the rural road system in Kansas.

DOT National Transportation Integrated Search

2011-11-01

Benefitcost analysis was used to examine the question of road closure in the three counties. The cost of road : closure is the additional travel cost of rural residents due to more circuitous routing to their destinations. The benefit is : the avo...

Software Measurement Guidebook Version 01.00.00

DTIC Science & Technology

1991-06-01

However, if PTR closures fall off in the presence of declining PTR openings, then the closure procedure is just catching up with the volume of PTRs, and...the activities in the development process in the WBS. The development activi- ties’ cost accounts should tier up to the CSCI total development cost...34* Establish separate WBS cost accounts for each CSCI. Establish separate CSCI-specific cost accounts for each development activity or phase that tier up

Results of comparing transthoracic device closure and surgical repair with right infra-axillary thoracotomy for perimembranous ventricular septal defects.

PubMed

Hu, Yijie; Li, Zhiping; Chen, Jianming; Li, Fuping; Shen, Cheng; Song, Yi; Zhao, Shulin; Peng, Caijing; Chen, Mingxiang; Zhong, Qianjin

2015-04-01

Transthoracic device closure (TTDC) and surgical repair with right infra-axillary thoracotomy (SRRIAT) are two main alternative minimally invasive approaches for restrictive perimembranous ventricular septal defect (VSD); however, few studies have compared them with each other in terms of effectiveness and cost. Patients with perimembranous VSD undergoing TTDC or SRRIAT from January 2012 to July 2013 were reviewed in a comparative investigation between the two procedures. Success from the procedures was achieved in 30 TTDC (30/33, 91%) and 96 SRRIAT patients (100%). Operation duration in the TTDC group was significantly shorter than that of the SRRIAT group (115.8 ± 43.8 vs 175.6 ± 41.3 min, P < 0.01). The total perioperative drainage, use of red blood cells, mechanical ventilation time, stay in the intensive care unit and hospital stay for the TTDC group were significantly less than those in the SRRIAT group. No deaths or complete atrioventricular block occurred in either group. One SRRIAT patient accepted a second surgery for residual shunt. TTDC costs slightly more than SRRIAT (40270.6 ± 2741.3 renmingbi [RMB] vs 32964.5 ± 8221.6 RMB, P < 0.01). Both TTDC and SRRIAT showed excellent outcomes and cosmetic appearance for suitable VSD candidates. Although its costs were higher, TTDC had the advantages over SRRIAT of a short operation duration and intensive care unit stay and fewer days in the hospital. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Protecting an island nation from extreme pandemic threats: Proof-of-concept around border closure as an intervention.

PubMed

Boyd, Matt; Baker, Michael G; Mansoor, Osman D; Kvizhinadze, Giorgi; Wilson, Nick

2017-01-01

Countries are well advised to prepare for future pandemic risks (e.g., pandemic influenza, novel emerging agents or synthetic bioweapons). These preparations do not typically include planning for complete border closure. Even though border closure may not be instituted in time, and can fail, there might still plausible chances of success for well organized island nations. To estimate costs and benefits of complete border closure in response to new pandemic threats, at an initial proof-of-concept level. New Zealand was used as a case-study for an island country. An Excel spreadsheet model was developed to estimate costs and benefits. Case-study specific epidemiological data was sourced from past influenza pandemics. Country-specific healthcare cost data, valuation of life, and lost tourism revenue were imputed (with lost trade also in scenario analyses). For a new pandemic equivalent to the 1918 influenza pandemic (albeit with half the mortality rate, "Scenario A"), it was estimated that successful border closure for 26 weeks provided a net societal benefit (e.g., of NZ$11.0 billion, USD$7.3 billion). Even in the face of a complete end to trade, a net benefit was estimated for scenarios where the mortality rate was high (e.g., at 10 times the mortality impact of "Scenario A", or 2.75% of the country's population dying) giving a net benefit of NZ$54 billion (USD$36 billion). But for some other pandemic scenarios where trade ceased, border closure resulted in a net negative societal value (e.g., for "Scenario A" times three for 26 weeks of border closure-but not for only 12 weeks of closure when it would still be beneficial). This "proof-of-concept" work indicates that more detailed cost-benefit analysis of border closure in very severe pandemic situations for some island nations is probably warranted, as this course of action might sometimes be worthwhile from a societal perspective.

Program closure and change among VA substance abuse treatment programs.

PubMed

Floyd, A S

1999-10-01

The population of Veterans Affairs (VA) substance abuse treatment programs in 1990 and 1994 was examined to determine which factors-program legitimacy or cost-accounted for program closure and change. Legitimacy is a concept in institutional theory that organizations tend to take on a form appropriate to the environment. The study had two competing hypotheses. The first was that if external pressures push programs to produce high-quality and efficient treatment, then those that are initially closer to the legitimate form should be less likely to close later, and among surviving programs they should be less likely to experience change. The second hypothesis was that cost is the primary factor in program closure and change. The study used data from administrative surveys of all VA programs (273 in 1990 and 389 in 1994). Program legitimacy variables measured whether programs offered the prevalent type of treatment, such as 12-step groups or behavioral treatment, and had the prevalent type of staff. Program costs did not explain closure or change. For inpatient programs, the risk of closure increased in facilities with more than one substance abuse treatment program. The risk of closure increased for outpatient programs offering the prevalent type of treatment, contrary to what was predicted by the legitimacy hypothesis. Inpatient programs that offered the prevalent treatment were less likely to change the type of treatment offered. Patterns of change differed over time for inpatient and outpatient programs. Legitimacy factors, rather than cost, seem to play a role in program closure and change, although the picture is clearer for inpatient programs than for outpatient programs.

Self-testing security sensor for monitoring closure of vault doors and the like

DOEpatents

Cawthorne, Duane C.

1997-05-27

A self-testing device is provided for a monitoring system for monitoring whether a closure member such as a door or window is closed. The monitoring system includes a switch unit mounted on the frame of the closure member being monitored and including magnetically biased switches connected in one or more electrical monitoring circuits, and a door magnet unit mounted on the closure member being monitored. The door magnet includes one or more permanent magnets that produce a magnetic field which, when the closure member is closed, cause said switches to assume a first state. When the closure member is opened, the switches switch to a second, alarm state. The self-testing device is electrically controllable from a remote location and produces a canceling or diverting magnetic field which simulates the effect of movement of the closure member from the closed position thereof without any actual movement of the member.

Self-testing security sensor for monitoring closure of vault doors and the like

DOEpatents

Cawthorne, D.C.

1997-05-27

A self-testing device is provided for a monitoring system for monitoring whether a closure member such as a door or window is closed. The monitoring system includes a switch unit mounted on the frame of the closure member being monitored and including magnetically biased switches connected in one or more electrical monitoring circuits, and a door magnet unit mounted on the closure member being monitored. The door magnet includes one or more permanent magnets that produce a magnetic field which, when the closure member is closed, cause said switches to assume a first state. When the closure member is opened, the switches switch to a second, alarm state. The self-testing device is electrically controllable from a remote location and produces a canceling or diverting magnetic field which simulates the effect of movement of the closure member from the closed position thereof without any actual movement of the member. 5 figs.

Early decision-analytic modeling - a case study on vascular closure devices.

PubMed

Brandes, Alina; Sinner, Moritz F; Kääb, Stefan; Rogowski, Wolf H

2015-10-27

As economic considerations become more important in healthcare reimbursement, decisions about the further development of medical innovations need to take into account not only medical need and potential clinical effectiveness, but also cost-effectiveness. Already early in the innovation process economic evaluations can support decisions on development in specific indications or patient groups by anticipating future reimbursement and implementation decisions. One potential concept for early assessment is value-based pricing. The objective is to assess the feasibility of value-based pricing and product design for a hypothetical vascular closure device in the pre-clinical stage which aims at decreasing bleeding events. A deterministic decision-analytic model was developed to estimate the cost-effectiveness of established vascular closure devices from the perspective of the Statutory Health Insurance system. To identify early benchmarks for pricing and product design, three strategies of determining the product's value are explored: 1) savings from complications avoided by the new device; 2) valuation of the avoided complications based on an assumed willingness-to-pay-threshold (the efficiency frontier approach); 3) value associated with modifying the care pathways within which the device would be applied. Use of established vascular closure devices is dominated by manual compression. The hypothetical vascular closure device reduces overall complication rates at higher costs than manual compression. Maximum cost savings of only about €4 per catheterization could be realized by applying the hypothetical device. Extrapolation of an efficiency frontier is only possible for one subgroup where vascular closure devices are not a dominated strategy. Modifying care in terms of same-day discharge of patients treated with vascular closure devices could result in cost savings of €400-600 per catheterization. It was partially feasible to calculate value-based prices for the novel closure device which can be used to inform product design. However, modifying the care pathway may generate much more value from the payers' perspective than modifying the device per se. Manufacturers should thus explore the feasibility of combining reimbursement of their product with arrangements that make same-day discharge attractive also for hospitals. Due to the early nature of the product, the results are afflicted with substantial uncertainty.

Effectiveness of closure of public places with time delay in disease control.

PubMed

Wang, Zhenggang; Szeto, Kwok Yip; Leung, Frederick Chi-Ching

2008-08-25

A theoretical basis for the evaluation of the effciency of quarantine measure is developed in a SIR model with time delay. In this model, the effectiveness of the closure of public places such as schools in disease control, modeled as a high degree node in a social network, is evaluated by considering the effect of the time delay in the identification of the infected. In the context of the SIR model, the relation between the number of infectious individuals who are identified with time delay and then quarantined and those who are not identified and continue spreading the virus are investigated numerically. The social network for the simulation is modeled by a scale free network. Closure measures are applied to those infected nodes with high degrees. The effectiveness of the measure can be controlled by the present value of the critical degree K(C): only those nodes with degree higher than K(C) will be quarantined. The cost C(Q) incurred for the closure measure is assumed to be proportional to the total links rendered inactive as a result of the measure, and generally decreases with K(C), while the medical cost C(Q) incurred for virus spreading increases with K(C). The total social cost (C(M) + C(Q)) will have a minimum at a critical K(*), which depends on the ratio of medical cost coeffcient alpha(M) and closure cost coeffcient alpha(Q). Our simulation results demonstrate a mathematical procedure to evaluate the effciency of quarantine measure. Although the numerical work is based on a scale free network, the procedure can be readily generalized and applied to a more realistic social network to determine the proper closure measure in future epidemics.

Closing Rocky Flats by 2006

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

Tuor, N. R.; Schubert, A. L.

2002-02-26

Safely accelerating the closure of Rocky Flats to 2006 is a goal shared by many: the State of Colorado, the communities surrounding the site, the U.S. Congress, the Department of Energy, Kaiser-Hill and its team of subcontractors, the site's employees, and taxpayers across the country. On June 30, 2000, Kaiser-Hill (KH) submitted to the Department of Energy (DOE), KH's plan to achieve closure of Rocky Flats by December 15, 2006, for a remaining cost of $3.96 billion (February 1, 2000, to December 15, 2006). The Closure Project Baseline (CPB) is the detailed project plan for accomplishing this ambitious closure goal.more » This paper will provide a status report on the progress being made toward the closure goal. This paper will: provide a summary of the closure contract completion criteria; give the current cost and schedule variance of the project and the status of key activities; detail important accomplishments of the past year; and discuss the challenges ahead.« less

40 CFR 267.143 - Financial assurance for closure.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 26 2010-07-01 2010-07-01 false Financial assurance for closure. 267... PERMIT Financial Requirements § 267.143 Financial assurance for closure. The owner or operator must establish financial assurance for closure of each storage or treatment unit that he owns or operates. In...

The Integration of the 241-Z Building Decontamination and Decommissioning Under Cercla with RCRA Closure at the Plutonium Finishing Plant

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

Mattlin, E.; Charboneau, S.; Johnston, G.

2007-07-01

The 241-Z treatment and storage tanks, a hazardous waste Treatment, Storage and Disposal (TSD) unit permitted pursuant to the Resource Conservation and Recovery Act of 1976 (RCRA) and Washington State Hazardous Waste Management Act, RCW 70.105, , have been deactivated and are being actively decommissioned under the provisions of the Hanford Federal Facility Agreement and Consent Order (HFFACO), RCRA and Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA) 42 U.S.C. 9601 et seq. The 241-Z TSD unit managed non-listed radioactive contaminated waste water, containing trace RCRA characteristic constituents. The 241-Z TSD unit consists of below grade tanks (D-4,more » D-5, D-7, D-8, and an overflow tank) located in a concrete containment vault, sample glovebox GB-2-241-ZA, and associated ancillary piping and equipment. The tank system is located beneath the 241-Z building. The 241-Z building is not a portion of the TSD unit. The sample glovebox is housed in the above-grade building. Waste managed at the TSD unit was received via underground piping from Plutonium Finishing Plant (PFP) sources. Tank D-6, located in the D-6 vault cell, is a past-practice tank that was taken out of service in 1972 and has never operated as a portion of the RCRA TSD unit. CERCLA actions will address Tank D-6, its containment vault cell, and soil beneath the cell that was potentially contaminated during past-practice operations and any other potential past-practice contamination identified during 241-Z closure, while outside the scope of the Hanford Facility Dangerous Waste Closure Plan, 241-Z Treatment and Storage Tanks. Under the RCRA closure plan, the 241-Z TSD unit is anticipated to undergo clean closure to the performance standards of the State of Washington with respect to dangerous waste contamination from RCRA operations. The TSD unit will be clean closed if physical closure activities identified in the plan achieve clean closure standards for all 241-Z locations. Clean closed 241-Z treatment and storage tanks, equipment and/or structures will remain after RCRA clean closure for future disposition in conjunction with PFP decommissioning activities which are integrated with CERCLA. (authors)« less

40 CFR 265.1202 - Closure and post-closure care.

Code of Federal Regulations, 2013 CFR

2013-07-01

..., STORAGE, AND DISPOSAL FACILITIES Hazardous Waste Munitions and Explosives Storage § 265.1202 Closure and... as long as it remains in service as a munitions or explosives magazine or storage unit. (b) If, after...

40 CFR 265.1202 - Closure and post-closure care.

Code of Federal Regulations, 2014 CFR

2014-07-01

..., STORAGE, AND DISPOSAL FACILITIES Hazardous Waste Munitions and Explosives Storage § 265.1202 Closure and... as long as it remains in service as a munitions or explosives magazine or storage unit. (b) If, after...

40 CFR 265.1202 - Closure and post-closure care.

Code of Federal Regulations, 2011 CFR

2011-07-01

..., STORAGE, AND DISPOSAL FACILITIES Hazardous Waste Munitions and Explosives Storage § 265.1202 Closure and... as long as it remains in service as a munitions or explosives magazine or storage unit. (b) If, after...

40 CFR 265.1202 - Closure and post-closure care.

Code of Federal Regulations, 2012 CFR

2012-07-01

..., STORAGE, AND DISPOSAL FACILITIES Hazardous Waste Munitions and Explosives Storage § 265.1202 Closure and... as long as it remains in service as a munitions or explosives magazine or storage unit. (b) If, after...

Closure Report for Corrective Action Unit 127: Areas 25 and 26 Storage Tanks, Nevada Test Site, Nevada

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

NSTec Environmental Restoration

CAU 127, Areas 25 and 26 Storage Tanks, consists of twelve CASs located in Areas 25 and 26 of the NTS. The closure alternatives included no further action, clean closure, and closure in place with administrative controls. The purpose of this Closure Report is to provide a summary of the completed closure activities, documentation of waste disposal, and analytical data to confirm that the remediation goals were met.

Hanford Facility Dangerous Waste Closure Plan - Plutonium Finishing Plant Treatment Unit Glovebox HA-20MB

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

PRIGNANO, A.L.

2003-06-25

This closure plan describes the planned activities and performance standards for closing the Plutonium Finishing Plant (PFP) glovebox HA-20MB that housed an interim status ''Resource Conservation and Recovery Act'' (RCRA) of 1976 treatment unit. This closure plan is certified and submitted to Ecology for incorporation into the Hanford Facility RCRA Permit (HF RCRA Permit) in accordance with Hanford Federal Facility Agreement and Consent Order (Tri-Party Agreement; TPA) Milestone M-83-30 requiring submittal of a certified closure plan for ''glovebox HA-20MB'' by July 31, 2003. Glovebox HA-20MB is located within the 231-5Z Building in the 200 West Area of the Hanford Facility.more » Currently glovebox HA-20MB is being used for non-RCRA analytical purposes. The schedule of closure activities under this plan supports completion of TPA Milestone M-83-44 to deactivate and prepare for dismantlement the above grade portions of the 234-5Z and ZA, 243-Z, and 291-Z and 291-Z-1 stack buildings by September 30, 2015. Under this closure plan, glovebox HA-20MB will undergo clean closure to the performance standards of Washington Administrative Code (WAC) 173-303-610 with respect to all dangerous waste contamination from glovebox HA-20MB RCRA operations. Because the intention is to clean close the PFP treatment unit, postclosure activities are not applicable to this closure plan. To clean close the unit, it will be demonstrated that dangerous waste has not been left at levels above the closure performance standard for removal and decontamination. If it is determined that clean closure is not possible or is environmentally impractical, the closure plan will be modified to address required postclosure activities. Because dangerous waste does not include source, special nuclear, and by-product material components of mixed waste, radionuclides are not within the scope of this documentation. Any information on radionuclides is provided only for general knowledge. Clearance form only sent to RHA.« less

Military Base Closures: Updated Status of Prior Base Realignments and Closures

EPA Pesticide Factsheets

As the Department of Defense (DOD) prepares for the 2005 base realignment and closure (BRAC) round, questions continue to be raised about the transfer and environmental cleanup of unneeded property arising from the prior four BRAC rounds and their impact on cost and savings and on local economies.

CLOSURE REPORT FOR CORRECTIVE ACTION UNIT 528: POLYCHLORINATED BIPHENYLS CONTAMINATION NEVADA TEST SITE, NEVADA

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

BECHTEL NEVADA

2006-09-01

This Closure Report (CR) describes the closure activities performed at CAU 528, Polychlorinated Biphenyls Contamination, as presented in the Nevada Division of Environmental Protection (NDEP)-approved Corrective Action Plan (CAP) (US. Department of Energy, National Nuclear Security Administration Nevada Site Office [NNSAINSO], 2005). The approved closure alternative was closure in place with administrative controls. This CR provides a summary of the completed closure activities, documentation of waste disposal, and analytical data to confirm that the remediation goals were met.

Analysis on influence of guide vanes closure laws of pump-turbine on load rejection transient process

NASA Astrophysics Data System (ADS)

Yao, Z.; Bi, H. L.; Huang, Q. S.; Li, Z. J.; Wang, Z. W.

2013-12-01

In load rejection transient process, the sudden shut down of guide vanes may cause units speed rise and a sharp increase in water hammer pressure of diversion system, which endangers the safety operation of the power plant. Adopting reasonable guide vane closure law is a kind of economic and effective measurement to reduce the water hammer pressure and limit rotational speed increases. In this paper, combined with Guangzhou Pumped Storage Power Station plant A, the load rejection condition under different guide vanes closure laws is calculated and the key factor of guide vanes closure laws on the impact of the load rejection transition process is analyzed. The different inflection points, which are the closure modes, on the impact of unit speed change, water level fluctuation of surge tank, and the pressure fluctuation of volute inlet and draft tube inlet are further discussed. By compared with the calculation results, a reasonable guide vanes inflection point position can be determined according to security requirements and a reasonable guide vanes closure law can be attained to effectively coordinate the unit speed rise and the rapid pressure change in the load rejection transient process.

40 CFR 258.74 - Allowable mechanisms.

Code of Federal Regulations, 2011 CFR

2011-07-01

... post-closure care, up to an amount equal to the face amount of the policy. (3) The insurance policy must be issued for a face amount at least equal to the current cost estimate for closure or post-closure care, whichever is applicable, except as provided in paragraph (k) of this section. The term face...

40 CFR 258.74 - Allowable mechanisms.

Code of Federal Regulations, 2010 CFR

2010-07-01

... post-closure care, up to an amount equal to the face amount of the policy. (3) The insurance policy must be issued for a face amount at least equal to the current cost estimate for closure or post-closure care, whichever is applicable, except as provided in paragraph (k) of this section. The term face...

Comparison Of Intake Gate Closure Methods At Lower Granite, Little Goose, Lower Monumental, And Mcnary Dams Using Risk-Based Analysis

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

Gore, Bryan F.; Blackburn, Tyrone R.; Heasler, Patrick G.

2001-01-19

The objective of this report is to compare the benefits and costs of modifications proposed for intake gate closure systems at four hydroelectric stations on the Lower Snake and Upper Columbia Rivers in the Walla Walla District that are unable to meet the COE 10-minute closure rule due to the installation of fish screens. The primary benefit of the proposed modifications is to reduce the risk of damage to the station and environs when emergency intake gate closure is required. Consequently, this report presents the results and methodology of an extensive risk analysis performed to assess the reliability of powerhousemore » systems and the costs and timing of potential damages resulting from events requiring emergency intake gate closure. As part of this analysis, the level of protection provided by the nitrogen emergency closure system was also evaluated. The nitrogen system was the basis for the original recommendation to partially disable the intake gate systems. The risk analysis quantifies this protection level.« less

Sampling and monitoring for closure

USGS Publications Warehouse

McLemore, Virginia T.; Smith, Kathleen S.; Russell, Carol C.

2007-01-01

An important aspect of planning a new mine or mine expansion within the modern regulatory framework is to design for ultimate closure. Sampling and monitoring for closure is a form of environmental risk management. By implementing a sampling and monitoring program early in the life of the mining operation, major costs can be avoided or minimized. The costs for treating mine drainage in perpetuity are staggering, especially if they are unanticipated. The Metal Mining Sector of the Acid Drainage Technology Initiative (ADTI-MMS), a cooperative government-industry-academia organization, was established to address drainage-quality technologies of metal mining and metallurgical operations. ADTI-MMS recommends that sampling and monitoring programs consider the entire mine-life cycle and that data needed for closure of an operation be collected from exploration through postclosure.

Planned secondary wound closure at the circular stapler insertion site after laparoscopic gastric bypass reduces postoperative morbidity, costs, and hospital stay.

PubMed

Vetter, Diana; Raptis, Dimitri Aristotle; Giama, Mira; Hosa, Hanna; Muller, Markus K; Nocito, Antonio; Schiesser, Marc; Moos, Rudolf; Bueter, Marco

2017-12-01

The aims of the present study were to assess whether planned secondary wound closure at the insertion site of the circular stapler reduces wound infection rate and postoperative morbidity after laparoscopic Roux-en-Y gastric bypass (RYGB) and to identify independent predictive factors increasing the risk for wound infections after RYGB. This paper is a retrospective single-center analysis of a prospectively collected database of 1400 patients undergoing RYGB surgery in circular technique between June 2000 and June 2016. Planned secondary wound closure at the circular stapler introduction site was performed at postoperative day 3 in 291 (20.8%) consecutive patients and compared to a historical control of 1109 (79.2%) consecutive patients with primary wound closure. Independent predictive factors for wound infection were assessed by multivariable analysis. Secondary wound closure significantly decreased wound infection rate from 9.3% (103/1109) to 1% (3/291) (p < 0.001) leading to a shorter hospital stay (mean 9 (SD8) vs. 7 days (SD2), p < 0.001), lower costs (p = 0.039), and reduced postoperative morbidity (mean 90-day Comprehensive Complication Index (CCI) 7.4 (SD14.0) vs. 5.1 (SD11.1) p = 0.008) when compared to primary wound closure. Primary wound closure, dyslipidemia, and preoperative gastritis were independent predictive risk factors for developing wound infections both in the univariate (p < 0.001; p = 0.048; p = 0.003) and multivariable analysis (p < 0.001; p = 0.040; p = 0.012). Further, on multivariable analysis, the female gender was a predictive factor (p = 0.034) for wound infection development. Secondary wound closure at the circular stapler introduction site in laparoscopic RYGB significantly reduces the overall wound infection rate as well as postoperative morbidity, costs, and hospital stay when compared to primary wound closure.

Defense Base Realignment and Closure Budget Data for Naval Air Technical Training Center, Naval Air Station Pensacola, Florida

DTIC Science & Technology

1994-06-07

023- S -94 Military Construction Projects Budgeted January 14, 1994 and Programmed for Bases Identified for Closure or Realignment 028-C-93...deferred to this analysis as the more accurate basis for design and construction costs, rather than the gross estimates in the 1391’ s submitted much...solutions( s ), it is imperative that design and construction costs, operation/maintenance costs, the specific health care needs of the population to

Protecting an island nation from extreme pandemic threats: Proof-of-concept around border closure as an intervention

PubMed Central

Boyd, Matt; Baker, Michael G.; Mansoor, Osman D.; Kvizhinadze, Giorgi; Wilson, Nick

2017-01-01

Background Countries are well advised to prepare for future pandemic risks (e.g., pandemic influenza, novel emerging agents or synthetic bioweapons). These preparations do not typically include planning for complete border closure. Even though border closure may not be instituted in time, and can fail, there might still plausible chances of success for well organized island nations. Objective To estimate costs and benefits of complete border closure in response to new pandemic threats, at an initial proof-of-concept level. New Zealand was used as a case-study for an island country. Methods An Excel spreadsheet model was developed to estimate costs and benefits. Case-study specific epidemiological data was sourced from past influenza pandemics. Country-specific healthcare cost data, valuation of life, and lost tourism revenue were imputed (with lost trade also in scenario analyses). Results For a new pandemic equivalent to the 1918 influenza pandemic (albeit with half the mortality rate, “Scenario A”), it was estimated that successful border closure for 26 weeks provided a net societal benefit (e.g., of NZ$11.0 billion, USD$7.3 billion). Even in the face of a complete end to trade, a net benefit was estimated for scenarios where the mortality rate was high (e.g., at 10 times the mortality impact of “Scenario A”, or 2.75% of the country’s population dying) giving a net benefit of NZ$54 billion (USD$36 billion). But for some other pandemic scenarios where trade ceased, border closure resulted in a net negative societal value (e.g., for “Scenario A” times three for 26 weeks of border closure–but not for only 12 weeks of closure when it would still be beneficial). Conclusions This “proof-of-concept” work indicates that more detailed cost-benefit analysis of border closure in very severe pandemic situations for some island nations is probably warranted, as this course of action might sometimes be worthwhile from a societal perspective. PMID:28622344

Performance characteristics of a novel blood bag in-line closure device and subsequent product quality assessment

PubMed Central

Serrano, Katherine; Levin, Elena; Culibrk, Brankica; Weiss, Sandra; Scammell, Ken; Boecker, Wolfgang F; Devine, Dana V

2010-01-01

BACKGROUND In high-volume processing environments, manual breakage of in-line closures can result in repetitive strain injury (RSI). Furthermore, these closures may be incorrectly opened causing shear-induced hemolysis. To overcome the variability of in-line closure use and minimize RSI, Fresenius Kabi developed a new in-line closure, the CompoFlow, with mechanical openers. STUDY DESIGN AND METHODS The consistency of the performance of the CompoFlow closure device was assessed, as was its effect on component quality. A total of 188 RBC units using CompoFlow blood bag systems and 43 using the standard bag systems were produced using the buffy coat manufacturing method. Twenty-six CompoFlow platelet (PLT) concentrates and 10 control concentrates were prepared from pools of four buffy coats. RBCs were assessed on Days 1, 21, and 42 for cellular variables and hemolysis. PLTs were assessed on Days 1, 3, and 7 for morphology, CD62P expression, glucose, lactate, and pH. A total of 308 closures were excised after processing and the apertures were measured using digital image analysis. RESULTS The use of the CompoFlow device significantly improved the mean extraction time with 0.46 ± 0.11 sec/mL for the CompoFlow units and 0.52 ± 0.13 sec/mL for the control units. The CompoFlow closures showed a highly reproducible aperture after opening (coefficient of variation, 15%) and the device always remained opened. PLT and RBC products showed acceptable storage variables with no differences between CompoFlow and control. CONCLUSIONS The CompoFlow closure devices improved the level of process control and processing time of blood component production with no negative effects on product quality. PMID:20529007

40 CFR 265.120 - Certification of completion of post-closure care.

Code of Federal Regulations, 2010 CFR

2010-07-01

... each hazardous waste disposal unit, the owner or operator must submit to the Regional Administrator, by registered mail, a certification that the post-closure care period for the hazardous waste disposal unit was...) SOLID WASTES (CONTINUED) INTERIM STATUS STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE TREATMENT...

40 CFR 258.50 - Applicability.

Code of Federal Regulations, 2011 CFR

2011-07-01

... in § 258.2) during the active life of the unit and the post-closure care period. This demonstration... shall be conducted throughout the active life and post-closure care period of that MSWLF unit as... scientist or engineer who has received a baccalaureate or post-graduate degree in the natural sciences or...

40 CFR 258.50 - Applicability.

Code of Federal Regulations, 2014 CFR

2014-07-01

... in § 258.2) during the active life of the unit and the post-closure care period. This demonstration... shall be conducted throughout the active life and post-closure care period of that MSWLF unit as... scientist or engineer who has received a baccalaureate or post-graduate degree in the natural sciences or...

40 CFR 258.50 - Applicability.

Code of Federal Regulations, 2012 CFR

2012-07-01

... in § 258.2) during the active life of the unit and the post-closure care period. This demonstration... shall be conducted throughout the active life and post-closure care period of that MSWLF unit as... scientist or engineer who has received a baccalaureate or post-graduate degree in the natural sciences or...

40 CFR 258.50 - Applicability.

Code of Federal Regulations, 2013 CFR

2013-07-01

... in § 258.2) during the active life of the unit and the post-closure care period. This demonstration... shall be conducted throughout the active life and post-closure care period of that MSWLF unit as... scientist or engineer who has received a baccalaureate or post-graduate degree in the natural sciences or...

Loop ileostomy closure: comparison of cost effectiveness between suture and stapler.

PubMed

Horisberger, Karoline; Beldi, Guido; Candinas, Daniel

2010-12-01

Closure of loop ileostomy can be safely performed using sutures or staplers. The aim of the present study was to compare the cost effectiveness of three different techniques. A total of 128 consecutive patients who underwent closure of loop ileostomy between January 2002 and December 2008 were analyzed retrospectively. The primary outcome parameter was operative cost. Closure of ileostomy was performed in 66 patients with hand-sewn anastomosis, in 25 patients with stapler only, and in 37 patients with a combination of stapler and suture. There were no differences in terms of early and late postoperative complications. Operative time was significantly longer for "suture only" (101.4 ± 26 min) than for "stapler/suture" (-4.9 min) and "stapler only" (-17.8 min); the difference between the three groups is significant (p = 0.05). Duration of hospital stay was not different among the three groups. Operative costs with "stapler/suture" (1,755.9 ± 355.6 EUR) were significantly higher than with "suture only" (-254 EUR; p = 0.001) and "stapler only" (-236 EUR; p = 0.005). Operative time using the stapler only is significantly shorter than with hand-sewn anastomosis or combinations of stapler and suture. Operative costs are significantly higher for a procedure that includes suture and stapler.

Clips versus suture technique: is there a difference?

PubMed

Chughtai, T; Chen, L Q; Salasidis, G; Nguyen, D; Tchervenkov, C; Morin, J F

2000-11-01

Coronary artery bypass grafting (CABG) is one of the most common procedures performed today, and wound complications are a major source of morbidity and cost. To determine whether there is any difference in wound outcome (including cost in a Canadian context) between a subcuticular suture technique and skin stapling technique for closure of sternal and leg incisions in CABG patients. One hundred and sixty-two patients undergoing CABG were prospectively, randomly placed to have their sternal and leg incisions closed with either a subcuticular suture technique or with a skin clip. Data were obtained through chart review, in-hospital assessments and follow-up visits. Nonblinded assessments were made regarding wound leakage, inflammation, infection, necrosis, swelling, dehiscence and cosmesis. Each of the parameters was graded on a scale from 1 to 4. The cost was evaluated in Canadian dollars. There were trends toward increased rates of in-hospital sternal (P=0.09) and leg (P=0.17) incision inflammation when the wounds were closed with skin clips. There was a significantly greater (P=0.05) rate of sternal wound infection with clips, as well as a tendency (P=0.15) toward a greater rate of mediastinitis at follow-up assessment. Cosmetic outcome was similar for both groups. The cost incurred was significantly greater when skin clips were used for closure. There was a greater than threefold difference, which translates to a greater than $10,000 difference over one year. Closure with a subcuticular technique achieves better outcomes than the use of skin clips. When factoring in the increased cost incurred by using clips, as well as other intangible factors such as surgical skill acquisition, subcuticular suture closure appears to be a favourable method of wound closure in CABG patients compared with the use of skin stapling techniques.

Household responses to school closure resulting from outbreak of influenza B, North Carolina.

PubMed

Johnson, April J; Moore, Zack S; Edelson, Paul J; Kinnane, Lynda; Davies, Megan; Shay, David K; Balish, Amanda; McCarron, Meg; Blanton, Lenee; Finelli, Lyn; Averhoff, Francisco; Bresee, Joseph; Engel, Jeffrey; Fiore, Anthony

2008-07-01

School closure is a proposed strategy for reducing influenza transmission during a pandemic. Few studies have assessed how families respond to closures, or whether other interactions during closure could reduce this strategy's effect. Questionnaires were administered to 220 households (438 adults and 355 children) with school-age children in a North Carolina county during an influenza B virus outbreak that resulted in school closure. Closure was considered appropriate by 201 (91%) households. No adults missed work to solely provide childcare, and only 22 (10%) households required special childcare arrangements; 2 households incurred additional costs. Eighty-nine percent of children visited at least 1 public location during the closure despite county recommendations to avoid large gatherings. Although behavior and attitudes might differ during a pandemic, these results suggest short-term closure did not cause substantial hardship for parents. Pandemic planning guidance should address the potential for transmission in public areas during school closure.

Closure Report for the 92-Acre Area and Corrective Action Unit 111: Area 5 WMD Retired Mixed Waste Pits, Nevada National Security Site, Nevada

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

NSTec Environmental Restoration

2012-02-21

This Closure Report (CR) presents information supporting closure of the 92-Acre Area, which includes Corrective Action Unit (CAU) 111, 'Area 5 WMD Retired Mixed Waste Pits.' This CR provides documentation supporting the completed corrective actions and confirmation that the closure objectives were met. This CR complies with the requirements of the Federal Facility Agreement and Consent Order (FFACO) (FFACO, 1996 [as amended March 2010]). Closure activities began in January 2011 and were completed in January 2012. Closure activities were conducted according to Revision 1 of the Corrective Action Decision Document/Corrective Action Plan (CADD/CAP) for the 92-Acre Area and CAU 111more » (U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office [NNSA/NSO], 2010). The following closure activities were performed: (1) Construct an engineered evapotranspiration cover over the boreholes, trenches, and pits in the 92-Acre Area; (2) Install use restriction (UR) warning signs, concrete monuments, and subsidence survey monuments; and (3) Establish vegetation on the covers. UR documentation is included as Appendix C of this report. The post-closure plan is presented in detail in Revision 1 of the CADD/CAP for the 92-Acre Area and CAU 111, and the requirements are summarized in Section 5.2 of this document. When the next request for modification of Resource Conservation and Recovery Act Permit NEV HW0101 is submitted to the Nevada Division of Environmental Protection (NDEP), the requirements for post-closure monitoring of the 92-Acre Area will be included. NNSA/NSO requests the following: (1) A Notice of Completion from NDEP to NNSA/NSO for closure of CAU 111; and (2) The transfer of CAU 111 from Appendix III to Appendix IV, Closed Corrective Action Units, of the FFACO.« less

Addendum to the Closure Report for Corrective Action Unit 411: Double Tracks Plutonium Dispersion (Nellis), Nevada Test and Training Range, Nevada, Revision 0

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

Burmeister, Mark

2016-11-01

The Corrective Action Unit (CAU) 411 Closure Report (CR) was published in June 2016 (NNSA/NFO, 2016). The purpose of this addendum is to clarify language in the CR relating to the field instrument for the detection of low-energy radiation (FIDLER), provide the waste disposal documentation for waste generated during the corrective action investigation (CAI), and reference a letter from the U.S. Air Force (USAF) regarding the closure of CAU 411.

76 FR 39313 - Fisheries of the Northeastern United States; Atlantic Mackerel, Squid, and Butterfish Fisheries...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-06

.... 100804323-0569-02] RIN 0648-XA523 Fisheries of the Northeastern United States; Atlantic Mackerel, Squid, and Butterfish Fisheries; Closure of the Directed Butterfish Fishery AGENCY: National Marine Fisheries Service...; closure. SUMMARY: NMFS announces that the directed fishery for butterfish in the Exclusive Economic Zone...

36 CFR 13.1120 - Bartlett Cove Developed Area closures and restrictions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... closures and restrictions. 13.1120 Section 13.1120 Parks, Forests, and Public Property NATIONAL PARK SERVICE, DEPARTMENT OF THE INTERIOR NATIONAL PARK SYSTEM UNITS IN ALASKA Special Regulations-Glacier Bay National Park and Preserve Bartlett Cove § 13.1120 Bartlett Cove Developed Area closures and restrictions...

36 CFR 13.1120 - Bartlett Cove Developed Area closures and restrictions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... closures and restrictions. 13.1120 Section 13.1120 Parks, Forests, and Public Property NATIONAL PARK SERVICE, DEPARTMENT OF THE INTERIOR NATIONAL PARK SYSTEM UNITS IN ALASKA Special Regulations-Glacier Bay National Park and Preserve Bartlett Cove § 13.1120 Bartlett Cove Developed Area closures and restrictions...

36 CFR 13.1120 - Bartlett Cove Developed Area closures and restrictions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... closures and restrictions. 13.1120 Section 13.1120 Parks, Forests, and Public Property NATIONAL PARK SERVICE, DEPARTMENT OF THE INTERIOR NATIONAL PARK SYSTEM UNITS IN ALASKA Special Regulations-Glacier Bay National Park and Preserve Bartlett Cove § 13.1120 Bartlett Cove Developed Area closures and restrictions...

40 CFR 264.120 - Certification of completion of post-closure care.

Code of Federal Regulations, 2010 CFR

2010-07-01

... certification that the post-closure care period for the hazardous waste disposal unit was performed in...) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE TREATMENT, STORAGE, AND... later than 60 days after completion of the established post-closure care period for each hazardous waste...

Not ''just'' pump and treat

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

Angleberger, K; Bainer, R W

2000-12-12

The Lawrence Livermore National Laboratory (LLNL) has been consistently improving the site cleanup methods by adopting new philosophies, strategies and technologies to address constrained or declining budgets, lack of useable space due to a highly industrialized site, and significant technical challenges. As identified in the ROD, the preferred remedy at the LLNL Livermore Site is pump and treat, although LLNL has improved this strategy to bring the remediation of the ground water to closure as soon as possible. LLNL took the logical progression from a pump and treat system to the philosophy of ''Smart Pump and Treat'' coupled with themore » concepts of ''Hydrostratigraphic Unit Analysis,'' ''Engineered Plume Collapse,'' and ''Phased Source Remediation,'' which led to the development of new, more cost-effective technologies which have accelerated the attainment of cleanup goals significantly. Modeling is also incorporated to constantly develop new, cost-effective methodologies to accelerate cleanup and communicate the progress of cleanup to stakeholders. In addition, LLNL improved on the efficiency and flexibility of ground water treatment facilities. Ground water cleanup has traditionally relied on costly and obtrusive fixed treatment facilities. LLNL has designed and implemented various portable ground water treatment units to replace the fixed facilities; the application of each type of facility is determined by the amount of ground water flow and contaminant concentrations. These treatment units have allowed for aggressive ground water cleanup, increased cleanup flexibility, and reduced capital and electrical costs. After a treatment unit has completed ground water cleanup at one location, it can easily be moved to another location for additional ground water cleanup.« less

Choledochorraphy (primary repair) versus t-tube drainage after open choledochotomy.

PubMed

Saeed, Nadia; Nasir, Muhammad Tauqeer; Khan, Muhammad Iqbal; Channa, Ghulam Asghar

2012-01-01

T-tube drainage used to be standard practice after surgical choledochotomy, but there is now a tendency in some canters to close the common bile duct primarily. This study was designed to compare the clinical results of primary closure with T-tube drainage after open choledocotomy and assess the safety of primary closure for future application. This study was conducted at surgical Unit-3, ward 26 Jinnah Postgraduate Medical Centre Karachi, from January 2007 to January 2008. Forty patients were included in this study out of which 20 underwent primary closure and 20 T-tube placements. It was Quasi-experimental, non-probability, purposive sampling. Main outcome measures were operating time, duration of hospital stay, and postoperative complications. SPSS-10 was used for data analysis. The age of patients in the study ranged from 29-83 years. There were 3 male while 37 female patients. Group-1 consisted of 20 patients underwent primary closure after choledocotomy, while Group-2 also consisted of 20 patients underwent T-tube drainage after duct exploration. Mean hospital stay in Group-1 patients was 7.63 days while in group 2 it was 13.6 days. Overall complication rate in group 1 was 15%, biliary leakage in 1 (5%), jaundice in 1 (5%), wound infection in 1 (5%). No re-exploration was required in Group-1. In Group-2 overall complication rate was 30%, biliary leakage in 2 (2%), jaundice in 1 (5%), dislodgement of T-tube in 1 (5%), wound infection in 1 (5%), and sepsis in 1 (5%) patients. Re-exploration was done in one patient. Primary closure of Common Bile Duct (CBD) is a safe and cost-effective alternative procedure to routine T-tube drainage after open choledocotomy.

Corrective Action Decision Document/Closure Report for Corrective Action Unit 477: Area 12 N-Tunnel Muckpile, Nevada Test Site

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

NSTec Environmental Restoration

This Corrective Action Decision Document (CADD)/Closure Report (CR) was prepared by the Defense Threat Reduction Agency (DTRA) for Corrective Action Unit (CAU) 477, N-Tunnel Muckpile. This CADD/CR is consistent with the requirements of the Federal Facility Agreement and Consent Order (FFACO) agreed to by the State of Nevada, the U.S. Department of Energy, and the U.S. Department of Defense. Corrective Action Unit 477 is comprised of one Corrective Action Site (CAS): • 12-06-03, Muckpile The purpose of this CADD/CR is to provide justification and documentation supporting the recommendation for closure with no further action, by placing use restrictions on CAUmore » 477.« less

Annual Report, Fall 2016: Identifying Cost Effective Tank Waste Characterization Approaches

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

Reboul, S. H.; DiPrete, D. P.

2016-12-12

This report documents the activities that were performed during the second year of a project undertaken to improve the cost effectiveness and timeliness of SRNL’s tank closure characterization practices. The activities performed during the first year of the project were previously reported in SRNL-STI-2015-00144. The scope of the second year activities was divided into the following three primary tasks: 1) develop a technical basis and strategy for improving the cost effectiveness and schedule of SRNL’s tank closure characterization program; 2) initiate the design and assembly of a new waste removal system for improving the throughput and reducing the personnel dosemore » associated with extraction chromatography radiochemical separations; and 3) develop and perform feasibility testing of three alternative radiochemical separation protocols holding promise for improving high resource demand/time consuming tank closure sample analysis methods.« less

Association of land use and its change with beach closure in the United States, 2004-2013

EPA Science Inventory

Land use and its change have great influences on water quality. However, their impacts on microbial contamination of beach water have been rarely investigated and their relationship with beach closure is still unknown. Here, we analyzed beach closure data obtained from 2004 to 20...

78 FR 76759 - Fisheries of the Northeastern United States; Northeast Multispecies Fishery; Trimester Closure...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-19

... Fishery; Trimester Closure for the Common Pool Fishery AGENCY: National Marine Fisheries Service (NMFS... Trimester 3, from January 1, 2014, through April 30, 2014, to common pool vessels, because the Trimester 3... intended to prevent the overharvest of the common pool's allocation of GOM haddock. DATES: The closure of...

Cost analysis of negative-pressure wound therapy with instillation for wound bed preparation preceding split-thickness skin grafts for massive (>100 cm(2)) chronic venous leg ulcers.

PubMed

Yang, C Kevin; Alcantara, Sean; Goss, Selena; Lantis, John C

2015-04-01

Massive (≥100 cm(2)) venous leg ulcers (VLUs) demonstrate very low closure rates with standard compression therapy and are costly to manage. Negative-pressure wound therapy (NPWT), followed by a split-thickness skin graft (STSG), can be a cost-effective alternative to this standard care. We performed a cost analysis of these two treatments. A retrospective review was performed of 10 ulcers treated with surgical debridement, 7 days of inpatient NPWT with topical antiseptic instillation (NPWTi), and STSG, with 4 additional days of inpatient NPWT bolster over the graft. Independent medical cost estimators were used to compare the cost of this treatment protocol with standard outpatient compression therapy. The average length of time ulcers were present before patients entered the study was 38 months (range, 3-120 months). Eight of 10 patients had complete VLU closure by 6 months after NPWTi with STSG. The 6-month costs of the proposed treatment protocol and standard twice-weekly compression therapy were estimated to be $27,000 and $28,000, respectively. NPWTi with STSG treatment is more effective for closure of massive VLUs at 6 months than that reported for standard compression therapy. Further, the cost of the proposed treatment protocol is comparable with standard compression therapy. Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

3718-F Alkali Metal Treatment and Storage Facility Closure Plan

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

None

Since 1987, Westinghouse Hanford Company has been a major contractor to the U.S. Department of Energy-Richland Operations Office and has served as co-operator of the 3718-F Alkali Metal Treatment and Storage Facility, the waste management unit addressed in this closure plan. The closure plan consists of a Part A Dangerous waste Permit Application and a RCRA Closure Plan. An explanation of the Part A Revision (Revision 1) submitted with this document is provided at the beginning of the Part A section. The closure plan consists of 9 chapters and 5 appendices. The chapters cover: introduction; facility description; process information; wastemore » characteristics; groundwater; closure strategy and performance standards; closure activities; postclosure; and references.« less

Transcatheter closure, mini-invasive closure and open-heart surgical repair for treatment of perimembranous ventricular septal defects in children: a protocol for a network meta-analysis.

PubMed

You, Tao; Yi, Kang; Ding, Zhao-Hong; Hou, Xiao-Dong; Liu, Xing-Guang; Wang, Xin-Kuan; Ge, Long; Tian, Jin-Hui

2017-06-21

Both transcatheter device closure and surgical repair are effective treatments with excellent midterm outcomes for perimembranous ventricular septal defects (pmVSDs) in children. The mini-invasive periventricular device occlusion technique has become prevalent in research and application, but evidence is limited for the assessment of transcatheter closure, mini-invasive closure and open-heart surgical repair. This study comprehensively compares the efficacy, safety and costs of transcatheter closure, mini-invasive closure and open-heart surgical repair for treatment of pmVSDs in children using Bayesian network meta-analysis. A systematic search will be performed using Chinese Biomedical Literature Database, China National Knowledge Infrastructure, PubMed, EMBASE.com and the Cochrane Central Register of Controlled Trials to include random controlled trials, prospective or retrospective cohort studies comparing the efficacy, safety and costs of transcatheter closure, mini-invasive closure and open-heart surgical repair. The risk of bias for the included prospective or retrospective cohort studies will be evaluated according to the risk of bias in non-randomised studies of interventions (ROBINS-I). For random controlled trials, we will use risk of bias tool from Cochrane Handbook version 5.1.0. A Bayesian network meta-analysis will be conducted using R-3.3.2 software. Ethical approval and patient consent are not required since this study is a network meta-analysis based on published trials. The results of this network meta-analysis will be submitted to a peer-reviewed journal for publication. CRD42016053352. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

BRAC, What Will it Cost

DTIC Science & Technology

1992-04-10

Devens - Fort Huachuca FY 91 FY 95 Fort McClellan FY 92 FY 96 Fort Chaffee FY 92 FY 97 Cameron Station FY 91 FY 95 53 Stand Alone Housing Sites FY 90 FY...Army, Headquarters Forces Command, &as Realianment and Closure Implementation Plan - Fort Devens Closure Package, Implementation Plan, Fort McPherson, GA...Classification) RAC , What Will It Cost? 12. PERSONAL AUTHOR(S) TLIN, Robert B. LTC, USA 13. TYPE OF REPORT 13b. TIME COVERED 14. DATE OF REPORT (Year

"We Felt They Took the Heart out of the Community": Examining a Community-Based Response to Urban School Closure

ERIC Educational Resources Information Center

Green, Terrance L.

2017-01-01

Massive school closures are occurring in urban school districts across the United States. Research suggests that school closures are the outcome of racialized neoliberal policies and decades of disinvestment that have left many urban districts with fiscal deficits and declining student enrollments. However, some urban communities have successfully…

Corrective Action Decision Document/Closure Report for Corrective Action Unit 478: Area 12 T-Tunnel Ponds, Nevada Test Site

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

NSTec Environmental Restoration

This Corrective Action Decision Document (CADD)/Closure Report (CR) was prepared by the Defense Threat Reduction Agency (DTRA) for Corrective Action Unit (CAU) 478, Area 12 T-Tunnel Ponds. This CADD/CR is consistent with the requirements of the Federal Facility Agreement and Consent Order (FFACO) agreed to by the State of Nevada, the U.S. Department of Energy (DOE), and the U.S. Department of Defense. Corrective Action Unit 478 is comprised of one corrective action site (CAS): • 12-23-01, Ponds (5) RAD Area The purpose of this CADD/CR is to provide justification and documentation supporting the recommendation for closure in place with usemore » restrictions for CAU 478.« less

Corrective Action Decision Document/Closure Report for Corrective Action Unit 559: T Tunnel Compressor/Blower Pad, Nevada Test Site

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

NSTec Environmental Restoration

This Corrective Action Decision Document (CADD)/Closure Report (CR) was prepared by the Defense Threat Reduction Agency (DTRA) for Corrective Action Unit (CAU) 559, T-Tunnel Compressor/Blower Pad. This CADD/CR is consistent with the requirements of the Federal Facility Agreement and Consent Order (FFACO) agreed to by the State of Nevada, the U.S. Department of Energy, and the U.S. Department of Defense. Corrective Action Unit 559 is comprised of one Corrective Action Site (CAS): • 12-25-13, Oil Stained Soil and Concrete The purpose of this CADD/CR is to provide justification and documentation supporting the recommendation for closure in place with use restrictionsmore » for CAU 559.« less

Babies born before arrival to hospital and maternity unit closures in Queensland and Australia.

PubMed

Kildea, Sue; McGhie, Alexandra C; Gao, Yu; Rumbold, Alice; Rolfe, Margaret

2015-09-01

Evidence suggests the closure of maternity units is associated with an increase in babies born before arrival (BBA). To explore the association between the number of maternity units in Australia and Queensland by birthing numbers, BBA rate and geographic remoteness of the health district where the mother lives. A retrospective study utilised routinely collected perinatal data (1992-2011). Pearson correlation tested the relationship between BBA rate and number of maternity units. Linear regression examined this association over time. During 1992-2011, the absolute numbers (N=22,814) of women having a BBA each year in Australia increased by 47% (N=836-1233); and 206% (n=140-429) in Queensland. This coincided with a 41% reduction in maternity units in Australia (N=623-368=18 per year) and a 28% reduction in Queensland (n=129-93). BBA rates increased significantly across Australia, r=0.837, n=20 years, p<0.001 and Queensland, r=0.917, n=20 years, p<0.001 and this was negatively correlated with the number of maternity units in Australia, r=-0.804, n=19 years, p<0.001 and Queensland, r=-0.906, n=19 years, p<0.001. The closure of maternity units over a 20-year period across Australia and Queensland is significantly associated with increased BBA rates. The distribution is not limited to rural and remote areas. Given the high risk of adverse maternal and neonatal outcomes associated with BBA, it is time to revisit the closure of units. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

CLOSURE REPORT FOR CORRECTIVE ACTION UNIT165: AREA 25 AND 26 DRY WELL AND WASH DOWN AREAS, NEVADA TEST SITE, NEVADA

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

BECHTEL NEVADA

This Closure Report (CR) documents the closure activities for Corrective Action Unit (CAU) 165, Area 25 and 26 Dry Well and Washdown Areas, according to the Federal Facility Agreement and Consent Order (FFACO) of 1996. CAU 165 consists of 8 Corrective Action Sites (CASs) located in Areas 25 and 26 of the Nevada Test Site (NTS). The NTS is located approximately 105 kilometers (65 miles) northwest of Las Vegas, nevada. Site closure activities were performed according to the Nevada Division of Environmental Protection (NDEP)-approved Corrective Action Plan (CAP) for CAU 165. CAU 165 consists of the following CASs: (1) CASmore » 25-07-06, Train Decontamination Area; (2) CAS 25-07-07, Vehicle Washdown; (3) CAS 25-20-01, Lab Drain Dry Well; (4) CAS 25-47-01, Reservoir and French Drain; (5) CAS 25-51-02, Drywell; (6) CAS 25-59-01, Septic System; (7) CAS 26-07-01, Vehicle Washdown Station; and (8) CAS 26-59-01, Septic System. CAU 165, Area 25 and 26 Dry Well and Washdown Areas, consists of eight CASs located in Areas 25 and 26 of the NTS. The approved closure alternatives included No Further Action, Clean Closure, and Closure in Place with Administrative Controls.« less

Port closure techniques.

PubMed

Shaher, Z

2007-08-01

Laparoscopic trocars do create wounds. This article aims to review and list different techniques used for closure of the fascia incision at trocar sites. A literature search was performed for articles dealing with closure techniques. The author searched this subject in English on Medline by combining the words "trocar" and "hernia," as well as "Deschamps" and "Reverdin." All articles reporting techniques with their references were reviewed. The articles described many techniques in addition to classical closure using curved needles, including Grice needle, Maciol needles, Endoclose device, Carter-Thomason device, Tahoe ligature device, Endo-Judge device, eXit puncture closure device, Lowsley retractor, spinal cord needles, dual hemostat, suture carrier, Riverdin and Deschamps needles, and Gore-Tex closure device. Three main groups of techniques were found with favor of extracorporeal manipulations under direct visualization. Old methods are sufficient and cost-effective.

Transcatheter Closure of Patent Foramen Ovale: Devices and Technique.

PubMed

Price, Matthew J

2017-10-01

Transcatheter closure of a patent foramen ovale (PFO) reduces the risk of recurrent cryptogenic stroke compared with medical therapy. PFO closure is a prophylactic procedure, and will not provide the patient with symptomatic improvement, except in cases of hypoxemia due to right-to-left shunt or possibly migraine headaches. Therefore, appropriate patient selection is critical, and procedural safety is paramount. Herein, we review key characteristics of the devices currently available for transcatheter PFO closure within the United States, and highlight key technical aspects of the PFO closure procedure that will maximize procedural success. Copyright © 2017 Elsevier Inc. All rights reserved.

Corrective Action Decision Document/Closure Report for Corrective Action Unit 570: Area 9 Yucca Flat Atmospheric Test Sites, Nevada National Security Site, Nevada, Revision 0

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

Matthews, Patrick

2013-11-01

This Corrective Action Decision Document/Closure Report presents information supporting the closure of Corrective Action Unit (CAU) 570: Area 9 Yucca Flat Atmospheric Test Sites, Nevada National Security Site, Nevada. This complies with the requirements of the Federal Facility Agreement and Consent Order (FFACO) that was agreed to by the State of Nevada; U.S. Department of Energy (DOE), Environmental Management; U.S. Department of Defense; and DOE, Legacy Management. The purpose of the CADD/CR is to provide justification and documentation supporting the recommendation that no further corrective action is needed.

External tissue expansion for difficult wounds using a simple cost effective technique.

PubMed

Nandhagopal, Vijayaraghavan; Chittoria, Ravi Kumar; Mohapatra, Devi Prasad; Thiruvoth, Friji Meethale; Sivakumar, Dinesh Kumar; Ashokan, Arjun

2015-01-01

To study and discuss role of external tissue expansion and wound closure (ETEWC) technique using hooks and rubber bands. The present study is a retrospective analysis of nine cases of wounds of different aetiology where ETEWC technique was applied using hooks and rubber bands. All the wounds in the study healed completely without split thickness skin graft (SSG) or flap. ETEWC technique using hooks and rubber bands is a cost-effective technique which can be used for wound closure without SSG or flap.

75 FR 60740 - Record of Decision for the Base Closure and Realignment Beddown and Flight Operations of Remotely...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-01

... DEPARTMENT OF DEFENSE Department of the Air Force Record of Decision for the Base Closure and Realignment Beddown and Flight Operations of Remotely Piloted Aircraft at Grand Forks Air Force Base (AFB), ND... United States Air Force signed the ROD for the 2005 Base Closure and Realignment (BRAC 2005) directed...

Development of a standardized laparoscopic caecum resection model to simulate laparoscopic appendectomy in rats

PubMed Central

2014-01-01

Background Laparoscopic appendectomy (LA) has become one of the most common surgical procedures to date. To improve and standardize this technique further, cost-effective and reliable animal models are needed. Methods In a pilot study, 30 Wistar rats underwent laparoscopic caecum resection (as rats do not have an appendix vermiformis), to optimize the instrumental and surgical parameters. A subsequent test study was performed in another 30 rats to compare three different techniques for caecum resection and bowel closure. Results Bipolar coagulation led to an insufficiency of caecal stump closure in all operated rats (Group 1, n = 10). Endoloop ligation followed by bipolar coagulation and resection (Group 2, n = 10) or resection with a LigaSure™ device (Group 3, n = 10) resulted in sufficient caecal stump closure. Conclusions We developed a LA model enabling us to compare three different caecum resection techniques in rats. In conclusion, only endoloop closure followed by bipolar coagulation proved to be a secure and cost-effective surgical approach. PMID:24934381

Impact of Vial Capping on Residual Seal Force and Container Closure Integrity.

PubMed

Mathaes, Roman; Mahler, Hanns-Christian; Roggo, Yves; Ovadia, Robert; Lam, Philippe; Stauch, Oliver; Vogt, Martin; Roehl, Holger; Huwyler, Joerg; Mohl, Silke; Streubel, Alexander

2016-01-01

The vial capping process is a critical unit operation during drug product manufacturing, as it could possibly generate cosmetic defects or even affect container closure integrity. Yet there is significant variability in capping equipment and processes, and their relation to potential defects or container closure integrity has not been thoroughly studied. In this study we applied several methods-residual seal force tester, a self-developed system of a piezo force sensor measurement, and computed tomography-to characterize different container closure system combinations that had been sealed using different capping process parameter settings. Additionally, container closure integrity of these samples was measured using helium leakage (physical container closure integrity) and compared to characterization data. The different capping equipment settings lead to residual seal force values from 7 to 115 N. High residual seal force values were achieved with high capping pre-compression force and a short distance between the capping plate and plunge. The choice of container closure system influenced the obtained residual seal force values. The residual seal force tester and piezoelectric measurements showed similar trends. All vials passed physical container closure integrity testing, and no stopper rupture was seen with any of the settings applied, suggesting that container closure integrity was warranted for the studied container closure system with the chosen capping setting ranges. The vial capping process is a critical unit operation during drug product manufacturing, as it could possibly generate cosmetic defects or even affect container closure integrity. Yet there is significant variability in capping equipment and processes, and their relation to potential defects or container closure integrity has not been thoroughly studied. In this study we applied several methods-residual seal force tester, a self-developed system of a piezo force sensor measurement, and computed tomography-to characterize different container closure system combinations that had been sealed using different capping process parameter settings. The residual seal force tester can analyze a variety of different container closure systems independent of the capping equipment. An adequate and safe residual seal force range for each container closure system configuration can be established with the residual seal force tester and additional methods like computed tomography scans and leak testing. In the residual seal force range studied, the physical container closure integrity of the container closure system was warranted. © PDA, Inc. 2016.

Outcomes and costs of left atrial appendage closure from randomized controlled trial and real-world experience relative to oral anticoagulation

PubMed Central

Panikker, Sandeep; Lord, Joanne; Jarman, Julian W.E.; Armstrong, Shannon; Jones, David G.; Haldar, Shouvik; Butcher, Charles; Khan, Habib; Mantziari, Lilian; Nicol, Edward; Hussain, Wajid; Clague, Jonathan R.; Foran, John P.; Markides, Vias; Wong, Tom

2016-01-01

Aims The aim of this study was to analyse randomized controlled study and real-world outcomes of patients with non-valvular atrial fibrillation (NVAF) undergoing left atrial appendage closure (LAAC) with the Watchman device and to compare costs with available antithrombotic therapies. Methods and results Registry data of LAAC from two centres were prospectively collected from 110 patients with NVAF at risk of stroke, suitable and unsuitable for long-term anticoagulation (age 71.3 ± 9.2 years, CHADS2 2.8 ± 1.2, CHA2DS2-VASc 4.5 ± 1.6, and HAS-BLED 3.8 ± 1.1). Outcomes from PROTECT AF and registry study LAAC were compared with warfarin, dabigatran, rivaroxaban, apixaban, aspirin, and no treatment using a network meta-analysis. Costs were estimated over a 10-year horizon. Uncertainty was assessed using sensitivity analyses. The procedural success rate was 92% (103/112). Follow-up was 24.1 ± 4.6 months, during which annual rates of stroke, major bleeding, and all-cause mortality were 0.9% (2/223 patient-years), 0.9% (2/223 patient-years), and 1.8% (4/223 patient-years), respectively. Anticoagulant therapy was successfully stopped in 91.2% (93/102) of implanted patients by 12 months. Registry study LAAC stroke and major bleeding rates were significantly lower than PROTECT AF results: mean absolute difference of stroke, 0.89% (P = 0.02) and major bleeding, 5.48% (P < 0.001). Left atrial appendage closure achieved cost parity between 4.9 years vs. dabigatran 110 mg and 8.4 years vs. warfarin. At 10 years, LAAC was cost-saving against all therapies (range £1162–£7194). Conclusion Left atrial appendage closure in NVAF in a real-world setting may result in lower stroke and major bleeding rates than reported in LAAC clinical trials. Left atrial appendage closure in both settings achieves cost parity in a relatively short period of time and may offer substantial savings compared with current therapies. Savings are most pronounced among higher risk patients and those unsuitable for anticoagulation. PMID:26935273

Role of Groundwater Monitoring for Closure of Underground Nuclear Tests on the Nevada Test Site

NASA Astrophysics Data System (ADS)

Chapman, J. B.; Pohlmann, K.; Pohll, G.; Russell, C.

2009-12-01

Over 800 underground nuclear tests were conducted at the Nevada Test Site in a variety of hydrogeologic environments. As of the 1996 Environmental Impact Statement for the site, more than 100 million curies of radioactivity remained in the subsurface from these tests, much of it near or below the water table. The U.S. Department of Energy Environmental Management program is implementing a closure strategy for these sites that anticipates closure-in-place, natural attenuation, and institutional controls. Groundwater monitoring is a key component of this strategy, but its role is significantly evolved from that of a detection- or compliance-based monitoring concept. Indeed, monitoring is part of the integrated closure process itself, not an activity confined to a static post-closure period. The reasons for this evolution derive from the complex hydrogeologic conditions, the long time-frames of concern, and recognition that a significant degree of uncertainty is irreducible. The hundreds of test locations are grouped into Corrective Action Units that measure over 100 km2 in area and extend to depths in excess of 1000 m. Despite concerted data collection efforts, the technical basis for closure of these large regions relies heavily on complex numerical models of flow and transport. The inherent uncertainties in these models present challenges for reaching regulatory acceptance of closure, and challenges for confidently locating monitoring wells. The solution now being pursued for the NTS is to integrate model evaluation and monitoring. In addition to standard goals of contaminant detection and protection of human health, an explicit monitoring objective is to increase confidence in model results by assessing the reliability of model forecasts. The initial monitoring network is expected to eventually transition to a long-term closure design, with less emphasis on confidence-building as uncertainty in forecasts is reduced. The methodology for this iterative process of monitoring and model refinement will incorporate expert-judgment and Bayesian updating of model input parameters to provide a cost-beneficial monitoring network that is expected to reduce model prediction uncertainty. This approach to monitoring for these large and complex contaminant areas is consistent with the underlying reliance on model predictions and will ensure that water quality samples are collected in a manner and location that is consistent with the current understanding of contaminant flowpaths.

Incremental cost-effectiveness of percutaneous versus surgical closure of atrial septal defects in children under a public health system perspective in Brazil.

PubMed

Costa, Rodrigo; Pedra, Carlos A C; Ribeiro, Marcelo; Pedra, Simone; Ferreira-Da-Silva, André Luis; Polanczyk, Carisi; Berwanger, Otávio; Biasi, Alexandre; Ribeiro, Rodrigo

2014-11-01

Cost-effectiveness (CE) studies of percutaneous (PC) versus surgical (SC) atrial septal defect closure are lacking. A systematic literature review in children and a CE analysis based on a model of long-term outcomes were performed. Direct costs of PC and SC were US$8700 (defined arbitrarily) and US$5700 (actually paid), respectively. Three-times the Brazilian GDI (US$28,700) per year of life saved (with a discount rate of 5%) was used as a limit for willingness-to-pay. PC had a high (US$104,500) incremental CE ratio despite lower complication rates, shorter hospital stay and better (nonsignificant) adjusted life expectancy. PC would be cost-effective if it cost US$6400 or SC had an 8% loss of utility or its indirect costs were US$2250. Costs of PC should be reduced to be cost-effective in the Brazilian public health system. Indirect costs and impact on quality of life should be further assessed.

Evaluation of high-performance fiber-reinforced concrete for bridge deck connections, closure pours, and joints : final report.

DOT National Transportation Integrated Search

2017-01-01

Connections, closure pours, and joints in bridges are often sources of distress because of cracks and openings. Wide separation facilitates the penetration of harmful solutions that can lead to costly repairs. Cracks are caused by volumetric changes ...

DOD Base Realignment and Closure Part 2 (BRAC 91). Department of the Air Force. FY 1997 Budget Estimates Submission. Justification Data Submitted to OSD: March 1996.

DTIC Science & Technology

1996-03-01

52 10. Myrtle Beach AFB, South Carolina ................................ 55 11. Richards-Gebaur ARS, M issouri...restoration actions. MacDill. Base Closure Account requirement: $13.2 Million The funding was due to environmental and restoration actions. Myrtle Beach ...environmental costs. FY 1993: Base Closure Account Requirement: $648.7 Million. Eaker and England AFBs closed 15 December 1992. Myrtle Beach AFB closed 31

Efficient algorithms and implementations of entropy-based moment closures for rarefied gases

NASA Astrophysics Data System (ADS)

Schaerer, Roman Pascal; Bansal, Pratyuksh; Torrilhon, Manuel

2017-07-01

We present efficient algorithms and implementations of the 35-moment system equipped with the maximum-entropy closure in the context of rarefied gases. While closures based on the principle of entropy maximization have been shown to yield very promising results for moderately rarefied gas flows, the computational cost of these closures is in general much higher than for closure theories with explicit closed-form expressions of the closing fluxes, such as Grad's classical closure. Following a similar approach as Garrett et al. (2015) [13], we investigate efficient implementations of the computationally expensive numerical quadrature method used for the moment evaluations of the maximum-entropy distribution by exploiting its inherent fine-grained parallelism with the parallelism offered by multi-core processors and graphics cards. We show that using a single graphics card as an accelerator allows speed-ups of two orders of magnitude when compared to a serial CPU implementation. To accelerate the time-to-solution for steady-state problems, we propose a new semi-implicit time discretization scheme. The resulting nonlinear system of equations is solved with a Newton type method in the Lagrange multipliers of the dual optimization problem in order to reduce the computational cost. Additionally, fully explicit time-stepping schemes of first and second order accuracy are presented. We investigate the accuracy and efficiency of the numerical schemes for several numerical test cases, including a steady-state shock-structure problem.

Participation in Lifelong Learning: Reality or Myth? Issues Arising from a United Kingdom Coalfield Closure

ERIC Educational Resources Information Center

Thursfield, Denise; Henderson, Roger

2004-01-01

In the spring of 2004, the Selby Coalfield, the largest of the remaining coal mines in the United Kingdom (UK) will close and 2071 employees will lose their jobs. The impact of the closure will be severe in the surrounding area, and will present a challenge to local employment services and training agencies. It will also test the UK government's…

Closure Report for Corrective Action Unit 415: Project 57 No. 1 Plutonium Dispersion (NTTR) Nevada Test and Training Range, Nevada, Revision 0 with ROTC-1

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

Cabble, Kevin J.; Boehlecke, Robert F.

This Closure Report (CR) presents information supporting the closure of Corrective Action Unit (CAU) 415: Project 57 No. 1 Plutonium Dispersion, which is located on Range 4808A of the Nevada Test and Training Range (NTTR). This CR complies with the requirements of the Federal Facility Agreement and Consent Order (FFACO) that was agreed to by the State of Nevada; U.S. Department of Energy (DOE), Environmental Management; U.S. Department of Defense; and DOE, Legacy Management. CAU 415 comprises one corrective action site (CAS): NAFR-23-02, Pu Contaminated Soil. The purpose of this CR is to provide justification and documentation supporting the recommendationmore » that no further corrective action is needed for CAU 415 based on the implementation of the corrective action of Closure in Place.« less

The Effect of Rural Hospital Closures on Community Economic Health

PubMed Central

Holmes, George M; Slifkin, Rebecca T; Randolph, Randy K; Poley, Stephanie

2006-01-01

Objective To examine the effect of rural hospital closures on the local economy. Data Sources U.S. Census Bureau, OSCAR, Medicare Cost Reports, and surveys of individuals knowledgeable about local hospital closures. Study Design Economic data at the county level for 1990–2000 were combined with information on hospital closures. The study sample was restricted to rural counties experiencing a closure during the sample period. Longitudinal regression methods were used to estimate the effect of hospital closure on per-capita income, unemployment rate, and other community economic measures. Models included both leading and lagged closure terms allowing a preclosure economic downturn as well as time for the closure to be fully realized by the community. Data Collection Information on closures was collected by contacting every state hospital association, reconciling information gathered with that contained in the American Hospital Association file and OIG reports. Principal Findings Results indicate that the closure of the sole hospital in the community reduces per-capita income by $703 (p<0.05) or 4 percent (p<0.05) and increases the unemployment rate by 1.6 percentage points (p<0.01). Closures in communities with alternative sources of hospital care had no long-term economic impact, although income decreased for 2 years following the closure. Conclusions The local economic effects of a hospital closure should be considered when regulations that affect hospitals' financial well-being are designed or changed. PMID:16584460

Closure Report for Corrective Action Unit 426: Cactus Spring Waste Trenches, Tonopah Test Range, Nevada

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

Dave Madsen

This Closure Report provides the documentation for closure of the Cactus Spring Waste Trenches Corrective Action Unit (CAU) 426. The site is located on the Tonopah Test Range, approximately 225 kilometers northwest of Las Vegas, NV. CAU 426 consists of one corrective action site (CAS) which is comprised of four waste trenches. The trenches were excavated to receive solid waste generated in support of Operation Roller Coaster, primary the Double Tracks Test in 1963, and were subsequently backfilled. The Double Tracks Test involved use of live animals to assess the biological hazards associated with the nonnuclear detonation of plutonium-bearing devices.more » The Nevada Division of Environmental Protection approved Corrective Action Plan (CAP)which proposed ''capping'' methodology. The closure activities were completed in accordance with the approved CAP and consisted of constructing an engineered cover in the area of the trenches, constructing/planting a vegetative cover, installing a perimeter fence and signs, implementing restrictions on future use, and preparing a Post-Closure Monitoring Plan.« less

Resource Conservation and Recovery Act (RCRA) Part B permit application for tank storage units at the Oak Ridge Y-12 Plant

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

Not Available

1994-05-01

In compliance with the Resource Conservation and Recovery Act (RCRA), this report discusses information relating to permit applications for three tank storage units at Y-12. The storage units are: Building 9811-1 RCRA Tank Storage Unit (OD-7); Waste Oil/Solvent Storage Unit (OD-9); and Liquid Organic Solvent Storage Unit (OD-10). Numerous sections discuss the following: Facility description; waste characteristics; process information; groundwater monitoring; procedures to prevent hazards; contingency plan; personnel training; closure plan, post closure plan, and financial requirements; record keeping; other federal laws; organic air emissions; solid waste management units; and certification. Sixteen appendices contain such items as maps, waste analysesmore » and forms, inspection logs, equipment identification, etc.« less

Comparison of effectiveness and cost of patent ductus arteriosus device occlusion versus surgical ligation of patent ductus arteriosus.

PubMed

Zulqarnain, Arif; Younas, Muhammad; Waqar, Tariq; Beg, Ahsan; Asma, Touseef; Baig, Mirza Ahmad Raza

2016-01-01

Comparison of effectiveness and cost of transcatheter occlusion of patent ductus arteriosus (PDA) with surgical ligation of PDA. This retrospective comparative study was conducted in the pediatric cardiology department of Ch. Pervaiz Elahi Institute of Cardiology Multan, Pakistan. Data of 250 patients who underwent patent ductus arteriosus (PDA) closure either surgical or trans-catheter closure using SHSMA Occluder having weight >5 kg from April 2012 to October 2015 were included in this study. SPSS version 20 was used for data analysis. Quantitative variables were compared using independent sample t-test. Chi-square test and fishers exact was used for qualitative variables. P-value <0.05 was considered statistically significant. There were one hundred and twenty (120) patients who underwent transcatheter occlusion of PDA using SHSMA occluder (PDA Device Group) and one hundred and thirty (130) patients who underwent surgical ligation of PDA (Surgical Group). Incidence of residual shunting was two (1.5%) in surgical group and 0 (0.0%) in PDA Device group for one month follow up period. There were 4 (3.1%) major complications in surgical group. The rate of blood transfusions were high in surgical group (p-value 0.04). Hospital stay time was significantly less in PDA Device group (P-value <0.001). Total procedural cost was 110695+1054 Pakistani rupees in PDA Device group and 92414+3512 in surgical group (p-value <0.001). The cost of PDA device closure was 16.52% higher than the surgical ligation of PDA. There was no operative mortality. The transcatheter closure of PDA is an effective and less invasive method as compared to the surgical ligation. There is a lower rate of complications and the cost is not much high as compared to surgical PDA ligation.

School closures during the 2009 influenza pandemic: national and local experiences

PubMed Central

2014-01-01

Background School closure is a non-pharmaceutical intervention that was considered in many national pandemic plans developed prior to the start of the influenza A(H1N1)pdm09 pandemic, and received considerable attention during the event. Here, we retrospectively review and compare national and local experiences with school closures in several countries during the A(H1N1)pdm09 pandemic. Our intention is not to make a systematic review of country experiences; rather, it is to present the diversity of school closure experiences and provide examples from national and local perspectives. Methods Data were gathered during and following a meeting, organized by the European Centres for Disease Control, on school closures held in October 2010 in Stockholm, Sweden. A standard data collection form was developed and sent to all participants. The twelve participating countries and administrative regions (Bulgaria, China, France, Hong Kong Special Administrative Region (SAR), Italy, Japan, New Zealand, Serbia, South Africa, Thailand, United Kingdom, and United States) provided data. Results Our review highlights the very diverse national and local experiences on school closures during the A(H1N1)pdm09 pandemic. The processes including who was in charge of making recommendations and who was in charge of making the decision to close, the school-based control strategies, the extent of school closures, the public health tradition of responses and expectations on school closure varied greatly between countries. Our review also discusses the many challenges associated with the implementation of this intervention and makes recommendations for further practical work in this area. Conclusions The single most important factor to explain differences observed between countries may have been the different public health practises and public expectations concerning school closures and influenza in the selected countries. PMID:24739814

Kyrgyzstan’s Closure of the Manas Airbase: Context and Implications

DTIC Science & Technology

2009-05-04

agreement with the United States, after the United States had criticized the Uzbek government for repressive actions against civilians. Some of the...Zealand, Norway, Poland , South Korea, Spain, and Turkey. Among the few legislators who opposed closing the airbase, Bakyt Beshimov, the leader of the...With Secretary of Defense Robert Gates, Krakow, Poland , February 20, 2009. 24 Saban Kardas “Will the Closure of Manas Airbase Strengthen U.S

4-inch sample recovery canisters, Test Model D series. Final report, September 1969--May 1970

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

Goode, P.L.; Neff, G.W.

1970-12-31

Six tests were conducted on 4-Inch Test Model D Closures to develop an improved closure for the redesigned Sandia Recovery Canister (SRC). The first three closures tested used variations of the high explosive (HE) design used on the previous Model B (Second) Series (P64283). The last three units tested used variations of the HE design used in the Midi Mist Event SRC.

Closure Report for Corrective Action Unit 536: Area 3 Release Site, Nevada Test Site, Nevada

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

NSTec Environmental Restoration

Corrective Action Unit (CAU) 536 is located in Area 3 of the Nevada Test Site. CAU 536 is listed in the Federal Facility Agreement and Consent Order of 1996 as Area 3 Release Site, and comprises a single Corrective Action Site (CAS): {sm_bullet} CAS 03-44-02, Steam Jenny Discharge The Nevada Division of Environmental Protection (NDEP)-approved corrective action alternative for CAS 03-44-02 is clean closure. Closure activities included removing and disposing of total petroleum hydrocarbon (TPH)- and polyaromatic hydrocarbon (PAH)-impacted soil, soil impacted with plutonium (Pu)-239, and concrete pad debris. CAU 536 was closed in accordance with the NDEP-approved CAU 536more » Corrective Action Plan (CAP), with minor deviations as approved by NDEP. The closure activities specified in the CAP were based on the recommendations presented in the CAU 536 Corrective Action Decision Document (U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office, 2004). This Closure Report documents CAU 536 closure activities. During closure activities, approximately 1,000 cubic yards (yd3) of hydrocarbon waste in the form of TPH- and PAH-impacted soil and debris, approximately 8 yd3 of Pu-239-impacted soil, and approximately 100 yd3 of concrete debris were generated, managed, and disposed of appropriately. Additionally, a previously uncharacterized, buried drum was excavated, removed, and disposed of as hydrocarbon waste as a best management practice. Waste minimization techniques, such as the utilization of laboratory analysis to characterize and classify waste streams, were employed during the performance of closure« less

Closure and Post-Closure Care Requirements for Hazardous Waste Treatment, Storage and Disposal Facilities

EPA Pesticide Factsheets

When a hazardous waste management unit stops receiving waste at the end of its active life, it must be cleaned up, closed, monitored, and maintained in accordance with the Resource Conservation and Recovery Ac

75 FR 17618 - Fisheries of the Northeastern United States; Black Sea Bass Recreational Fishery; Emergency Rule...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-07

.... The initial closure was highly controversial and a great deal of negative reaction was received... the initial 180-day closure appear in the plaintiff's motion for relief and, as such, NMFS will...

Choice in maternity care: associations with unit supply, geographic accessibility and user characteristics

PubMed Central

2012-01-01

Background Despite national policies to promote user choice for health services in many European countries, current trends in maternity unit closures create a context in which user choice may be reduced, not expanded. Little attention has been paid to the potential impact of closures on pregnant women’s choice of maternity unit. We study here how pregnant women’s choices interact with the distance they must travel to give birth, individual socioeconomic characteristics and the supply of maternity units in France in 2003. Results Overall, about one-third of women chose their maternity units based on proximity. This proportion increased steeply as supply was constrained. Greater distances between the first and second closest maternity unit were strongly associated with increasing preferences for proximity; when these distances were ≥ 30 km, over 85% of women selected the closest unit (revealed preference) and over 70% reported that proximity was the reason for their choice (expressed preference). Women living at a short distance to the closest maternity unit appeared to be more sensitive to increases in distance between their first and second closest available maternity units. The preference for proximity, expressed and revealed, was related to demographic and social characteristics: women from households in the manual worker class chose a maternity unit based on its proximity more often and also went to the nearest unit when compared with women from professional and managerial households. These sociodemographic associations held true after adjusting for supply factors, maternal age and socioeconomic status. Conclusions Choice seems to be arbitrated in both absolute and relative terms. Taking changes in supply into consideration and how these affect choice is an important element for assessing the real impact of maternity unit closures on pregnant women’s experiences. An indicator measuring the proportion of women for whom the distance between the first and second maternity unit is greater than 30 km can provide a simple measure of choice to complement indicators of geographic accessibility in evaluations of the impact of maternity unit closures. PMID:22905951

Engineering study for closure of 209E facility

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

Brevick, C.H.; Heys, W.H.; Johnson, E.D.

1997-07-07

This document is an engineering study for evaluating alternatives to determine the most cost effective closure plan for the 209E Facility, Critical Mass Laboratory. This laboratory is located in the 200 East Area of the Hanford Site and contains a Critical Assembly Room and a Mix room were criticality experiments were once performed.

Competitive Employment for People with Autism: Correlates of Successful Closure in Competitive and Supported Employment

ERIC Educational Resources Information Center

Schaller, James; Yang, Nancy K.

2005-01-01

Differences in rates of case closure, case service cost, hours worked per week, and weekly wage between customers with autism closed successfully in competitive employment and supported employment were found using the Rehabilitation Service Administration national database of 2001. Using logistic regression, customer demographic variables related…

The economy-wide impact of pandemic influenza on the UK: a computable general equilibrium modelling experiment.

PubMed

Smith, Richard D; Keogh-Brown, Marcus R; Barnett, Tony; Tait, Joyce

2009-11-19

To estimate the potential economic impact of pandemic influenza, associated behavioural responses, school closures, and vaccination on the United Kingdom. A computable general equilibrium model of the UK economy was specified for various combinations of mortality and morbidity from pandemic influenza, vaccine efficacy, school closures, and prophylactic absenteeism using published data. The 2004 UK economy (the most up to date available with suitable economic data). The economic impact of various scenarios with different pandemic severity, vaccination, school closure, and prophylactic absenteeism specified in terms of gross domestic product, output from different economic sectors, and equivalent variation. The costs related to illness alone ranged between 0.5% and 1.0% of gross domestic product ( pound8.4bn to pound16.8bn) for low fatality scenarios, 3.3% and 4.3% ( pound55.5bn to pound72.3bn) for high fatality scenarios, and larger still for an extreme pandemic. School closure increases the economic impact, particularly for mild pandemics. If widespread behavioural change takes place and there is large scale prophylactic absence from work, the economic impact would be notably increased with few health benefits. Vaccination with a pre-pandemic vaccine could save 0.13% to 2.3% of gross domestic product ( pound2.2bn to pound38.6bn); a single dose of a matched vaccine could save 0.3% to 4.3% ( pound5.0bn to pound72.3bn); and two doses of a matched vaccine could limit the overall economic impact to about 1% of gross domestic product for all disease scenarios. Balancing school closure against "business as usual" and obtaining sufficient stocks of effective vaccine are more important factors in determining the economic impact of an influenza pandemic than is the disease itself. Prophylactic absence from work in response to fear of infection can add considerably to the economic impact.

The economy-wide impact of pandemic influenza on the UK: a computable general equilibrium modelling experiment

PubMed Central

Keogh-Brown, Marcus R; Barnett, Tony; Tait, Joyce

2009-01-01

Objectives To estimate the potential economic impact of pandemic influenza, associated behavioural responses, school closures, and vaccination on the United Kingdom. Design A computable general equilibrium model of the UK economy was specified for various combinations of mortality and morbidity from pandemic influenza, vaccine efficacy, school closures, and prophylactic absenteeism using published data. Setting The 2004 UK economy (the most up to date available with suitable economic data). Main outcome measures The economic impact of various scenarios with different pandemic severity, vaccination, school closure, and prophylactic absenteeism specified in terms of gross domestic product, output from different economic sectors, and equivalent variation. Results The costs related to illness alone ranged between 0.5% and 1.0% of gross domestic product (£8.4bn to £16.8bn) for low fatality scenarios, 3.3% and 4.3% (£55.5bn to £72.3bn) for high fatality scenarios, and larger still for an extreme pandemic. School closure increases the economic impact, particularly for mild pandemics. If widespread behavioural change takes place and there is large scale prophylactic absence from work, the economic impact would be notably increased with few health benefits. Vaccination with a pre-pandemic vaccine could save 0.13% to 2.3% of gross domestic product (£2.2bn to £38.6bn); a single dose of a matched vaccine could save 0.3% to 4.3% (£5.0bn to £72.3bn); and two doses of a matched vaccine could limit the overall economic impact to about 1% of gross domestic product for all disease scenarios. Conclusion Balancing school closure against “business as usual” and obtaining sufficient stocks of effective vaccine are more important factors in determining the economic impact of an influenza pandemic than is the disease itself. Prophylactic absence from work in response to fear of infection can add considerably to the economic impact. PMID:19926697

Effects of fisheries closures and gear restrictions on fishing income in a Kenyan coral reef.

PubMed

McClanahan, Timothy R

2010-12-01

The adoption of fisheries closures and gear restrictions in the conservation of coral reefs may be limited by poor understanding of the economic profitability of competing economic uses of marine resources. Over the past 12 years, I evaluated the effects of gear regulation and fisheries closures on per person and per area incomes from fishing in coral reefs of Kenya. In two of my study areas, the use of small-meshed beach seines was stopped after 6 years; one of these areas was next to a fishery closure. In my third study area, fishing was unregulated. Fishing yields on per capita daily wet weight basis were 20% higher after seine-net fishing was stopped. The per person daily fishing income adjacent to the closed areas was 14 and 22% higher than the fishing income at areas with only gear restrictions before and after the seine-net restriction, respectively. Incomes differed because larger fish were captured next to the closed area and the price per weight (kilograms) increased as fish size increased and because catches adjacent to the closure contained fish species of higher market value. Per capita incomes were 41 and 135% higher for those who fished in gear-restricted areas and near-closed areas, respectively, compared with those who fished areas with no restrictions. On a per unit area basis (square kilometers), differences in fishing income among the three areas were not large because fishing effort increased as the number of restrictions decreased. Changes in catch were, however, larger and often in the opposite direction expected from changes in effort alone. For example, effort declined 21% but nominal profits per square kilometer (not accounting for inflation) increased 29% near the area with gear restrictions. Gear restrictions also reduced the cost of fishing and increased the proportion of self-employed fishers. © 2010 Society for Conservation Biology.

Closure Report for Corrective Action Unit 117: Area 26 Pluto Disassembly Facility, Nevada Test Site, Nevada, Revision 0

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

Mark Burmeister

This Closure Report (CR) presents information supporting the closure of Corrective Action Unit (CAU) 117: Area 26 Pluto Disassembly Facility, Nevada Test Site, Nevada. This CR complies with the requirements of the Federal Facility Agreement and Consent Order that was agreed to by the State of Nevada; U.S. Department of Energy (DOE), Environmental Management; U.S. Department of Defense; and DOE, Legacy Management. Corrective Action Unit 117 comprises Corrective Action Site (CAS) 26-41-01, Pluto Disassembly Facility, located in Area 26 of the Nevada Test Site. The purpose of this CR is to provide documentation supporting the completed corrective actions and providemore » data confirming that the closure objectives for CAU 117 were met. To achieve this, the following actions were performed: • Review the current site conditions, including the concentration and extent of contamination. • Implement any corrective actions necessary to protect human health and the environment. • Properly dispose of corrective action and investigation wastes. • Document Notice of Completion and closure of CAU 117 issued by the Nevada Division of Environmental Protection. From May 2008 through February 2009, closure activities were performed as set forth in the Streamlined Approach for Environmental Restoration Plan for Corrective Action Unit 117, Area 26 Pluto Disassembly Facility, Nevada Test Site, Nevada. The purpose of the activities as defined during the data quality objectives process were: • Determine whether contaminants of concern (COCs) are present. • If COCs are present, determine their nature and extent, implement appropriate corrective actions, and properly dispose of wastes. Analytes detected during the closure activities were evaluated against final action levels to determine COCs for CAU 117. Assessment of the data generated from closure activities indicated that the final action levels were exceeded for polychlorinated biphenyls (PCBs) reported as total Aroclor and radium-226. A corrective action was implemented to remove approximately 50 cubic yards of PCB-contaminated soil, approximately 1 cubic foot of radium-226 contaminated soil (and scabbled asphalt), and a high-efficiency particulate air filter that was determined to meet the criteria of a potential source material (PSM). Electrical and lighting components (i.e., PCB-containing ballasts and capacitors) and other materials (e.g., mercury-containing thermostats and switches, lead plugs and bricks) assumed to be PSM were also removed from Building 2201, as practical, without the need for sampling. Because the COC contamination and PSMs have been removed, clean closure of CAS 26-41-01 is recommended, and no use restrictions are required to be placed on this CAU. No further action is necessary because no other contaminants of potential concern were found above preliminary action levels. The physical end state for Building 2201 is expected to be eventual demolition to slab. The DOE, National Nuclear Security Administration Nevada Site Office provides the following recommendations: • Clean closure is the recommended corrective action for CAS 26-41-01 in CAU 117. • A Notice of Completion to the DOE, National Nuclear Security Administration Nevada Site Office is requested from the Nevada Division of Environmental Protection for closure of CAU 117. • Corrective Action Unit 117 should be moved from Appendix III to Appendix IV of the Federal Facility Agreement and Consent Order.« less

Efficient algorithms and implementations of entropy-based moment closures for rarefied gases

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

Schaerer, Roman Pascal, E-mail: schaerer@mathcces.rwth-aachen.de; Bansal, Pratyuksh; Torrilhon, Manuel

We present efficient algorithms and implementations of the 35-moment system equipped with the maximum-entropy closure in the context of rarefied gases. While closures based on the principle of entropy maximization have been shown to yield very promising results for moderately rarefied gas flows, the computational cost of these closures is in general much higher than for closure theories with explicit closed-form expressions of the closing fluxes, such as Grad's classical closure. Following a similar approach as Garrett et al. (2015) , we investigate efficient implementations of the computationally expensive numerical quadrature method used for the moment evaluations of the maximum-entropymore » distribution by exploiting its inherent fine-grained parallelism with the parallelism offered by multi-core processors and graphics cards. We show that using a single graphics card as an accelerator allows speed-ups of two orders of magnitude when compared to a serial CPU implementation. To accelerate the time-to-solution for steady-state problems, we propose a new semi-implicit time discretization scheme. The resulting nonlinear system of equations is solved with a Newton type method in the Lagrange multipliers of the dual optimization problem in order to reduce the computational cost. Additionally, fully explicit time-stepping schemes of first and second order accuracy are presented. We investigate the accuracy and efficiency of the numerical schemes for several numerical test cases, including a steady-state shock-structure problem.« less

Sulimar Queen environmental restoration project closure package Sandia environmental stewardship exemplar.

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

Tillman, Jack B.

In March 2008, Sandia National Laboratories (Sandia), in partnership with the Bureau of Land Management, Roswell Field Office, completed its responsibilities to plug and abandon wells and restore the surface conditions for the Sulimar Queens Unit, a 2,500 acre oil field, in Chaves County, Southeast New Mexico. Sandia assumed this liability in an agreement to obtain property to create a field laboratory to perform extensive testing and experimentation on enhanced oil recovery techniques for shallow oil fields. In addition to plugging and abandoning 28 wells, the project included the removal of surface structures and surface reclamation of disturbed lands associatedmore » with all plugged and abandoned wells, access roads, and other auxiliary facilities within unit boundaries. A contracting strategy was implemented to mitigate risk and reduce cost. As the unit is an important wildlife habitat for prairie chickens, sand dune lizards, and mule deer, the criteria for the restoration and construction process were designed to protect and enhance the wildlife habitat. Lessons learned from this project include: (1) extreme caution should be exercised when entering agreements that include future liabilities, (2) partnering with the regulator has huge benefits, and (3) working with industry experts, who were familiar with the work, and subcontractors, who provided the network to complete the project cost effectively.« less

Tonopah Test Range Post-Closure Inspection Annual Report, Tonopah Test Range, Nevada, Calendar Year 2003

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

U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office; Bechtel Nevada

This post-closure inspection report provides documentation of the semiannual inspection activities, maintenance and repair activities, and conclusions and recommendations for calendar year 2003 for eight corrective action units located on the Tonopah Test Range, Nevada.

36 CFR 13.50 - Closure procedures.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Section 13.50 Parks, Forests, and Public Property NATIONAL PARK SERVICE, DEPARTMENT OF THE INTERIOR NATIONAL PARK SYSTEM UNITS IN ALASKA General Provisions § 13.50 Closure procedures. (a) Authority. The... cultural or scientific values, subsistence uses, endangered or threatened species conservation, and other...

50 CFR 648.101 - Closures.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., DEPARTMENT OF COMMERCE FISHERIES OF THE NORTHEASTERN UNITED STATES Management Measures for the Summer...) EEZ closure. The Regional Administrator shall close the EEZ to fishing for summer flounder by... notifying vessel and dealer permit holders that no commercial quota is available for landing summer flounder...

Streamlined Approach for Environmental Restoration Plan for Corrective Action Unit 574: Neptune, Nevada National Security Site, Nevada

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

NSTec Environmental Restoration

2011-08-31

This Streamlined Approach for Environmental Restoration (SAFER) Plan identifies the activities required for closure of Corrective Action Unit (CAU) 574, Neptune. CAU 574 is included in the Federal Facility Agreement and Consent Order (FFACO) (1996 [as amended March 2010]) and consists of the following two Corrective Action Sites (CASs) located in Area 12 of the Nevada National Security Site: (1) CAS 12-23-10, U12c.03 Crater (Neptune); (2) CAS 12-45-01, U12e.05 Crater (Blanca). This plan provides the methodology for the field activities that will be performed to gather the necessary information for closure of the two CASs. There is sufficient information andmore » process knowledge regarding the expected nature and extent of potential contaminants to recommend closure of CAU 574 using the SAFER process. Based on historical documentation, personnel interviews, site process knowledge, site visits, photographs, field screening, analytical results, the results of the data quality objective (DQO) process (Section 3.0), and an evaluation of corrective action alternatives (Appendix B), closure in place with administrative controls is the expected closure strategy for CAU 574. Additional information will be obtained by conducting a field investigation to verify and support the expected closure strategy and provide a defensible recommendation that no further corrective action is necessary. This will be presented in a Closure Report that will be prepared and submitted to the Nevada Division of Environmental Protection (NDEP) for review and approval.« less

Closure Report for Corrective Action Unit 563: Septic Systems, Nevada Test Site, Nevada

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

NSTec Environmental Restoration

2010-02-28

Corrective Action Unit (CAU) 563 is identified in the Federal Facility Agreement and Consent Order (FFACO) as “Septic Systems” and consists of the following four Corrective Action Sites (CASs), located in Areas 3 and 12 of the Nevada Test Site: · CAS 03-04-02, Area 3 Subdock Septic Tank · CAS 03-59-05, Area 3 Subdock Cesspool · CAS 12-59-01, Drilling/Welding Shop Septic Tanks · CAS 12-60-01, Drilling/Welding Shop Outfalls Closure activities were conducted from September to November 2009 in accordance with the FFACO (1996, as amended February 2008) and the Corrective Action Plan for CAU 563. The corrective action alternatives includedmore » No Further Action and Clean Closure.« less

Underground Test Area (UGTA) Closure Report for Corrective Action Unit 98: Frenchman Flat Nevada National Security Site, Nevada, Revision 1 ROTC-1

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

Farnham, Irene

This Closure Report (CR) has been prepared for Corrective Action Unit (CAU) 98, Frenchman Flat, Nevada National Security Site (NNSS), Nevada. The Frenchman Flat CAU was the site of 10 underground nuclear tests, some of which have impacted groundwater near the tests. This work was performed as part of the U.S. Department of Energy, National Nuclear Security Administration Nevada Field Office (NNSA/NFO) Underground Test Area (UGTA) Activity in accordance with the Federal Facility Agreement and Consent Order (FFACO). This CR describes the selected corrective action to be implemented during closure to protect human health and the environment from the impactedmore » groundwater« less

Closure Report for Corrective Action Unit 412: Clean Slate I Plutonium Dispersion (TTR) Tonopah Test Range, Nevada, Revision 0

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

Matthews, Patrick

This Closure Report (CR) presents information supporting the clean closure of Corrective Action Unit (CAU) 412: Clean Slate I Plutonium Dispersion (TTR), located on the Tonopah Test Range, Nevada. CAU 412 consists of a release of radionuclides to the surrounding soil from a storage–transportation test conducted on May 25, 1963. Corrective action investigation (CAI) activities were performed in April and May 2015, as set forth in the Streamlined Approach for Environmental Restoration (SAFER) Plan for Corrective Action Unit 412: Clean Slate I Plutonium Dispersion (TTR), Tonopah Test Range, Nevada; and in accordance with the Soils Activity Quality Assurance Plan. Themore » purpose of the CAI was to fulfill data needs as defined during the data quality objectives process. The CAU 412 dataset of investigation results was evaluated based on a data quality assessment. This assessment demonstrated the dataset is complete and acceptable for use in fulfilling the data needs identified by the data quality objectives process. This CR provides documentation and justification for the clean closure of CAU 412 under the FFACO without further corrective action. This justification is based on historical knowledge of the site, previous site investigations, implementation of the 1997 interim corrective action, and the results of the CAI. The corrective action of clean closure was confirmed as appropriate for closure of CAU 412 based on achievement of the following closure objectives: Radiological contamination at the site is less than the final action level using the ground troops exposure scenario (i.e., the radiological dose is less than the final action level): Removable alpha contamination is less than the high contamination area criterion: No potential source material is present at the site, and any impacted soil associated with potential source material has been removed so that remaining soil contains contaminants at concentrations less than the final action levels: and There is sufficient information to characterize investigation and remediation waste for disposal.« less

Hanford facility dangerous waste permit application, general information portion. Revision 3

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

Sonnichsen, J.C.

1997-08-21

For purposes of the Hanford facility dangerous waste permit application, the US Department of Energy`s contractors are identified as ``co-operators`` and sign in that capacity (refer to Condition I.A.2. of the Dangerous Waste Portion of the Hanford Facility Resource Conservation and Recovery Act Permit). Any identification of these contractors as an ``operator`` elsewhere in the application is not meant to conflict with the contractors` designation as co-operators but rather is based on the contractors` contractual status with the U.S. Department of Energy, Richland Operations Office. The Dangerous Waste Portion of the initial Hanford Facility Resource Conservation and Recovery Act Permit,more » which incorporated five treatment, storage, and/or disposal units, was based on information submitted in the Hanford Facility Dangerous Waste Permit Application and in closure plan and closure/postclosure plan documentation. During 1995, the Dangerous Waste Portion was modified twice to incorporate another eight treatment, storage, and/or disposal units; during 1996, the Dangerous Waste Portion was modified once to incorporate another five treatment, storage, and/or disposal units. The permit modification process will be used at least annually to incorporate additional treatment, storage, and/or disposal units as permitting documentation for these units is finalized. The units to be included in annual modifications are specified in a schedule contained in the Dangerous Waste Portion of the Hanford Facility Resource Conservation and Recovery Act Permit. Treatment, storage, and/or disposal units will remain in interim status until incorporated into the Permit. The Hanford Facility Dangerous Waste Permit Application is considered to be a single application organized into a General Information Portion (this document, DOE/RL-91-28) and a Unit-Specific Portion. The scope of the Unit-Specific Portion is limited to individual operating treatment, storage, and/or disposal units for which Part B permit application documentation has been, or is anticipated to be, submitted. Documentation for treatment, storage, and/or disposal units undergoing closure, or for units that are, or are anticipated to be, dispositioned through other options, will continue to be submitted by the Permittees in accordance with the provisions of the Hanford Federal Facility Agreement and Consent Order. However, the scope of the General Information Portion includes information that could be used to discuss operating units, units undergoing closure, or units being dispositioned through other options. Both the General Information and Unit-Specific portions of the Hanford Facility Dangerous Waste Permit Application address the contents of the Part B permit application guidance documentation prepared by the Washington State Department of Ecology and the U.S. Environmental Protection Agency, with additional information needs defined by revisions of Washington Administrative Code 173-303 and by the Hazardous and Solid Waste Amendments. Documentation contained in the General Information Portion is broader in nature and could be used by multiple treatment, storage, and/or disposal units (i.e., either operating units, units undergoing closure, or units being dispositioned through other options).« less

Outcomes and costs of left atrial appendage closure from randomized controlled trial and real-world experience relative to oral anticoagulation.

PubMed

Panikker, Sandeep; Lord, Joanne; Jarman, Julian W E; Armstrong, Shannon; Jones, David G; Haldar, Shouvik; Butcher, Charles; Khan, Habib; Mantziari, Lilian; Nicol, Edward; Hussain, Wajid; Clague, Jonathan R; Foran, John P; Markides, Vias; Wong, Tom

2016-12-07

The aim of this study was to analyse randomized controlled study and real-world outcomes of patients with non-valvular atrial fibrillation (NVAF) undergoing left atrial appendage closure (LAAC) with the Watchman device and to compare costs with available antithrombotic therapies. Registry data of LAAC from two centres were prospectively collected from 110 patients with NVAF at risk of stroke, suitable and unsuitable for long-term anticoagulation (age 71.3 ± 9.2 years, CHADS 2 2.8 ± 1.2, CHA 2 DS 2 -VASc 4.5 ± 1.6, and HAS-BLED 3.8 ± 1.1). Outcomes from PROTECT AF and registry study LAAC were compared with warfarin, dabigatran, rivaroxaban, apixaban, aspirin, and no treatment using a network meta-analysis. Costs were estimated over a 10-year horizon. Uncertainty was assessed using sensitivity analyses. The procedural success rate was 92% (103/112). Follow-up was 24.1 ± 4.6 months, during which annual rates of stroke, major bleeding, and all-cause mortality were 0.9% (2/223 patient-years), 0.9% (2/223 patient-years), and 1.8% (4/223 patient-years), respectively. Anticoagulant therapy was successfully stopped in 91.2% (93/102) of implanted patients by 12 months. Registry study LAAC stroke and major bleeding rates were significantly lower than PROTECT AF results: mean absolute difference of stroke, 0.89% (P = 0.02) and major bleeding, 5.48% (P < 0.001). Left atrial appendage closure achieved cost parity between 4.9 years vs. dabigatran 110 mg and 8.4 years vs. warfarin. At 10 years, LAAC was cost-saving against all therapies (range £1162-£7194). Left atrial appendage closure in NVAF in a real-world setting may result in lower stroke and major bleeding rates than reported in LAAC clinical trials. Left atrial appendage closure in both settings achieves cost parity in a relatively short period of time and may offer substantial savings compared with current therapies. Savings are most pronounced among higher risk patients and those unsuitable for anticoagulation. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

Hospital closure: a review of current and proposed research.

PubMed Central

Hernandez, S R; Kaluzny, A D

1983-01-01

This paper reviews available data describing issues and research findings with implications for hospital closings. Factors contributing to fiscal problems of hospitals (e.g., inadequate reimbursement, inflation, management problems, organizational structure, societal factors) are discussed. Selected studies offering examples of hospital and community characteristics associated with closure are presented. This review suggests that future directions for research should focus not only on hospital cost control but also on insuring equity in the distribution of hospital services. Specifically, research is needed that further describes the hospital closure phenomenon, the effects of closure, and the policy choices that might be pursued to insure equity in the continuation of hospital services to disadvantaged populations. PMID:6360954

Closure Report for Corrective Action Unit 562: Waste Systems, Nevada National Security Site, Nevada

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

NSTec Environmental Restoration

2012-08-15

This Closure Report (CR) presents information supporting closure of Corrective Action Unit (CAU) 562, Waste Systems, and provides documentation supporting the completed corrective actions and confirmation that closure objectives for CAU 562 were met. This CR complies with the requirements of the Federal Facility Agreement and Consent Order (FFACO) that was agreed to by the State of Nevada; the U.S. Department of Energy (DOE), Environmental Management; the U.S. Department of Defense; and DOE, Legacy Management (FFACO, 1996 as amended). CAU 562 consists of the following 13 Corrective Action Sites (CASs), located in Areas 2, 23, and 25 of the Nevadamore » National Security Site: · CAS 02-26-11, Lead Shot · CAS 02-44-02, Paint Spills and French Drain · CAS 02-59-01, Septic System · CAS 02-60-01, Concrete Drain · CAS 02-60-02, French Drain · CAS 02-60-03, Steam Cleaning Drain · CAS 02-60-04, French Drain · CAS 02-60-05, French Drain · CAS 02-60-06, French Drain · CAS 02-60-07, French Drain · CAS 23-60-01, Mud Trap Drain and Outfall · CAS 23-99-06, Grease Trap · CAS 25-60-04, Building 3123 Outfalls Closure activities began in October 2011 and were completed in April 2012. Activities were conducted according to the Corrective Action Plan for CAU 562 (U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office [NNSA/NSO], 2011). The corrective actions included No Further Action and Clean Closure. Closure activities generated sanitary waste and hazardous waste. Some wastes exceeded land disposal limits and required offsite treatment prior to disposal. Other wastes met land disposal restrictions and were disposed in appropriate onsite or offsite landfills. NNSA/NSO requests the following: · A Notice of Completion from the Nevada Division of Environmental Protection to NNSA/NSO for closure of CAU 562 · The transfer of CAU 562 from Appendix III to Appendix IV, Closed Corrective Action Units, of the FFACO« less

Priming of Early Closure: Evidence for the Lexical Boost during Sentence Comprehension

PubMed Central

Traxler, Matthew J.

2014-01-01

Two self-paced reading experiments investigated priming in sentences containing “early” vs. “late closure” ambiguities. Early closure sentences impose relatively large processing costs at the point of syntactic disambiguation (Frazier & Rayner, 1982). The current study investigated a possible way to reduce processing costs. Target sentences were temporarily ambiguous and were disambiguated towards either the preferred “late” closure analysis or the dispreferred “early” closure analysis. Each target sentence was preceded by a prime that was either structurally identical or that required a different syntactic analysis. In Experiment 1, all of the prime sentences shared the same critical verb as the target (Arai et al., 2007; Carminati et al., 2008; Tooley et al., 2009, in press; Traxler et al., in press; Weber & Indefrey, 2009). In Experiment 2, verb repetition was eliminated by reorganizing the stimuli from Experiment 1. In Experiment 1, processing of the disambiguating verb was facilitated when an “early” closure target sentence followed an “early” closure prime. In Experiment 2, there were no significant priming effects, although an overall difference in processing time favored “late closure” targets. Combined analyses verified that the pattern of results in Experiment 1 differed significantly from Experiment 2. These experiments provide the first indication that “early” closure analyses can be primed and that such priming is more robust when a critical verb appears in both the prime and the target sentence. The results add to the body of data indicating a “lexical boost” for syntactic priming effects during comprehension. They have implications for theories of syntactic representation and processing (e.g., Boland & Blodgett, 2006; Vosse & Kempen, 2009; Sag et al., 2003). PMID:25750915

40 CFR 264.603 - Post-closure care.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 25 2010-07-01 2010-07-01 false Post-closure care. 264.603 Section 264.603 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED... treatment or storage unit has contaminated soils or ground water that cannot be completely removed or...

THE U.S. EPA'S VISION FOR A BEACH FORECASTING TOOL

EPA Science Inventory

Beach closures due to water quality that exceeds standard limits occur frequently in the United States. These beach closures deprive the public of opportunities for recreational activities and can have a significant impact on local economics. Because of the large number of mari...

Incorporating Conservation Zone Effectiveness for Protecting Biodiversity in Marine Planning

PubMed Central

Makino, Azusa; Klein, Carissa J.; Beger, Maria; Jupiter, Stacy D.; Possingham, Hugh P.

2013-01-01

Establishing different types of conservation zones is becoming commonplace. However, spatial prioritization methods that can accommodate multiple zones are poorly understood in theory and application. It is typically assumed that management regulations across zones have differential levels of effectiveness (“zone effectiveness”) for biodiversity protection, but the influence of zone effectiveness on achieving conservation targets has not yet been explored. Here, we consider the zone effectiveness of three zones: permanent closure, partial protection, and open, for planning for the protection of five different marine habitats in the Vatu-i-Ra Seascape, Fiji. We explore the impact of differential zone effectiveness on the location and costs of conservation priorities. We assume that permanent closure zones are fully effective at protecting all habitats, open zones do not contribute towards the conservation targets and partial protection zones lie between these two extremes. We use four different estimates for zone effectiveness and three different estimates for zone cost of the partial protection zone. To enhance the practical utility of the approach, we also explore how much of each traditional fishing ground can remain open for fishing while still achieving conservation targets. Our results show that all of the high priority areas for permanent closure zones would not be a high priority when the zone effectiveness of the partial protection zone is equal to that of permanent closure zones. When differential zone effectiveness and costs are considered, the resulting marine protected area network consequently increases in size, with more area allocated to permanent closure zones to meet conservation targets. By distributing the loss of fishing opportunity equitably among local communities, we find that 84–88% of each traditional fishing ground can be left open while still meeting conservation targets. Finally, we summarize the steps for developing marine zoning that accounts for zone effectiveness. PMID:24223870

Post-Closure Monitoring Report for Corrective Action Unit 339: Area 12 Fleet Operations Steam Cleaning Effluent Nevada Test Site, Nevada

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

K. B. Campbell

2002-09-01

The Area 12 Fleet Operations Steam Cleaning Effluent site is located in the southeastern portion of the Area 12 Camp at the Nevada Test Site. This site is identified in the Federal Facility Agreement and Consent Order (1996) as Corrective Action Site (CAS) 12-19-01 and is the only CAS assigned to Corrective Action Unit (CAU) 339. Post-closure sampling and inspection of the site were completed on March 27, 2002. Post-closure monitoring activities were scheduled biennially (every two years) in the Post-Closure Monitoring Plan provided in the Closure Report for CAU 339: Area 12 Fleet Operations Steam Cleaning Effluent, Nevada Testmore » Site (U.S. Department of Energy, Nevada Operations Office [DOEN], 1997). A baseline for the site was established by sampling in 1997. Based on the recommendations from the 1999 post-closure monitoring report (DOE/NV, 1999), samples were collected in 2000, earlier than originally proposed, because the 1999 sample results did not provide the expected decrease in total petroleum hydrocarbon (TPH) concentrations at the site. Sampling results from 2000 (DOE/NV, 2000) and 2001 (DOE/NV, 2001) revealed favorable conditions for natural degradation at the CAU 339 site, but because of differing sample methods and heterogeneity of the soil, data results from 2000 and later were not directly correlated with previous results. Post-closure monitoring activities for 2002 consisted of the following: (1) Soil sample collection from three undisturbed plots (Plots A, B, and C, Figure 2). (2) Sample analysis for TPH as oil and bio-characterization parameters (Comparative Enumeration Assay [CEA] and Standard Nutrient Panel [SNP]). (3) Site inspection to evaluate the condition of the fencing and signs. (4) Preparation and submittal of the Post-Closure Monitoring Report.« less

Post-Closure Report for Closed Resource Conservation and Recovery Act Corrective Action Units, Nevada National Security Site, Nevada for fiscal year 2013 (October 2012 - September 2013)

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

None, None

2014-01-31

This report serves as the combined annual report for post-closure activities for the following closed Corrective Action Units (CAUs): CAU 90, Area 2 Bitcutter Containment; CAU 91, Area 3 U-3fi Injection Well; CAU 92, Area 6 Decon Pond Facility; CAU 110, Area 3 WMD U-3ax/bl Crater; CAU 111, Area 5 WMD Retired Mixed Waste Pits; and, CAU 112, Area 23 Hazardous Waste Trenches.

Tactical Sensors for Dispersed TNF (Tactical Nuclear Force) Units. Appendix 1.Tactical Sensory Survey.

DTIC Science & Technology

1983-06-30

activating a separate transmitter, audible alarm, or contact closure. This sensor is compatible with any device that utilizes an input pulse or...transmitter, audible alarm, or contact closure. This sensor is compatible *i with any device that utilizes an output to produce an alarm. 110-4769-002. This...used to generate an alarm by activating a separate transmitter, audible alarm, or contact closure. This sensor is compatible with any device that

Mitigation of infectious disease at school: targeted class closure vs school closure.

PubMed

Gemmetto, Valerio; Barrat, Alain; Cattuto, Ciro

2014-12-31

School environments are thought to play an important role in the community spread of infectious diseases such as influenza because of the high mixing rates of school children. The closure of schools has therefore been proposed as an efficient mitigation strategy. Such measures come however with high associated social and economic costs, making alternative, less disruptive interventions highly desirable. The recent availability of high-resolution contact network data from school environments provides an opportunity to design models of micro-interventions and compare the outcomes of alternative mitigation measures. We model mitigation measures that involve the targeted closure of school classes or grades based on readily available information such as the number of symptomatic infectious children in a class. We focus on the specific case of a primary school for which we have high-resolution data on the close-range interactions of children and teachers. We simulate the spread of an influenza-like illness in this population by using an SEIR model with asymptomatics, and compare the outcomes of different mitigation strategies. We find that targeted class closure affords strong mitigation effects: closing a class for a fixed period of time--equal to the sum of the average infectious and latent durations--whenever two infectious individuals are detected in that class decreases the attack rate by almost 70% and significantly decreases the probability of a severe outbreak. The closure of all classes of the same grade mitigates the spread almost as much as closing the whole school. Our model of targeted class closure strategies based on readily available information on symptomatic subjects and on limited information on mixing patterns, such as the grade structure of the school, shows that these strategies might be almost as effective as whole-school closure, at a much lower cost. This may inform public health policies for the management and mitigation of influenza-like outbreaks in the community.

CENTRAL PLATEAU REMEDIATION

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

ROMINE, L.D.

2006-02-01

A systematic approach to closure planning is being implemented at the Hanford Site's Central Plateau to help achieve the goal of closure by the year 2035. The overall objective of Central Plateau remediation is to protect human health and the environment from the significant quantity of contaminated material that resulted from decades of plutonium production in support of the nation's defense. This goal will be achieved either by removing contaminants or placing the residual contaminated materials in a secure configuration that minimizes further migration to the groundwater and reduces the potential for inadvertent intrusion into contaminated sites. The approach tomore » Central Plateau cleanup used three key concepts--closure zones, closure elements, and closure process steps--to create an organized picture of actions required to complete remediation. These actions were merged with logic ties, constraints, and required resources to produce an integrated time-phased schedule and cost profile for Central Plateau closure. Programmatic risks associated with implementation of Central Plateau closure were identified and analyzed. Actions to mitigate the most significant risks are underway while high priority remediation projects continue to make progress.« less

50 CFR 648.22 - Closure of the fishery.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 50 Wildlife and Fisheries 8 2010-10-01 2010-10-01 false Closure of the fishery. 648.22 Section 648.22 Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT, NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE FISHERIES OF THE NORTHEASTERN UNITED STATES Management Measures for the...

36 CFR 13.1242 - BCDA closures and restrictions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 36 Parks, Forests, and Public Property 1 2012-07-01 2012-07-01 false BCDA closures and restrictions. 13.1242 Section 13.1242 Parks, Forests, and Public Property NATIONAL PARK SERVICE, DEPARTMENT OF THE INTERIOR NATIONAL PARK SYSTEM UNITS IN ALASKA Special Regulations-Katmai National Park and...

Space Station evolution study oxygen loop closure

NASA Technical Reports Server (NTRS)

Wood, M. G.; Delong, D.

1993-01-01

In the current Space Station Freedom (SSF) Permanently Manned Configuration (PMC), physical scars for closing the oxygen loop by the addition of oxygen generation and carbon dioxide reduction hardware are not included. During station restructuring, the capability for oxygen loop closure was deferred to the B-modules. As such, the ability to close the oxygen loop in the U.S. Laboratory module (LAB A) and the Habitation A module (HAB A) is contingent on the presence of the B modules. To base oxygen loop closure of SSF on the funding of the B-modules may not be desirable. Therefore, this study was requested to evaluate the necessary hooks and scars in the A-modules to facilitate closure of the oxygen loop at or subsequent to PMC. The study defines the scars for oxygen loop closure with impacts to cost, weight and volume and assesses the effects of byproduct venting. In addition, the recommended scenarios for closure with regard to topology and packaging are presented.

Cutaneous Wound Closure Materials: An Overview and Update

PubMed Central

Al-Mubarak, Luluah; Al-Haddab, Mohammed

2013-01-01

Introduction: On a daily basis, dermasurgeons are faced with different kinds of wounds that have to be closed. With a plethora of skin closure materials currently available, choosing a solution that combines excellent and rapid cosmetic results with practicality and cost-effectiveness can be difficult, if not tricky. Objectives: We aimed to review the available skin closure materials over the past 20 years and the scientific claims behind their effectiveness in repairing various kinds of wounds. Materials and Methods: The two authors independently searched and scrutinised the literature. The search was performed electronically using Pub Med, the Cochrane Database, Google Scholar and Ovid as search engines to find articles concerning skin closure materials written since 1990. Conclusion: Many factors are involved in the choice of skin closure material, including the type and place of the wound, available materials, physician expertise and preferences, and patient age and health. Evidence-based main uses of different skin closure materials are provided to help surgeons choose the appropriate material for different wounds. PMID:24470712

California Emergency Department Closures Are Associated With Increased Inpatient Mortality At Nearby Hospitals

PubMed Central

Liu, Charles; Srebotnjak, Tanja; Hsia, Renee Y.

2014-01-01

Between 1996 and 2009 the annual number of emergency department (ED) visits in the United States increased by 51 percent while the number of EDs nationwide decreased by 6 percent, which placed unprecedented strain on the nation’s EDs. To investigate the effects of an ED closing on surrounding communities, we identified all ED closures in California during the period 1999–2010 and examined their association with inpatient mortality rates at nearby hospitals. We found that 24.9 percent of hospital admissions in this period occurred near an ED closure, and that these admissions had 5 percent higher odds of inpatient mortality than admissions not occurring near a closure. This association persisted whether we considered ED closures as affecting all future nearby admissions or only those occurring in the subsequent two years. These results suggest that ED closures have ripple effects on patient outcomes that should be considered when health systems and policy makers decide how to regulate ED closures. PMID:25092832

Monitoring calculation of closure change of Extradosed Cable-stayed Bridge

NASA Astrophysics Data System (ADS)

Shi, Jing Xian; Ran, Zhi Hong

2018-06-01

During the construction of extradosed cable-stayed bridge in Yunnan province, China, the construction unit has made certain changes in the construction process of the closure section due to environmental restrictions: remove the hanging basket after the closure, the sling shall not be provided in closure section, the function of the sling is realized by the hanging basket on the 16th beam. In case of this change, the bridge has been constructed to section 15th. In order to ensure the smooth and orderly progress of each stage in the closure phase, this article is arranged according to the construction plan, appropriate adjustment of related procedures, checking the bridge safety at all stages of construction, the stress and force of the main girder are compared to ensure the safety of the construction after closure changes. Adjust the height of the beam of the 16th and 17th to adapt the new construction plan, and the bridge closure smoothly.

HANFORD SITE RIVER CORRIDOR CLEANUP

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

BAZZELL, K.D.

2006-02-01

In 2005, the US Department of Energy (DOE) launched the third generation of closure contracts, including the River Corridor Closure (RCC) Contract at Hanford. Over the past decade, significant progress has been made on cleaning up the river shore that bordes Hanford. However, the most important cleanup challenges lie ahead. In March 2005, DOE awarded the Hanford River Corridor Closure Contract to Washington Closure Hanford (WCH), a limited liability company owned by Washington Group International, Bechtel National and CH2M HILL. It is a single-purpose company whose goal is to safely and efficiently accelerate cleanup in the 544 km{sup 2} Hanfordmore » river corridor and reduce or eliminate future obligations to DOE for maintaining long-term stewardship over the site. The RCC Contract is a cost-plus-incentive-fee closure contract, which incentivizes the contractor to reduce cost and accelerate the schedule. At $1.9 billion and seven years, WCH has accelerated cleaning up Hanford's river corridor significantly compared to the $3.2 billion and 10 years originally estimated by the US Army Corps of Engineers. Predictable funding is one of the key features of the new contract, with funding set by contract at $183 million in fiscal year (FY) 2006 and peaking at $387 million in FY2012. Another feature of the contract allows for Washington Closure to perform up to 40% of the value of the contract and subcontract the balance. One of the major challenges in the next few years will be to identify and qualify sufficient subcontractors to meet the goal.« less

50 CFR 36.42 - Public participation and closure procedures.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 50 Wildlife and Fisheries 9 2012-10-01 2012-10-01 false Public participation and closure procedures. 36.42 Section 36.42 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF... community post offices within the vicinity affected, made available for broadcast on local radio stations in...

50 CFR 36.42 - Public participation and closure procedures.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 50 Wildlife and Fisheries 9 2013-10-01 2013-10-01 false Public participation and closure procedures. 36.42 Section 36.42 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF... community post offices within the vicinity affected, made available for broadcast on local radio stations in...

40 CFR 264.119 - Post-closure notices.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 264.119 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED... closure of each hazardous waste disposal unit, the owner or operator must submit to the local zoning... required by §§ 264.116 and 264.119(a) have been filed with the local zoning authority or the authority with...

40 CFR 264.119 - Post-closure notices.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 264.119 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED... closure of each hazardous waste disposal unit, the owner or operator must submit to the local zoning... required by §§ 264.116 and 264.119(a) have been filed with the local zoning authority or the authority with...

36 CFR 13.1910 - KNHL and developed area closures and restrictions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 36 Parks, Forests, and Public Property 1 2010-07-01 2010-07-01 false KNHL and developed area closures and restrictions. 13.1910 Section 13.1910 Parks, Forests, and Public Property NATIONAL PARK SERVICE, DEPARTMENT OF THE INTERIOR NATIONAL PARK SYSTEM UNITS IN ALASKA Special Regulations-Wrangell-St...

36 CFR 13.1328 - EGDA closures and restrictions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 36 Parks, Forests, and Public Property 1 2012-07-01 2012-07-01 false EGDA closures and restrictions. 13.1328 Section 13.1328 Parks, Forests, and Public Property NATIONAL PARK SERVICE, DEPARTMENT OF THE INTERIOR NATIONAL PARK SYSTEM UNITS IN ALASKA Special Regulations-Kenai Fjords National Park Exit...

36 CFR 13.1120 - Bartlett Cove Developed Area closures and restrictions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 36 Parks, Forests, and Public Property 1 2012-07-01 2012-07-01 false Bartlett Cove Developed Area closures and restrictions. 13.1120 Section 13.1120 Parks, Forests, and Public Property NATIONAL PARK SERVICE, DEPARTMENT OF THE INTERIOR NATIONAL PARK SYSTEM UNITS IN ALASKA Special Regulations-Glacier Bay...

36 CFR 13.1120 - Bartlett Cove Developed Area closures and restrictions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 36 Parks, Forests, and Public Property 1 2011-07-01 2011-07-01 false Bartlett Cove Developed Area closures and restrictions. 13.1120 Section 13.1120 Parks, Forests, and Public Property NATIONAL PARK SERVICE, DEPARTMENT OF THE INTERIOR NATIONAL PARK SYSTEM UNITS IN ALASKA Special Regulations-Glacier Bay...

Closure Report for Corrective Action Unit 539: Areas 25 and 26 Railroad Tracks Nevada National Security Site, Nevada with ROTC-1, Revision 0

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

Mark Kauss

2011-06-01

This Closure Report (CR) presents information supporting the closure of Corrective Action Unit (CAU) 539: Areas 25 and 26 Railroad Tracks, Nevada National Security Site, Nevada. This CR complies with the requirements of the Federal Facility Agreement and Consent Order (FFACO) that was agreed to by the State of Nevada; U.S. Department of Energy (DOE), Environmental Management; U.S. Department of Defense; and DOE, Legacy Management. The corrective action sites (CASs) within CAU 539 are located within Areas 25 and 26 of the Nevada National Security Site. Corrective Action Unit 539 comprises the following CASs: • 25-99-21, Area 25 Railroad Tracksmore » • 26-99-05, Area 26 Railroad Tracks The purpose of this CR is to provide documentation supporting the completed corrective actions and provide data confirming that the closure objectives for CASs within CAU 539 were met. To achieve this, the following actions were performed: • Reviewed documentation on historical and current site conditions, including the concentration and extent of contamination. • Conducted radiological walkover surveys of railroad tracks in both Areas 25 and 26. • Collected ballast and soil samples and calculated internal dose estimates for radiological releases. • Collected in situ thermoluminescent dosimeter measurements and calculated external dose estimates for radiological releases. • Removed lead bricks as potential source material (PSM) and collected verification samples. • Implemented corrective actions as necessary to protect human health and the environment. • Properly disposed of corrective action and investigation wastes. • Implemented an FFACO use restriction (UR) for radiological contamination at CAS 25-99-21. The approved UR form and map are provided in Appendix F and will be filed in the DOE, National Nuclear Security Administration Nevada Site Office (NNSA/NSO), Facility Information Management System; the FFACO database; and the NNSA/NSO CAU/CAS files. From November 29, 2010, through May 2, 2011, closure activities were performed as set forth in the Streamlined Approach for Environmental Restoration (SAFER) Plan for Corrective Action Unit 539: Areas 25 and 26 Railroad Tracks, Nevada Test Site, Nevada. The purposes of the activities as defined during the data quality objectives process were as follows: • Determine whether contaminants of concern (COCs) are present. • If COCs are present, determine their nature and extent, implement appropriate corrective actions, and properly dispose of wastes. Analytes detected during the closure activities were evaluated against final action levels (FALs) to determine COCs for CAU 539. Assessment of the data generated from closure activities revealed the following: • At CAS 26-99-05, the total effective dose for radiological releases did not exceed the FAL of 25 millirem per Industrial Area year. Potential source material in the form of lead bricks was found at three locations. A corrective action of clean closure was implemented at these locations, and verification samples indicated that no further action is necessary. • At CAS 25-99-21, the total effective dose for radiological releases exceeds the FAL of 25 millirem per Industrial Area year. Potential source material in the form of lead bricks was found at eight locations. A corrective action was implemented by removing the lead bricks and soil above FALs at these locations, and verification samples indicated that no further action is necessary. Pieces of debris with high radioactivity were identified as PSM and remain within the CAS boundary. A corrective action of closure in place with a UR was implemented at this CAS because closure activities showed evidence of remaining soil contamination and radioactive PSM. Future land use will be restricted from surface and intrusive activities. Closure activities generated waste streams consisting of industrial solid waste, recyclable materials, low-level radioactive waste, and mixed low-level radioactive waste. Wastes were disposed of in the appropriate onsite landfills. The NNSA/NSO provides the following recommendations: • Clean closure is required at CAS 26-99-05. • Closure in place is required at CAS 25-99-21. • A UR is required at CAS 25-99-21. • A Notice of Completion to the NNSA/NSO is requested from the Nevada Division of Environmental Protection for closure of CAU 539. • Corrective Action Unit 539 should be moved from Appendix III to Appendix IV of the FFACO.« less

Limited utility of preoperative studies in preparation for colostomy closure.

PubMed

Pokorny, R M; Heniford, T; Allen, J W; Tuckson, W B; Galandiuk, S

1999-04-01

Numerous diagnostic and therapeutic practices are used in an attempt to reduce the morbidity of colostomy closures. Our principal aim was to evaluate the role of preoperative studies, specifically barium enemas and endoscopic examinations, performed before colostomy closures. Additionally, we wished to identify other practices involved in the perioperative management of patients undergoing colostomy closure that influenced morbidity. The records of 100 consecutive patients who underwent elective colostomy closure at University of Louisville Hospital between January 1989 and July 1995 were reviewed. Wound infection was the most common complication (12%). Various bowel preparations were equivalent in efficacy and did not influence the complication rate. Intermittent wound irrigation with antibiotics for 3 days postoperatively, via subcutaneous drains, was associated with a low incidence of incision infection. Preoperative barium enema or sigmoidoscopy were often performed but rarely useful. Performing these examinations merely increased hospital cost without a corresponding decline in morbidity.

The urethral closure function in continent and stress urinary incontinent women assessed by urethral pressure reflectometry.

PubMed

Saaby, Marie-Louise

2014-02-01

Stress urinary incontinence (SUI) occurs when the bladder pressure exceeds the urethral pressure in connection with physical effort or exertion or when sneezing or coughing and depends both on the strength of the urethral closure function and the abdominal pressure to which it is subjected. The urethral closure function in continent women and the dysfunction causing SUI are not known in details. The currently accepted view is based on the concept of a sphincteric unit and a support system. Our incomplete knowledge relates to the complexity of the closure apparatus and to inadequate assessment methods which so far have not provided robust urodynamic diagnostic tools, severity measures, or parameters to assess outcome after intervention. Urethral Pressure Reflectometry (UPR) is a novel method that measures the urethral pressure and cross-sectional area (by use of sound waves) simultaneously. The technique involves insertion of only a small, light and flexible polyurethane bag in the urethra and therefore avoids the common artifacts encountered with conventional methods. The UPR parameters can be obtained at a specific site of the urethra, e.g. the high pressure zone, and during various circumstances, i.e. resting and squeezing. During the study period, we advanced the UPR technique to enable faster measurement (within 7 seconds by the continuous technique) which allowed assessment during increased intra-abdominal pressure induced by physical straining. We investigated the urethral closure function in continent and SUI women during resting and straining by the "fast" UPR technique. Thereby new promising urethral parameters were provided that allowed characterization of the closure function based on the permanent closure forces (primarily generated by the sphincteric unit, measured by the Po-rest) and the adjunctive closure forces (primarily generated by the support system, measured by the abdominal to urethral pressure impact ratio (APIR)). The new parameters enabled a more detailed description of the efficiency of the closure function and the extent and nature of a possible dysfunction in the individual woman. The urethral closure equation (UCE) and urethral opening pressure at an abdominal pressure of 50 cm H2O (Po-Abd 50), respectively, which combine the permanent and the adjunctive closure forces, could separate continent and SUI women and thus appear to be excellent diagnostic tests. Moreover, the parameters showed highly significant negative correlation with ICIQ-SF, pad test and the number of incontinence episodes per week and are therefore valid as urodynamic severity measures. UPR in SUI women before and after TVT demonstrated a more efficient urethral closure function after the operation. The Po-rest was unchanged suggesting that the sphincteric unit was virtually unaltered and hence the permanent closure forces unchanged. However, the resting opening elastance increased by 18% indicating that at the resting state the TVT somewhat improves the closure function by providing increased resistance against the dilation of the urethra, which probably explains the decreased maximum urine flow rate found after TVT in this and previous studies. The APIR increased in all patients after TVT suggesting that the support system was re-established and thus the adjunctive closure forces improved, regardless of the type of pre-operative dysfunction. The new UPR parameters may be used as outcome measures after treatment.

Cost-identification analysis of total laryngectomy: an itemized approach to hospital costs.

PubMed

Dedhia, Raj C; Smith, Kenneth J; Weissfeld, Joel L; Saul, Melissa I; Lee, Steve C; Myers, Eugene N; Johnson, Jonas T

2011-02-01

To understand the contribution of intraoperative and postoperative hospital costs to total hospital costs, examine the costs associated with specific hospital services in the postoperative period, and recognize the impact of patient factors on hospital costs. Case series with chart review. Large tertiary care teaching hospital system. Using the Pittsburgh Head and Neck Organ-Specific Database, 119 patients were identified as having total laryngectomy with bilateral selective neck dissection and primary closure from 1999 to 2009. Cost data were obtained for 112 patients. Costs include fixed and variable costs, adjusted to 2010 US dollars using the Consumer Price Index. Mean total hospital costs were $29,563 (range, $10,915 to $120,345). Operating room costs averaged 24% of total hospital costs, whereas room charges, respiratory therapy, laboratory, pharmacy, and radiology accounted for 38%, 14%, 8%, 7%, and 3%, respectively. Median length of stay was 9 days (range, 6-43), and median Charlson comorbidity index score was 8 (2-16). Patients with ≥1 day in the intensive care unit had significantly higher hospital costs ($46,831 vs $24,601, P < .01). The authors found no significant cost differences with stratification based on previous radiation therapy ($27,598 vs $29,915 with no prior radiation, P = .62) or hospital readmission within 30 days ($29,483 vs $29,609 without readmission, P = .97). This is one of few studies in surgery and the first in otolaryngology to analyze hospital costs for a relatively standardized procedure. Further work will include cost analysis from multiple centers with investigation of global cost drivers.

Comparison of effectiveness and cost of patent ductus arteriosus device occlusion versus surgical ligation of patent ductus arteriosus

PubMed Central

Zulqarnain, Arif; Younas, Muhammad; Waqar, Tariq; Beg, Ahsan; Asma, Touseef; Baig, Mirza Ahmad Raza

2016-01-01

Objectives: Comparison of effectiveness and cost of transcatheter occlusion of patent ductus arteriosus (PDA) with surgical ligation of PDA. Methods: This retrospective comparative study was conducted in the pediatric cardiology department of Ch. Pervaiz Elahi Institute of Cardiology Multan, Pakistan. Data of 250 patients who underwent patent ductus arteriosus (PDA) closure either surgical or trans-catheter closure using SHSMA Occluder having weight >5 kg from April 2012 to October 2015 were included in this study. SPSS version 20 was used for data analysis. Quantitative variables were compared using independent sample t-test. Chi-square test and fishers exact was used for qualitative variables. P-value <0.05 was considered statistically significant. Results: There were one hundred and twenty (120) patients who underwent transcatheter occlusion of PDA using SHSMA occluder (PDA Device Group) and one hundred and thirty (130) patients who underwent surgical ligation of PDA (Surgical Group). Incidence of residual shunting was two (1.5%) in surgical group and 0 (0.0%) in PDA Device group for one month follow up period. There were 4 (3.1%) major complications in surgical group. The rate of blood transfusions were high in surgical group (p-value 0.04). Hospital stay time was significantly less in PDA Device group (P-value <0.001). Total procedural cost was 110695+1054 Pakistani rupees in PDA Device group and 92414+3512 in surgical group (p-value <0.001). The cost of PDA device closure was 16.52% higher than the surgical ligation of PDA. There was no operative mortality. Conclusion: The transcatheter closure of PDA is an effective and less invasive method as compared to the surgical ligation. There is a lower rate of complications and the cost is not much high as compared to surgical PDA ligation. PMID:27648051

75 FR 79417 - Record of Vote of Meeting Closure

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-20

...] Record of Vote of Meeting Closure I, Isaac Fulwood, of the United States Parole Commission, was present... following Commissioners voted that the meeting be closed: Isaac Fulwood, Cranston J. Mitchell and Patricia K.... Isaac Fulwood, Chairman, U.S. Parole Commission. [FR Doc. 2010-31860 Filed 12-17-10; 8:45 am] BILLING...

50 CFR 36.16 - Closure to subsistence uses of fish and wildlife.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 50 Wildlife and Fisheries 9 2014-10-01 2014-10-01 false Closure to subsistence uses of fish and wildlife. 36.16 Section 36.16 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE INTERIOR (CONTINUED) THE NATIONAL WILDLIFE REFUGE SYSTEM ALASKA NATIONAL WILDLIFE REFUGES...

50 CFR 36.16 - Closure to subsistence uses of fish and wildlife.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 50 Wildlife and Fisheries 9 2012-10-01 2012-10-01 false Closure to subsistence uses of fish and wildlife. 36.16 Section 36.16 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE INTERIOR (CONTINUED) THE NATIONAL WILDLIFE REFUGE SYSTEM ALASKA NATIONAL WILDLIFE REFUGES...

50 CFR 36.16 - Closure to subsistence uses of fish and wildlife.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 50 Wildlife and Fisheries 9 2013-10-01 2013-10-01 false Closure to subsistence uses of fish and wildlife. 36.16 Section 36.16 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE INTERIOR (CONTINUED) THE NATIONAL WILDLIFE REFUGE SYSTEM ALASKA NATIONAL WILDLIFE REFUGES...

50 CFR 36.16 - Closure to subsistence uses of fish and wildlife.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 50 Wildlife and Fisheries 6 2010-10-01 2010-10-01 false Closure to subsistence uses of fish and wildlife. 36.16 Section 36.16 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE INTERIOR (CONTINUED) THE NATIONAL WILDLIFE REFUGE SYSTEM ALASKA NATIONAL WILDLIFE REFUGES...

50 CFR 36.16 - Closure to subsistence uses of fish and wildlife.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 50 Wildlife and Fisheries 8 2011-10-01 2011-10-01 false Closure to subsistence uses of fish and wildlife. 36.16 Section 36.16 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE INTERIOR (CONTINUED) THE NATIONAL WILDLIFE REFUGE SYSTEM ALASKA NATIONAL WILDLIFE REFUGES...

75 FR 32158 - New Pneumatic Off-the-Road Tires from the People's Republic of China: Extension of Preliminary...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-07

..., 2010, Tianjin United Tire & Rubber International Co., Ltd. (``TUTRIC''), a mandatory respondent... deadlines by seven calendar days due to closure of federal government offices in February 2010 from a...: Tolling of Administrative Deadlines As A Result of the Government Closure During the Recent Snowstorm...

77 FR 73013 - Stainless Steel Plate in Coils From Belgium: Antidumping Duty Administrative Review, 2010-2011

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-07

... Independent Organization, and the United Steel, Paper and Forestry, Rubber, Manufacturing, Energy, Allied... the closure of the Federal Government from October 29, through October 30, 2012. Thus, all deadlines... Government Closure during Hurricane Sandy,'' dated October 31, 2012. On October 22, 2012, the Department...

78 FR 45896 - Fisheries of the Northeastern United States; Northeast Multispecies Fishery; Trimester Closure...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-30

... Fishery; Trimester Closure for the Common Pool Fishery AGENCY: National Marine Fisheries Service (NMFS... remainder of Trimester 1, through August 31, 2013. Based on our projection, the common pool fishery has... area for the remainder of the trimester. This action is intended to prevent an overage of the common...

Corrective Action Decision Document/Closure Report for Corrective Action Unit 569: Area 3 Yucca Flat Atmospheric Test Sites Nevada National Security Site, Nevada with ROTC 1, Revision 0

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

Sloop, Christy

2013-04-01

This Corrective Action Decision Document/Closure Report presents information supporting the closure of Corrective Action Unit (CAU) 569: Area 3 Yucca Flat Atmospheric Test Sites, Nevada National Security Site, Nevada. CAU 569 comprises the following nine corrective action sites (CASs): • 03-23-09, T-3 Contamination Area • 03-23-10, T-3A Contamination Area • 03-23-11, T-3B Contamination Area • 03-23-12, T-3S Contamination Area • 03-23-13, T-3T Contamination Area • 03-23-14, T-3V Contamination Area • 03-23-15, S-3G Contamination Area • 03-23-16, S-3H Contamination Area • 03-23-21, Pike Contamination Area The purpose of this Corrective Action Decision Document/Closure Report is to provide justification and documentation supportingmore » the recommendation that no further corrective action is needed for CAU 569 based on the implementation of the corrective actions listed in Table ES-2.« less

A Foot-Mounted Inertial Measurement Unit (IMU) Positioning Algorithm Based on Magnetic Constraint

PubMed Central

Zou, Jiaheng

2018-01-01

With the development of related applications, indoor positioning techniques have been more and more widely developed. Based on Wi-Fi, Bluetooth low energy (BLE) and geomagnetism, indoor positioning techniques often rely on the physical location of fingerprint information. The focus and difficulty of establishing the fingerprint database are in obtaining a relatively accurate physical location with as little given information as possible. This paper presents a foot-mounted inertial measurement unit (IMU) positioning algorithm under the loop closure constraint based on magnetic information. It can provide relatively reliable position information without maps and geomagnetic information and provides a relatively accurate coordinate for the collection of a fingerprint database. In the experiment, the features extracted by the multi-level Fourier transform method proposed in this paper are validated and the validity of loop closure matching is tested with a RANSAC-based method. Moreover, the loop closure detection results show that the cumulative error of the trajectory processed by the graph optimization algorithm is significantly suppressed, presenting a good accuracy. The average error of the trajectory under loop closure constraint is controlled below 2.15 m. PMID:29494542

A Foot-Mounted Inertial Measurement Unit (IMU) Positioning Algorithm Based on Magnetic Constraint.

PubMed

Wang, Yan; Li, Xin; Zou, Jiaheng

2018-03-01

With the development of related applications, indoor positioning techniques have been more and more widely developed. Based on Wi-Fi, Bluetooth low energy (BLE) and geomagnetism, indoor positioning techniques often rely on the physical location of fingerprint information. The focus and difficulty of establishing the fingerprint database are in obtaining a relatively accurate physical location with as little given information as possible. This paper presents a foot-mounted inertial measurement unit (IMU) positioning algorithm under the loop closure constraint based on magnetic information. It can provide relatively reliable position information without maps and geomagnetic information and provides a relatively accurate coordinate for the collection of a fingerprint database. In the experiment, the features extracted by the multi-level Fourier transform method proposed in this paper are validated and the validity of loop closure matching is tested with a RANSAC-based method. Moreover, the loop closure detection results show that the cumulative error of the trajectory processed by the graph optimization algorithm is significantly suppressed, presenting a good accuracy. The average error of the trajectory under loop closure constraint is controlled below 2.15 m.

Addendum to the Closure Report for Corrective Action Unit 113: Area 25 R-MAD Facility, Nevada National Security Site, Nevada

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

NSTec Environmental Restoration

2011-02-24

This addendum to the Closure Report for Corrective Action Unit 113: Area 25, Reactor Maintenance, Assembly, and Disassembly Facility, Building 3110, Nevada Test Site, Nevada, DOE/NV--891-VOL I-Rev. 1, dated July 2003, provides details of demolition, waste disposal, and use restriction (UR) modification for Corrective Action Unit 113, Area 25 R-MAD Facility. Demolition was completed on July 15, 2010, when the last of the building debris was disposed. Final field activities were concluded on August 30, 2010, after all equipment was demobilized and UR signs were posted. This work was funded by the American Recovery and Reinvestment Act.

Life Support System Technologies for NASA Exploration Missions

NASA Technical Reports Server (NTRS)

Ewert, Michael K.

2007-01-01

The Lunar Mars Life Support Test series successfully demonstrated integration and operation of advanced technologies for closed-loop life support systems, including physicochemical and biological subsystems. Increased closure was obtained when targeted technologies, such as brine dewatering subsystems, were added to further process life support system byproducts to recover resources. Physicochemical and biological systems can be integrated satisfactorily to achieve desired levels of closure. Imbalances between system components, such as differences in metabolic quotients between human crews and plants, must be addressed. Each subsystem or component that is added to increase closure will likely have added costs, ranging from initial launch mass, power, thermal, crew time, byproducts, etc., that must be factored into break even analysis. Achieving life support system closure while maintaining control of total mass and system complexity will be a challenge.

Factors associated with increasing nursing home closures.

PubMed

Castle, Nicholas G; Engberg, John; Lave, Judith; Fisher, Andrew

2009-06-01

We determine the rate of nursing home closures for 7 years (1999-2005) and examine internal (e.g., quality), organizational (e.g., chain membership), and external (e.g., competition) factors associated with these closures. The names of the closed facilities and dates of closure from state regulators in all 50 states were obtained. This information was linked to the Online Survey, Certification, and Reporting data, which contains information on internal, organizational, and market factors for almost all nursing homes in the United States. One thousand seven hundred and eighty-nine facilities closed over this time period (1999-2005). The average annual rate of closure was about 2 percent of facilities, but the rate of closure was found to be increasing. Nursing homes with higher rates of deficiency citations, hospital-based facilities, chain members, small bed size, and facilities located in markets with high levels of competition were more likely to close. High Medicaid occupancy rates were associated with a high likelihood of closure, especially for facilities with low Medicaid reimbursement rates. As states actively debate about how to redistribute long-term care services/dollars, our findings show that they should be cognizant of the potential these decisions have for facilitating nursing home closures.

Closure Report for Corrective Action Unit 139: Waste Disposal Sites, Nevada Test Site, Nevada

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

NSTec Environmental Restoration

2009-07-31

Corrective Action Unit (CAU) 139 is identified in the Federal Facility Agreement and Consent Order (FFACO) as 'Waste Disposal Sites' and consists of the following seven Corrective Action Sites (CASs), located in Areas 3, 4, 6, and 9 of the Nevada Test Site: CAS 03-35-01, Burn Pit; CAS 04-08-02, Waste Disposal Site; CAS 04-99-01, Contaminated Surface Debris; CAS 06-19-02, Waste Disposal Site/Burn Pit; CAS 06-19-03, Waste Disposal Trenches; CAS 09-23-01, Area 9 Gravel Gertie; and CAS 09-34-01, Underground Detection Station. Closure activities were conducted from December 2008 to April 2009 according to the FFACO (1996, as amended February 2008) andmore » the Corrective Action Plan for CAU 139 (U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office, 2007b). The corrective action alternatives included No Further Action, Clean Closure, and Closure in Place with Administrative Controls. Closure activities are summarized. CAU 139, 'Waste Disposal Sites,' consists of seven CASs in Areas 3, 4, 6, and 9 of the NTS. The closure alternatives included No Further Action, Clean Closure, and Closure in Place with Administrative Controls. This CR provides a summary of completed closure activities, documentation of waste disposal, and confirmation that remediation goals were met. The following site closure activities were performed at CAU 139 as documented in this CR: (1) At CAS 03-35-01, Burn Pit, soil and debris were removed and disposed as LLW, and debris was removed and disposed as sanitary waste. (2) At CAS 04-08-02, Waste Disposal Site, an administrative UR was implemented. No postings or post-closure monitoring are required. (3) At CAS 04-99-01, Contaminated Surface Debris, soil and debris were removed and disposed as LLW, and debris was removed and disposed as sanitary waste. (4) At CAS 06-19-02, Waste Disposal Site/Burn Pit, no work was performed. (5) At CAS 06-19-03, Waste Disposal Trenches, a native soil cover was installed, and a UR was implemented. (6) At CAS 09-23-01, Area 9 Gravel Gertie, a UR was implemented. (7) At CAS 09-34-01, Underground Detection Station, no work was performed.« less

Neutrinoless double-β decay of 48Ca in the shell model: Closure versus nonclosure approximation

NASA Astrophysics Data System (ADS)

Sen'kov, R. A.; Horoi, M.

2013-12-01

Neutrinoless double-β decay (0νββ) is a unique process that could reveal physics beyond the Standard Model. Essential ingredients in the analysis of 0νββ rates are the associated nuclear matrix elements. Most of the approaches used to calculate these matrix elements rely on the closure approximation. Here we analyze the light neutrino-exchange matrix elements of 48Ca 0νββ decay and test the closure approximation in a shell-model approach. We calculate the 0νββ nuclear matrix elements for 48Ca using both the closure approximation and a nonclosure approach, and we estimate the uncertainties associated with the closure approximation. We demonstrate that the nonclosure approach has excellent convergence properties which allow us to avoid unmanageable computational cost. Combining the nonclosure and closure approaches we propose a new method of calculation for 0νββ decay rates which can be applied to the 0νββ decay rates of heavy nuclei, such as 76Ge or 82Se.

Common side closure type, but not stapler brand or oversewing, influences side-to-side anastomotic leak rates.

PubMed

Fleetwood, V A; Gross, K N; Alex, G C; Cortina, C S; Smolevitz, J B; Sarvepalli, S; Bakhsh, S R; Poirier, J; Myers, J A; Singer, M A; Orkin, B A

2017-03-01

Anastomotic leak (AL) increases costs and cancer recurrence. Studies show decreased AL with side-to-side stapled anastomosis (SSA), but none identify risk factors within SSAs. We hypothesized that stapler characteristics and closure technique of the common enterotomy affect AL rates. Retrospective review of bowel SSAs was performed. Data included stapler brand, staple line oversewing, and closure method (handsewn, HC; linear stapler [Barcelona technique], BT; transverse stapler, TX). Primary endpoint was AL. Statistical analysis included Fisher's test and logistic regression. 463 patients were identified, 58.5% BT, 21.2% HC, and 20.3% TX. Covidien staplers comprised 74.9%, Ethicon 18.1%. There were no differences between stapler types (Covidien 5.8%, Ethicon 6.0%). However, AL rates varied by common side closure (BT 3.7% vs. TX 10.6%, p = 0.017), remaining significant on multivariate analysis. Closure method of the common side impacts AL rates. Barcelona technique has fewer leaks than transverse stapled closure. Further prospective evaluation is recommended. Copyright © 2017. Published by Elsevier Inc.

Surgical Treatment of Pressure Ulcers with a Fibrin Sealant in Patients with Spinal Cord Injury: A Cost-Consequence Analysis.

PubMed

Velasco, Jose Manuel Arévalo; Lozano, Virginia; Oyagüez, Itziar; Casado, Miguel Angel

2015-11-01

A comparative study was performed to evaluate the effectiveness and costs of a fibrin sealant (Tissucol Duo [known as Tisseel in the United States], Baxter International, Deerfield, Illinois) to improve postoperative outcomes in patients with spinal cord injury undergoing surgical treatment for pressure ulcers (PrUs). Between January and June 2011, 27 patients underwent surgical treatment for PrUs with the direct application of Tissucol Duo sprayed before closure. The costs and outcomes obtained in this cohort were compared with those obtained in a previous retrospective study where 71 patients underwent conventional surgery. Lower rates of hematoma-seroma were observed in the study group (3.7% vs 33.8%; P < .05). Drain removal occurred earlier (10 vs 15 days; P < .05), and the average drain volume was also lower (155 vs 360 mL; P < .05) for this group. The mean length of hospital stay was significantly lower in the study group and was the main contributing factor to the overall costs. The application of Tissucol Duo during surgical treatment of PrUs in patients with spinal cord injury has been shown to be effective in reducing postoperative complications and in shortening the duration of the hospital stay with a consequent savings in costs.

Left Atrial Appendage Closure for Stroke Prevention: Devices, Techniques, and Efficacy.

PubMed

Iskandar, Sandia; Vacek, James; Lavu, Madhav; Lakkireddy, Dhanunjaya

2016-05-01

Left atrial appendage closure can be performed either surgically or percutaneously. Surgical approaches include direct suture, excision and suture, stapling, and clipping. Percutaneous approaches include endocardial, epicardial, and hybrid endocardial-epicardial techniques. Left atrial appendage anatomy is highly variable and complex; therefore, preprocedural imaging is crucial to determine device selection and sizing, which contribute to procedural success and reduction of complications. Currently, the WATCHMAN is the only device that is approved for left atrial appendage closure in the United States. Copyright © 2016 Elsevier Inc. All rights reserved.

Association of land use and beach closure in the United ...

EPA Pesticide Factsheets

Swimming in natural waters (e.g., oceans, lakes, rivers) is one of most popular recreational activities in the United States. However, exposure to pathogens (e.g., Salmonella spp., Shigella spp., Cryptosporidium, Giardia, adenovirus, norovirus) in recreational waters can lead to a variety of adverse health outcomes. To protect public health and reduce the number of outbreaks associated with recreational waters, the BEACH Act was passed in 2000, which required beach regulators to develop a formal plan to assess beach water quality and to notify the public if recreational waters are unsafe. High levels of microorganisms in water often follow extreme weather events. Besides extreme weather events, the proximity of certain land uses to beaches may also have great influence on beach water quality. Microbial contaminants that lead to beach closures and human illness come mainly from land, either from discrete point sources or from diffuse non-point sources. It is expected that land use will have considerable influence on beach microbial water quality. However, to date, studies on impacts of land use on beach microbial contamination are rare, and few researchers are aware of the relationship between land use and beach closures.In this study, we analyzed beach closure data obtained from 2004 to 2013 for more than 500 beaches in the United States, and examined their associations with land use around beaches in 2006 and 2011. The results show that the number of beach clos

Closure Report for Corrective Action Unit 516: Septic Systems and Discharge Points

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

NSTec Environmental Restoration

Corrective Action Unit (CAU) 516 is located in Areas 3, 6, and 22 of the Nevada Test Site. CAU 516 is listed in the Federal Facility Agreement and Consent Order of 1996 as Septic Systems and Discharge Points, and is comprised of six Corrective Action Sites (CASs): {sm_bullet} CAS 03-59-01, Bldg 3C-36 Septic System {sm_bullet} CAS 03-59-02, Bldg 3C-45 Septic System {sm_bullet} CAS 06-51-01, Sump and Piping {sm_bullet} CAS 06-51-02, Clay Pipe and Debris {sm_bullet} CAS 06-51-03, Clean Out Box and Piping {sm_bullet} CAS 22-19-04, Vehicle Decontamination Area The Nevada Division of Environmental Protection (NDEP)-approved corrective action alternative for CASsmore » 06-51-02 and 22-19-04 is no further action. The NDEP-approved corrective action alternative for CASs 03-59-01, 03-59-02, 06-51-01, and 06-51-03 is clean closure. Closure activities included removing and disposing of total petroleum hydrocarbon (TPH)-impacted septic tank contents, septic tanks, distribution/clean out boxes, and piping. CAU 516 was closed in accordance with the NDEP-approved CAU 516 Corrective Action Plan (CAP). The closure activities specified in the CAP were based on the recommendations presented in the CAU 516 Corrective Action Decision Document (U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office, 2004). This Closure Report documents CAU 516 closure activities. During closure activities, approximately 186 tons of hydrocarbon waste in the form of TPH-impacted soil and debris, as well as 89 tons of construction debris, were generated and managed and disposed of appropriately. Waste minimization techniques, such as field screening of soil samples and the utilization of laboratory analysis to characterize and classify waste streams, were employed during the performance of closure work.« less

78 FR 23515 - Regulated Navigation Areas, Security Zones: Dignitary Arrival/Departure and United Nations...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-19

... security zones as RNAs. The Marine Air Terminal, United Nations, and United Nations West Channel Closure... United Nations General Assembly RNA Regulated Navigation Area UN United Nations A. Public Participation... comment, it will be considered as having been received by the Coast Guard when it is received at the...

Randomized controlled multicentre study comparing biological mesh closure of the pelvic floor with primary perineal wound closure after extralevator abdominoperineal resection for rectal cancer (BIOPEX-study)

PubMed Central

2014-01-01

Background Primary perineal wound closure after conventional abdominoperineal resection (cAPR) for rectal cancer has been the standard of care for many years. Since the introduction of neo-adjuvant radiotherapy and the extralevator APR (eAPR), oncological outcome has been improved, but at the cost of increased rates of perineal wound healing problems and perineal hernia. This has progressively increased the use of biological meshes, although not supported by sufficient evidence. The aim of this study is to determine the effectiveness of pelvic floor reconstruction using a biological mesh after standardized eAPR with neo-adjuvant (chemo)radiotherapy compared to primary perineal wound closure. Methods/Design In this multicentre randomized controlled trial, patients with a clinical diagnosis of primary rectal cancer who are scheduled for eAPR after neo-adjuvant (chemo)radiotherapy will be considered eligible. Exclusion criteria are prior radiotherapy, sacral resection above S4/S5, allergy to pig products or polysorbate, collagen disorders, and severe systemic diseases affecting wound healing, except for diabetes. After informed consent, 104 patients will be randomized between standard care using primary wound closure of the perineum and the experimental arm consisting of suturing a biological mesh derived from porcine dermis in the pelvic floor defect, followed by perineal closure similar to the control arm. Patients will be followed for one year after the intervention and outcome assessors and patients will be blinded for the study treatment. The primary endpoint is the percentage of uncomplicated perineal wound healing, defined as a Southampton wound score of less than II on day 30. Secondary endpoints are hospital stay, incidence of perineal hernia, quality of life, and costs. Discussion The BIOPEX-study is the first randomized controlled multicentre study to determine the additive value of using a biological mesh for perineal wound closure after eAPR with neo-adjuvant radiotherapy compared to primary perineal wound closure with regard to perineal wound healing and the occurrence of perineal hernia. Trail registration number NCT01927497 (Clinicaltrial.gov). PMID:25163547

Corrective Action Decision Document/Closure Report for Corrective Action Unit 383: Area E-Tunnel Sites, Nevada Test Site

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

NSTec Environmental Restoration

This Corrective Action Decision Document/Closure Report (CADD/CR) was prepared by the Defense Threat Reduction Agency (DTRA) for Corrective Action Unit (CAU) 383, Area 12 E-Tunnel Sites, which is the joint responsibility of DTRA and the U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Site Office (NNSA/NSO). This CADD/CR is consistent with the requirements of the Federal Facility Agreement and Consent Order (FFACO) agreed to by the State of Nevada, the DOE, and the U.S. Department of Defense. Corrective Action Unit 383 is comprised of three Corrective Action Sites (CASs) and two adjacent areas: • CAS 12-06-06, Muckpile •more » CAS 12-25-02, Oil Spill • CAS 12-28-02, Radioactive Material • Drainage below the Muckpile • Ponds 1, 2, and 3 The purpose of this CADD/CR is to provide justification and documentation to support the recommendation for closure with no further corrective action, by placing use restrictions at the three CASs and two adjacent areas of CAU 383.« less

36 CFR 13.1146 - What other closures and restrictions apply to commercial fishermen and commercial fishing vessels?

Code of Federal Regulations, 2013 CFR

2013-07-01

..., Forests, and Public Property NATIONAL PARK SERVICE, DEPARTMENT OF THE INTERIOR NATIONAL PARK SYSTEM UNITS IN ALASKA Special Regulations-Glacier Bay National Park and Preserve Commercial Fishing § 13.1146... 36 Parks, Forests, and Public Property 1 2013-07-01 2013-07-01 false What other closures and...

75 FR 31425 - Drill Pipe from the People's Republic of China: Postponement of Preliminary Determination of...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-03

..., as amended (``the Act'').\\1\\ \\1\\ Due to the extended closure of the Government between February 5 and... Government Closure During the Recent Snowstorm, available at http://ia.ita.doc.gov/download/administrative... Conversion, Inc., Rotary Drilling Tools, TMK IPSCO, and the United Steel, Paper and Forestry, Rubber...

40 CFR 267.142 - Cost estimate for closure.

Code of Federal Regulations, 2014 CFR

2014-07-01

... zero cost for hazardous wastes, or non-hazardous wastes that might have economic value. (b) During the... Section 267.142 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE FACILITIES OPERATING UNDER A STANDARDIZED...

40 CFR 267.142 - Cost estimate for closure.

Code of Federal Regulations, 2013 CFR

2013-07-01

... zero cost for hazardous wastes, or non-hazardous wastes that might have economic value. (b) During the... Section 267.142 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE FACILITIES OPERATING UNDER A STANDARDIZED...

40 CFR 267.142 - Cost estimate for closure.

Code of Federal Regulations, 2012 CFR

2012-07-01

... zero cost for hazardous wastes, or non-hazardous wastes that might have economic value. (b) During the... Section 267.142 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE FACILITIES OPERATING UNDER A STANDARDIZED...

Evaluation of methods to limit the time taken to investigate crash sites.

DOT National Transportation Integrated Search

2005-06-01

Highway crashes have significant direct and indirect costs associated with them. Substantial sources of indirect costs are the congestion and delays that result from lane blockages or road closures while the crash is being investigated and the site c...

Recommendations for a barrier island breach management plan for Fire Island National Seashore, including the Otis Pike High Dune Wilderness Area, Long Island, New York

USGS Publications Warehouse

Williams, S. Jeffress; Foley, Mary K.

2007-01-01

4. Economic costs and benefits of artificial closure. This report for breach management presents protocols which specify when breach closures within the FIIS might be desirable and necessary, as well as provides recommendations for structural breach closure engineering operations which are indented to minimize negative impacts to the natural wilderness values and cultural resources within the FIIS, particularly the Otis Pike Wilderness Area. The goal of the plan is to strike a balance between protecting natural resources and allowing natural processes to operate and avoiding loss of life and excessive property damage.

Neutrinoless double-β decay of Se82 in the shell model: Beyond the closure approximation

NASA Astrophysics Data System (ADS)

Sen'kov, R. A.; Horoi, M.; Brown, B. A.

2014-05-01

We recently proposed a method [R. A. Senkov and M. Horoi, Phys. Rev. C 88, 064312 (2013), 10.1103/PhysRevC.88.064312] to calculate the standard nuclear matrix elements for neutrinoless double-β decay (0νββ) of Ca48 going beyond the closure approximation. Here we extend this analysis to the important case of Se82, which was chosen as the base isotope for the upcoming SuperNEMO experiment. We demonstrate that by using a mixed method that considers information from closure and nonclosure approaches, one can get excellent convergence properties for the nuclear matrix elements, which allows one to avoid unmanageable computational costs. We show that in contrast with the closure approximation the mixed approach has a very weak dependence on the average closure energy. The matrix elements for the heavy neutrino-exchange mechanism that could contribute to the 0νββ decay of Se82 are also presented.

Streamlined Approach for Environmental Restoration (SAFER) Plan for Corrective Action Unit 411. Double Tracks Plutonium Dispersion (Nellis), Nevada Test and Training Range, Nevada, Revision 0

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

Matthews, Patrick K.

2015-03-01

This Streamlined Approach for Environmental Restoration (SAFER) Plan addresses the actions needed to achieve closure for Corrective Action Unit (CAU) 411, Double Tracks Plutonium Dispersion (Nellis). CAU 411 is located on the Nevada Test and Training Range and consists of a single corrective action site (CAS), NAFR-23-01, Pu Contaminated Soil. There is sufficient information and historical documentation from previous investigations and the 1996 interim corrective action to recommend closure of CAU 411 using the SAFER process. Based on existing data, the presumed corrective action for CAU 411 is clean closure. However, additional data will be obtained during a field investigationmore » to document and verify the adequacy of existing information, and to determine whether the CAU 411 closure objectives have been achieved. This SAFER Plan provides the methodology to gather the necessary information for closing the CAU. The results of the field investigation will be presented in a closure report that will be prepared and submitted to the Nevada Division of Environmental Protection (NDEP) for review and approval. The site will be investigated based on the data quality objectives (DQOs) developed on November 20, 2014, by representatives of NDEP, the U.S. Air Force (USAF), and the U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Field Office. The DQO process was used to identify and define the type, amount, and quality of data needed to determine whether CAU 411 closure objectives have been achieved. The following text summarizes the SAFER activities that will support the closure of CAU 411; Collect environmental samples from designated target populations to confirm or disprove the presence of contaminants of concern (COCs) as necessary to supplement existing information; If COCs are no longer present, establish clean closure as the corrective action; If COCs are present, the extent of contamination will be defined and further corrective actions will be evaluated with the stakeholders (NDEP, USAF); and Confirm the preferred closure option is sufficient to protect human health and the environment.« less

Unintended costs and consequences of school closures implemented in preparation for Hurricane Isaac in Harrison County School District, Mississippi, August-September 2012

PubMed Central

Zheteyeva, Yenlik; Rainey, Jeanette J.; Gao, Hongjiang; Jacobson, Evin U.; Adhikari, Bishwa B.; Shi, Jianrong; Mpofu, Jonetta J.; Bhavnani, Darlene; Dobbs, Thomas; Uzicanin, Amra

2017-01-01

Introduction School closures, while an effective measure against the spread of disease during a pandemic, may carry unintended social and economic consequences for students and families. We evaluated these costs and consequences following a 4-day school closure in Mississippi’s Harrison County School District (HCSD). Methods In a survey of all households with students enrolled in HCSD, we collected information on difficulties related to the school closure, including interruption of employment and pay, loss of access to subsidized school meals, and arrangement of alternative childcare. We analyzed this information in the context of certain demographic characteristics of the survey respondents and households, such as race, level of education, and income. We also estimated the average number of lost work days and documented the childcare alternatives chosen by households affected by the school closure. Results We received 2,229 (28.4%) completed surveys from an estimated 7,851 households eligible to participate. About half (1,082 [48.5%]) of the households experienced at least some difficulty during the closure, primarily in three areas: uncertainty about duration of the closure, lost income, and the effort of arranging alternate childcare. Adults working outside the home, particularly the major wage earner in the household, were more likely to suffer lost income while schools were closed, an effect mitigated by paid leave benefits. Difficulty arranging childcare was reported most frequently by respondents with lower levels of education and households with younger children. Beyond the top three concerns expressed by households in HCSD, the survey also shed light on the issue of food insecurity when subsidized school meals are not available. Reported by 17.9% of households participating in the subsidized school lunch program, difficulty providing meals during the closure was associated with higher numbers of dependent children, selection of “other” as the race of the household respondent, and lower levels of education. Conclusion To help prevent undue financial hardship in families of school children, public health authorities and school administrators should provide recommendations for childcare alternatives and paid leave or remote work options during prolonged school closures, particularly to households in which all adults work outside of the home. PMID:29091717

Cost-Identification Analysis of Total Laryngectomy: An Itemized Approach to Hospital Costs

PubMed Central

Dedhia, Raj C.; Smith, Kenneth J.; Weissfeld, Joel L.; Saul, Melissa I.; Lee, Steve C.; Myers, Eugene N.; Johnson, Jonas T.

2012-01-01

Objectives To understand the contribution of intraoperative and postoperative hospital costs to total hospital costs, examine the costs associated with specific hospital services in the postoperative period, and recognize the impact of patient factors on hospital costs. Study Design Case series with chart review. Setting Large tertiary care teaching hospital system. Subjects and Methods Using the Pittsburgh Head and Neck Organ-Specific Database, 119 patients were identified as having total laryngectomy with bilateral selective neck dissection and primary closure from 1999 to 2009. Cost data were obtained for 112 patients. Costs include fixed and variable costs, adjusted to 2010 US dollars using the Consumer Price Index. Results Mean total hospital costs were $29 563 (range, $10 915 to $120 345). Operating room costs averaged 24% of total hospital costs, whereas room charges, respiratory therapy, laboratory, pharmacy, and radiology accounted for 38%, 14%, 8%, 7%, and 3%, respectively. Median length of stay was 9 days (range, 6–43), and median Charlson comorbidity index score was 8 (2–16). Patients with ≥1 day in the intensive care unit had significantly higher hospital costs ($46 831 vs $24 601, P < .01). The authors found no significant cost differences with stratification based on previous radiation therapy ($27 598 vs $29 915 with no prior radiation, P = .62) or hospital readmission within 30 days ($29 483 vs $29 609 without readmission, P = .97). Conclusion This is one of few studies in surgery and the first in otolaryngology to analyze hospital costs for a relatively standardized procedure. Further work will include cost analysis from multiple centers with investigation of global cost drivers. PMID:21493420

[Prompt control of an imported carbapenem-resistant Acinetobacter baumanii outbreak in a French intensive care unit].

PubMed

Guth, C; Cavalli, Z; Pernod, C; Lhopital, C; Wey, Pf; Gerome, P; Turc, J

2016-01-01

to describe the management and control of a limited outbreak of carbapenem-resistant Acinetobacter baumanii (CRAB) outbreak in a French intensive care unit. Careful review of the contact's and carrier's files and outbreak management procedures. An undiagnosed CRAB carrier was admitted to our intensive care unit after medical evacuation from Turkey. Despite preventive isolation and contact precautions, a secondary case was diagnosed 5 days after admission of the index case and resulted in the creation of a crisis unit. Prompt management included an epidemiologic investigation with contact screening and follow-up, environmental screening, and additional restrictive measures: isolation room, closure of adjacent rooms, patient cohorting with designated nurses, and reinforcement of contact precautions. restrictive management of CRAB outbreaks may allow prompt outbreak control and avoid prolonged room closures.

Military Construction, Veterans Affairs, and Related Agencies: FY2009 Appropriations

DTIC Science & Technology

2008-07-07

Posture Realignment ( GDPR ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 “Growing the Force...Supplemental (P.L. 110-252) . . . . . . . . . . . . . . . . . . . . 5 Table 3. IGPBS/ GDPR One-Time Implementation Costs...this report. Base Realignment and Closure (BRAC)/Integrated Global Presence and Basing Strategy (IGPBS)/Global Defense Posture Realignment ( GDPR ). Cost

Contact behaviour of children and parental employment behaviour during school closures against the pandemic influenza A (H1N1-2009) in Japan.

PubMed

Mizumoto, Kenji; Yamamoto, Taro; Nishiura, Hiroshi

2013-06-01

To identify epidemiological determinants of the contact behaviour of children and their impact on parental employment, during school closures that took place over the course of the 2009 pandemic influenza (H1N1-2009) in Japan. A retrospective survey was conducted in Japanese households between October 2009 and May 2010 by administration of a standardized questionnaire. Demographic and behavioural variables were explored, in association with the frequency with which children left the home and the risk of parents being absent from work during school closures. Data from 882 eligible households were analysed. A total of 181/882 (20.5%) of households reported that children left the home for nonessential reasons during school closures. No impact on parental working hours was reported by 742/882 (84.1%) of households. Univariate analyses showed that the frequency with which children left the home was dependent on age, extent of school closure and requirement for special childcare arrangements. A greater understanding of age-dependent behaviours, during school closures as a consequence of a pandemic, is required. Consideration of a public policy to permit a paid leave of absence from work for parents during school closures may be beneficial; the cost-effectiveness of such a measure should be assessed in future.

No evidence that manual closure of the bronchial stump has a lower failure rate than mechanical stapler closure following anatomical lung resection.

PubMed

Zakkar, Mustafa; Kanagasabay, Robin; Hunt, Ian

2014-04-01

A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether manual closure of the bronchial stump is safer with lower failure rates than mechanical closure using a stapling device following anatomical lung resection. One hundred and twenty-nine papers were identified using the search below. Eight papers presented the best evidence to answer the clinical question as they included sufficient number of patients to reach conclusions regarding the issues of interest for this review. Complications, complication rates and operation time were included in the assessment. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of the papers are tabulated. When looking at manual vs mechanical staples, it was noted that stapler failure can occur in around 4% of cases. The rate of bronchopleural fistula (BPF) development varied more in patients who underwent manual closure (1.5-12.5%) than in patients who underwent mechanical closure (1-5.7%). Although most of the studies reviewed showed no statistical differences between manual and mechanical closure in terms of BPF development, one study, however, showed that manual closure was significantly associated with lower numbers of postoperative BPF, while another study showed that mechanical closure is significantly associated with lower incidence of BPF. When looking at the role of the learning curve and training opportunities, it seems that the surgeon's inexperience when using mechanical staples can contribute to BPF development. A surgeon's experience can play a major role in the prevention of BPF development in patients having manual closure. Manual closure can provide a cheap and reliable technique when compared with costs incurred from using staplers, it is applicable in all situations and can be taught to surgeons in training with an acceptable risk. However, there is a lack of evidence to suggest that manual closure is better than mechanical stapler closure following anatomical lung resection.

Topical Naltrexone Is a Safe and Effective Alternative to Standard Treatment of Diabetic Wounds.

PubMed

McLaughlin, Patricia J; Cain, Jarrett D; Titunick, Michelle B; Sassani, Joseph W; Zagon, Ian S

2017-09-01

Objective: Diabetes affects more than 29 million individuals in the United States, resulting in healthcare costs approaching $245 billion. Approximately 15% of these individuals will develop a chronic, non-healing foot ulcer (diabetic foot ulcer [DFU]) that, if untreated, may lead to amputation. The current treatments for DFU are expensive, have significant side-effects, and often result in non-compliance. A new topical treatment is described that accelerates cutaneous wound repair and is disease modifying by targeting underlying aberrant diabetic pathways. Approach: The efficacy of naltrexone (NTX), an opioid receptor antagonist, and Regranex ® was compared in preclinical studies using type 1 diabetic rats. Dorsal cutaneous wounds were treated topically with 0.03% NTX, Regranex, or moisturizing cream alone. Wound closure, DNA synthesis, and cytokine production were monitored. Results: Wound closure rates with topical NTX in type 1 diabetic rats were comparable to Regranex. Topical NTX accelerated DNA synthesis, as measured by BrdU incorporation, increased mast cells, and enhanced expression of platelet-derived growth factor (PDGF) and vascular endothelial growth factor (VEGF), a marker for angiogenesis. Regranex had little effect on DNA synthesis, mast cells, and VEGF expression relative to vehicle-treated wounds, and it only temporarily increased PDGF expression. Fibroblast growth factor expression was not altered by either treatment. Innovation: Topical application of 0.03% NTX cream accelerates diabetic wound closure. Conclusion: Blockade of the opioid growth factor (OGF)-OGF receptor (OGFr) axis utilizing 0.03% NTX cream is comparable to standard care in preclinical studies, and it provides a safe, inexpensive, and effective alternative for treatment of diabetic wounds.

Hospital closures had no measurable impact on local hospitalization rates or mortality rates, 2003-11.

PubMed

Joynt, Karen E; Chatterjee, Paula; Orav, E John; Jha, Ashish K

2015-05-01

The Affordable Care Act (ACA) set in motion payment changes that could put pressure on hospital finances and lead some hospitals to close. Understanding the impact of closures on patient care and outcomes is critically important. We identified 195 hospital closures in the United States between 2003 and 2011. We found no significant difference between the change in annual mortality rates for patients living in hospital service areas (HSAs) that experienced one or more closures and the change in rates in matched HSAs without a closure (5.5 percent to 5.2 percent versus 5.4 percent to 5.4 percent, respectively). Nor was there a significant difference in the change in all-cause mortality rates following hospitalization (9.1 percent to 8.2 percent in HSAs with a closure versus 9.0 percent to 8.4 percent in those without a closure). HSAs with a closure had a drop in readmission rates compared to controls (19.4 percent to 18.2 percent versus 18.8 percent to 18.3 percent). Overall, we found no evidence that hospital closures were associated with worse outcomes for patients living in those communities. These findings may offer reassurance to policy makers and clinical leaders concerned about the potential acceleration of hospital closures as a result of health care reform. Project HOPE—The People-to-People Health Foundation, Inc.

78 FR 33067 - Fisheries of the United States; NOAA Fisheries Policy for Modifying Fisheries Closures in the...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-03

... regarding those closures to the public during a public health emergency or oil spill characterized by... regulations to address a public health emergency or oil spill. Section 305(c)(3) states: (3) Any emergency... on a permanent basis; (C) that responds to a public health emergency or an oil spill may remain in...

Corrective Action Decision Document/Closure Report for Corrective Action Unit 541: Small Boy Nevada National Security Site and Nevada Test and Training Range, Nevada, Revision 0 with ROTC-1

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

Kidman, Raymond; Matthews, Patrick

The purpose of this Corrective Action Decision Document/Closure Report is to provide justification and documentation supporting the recommendation that no further corrective action is needed for CAU 541 based on the no further action alternative listed in Table ES-1.

77 FR 73957 - Fisheries of the Northeastern United States; Atlantic Sea Scallop Fishery; Closure of the...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-12

... fishing effort in this area, which could reduce long-term scallop biomass and optimum yield from the ETA... them to grow. Following closure of the ETA, scallop biomass increased steadily in the area. When the ETA opened in 2007, it contained over one-quarter of the total scallop biomass. The area was fished as...

FACTORS ASSOCIATED WITH CLOSURES OF EMERGENCY DEPARTMENTS IN THE UNITED STATES

PubMed Central

Hsia, Renee Y.; Kellerman, Arthur L.; Shen, Yu-Chu

2014-01-01

Context Between 1998 and 2008, the number of hospital-based emergency departments (EDs) in the United States declined, while the number of ED visits increased, particularly visits by publicly-insured and uninsured patients. Little is known about the hospital, community, and market factors associated with ED closures. Federal law requiring EDs to treat all in need regardless of a patient’s ability to pay may make EDs more vulnerable to the market forces that govern US health care. Objective To determine hospital, community, and market factors associated with ED closures. Design ED and hospital organizational information from 1990 through 2009 was acquired from the American Hospital Association (AHA) Annual Surveys (annual response rates ranging from 84–92%) and merged with hospital financial and payer mix information available through 2007 from Medicare hospital cost reports. We evaluated 3 sets of risk factors: hospital characteristics (safety-net as defined by hospitals caring for more than double their Medicaid share of discharges, compared with other hospitals within a 15-mile radius) ownership, teaching status, system membership, hospital size, case-mix), county population demographics (race, poverty, uninsurance, elderly), and market factors (ownership mix, profit margin, location in a competitive market, presence of other EDs). Setting All general, acute, non-rural, short-stay hospitals in the US with an operating ED anytime from 1990–2009. Main Outcome Closure of an emergency department anytime during the study period. Results The number of hospitals with EDs in non-rural areas declined from 2446 in 1990 to 1779 in 2009, with 1041 EDs closing and 374 hospitals opening EDs. Based on analysis of 2,814 urban acute care hospitals, constituting 36,335 hospital-year observations over an 18-year study interval (1990–2007), for-profit hospitals and those with low profit margins were more likely to close than their counterparts (26% vs 16%; HR 1.8, 95% CI 1.5 to 2.1 and 36% vs 18%; HR 1.9, 95% CI 1.6 to 2.3, respectively]. Hospitals in more competitive markets had a significantly higher risk of closing their EDs (34% vs 17%; HR 1.3, 95% CI 1.1 to 1.6), as did safety-net hospitals (10% vs 6%; HR 1.4, 95% CI 1.1 to 1.7) and those serving a higher share of populations in poverty (37% vs 31%; HR 1.4, 95% CI 1.1 to 1.7). Conclusion From 1990 to 2009, the number of hospital EDs in non-rural areas declined by 27%, with for-profit ownership, location in a competitive market, safety-net status, and low profit margin associated with increased risk of ED closure. PMID:21586713

Cost-effective non-surgical treatment of chronic pressure ulcers in the community.

PubMed

Dale, Megan; Cox-Martin, Bill; Shaw, Paula; Carolan-Rees, Grace

2014-03-01

The Salisbury Pressure Ulcer Outreach Service successfully treats patients with chronic pressure ulcers that have not healed during routine community treatment. These patients have grade 4 pressure ulcers, involving extensive destruction, or damage to muscle and bone. A combination of scientific, seating and tissue viability expertise with a holistic approach results in non-surgical healing for 70% of patients. For those who still require surgery, outcomes are more successful with this approach, resulting in low recurrence rates. Prior to creation of the outreach service, patients were referred directly for surgical closure, resulting in high recurrence levels and long waiting lists. The authors compared costs of the Pressure Ulcer Outreach Service with the previous system of surgical closure. The model base case found that the Pressure Ulcer Outreach Service saved £8588 per patient, and that cost savings could be even greater if the outreach service was extended into preventative work.

Closure Report for Corrective Action Unit 104: Area 7 Yucca Flat Atmospheric Test Sites, Nevada National Security Site, Nevada

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

None

2013-06-27

This Closure Report (CR) presents information supporting closure of Corrective Action Unit (CAU) 104, Area 7 Yucca Flat Atmospheric Test Sites, and provides documentation supporting the completed corrective actions and confirmation that closure objectives for CAU 104 were met. This CR complies with the requirements of the Federal Facility Agreement and Consent Order (FFACO) that was agreed to by the State of Nevada; the U.S. Department of Energy (DOE), Environmental Management; the U.S. Department of Defense; and DOE, Legacy Management. CAU 104 consists of the following 15 Corrective Action Sites (CASs), located in Area 7 of the Nevada National Securitymore » Site: · CAS 07-23-03, Atmospheric Test Site T-7C · CAS 07-23-04, Atmospheric Test Site T7-1 · CAS 07-23-05, Atmospheric Test Site · CAS 07-23-06, Atmospheric Test Site T7-5a · CAS 07-23-07, Atmospheric Test Site - Dog (T-S) · CAS 07-23-08, Atmospheric Test Site - Baker (T-S) · CAS 07-23-09, Atmospheric Test Site - Charlie (T-S) · CAS 07-23-10, Atmospheric Test Site - Dixie · CAS 07-23-11, Atmospheric Test Site - Dixie · CAS 07-23-12, Atmospheric Test Site - Charlie (Bus) · CAS 07-23-13, Atmospheric Test Site - Baker (Buster) · CAS 07-23-14, Atmospheric Test Site - Ruth · CAS 07-23-15, Atmospheric Test Site T7-4 · CAS 07-23-16, Atmospheric Test Site B7-b · CAS 07-23-17, Atmospheric Test Site - Climax Closure activities began in October 2012 and were completed in April 2013. Activities were conducted according to the Corrective Action Decision Document/Corrective Action Plan for CAU 104. The corrective actions included No Further Action and Clean Closure. Closure activities generated sanitary waste, mixed waste, and recyclable material. Some wastes exceeded land disposal limits and required treatment prior to disposal. Other wastes met land disposal restrictions and were disposed in appropriate onsite landfills. The U.S. Department of Energy, National Nuclear Security Administration Nevada Field Office (NNSA/NFO) requests the following: · A Notice of Completion from the Nevada Division of Environmental Protection to NNSA/NFO for closure of CAU 104 · The transfer of CAU 104 from Appendix III to Appendix IV, Closed Corrective Action Units, of the FFACO« less

Open abdomen in gastrointestinal surgery: Which technique is the best for temporary closure during damage control?

PubMed Central

Ribeiro Junior, Marcelo A F; Barros, Emily Alves; de Carvalho, Sabrina Marques; Nascimento, Vinicius Pereira; Cruvinel Neto, José; Fonseca, Alexandre Zanchenko

2016-01-01

AIM To compare the 3 main techniques of temporary closure of the abdominal cavity, vacuum assisted closure (vacuum-assisted closure therapy - VAC), Bogota bag and Barker technique, in damage control surgery. METHODS After systematic review of the literature, 33 articles were selected to compare the efficiency of the three procedures. Criteria such as cost, infections, capacity of reconstruction of the abdominal wall, diseases associated with the technique, among others were analyzed. RESULTS The Bogota bag and Barker techniques present as advantage the availability of material and low cost, what is not observed in the VAC procedure. The VAC technique is the most efficient, not only because it reduces the tension on the boarders of the lesion, but also removes stagnant fluids and debris and acts at cellular level increasing cell proliferation and division. Bogota bag presents the higher rates of skin laceration and evisceration, greater need for a stent for draining fluids and wash-ups, higher rates of intestinal adhesion to the abdominal wall. The Barker technique presents lack of efficiency in closing the abdominal wall and difficulty on maintaining pressure on the dressing. The VAC dressing can generate irritation and dermatitis when the drape is applied, in addition to pain, infection and bleeding, as well as toxic shock syndrome, anaerobic sepsis and thrombosis. CONCLUSION The VAC technique, showed to be superior allowing a better control of liquid on the third space, avoiding complications such as fistula with small mortality, low infection rate, and easier capability on primary closure of the abdominal cavity. PMID:27648164

Closure Report for Corrective Action Unit 573: Alpha Contaminated Sites Nevada National Security Site, Nevada

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

Matthews, Patrick

This Closure Report (CR) presents information supporting the closure of Corrective Action Unit (CAU) 573: Alpha Contaminated Sites, Nevada National Security Site, Nevada. CAU 573 comprises the two corrective action sites (CASs): 05-23-02-GMX Alpha Contaminated Are-Closure in Place and 05-45-01-Atmospheric Test Site - Hamilton- Clean Closure. The purpose of this CR is to provide justification and documentation supporting the recommendation that no further corrective action is needed for CAU 573 based on the implementation of the corrective actions. Corrective action activities were performed at Hamilton from May 25 through June 30, 2016; and at GMX from May 25 to Octobermore » 27, 2016, as set forth in the Corrective Action Decision Document (CADD)/Corrective Action Plan (CAP) for Corrective Action Unit 573: Alpha Contaminated Sites; and in accordance with the Soils Activity Quality Assurance Plan, which establishes requirements, technical planning, and general quality practices. Verification sample results were evaluated against data quality objective criteria developed by stakeholders that included representatives from the Nevada Division of Environmental Protection and the DOE, National Nuclear Security Administration Nevada Field Office (NNSA/NFO) during the corrective action alternative (CAA) meeting held on November 24, 2015. Radiological doses exceeding the final action level were assumed to be present within the high contamination areas associated with CAS 05-23-02, thus requiring corrective action. It was also assumed that radionuclides were present at levels that require corrective action within the soil/debris pile associated with CAS 05-45-01. During the CAU 573 CAA meeting, the CAA of closure in place with a use restriction (UR) was selected by the stakeholders as the preferred corrective action of the high contamination areas at CAS 05-23-02 (GMX), which contain high levels of removable contamination; and the CAA of clean closure was selected by the stakeholders as preferred corrective action for the debris pile at CAS 05-45-01 (Hamilton). The closure in place was accomplished by posting signs containing a warning label on the existing contamination area fence line; and recording the FFACO UR and administrative UR in the FFACO database, the NNSA/NFO CAU/CAS files, and the management and operating contractor Geographic Information Systems. The clean closure was accomplished by excavating the soil/debris pile, disposing of the contents at the Area 5 Radioactive Waste Management Complex, and collecting verification samples. The corrective actions were implemented as stipulated in the CADD/CAP, and verification sample results confirm that the criteria for the completion of corrective actions have been met. Based on the implementation of these corrective actions, NNSA/NFO provides the following recommendations: No further corrective actions are necessary for CAU 573; The Nevada Division of Environmental Protection should issue a Notice of Completion to NNSA/NFO for closure of CAU 573; CAU 573 should be moved from Appendix III to Appendix IV of the FFACO.« less

Complete closure of artificial gastric ulcer after endoscopic submucosal dissection by combined use of a single over-the-scope clip and through-the-scope clips (with videos).

PubMed

Maekawa, Satoshi; Nomura, Ryosuke; Murase, Takayuki; Ann, Yasuyoshi; Harada, Masaru

2015-02-01

A 5-7 day hospital stay is usually needed after endoscopic submucosal dissection (ESD) of gastric tumor because of the possibility of delayed perforation or bleeding. The aim of this study was to evaluate the efficacy of combined use of a single over-the-scope clip (OTSC) and through-the-scope clips (TTSCs) to achieve complete closure of artificial gastric ulcer after ESD. We prospectively studied 12 patients with early gastric cancer or gastric adenoma. We performed complete closure of post-ESD artificial gastric ulcer using a combination of a single OTSC and TTSCs. Mean size of post-ESD artificial ulcer was 54.6 mm. The mean operating time for the closure procedure was 15.2 min., and the success rate was 91.7 % (11/12). Patients who underwent complete closure of post-ESD artificial gastric ulcer could be discharged the day after ESD and the closing procedure. Complete closure of post-ESD artificial gastric ulcer using a combination of a single OTSC and TTSCs is useful for shortening the period of hospitalization and reducing treatment cost.

Columbus Closure Project Released without Radiological Restrictions

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

Henderson, G.

2007-07-01

The Columbus Closure Project (CCP), a historic radiological research complex, was cleaned up for future use without radiological restriction in 2006. The CCP research and development site contributed to national defense, nuclear fuel fabrication, and the development of safe nuclear reactors in the United States until 1988 when research activities were concluded for site decommissioning. In November of 2003, the Ohio Field Office of the U.S. Department of Energy contracted ECC/E2 Closure Services, LLC (Closure Services) to complete the removal of radioactive contamination from of a 1955 era nuclear sciences area consisting of a large hot cell facility, research reactormore » building and underground piping. The project known as the Columbus Closure Project (CCP) was completed in 27 months and brought to a close 16 years of D and D in Columbus, Ohio. This paper examines the project innovations and challenges presented during the Columbus Closure Project. The examination of the CCP includes the project regulatory environment, the CS safety program, accelerated clean up innovation, project execution strategies and management of project waste issues and the regulatory approach to site release 'without radiological restrictions'. (authors)« less

21 CFR 211.186 - Master production and control records.

Code of Federal Regulations, 2011 CFR

2011-04-01

... description of the drug product containers, closures, and packaging materials, including a specimen or copy of... form; (2) The name and weight or measure of each active ingredient per dosage unit or per unit of...

21 CFR 211.186 - Master production and control records.

Code of Federal Regulations, 2010 CFR

2010-04-01

... description of the drug product containers, closures, and packaging materials, including a specimen or copy of... form; (2) The name and weight or measure of each active ingredient per dosage unit or per unit of...

Effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma (EAGLE): a randomised controlled trial.

PubMed

Azuara-Blanco, Augusto; Burr, Jennifer; Ramsay, Craig; Cooper, David; Foster, Paul J; Friedman, David S; Scotland, Graham; Javanbakht, Mehdi; Cochrane, Claire; Norrie, John

2016-10-01

Primary angle-closure glaucoma is a leading cause of irreversible blindness worldwide. In early-stage disease, intraocular pressure is raised without visual loss. Because the crystalline lens has a major mechanistic role, lens extraction might be a useful initial treatment. From Jan 8, 2009, to Dec 28, 2011, we enrolled patients from 30 hospital eye services in five countries. Randomisation was done by a web-based application. Patients were assigned to undergo clear-lens extraction or receive standard care with laser peripheral iridotomy and topical medical treatment. Eligible patients were aged 50 years or older, did not have cataracts, and had newly diagnosed primary angle closure with intraocular pressure 30 mm Hg or greater or primary angle-closure glaucoma. The co-primary endpoints were patient-reported health status, intraocular pressure, and incremental cost-effectiveness ratio per quality-adjusted life-year gained 36 months after treatment. Analysis was by intention to treat. This study is registered, number ISRCTN44464607. Of 419 participants enrolled, 155 had primary angle closure and 263 primary angle-closure glaucoma. 208 were assigned to clear-lens extraction and 211 to standard care, of whom 351 (84%) had complete data on health status and 366 (87%) on intraocular pressure. The mean health status score (0·87 [SD 0·12]), assessed with the European Quality of Life-5 Dimensions questionnaire, was 0·052 higher (95% CI 0·015-0·088, p=0·005) and mean intraocular pressure (16·6 [SD 3·5] mm Hg) 1·18 mm Hg lower (95% CI -1·99 to -0·38, p=0·004) after clear-lens extraction than after standard care. The incremental cost-effectiveness ratio was £14 284 for initial lens extraction versus standard care. Irreversible loss of vision occurred in one participant who underwent clear-lens extraction and three who received standard care. No patients had serious adverse events. Clear-lens extraction showed greater efficacy and was more cost-effective than laser peripheral iridotomy, and should be considered as an option for first-line treatment. Medical Research Council. Copyright © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license. Published by Elsevier Ltd.. All rights reserved.

Comparison of rate of surgical wound infection, length of hospital stay and patient convenience in complicated appendicitis between primary closure and delayed primary closure.

PubMed

Khan, Khizar Ishtiaque; Mahmood, Shahid; Akmal, Muhammad; Waqas, Ahmed

2012-06-01

To compare the difference in the rate of surgical wound infection, patient's convenience and length of hospital stay between Primary Closure and Delayed Primary Closure in cases of complicated appendicitis in adults. This randomised control trial was conducted at the Combined Military Hospital, Kharian and Malir from June 5, 2006, to September 10, 2009. Patients > or = 15 years of both gender who underwent appendectomy through grid iron or Lanz incision and having complicated appendicitis were included. The 100 patients who were included in the study out of the initial size of 393, were randomised into two equal groups of 50 each (Group A: Primary Closure; Group B: Delayed Primary Closure) using a computer-generated table. All the surgeries were done by the same surgeon and the operative steps and antibiotic coverage were standardised. The rate of surgical wound infection, patient's convenience (on visual analogue scale in mm) and the length of hospital stay were recorded. Data was analysed using SPSS version 11, and p value was calculated. Demographic data, comorbids and medication of both the groups was comparable. There was no significant difference in rate of surgical wound infection (p > 0.05). The difference in patient's convenience and length of hospital stay were significant (p < 0.05), showing superiority of Primary Closure over Delayed Primary Closure with no added morbidity/mortality. Primary Closure in complicated appendicitis not only reduces the cost of treatment, but is also more convenient and satisfying for the patients, with no added risk of surgical wound infection.

Closure Report for Corrective Action Unit 151: Septic Systems and Discharge Area, Nevada Test Site, Nevada

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

NSTec Environmental Restoration

2008-04-01

Corrective Action Unit (CAU) 151 is identified in the Federal Facility Agreement and Consent Order (FFACO) as Septic Systems and Discharge Area. CAU 151 consists of the following eight Corrective Action Sites (CASs), located in Areas 2, 12, and 18 of the Nevada Test Site, approximately 65 miles northwest of Las Vegas, Nevada: (1) CAS 02-05-01, UE-2ce Pond; (2) CAS 12-03-01, Sewage Lagoons (6); (3) CAS 12-04-01, Septic Tanks; (4) CAS 12-04-02, Septic Tanks; (5) CAS 12-04-03, Septic Tank; (6) CAS 12-47-01, Wastewater Pond; (7) CAS 18-03-01, Sewage Lagoon; and (8) CAS 18-99-09, Sewer Line (Exposed). CAU 151 closure activitiesmore » were conducted according to the FFACO (FFACO, 1996; as amended February 2008) and the Corrective Action Plan for CAU 151 (U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office, 2007) from October 2007 to January 2008. The corrective action alternatives included no further action, clean closure, and closure in place with administrative controls. CAU 151 closure activities are summarized in Table 1. Closure activities generated liquid remediation waste, sanitary waste, hydrocarbon waste, and mixed waste. Waste generated was appropriately managed and disposed. Waste that is currently staged onsite is being appropriately managed and will be disposed under approved waste profiles in permitted landfills. Waste minimization activities included waste characterization sampling and segregation of waste streams. Some waste exceeded land disposal restriction limits and required offsite treatment prior to disposal. Other waste meeting land disposal restrictions was disposed of in appropriate onsite or offsite landfills. Waste disposition documentation is included as Appendix C.« less

Influence of canopy closure and shrub coverage on travel along coarse woody debris by Eastern chipmunks (Tamias striatus)

Treesearch

Patrick A. Zollner; Kevin J. Crane

2003-01-01

We investigated relationships between canopy closure, shrub cover and the use of coarse woody debris as a travel path by eastern chipmunks (Tamias striatus) in the north central United States. Fine scale movements of chipmunks were followed with tracking spools and the percentage of each movement path directly along coarse woody debris was recorded...

Closure Report for Corrective Action Unit 394: Areas 12, 18, and 29 Spill/Release Sites, Nevada Test Site, Nevada: Revision 0

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

U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office

This Closure Report (CR) presents information supporting a closure recommendation for Corrective Action Unit (CAU) 394: Areas 12, 18, and 29 Spill/Release Sites, Nevada Test Site, Nevada, in compliance with the requirements of the Federal Facility Agreement and Consent Order. This CAU contains six Corrective Action Sites (CASs): 12-25-04, UST 12-16-2 Waste Oil Release; 18-25-01, 18-25-02, 18-25-03, Oil Spills; 18-25-04, Spill (Diesel Fuel); and 29-44-01, Fuel Spill, located within Areas 12, 18, and 29 on the Nevada Test Site. The purpose of this CR is to provide documentation supporting recommendations of no further action or closure in place for CASsmore » within CAU 394. Throughout late 2002 and early to mid 2003, closure activities were performed as set forth in the CAU 394 Streamlined Approach for Environmental Restoration Plan. The closure activities identified the nature and extent of contaminants of potential concern at the CASs, and provided sufficient information and data to complete appropriate corrective actions for the CASs. Soil in CASs 18-25-02 and 18-25-03 containing polychlorinated biphenyls exceeding the action levels established by the Nevada Administrative Code were removed for proper disposal. The soil remaining in these CASs containing petroleum hydrocarbons exceeding the action level were closed in place with use restrictions. Corrective Action Sites 18-25-04 required no further corrective action; closure in place is required at CASs 12-25-04, 18-25-01, 18-25-02, 18-25-03, and 29-44-01; and use restrictions are required at CASs 12-25-04, 18-25-01, 18-25-02, 18-25-03 and 29-44-01. In summary, no corrective action plan is required for CAU 394.« less

Post-Closure Report for Closed Resource Conservation and Recovery Act Corrective Action Units, Nevada National Security Site, Nevada For Fiscal Year 2012 (October 2011–September 2012)

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

NSTec Environmental Restoration

2013-01-17

This report serves as the combined annual report for post-closure activities for the following closed Corrective Action Units (CAUs): · CAU 90, Area 2 Bitcutter Containment · CAU 91, Area 3 U-3fi Injection Well · CAU 92, Area 6 Decon Pond Facility · CAU 110, Area 3 WMD U-3ax/bl Crater · CAU 111, Area 5 WMD Retired Mixed Waste Pits · CAU 112, Area 23 Hazardous Waste Trenches This report covers fiscal year 2012 (October 2011–September 2012).

Corrective Action Decision Document/Closure Report for Corrective Action Unit 105: Area 2 Yucca Flat Atmospheric Test Sites, Nevada National Security Site, Nevada, Revision 1

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

Matthews, Patrick

2014-01-01

The purpose of this Corrective Action Decision Document/Closure Report is to provide justification and documentation supporting the recommendation that no further corrective action is needed for CAU 105 based on the implementation of the corrective actions. Corrective action investigation (CAI) activities were performed from October 22, 2012, through May 23, 2013, as set forth in the Corrective Action Investigation Plan for Corrective Action Unit 105: Area 2 Yucca Flat Atmospheric Test Sites; and in accordance with the Soils Activity Quality Assurance Plan, which establishes requirements, technical planning, and general quality practices.

Addendum to the Closure Report for Corrective Action Unit 262: Area 25 Septic Systems and Underground Discharge Point, Nevada Test Site, Nevada

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

Lynn Kidman

2008-10-01

This document constitutes an addendum to the July 2003, Closure Report for Corrective Action Unit 262: Area 25 Septic Systems and Underground Discharge Point as described in the document Recommendations and Justifications for Modifications for Use Restrictions Established under the U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office Federal Facility Agreement and Consent Order (UR Modification document) dated February 2008. The UR Modification document was approved by NDEP on February 26, 2008. The approval of the UR Modification document constituted approval of each of the recommended UR modifications.

Severe Accident Sequence Analysis Program: Anticipated transient without scram simulations for Browns Ferry Nuclear Plant Unit 1

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

Dallman, R J; Gottula, R C; Holcomb, E E

1987-05-01

An analysis of five anticipated transients without scram (ATWS) was conducted at the Idaho National Engineering Laboratory (INEL). The five detailed deterministic simulations of postulated ATWS sequences were initiated from a main steamline isolation valve (MSIV) closure. The subject of the analysis was the Browns Ferry Nuclear Plant Unit 1, a boiling water reactor (BWR) of the BWR/4 product line with a Mark I containment. The simulations yielded insights to the possible consequences resulting from a MSIV closure ATWS. An evaluation of the effects of plant safety systems and operator actions on accident progression and mitigation is presented.

Closure plan for Corrective Action Unit 109: U-2bu subsidence crater, Nevada Test Site, Nevada

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

NONE

1999-03-01

The U-2bu subsidence crater, Corrective Action Unit 109, will be closed in accordance with the Resource Conservation and Recovery Act, the Nevada Division of Environmental Protection operational permit, and the Federal Facility Agreement and Consent Order. The U-2bu subsidence crater is located in Area 2 of the Nevada Test Site. It was created in 1971 by an underground nuclear test with the name Miniata. The crater has a diameter of 288 meters (944 feet) and an approximate depth of 35 meters (115 feet). Based on the results of the analyses reported in the site characterization report, the only constituents ofmore » concern in the U-2bu subsidence crater include leachable lead and total petroleum hydrocarbons. Closure activities will include the excavation and disposal of impacted soil from the top of the crater. Upon completion of excavation, verification samples will be collected to show that the leachable lead has been removed to concentrations below the regulatory action level. After sample results show that the lead has been removed, the excavated area will be backfilled and a soil flood diversion berm will be constructed as a best management practice. An independent registered professional engineer will certify the site was closed following the approved Closure Plan. Post-closure care is not warranted for this site because closure activities will involve removal of the Resource Conservation and Recovery Act constituents of concern.« less

A prospective, randomized clinical trial to assess the cost-effectiveness of a modern foam dressing versus a traditional saline gauze dressing in the treatment of stage II pressure ulcers.

PubMed

Payne, Wyatt G; Posnett, John; Alvarez, Oscar; Brown-Etris, Marie; Jameson, Gayle; Wolcott, Randall; Dharma, Hussein; Hartwell, Samantha; Ochs, Diane

2009-02-01

Modern dressings such as hydrocolloids, gels, and foams are typically more expensive than traditional dressings such as gauze. However, if modern dressings require fewer changes, the overall cost of treatment may be lower despite the higher initial purchase price. If healing rates are comparable or better, modern dressings also may be cost-effective. A 4-week, prospective, randomized clinical trial to assess differences in treatment costs and cost-effectiveness between a modern foam dressing and saline-soaked gauze was conducted among 36 patients (22 men, 14 women, mean age 72.8 years) with a Stage II pressure ulcer (mean duration 35 weeks) at five centers in the United States. Participants were randomized to treatment with a self-adhesive polyurethane foam (n = 20) or saline-soaked gauze dressing (n = 16). No difference in time to wound closure was observed (P = 0.817). Patients in the foam group had less frequent dressing changes (P <0.001). Total cost over the study period was lower by $466 per patient (P = 0.055) and spending on dressings was lower by $92 per patient in the foam group (P = 0.025). Cost per ulcer healed was lower by $1,517 and cost per ulcer-free day was lower by $80 for patients in the foam group. On the evidence of this study, the foam dressing is a more cost-effective treatment than saline-soaked gauze for the treatment of Stage II pressure ulcers.

THE INTEGRATION OF THE 241-Z BUILDING DECONTAMINATION & DECOMMISSIONING (D&D) UNDER COMPREHENSIVE ENVIRONMENTAL RESPONSE COMPENSATION & LIABILITY ACT (CERCLA) WITH RESOURCE CONSERVATION & RECOVERY ACT (RCRA) CLOSURE AT THE PLUTONIUM FINISHING PLANT (PFP)

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

HOPKINS, A.M.

2007-02-20

The 241-Z treatment and storage tanks, a hazardous waste Treatment, Storage and Disposal (TSD) unit permitted pursuant to the ''Resource Conservation and Recovery Act of 1976'' (RCRA) and Washington State ''Hazardous Waste Management Act, RCW 70.105'', have been deactivated and are being actively decommissioned. The 241-Z TSD unit managed non-listed radioactive contaminated waste water, containing trace RCRA characteristic constituents. The 241-Z TSD unit consists of below grade tanks (D-4, D-5, D-7, D-8, and an overflow tank) located in a concrete containment vault, sample glovebox GB-2-241-ZA, and associated ancillary piping and equipment. The tank system is located beneath the 241-Z building.more » The 241-Z building is not a portion of the TSD unit. The sample glovebox is housed in the above-grade building. Waste managed at the TSD unit was received via underground mining from Plutonium Finishing Plant (PFP) sources. Tank D-6, located in the D-6 vault cell, is a past-practice tank that was taken out of service in 1972 and has never operated as a portion of the RCRA TSD unit. CERCLA actions address Tank D-6, its containment vault cell, and soil beneath the cell that was potentially contaminated during past-practice operations and any other potential past-practice contamination identified during 241-Z closure, while outside the scope of the ''Hanford Facility Dangerous Waste Closure Plant, 241-Z Treatment and Storage Tanks''.« less

Multidisciplinary management of patent foramen ovale (PFO) and cryptogenic stroke/TIA

PubMed Central

Mirzada, Naqibullah; Ladenvall, Per; Hansson, Per-Olof; Eriksson, Peter; Dellborg, Mikael

2013-01-01

Purpose Patent foramen ovale (PFO) has been implicated as a risk factor for cryptogenic ischemic stroke (CS). However, there is still a lack of widely accepted, undisputed indications for PFO closure. The present study describes the concept of the multidisciplinary PFO conference and a decision making process for closure versus no closure that was developed into a formalized clinical algorithm, and presents the results of implementing these, in terms of number and proportion of PFO closures as well as repeat referrals. Design Five specialists in neurology, cardiology, internal medicine, thromboembolism, and echocardiography evaluated the clinical data of 311 patients at PFO conferences during 2006 to 2009. The main criteria for closure were patients with first-ever CS with PFO and atrial septal aneurysm, or patients with recurrent CS and PFO without atrial septal aneurysm. Results A total of 143 patients (46%) were accepted for closure and 167 patients were rejected. Patients accepted for closure were younger (mean 50 years versus 58 years) (P < 0.001). The acceptance rate for PFO closure was similar throughout these years, with an average of 45%. Three of 167 patients (1.8%) initially rejected for PFO closure were re-referred due to recurrent stroke, and the PFO closure was subsequently performed. Conclusion The acceptance rate of less than 50% in the present study underscores the complex relationship between CS and PFO. Whatever the criteria used for PFO closure, any unit caring for these patients needs to have a rigorous process to avoid overtreatment as well as undertreatment and to ensure that personal preferences and economic incentives do not steer the selection process. Our algorithm provides a stable acceptance rate and a low rate of repeat referrals. PMID:24082787

Variability in school closure decisions in response to 2009 H1N1: a qualitative systems improvement analysis

PubMed Central

2011-01-01

Background School closure was employed as a non-pharmaceutical intervention against pandemic 2009 H1N1, particularly during the first wave. More than 700 schools in the United States were closed. However, closure decisions reflected significant variation in rationales, decision triggers, and authority for closure. This variability presents the opportunity for improved efficiency and decision-making. Methods We identified media reports relating to school closure as a response to 2009 H1N1 by monitoring high-profile sources and searching Lexis-Nexis and Google news alerts, and reviewed reports for key themes. News stories were supplemented by observing conference calls and meetings with health department and school officials, and by discussions with decision-makers and community members. Results There was significant variation in the stated goal of closure decision, including limiting community spread of the virus, protecting particularly vulnerable students, and responding to staff shortages or student absenteeism. Because the goal of closure is relevant to its timing, nature, and duration, unclear rationales for closure can challenge its effectiveness. There was also significant variation in the decision-making authority to close schools in different jurisdictions, which, in some instances, was reflected in open disagreement between school and public health officials. Finally, decision-makers did not appear to expect the level of scientific uncertainty encountered early in the pandemic, and they often expressed significant frustration over changing CDC guidance. Conclusions The use of school closure as a public health response to epidemic disease can be improved by ensuring that officials clarify the goals of closure and tailor closure decisions to those goals. Additionally, authority to close schools should be clarified in advance, and decision-makers should expect to encounter uncertainty disease emergencies unfold and plan accordingly. PMID:21284865

Understanding the basis of space closure in Orthodontics for a more efficient orthodontic treatment

PubMed Central

Ribeiro, Gerson Luiz Ulema; Jacob, Helder B.

2016-01-01

ABSTRACT Introduction: Space closure is one of the most challenging processes in Orthodontics and requires a solid comprehension of biomechanics in order to avoid undesirable side effects. Understanding the biomechanical basis of space closure better enables clinicians to determine anchorage and treatment options. In spite of the variety of appliance designs, space closure can be performed by means of friction or frictionless mechanics, and each technique has its advantages and disadvantages. Friction mechanics or sliding mechanics is attractive because of its simplicity; the space site is closed by means of elastics or coil springs to provide force, and the brackets slide on the orthodontic archwire. On the other hand, frictionless mechanics uses loop bends to generate force to close the space site, allowing differential moments in the active and reactive units, leading to a less or more anchorage control, depending on the situation. Objective: This article will discuss various theoretical aspects and methods of space closure based on biomechanical concepts. PMID:27275623

Understanding the basis of space closure in Orthodontics for a more efficient orthodontic treatment.

PubMed

Ribeiro, Gerson Luiz Ulema; Jacob, Helder B

2016-01-01

Space closure is one of the most challenging processes in Orthodontics and requires a solid comprehension of biomechanics in order to avoid undesirable side effects. Understanding the biomechanical basis of space closure better enables clinicians to determine anchorage and treatment options. In spite of the variety of appliance designs, space closure can be performed by means of friction or frictionless mechanics, and each technique has its advantages and disadvantages. Friction mechanics or sliding mechanics is attractive because of its simplicity; the space site is closed by means of elastics or coil springs to provide force, and the brackets slide on the orthodontic archwire. On the other hand, frictionless mechanics uses loop bends to generate force to close the space site, allowing differential moments in the active and reactive units, leading to a less or more anchorage control, depending on the situation. This article will discuss various theoretical aspects and methods of space closure based on biomechanical concepts.

Indirect economic impact of landslide hazards by disruption to national road transportation networks; Scotland, United Kingdom.

NASA Astrophysics Data System (ADS)

Postance, Benjamin; Hillier, John; Dijkstra, Tom; Dixon, Neil

2016-04-01

The failure of engineered or natural slopes which support or are adjacent to transportation systems often inflicts costly direct physical damage and indirect system disruption. The consequences and severity of indirect impacts vary according to which links, nodes or network facilities are physically disrupted. Moreover, it is often the case that multiple slope failure disruptions are triggered simultaneously following prolonged or intense precipitation events due to a degree of local homogeneity of slope characteristics and materials. This study investigates the application of national commuter statistics and network agent simulation to evaluate indirect impacts of landslide events disrupting the Scottish trunk road transportation network (UK). Previous studies often employ shortest pathway analysis whereas agent simulation has received relatively little attention. British Geological Survey GeoSure landslide susceptibility data is used to select 35 susceptible trunk road segments by means of neighbouring total area at risk. For each of the candidate 35 segments the network and zonal variation in travel time is calculated for a single day of disruption, economic impact is approximated using established governmental and industry transport planning and appraisal values. The results highlight that a number of trunk road segments incur indirect economic losses in the order of tens of thousands of pounds for each day of closure. Calculated losses at the A83 Rest and Be Thankful are 50% greater than previous estimates at £75 thousand per day of closure. Also highlighted are events in which economic impact is relatively minor, yet concentrating on particular communities that can become substantially isolated as a consequence of a single event. The findings of this study are of interest and support wider investigations exploring cost considerations for decision makers and mitigation strategies, in addition to identifying network topological and demand indicators conducive to high indirect economic cost events.

Post-Closure Report for Closed Resource Conservation and Recovery Act Corrective Action Units, Nevada National Security Site, Nevada: For Fiscal Year 2015 (October 2014–September 2015), Revision 0

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

Matthews, Patrick

This report serves as the combined annual report for post-closure activities for the following closed corrective action units (CAUs); CAU 90, Area 2 Bitcutter Containment; CAU 91, Area 3 U-3fi Injection Well; CAU 92, Area 6 Decon Pond Facility; CAU 110, Area 3 WMD U-3ax/bl Crater; CAU 111, Area 5 WMD Retired Mixed Waste Pits; and CAU 112, Area 23 Hazardous Waste Trenches. This report covers fiscal year 2015 (October 2014 through September 2015). The post-closure requirements for these sites are described in Resource Conservation and Recovery Act Permit Number NEV HW0101 and are summarized in each CAU-specific section inmore » Section 1.0 of this report. The results of the inspections, a summary of maintenance activities, and an evaluation of monitoring data are presented in this report.« less

10 CFR 960.5-2-8 - Surface characteristics.

Code of Federal Regulations, 2010 CFR

2010-01-01

... NUCLEAR WASTE REPOSITORY Preclosure Guidelines Ease and Cost of Siting, Construction, Operation, and... repository siting, construction, operation, and closure. (b) Favorable conditions. (1) Generally flat terrain...

10 CFR 960.5-2-8 - Surface characteristics.

Code of Federal Regulations, 2014 CFR

2014-01-01

... NUCLEAR WASTE REPOSITORY Preclosure Guidelines Ease and Cost of Siting, Construction, Operation, and... repository siting, construction, operation, and closure. (b) Favorable conditions. (1) Generally flat terrain...

10 CFR 960.5-2-8 - Surface characteristics.

Code of Federal Regulations, 2012 CFR

2012-01-01

... NUCLEAR WASTE REPOSITORY Preclosure Guidelines Ease and Cost of Siting, Construction, Operation, and... repository siting, construction, operation, and closure. (b) Favorable conditions. (1) Generally flat terrain...

10 CFR 960.5-2-8 - Surface characteristics.

Code of Federal Regulations, 2013 CFR

2013-01-01

... NUCLEAR WASTE REPOSITORY Preclosure Guidelines Ease and Cost of Siting, Construction, Operation, and... repository siting, construction, operation, and closure. (b) Favorable conditions. (1) Generally flat terrain...

Closure Report for Corrective Action Unit 568: Area 3 Plutonium Dispersion Sites Nevada National Security Site, Nevada, Revision 1

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

Matthews, Patrick

The purpose of this CR is to provide documentation and justification that no further corrective action is needed for the closure of CAU 568 based on the implementation of corrective actions. This includes a description of closure activities that were performed and an evaluation of the verification data. The CAP (NNSA/NFO, 2016a) and ROTC-1 (NNSA/NFO, 2016c) provide information relating to the selection of CAAs and the reasoning behind their selection. The CADD (NNSA/NFO, 2015) identifies the release sites that require additional corrective action and presents information supporting the selection of CAAs.

The Impact of Public Hospital Closure on Medical and Residency Education: Implications and Recommendations

PubMed Central

Walker, Kara Odom; Calmes, Daphne; Hanna, Nancy; Baker, Richard

2010-01-01

Background Challenges around safety-net hospital closure have impacted medical student and resident exposure to urban public healthcare sites that may influence their future practice choices. Objective To assess the impact of the closure of a public safety-net teaching hospital for the clinical medical education of Charles Drew University medical students and residents. Method Retrospective cohort study of medical students’ and residents’ and clinical placement into safety-net experiences after the closure of the primary teaching hospital. Results The hospital closure impacted both medical student and residency training experiences. Only 71% (17/24) of medical student rotations and 13% (23/180) of residents were maintained at public safety-net clinical sittings. The closure of the public safety-net hospital resulted in the loss of 36% of residency training spots sponsored by historically black medical schools in the United States and an even larger negative impact on the number of physicians training in underserved urban areas of Los Angeles County. Conclusion While the medical educational program changes undertaken in the wake of hospital closure have negatively affected the immediate clinical educational experiences of medical students and residents, it remains to be seen whether the training site location changes will alter their long-term preferences in specialty choice and practice location. PMID:19110905

The impact of public hospital closure on medical and residency education: implications and recommendations.

PubMed

Walker, Kara Odom; Calmes, Daphne; Hanna, Nancy; Baker, Richard

2008-12-01

Challenges around safety-net hospital closure have impacted medical student and resident exposure to urban public healthcare sites that may influence their future practice choices. To assess the impact of the closure of a public safety-net teaching hospital for the clinical medical education of Charles Drew University medical students and residents. Retrospective cohort study of medical students' and residents' and clinical placement into safety-net experiences after the closure of the primary teaching hospital. The hospital closure impacted both medical student and residency training experiences. Only 71% (17/24) of medical student rotations and 13% (23/180) of residents were maintained at public safety-net clinical sittings. The closure of the public safety-net hospital resulted in the loss of 36% of residency training spots sponsored by historically black medical schools in the United States and an even larger negative impact on the number of physicians training in underserved urban areas of Los Angeles County. While the medical educational program changes undertaken in the wake of hospital closure have negatively affected the immediate clinical educational experiences of medical students and residents, it remains to be seen whether the training site location changes will alter their long-term preferences in specialty choice and practice location.

Closure Report for Corrective Action Unit 408: Bomblet Target Area Tonopah Test Range (TTR), Nevada, Revision 0

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

Mark Krauss

2010-09-01

This Closure Report (CR) presents information supporting the closure of Corrective Action Unit (CAU) 408: Bomblet Target Area (TTR), Tonopah Test Range, Nevada. This CR complies with the requirements of the Federal Facility Agreement and Consent Order that was agreed to by the State of Nevada; U.S. Department of Energy (DOE), Environmental Management; U.S. Department of Defense; and DOE, Legacy Management. Corrective Action Unit 408 is located at the Tonopah Test Range, Nevada, and consists of Corrective Action Site (CAS) TA-55-002-TAB2, Bomblet Target Areas. This CAS includes the following seven target areas: • Mid Target • Flightline Bomblet Location •more » Strategic Air Command (SAC) Target Location 1 • SAC Target Location 2 • South Antelope Lake • Tomahawk Location 1 • Tomahawk Location 2 The purpose of this CR is to provide documentation supporting the completed corrective actions and data confirming that the closure objectives for the CAS within CAU 408 were met. To achieve this, the following actions were performed: • Review the current site conditions, including the concentration and extent of contamination. • Implement any corrective actions necessary to protect human health and the environment. • Properly dispose of corrective action and investigation wastes. • Document Notice of Completion and closure of CAU 408 issued by the Nevada Division of Environmental Protection. From July 2009 through August 2010, closure activities were performed as set forth in the Streamlined Approach for Environmental Restoration Plan for CAU 408: Bomblet Target Area, Tonopah Test Range (TTR), Nevada. The purposes of the activities as defined during the data quality objectives process were as follows: • Identify and remove munitions of explosive concern (MEC) associated with DOE activities. • Investigate potential disposal pit locations. • Remove depleted uranium-contaminated fragments and soil. • Determine whether contaminants of concern (COCs) are present. • If COCs are present, determine their nature and extent, implement appropriate corrective actions, and properly dispose of wastes. Analytes detected during the closure activities were evaluated against final action levels to determine COCs for CAU 408. Assessment of the data indicated COCs are not present at CAS TA-55-002-TAB2; therefore, no corrective action is necessary. No use restrictions are required to be placed on this CAU because the investigation showed no evidence of remaining soil contamination or remaining debris/waste upon completion of all investigation activities. The MEC was successfully removed and dispositioned as planned using current best available technologies. As MEC guidance and general MEC standards acknowledge that MEC response actions cannot determine with 100 percent certainty that all MEC and unexploded ordnance (UXO) are removed, the clean closure of CAU 408 will implement a best management practice of posting UXO hazard warning signs near the seven target areas. The signs will warn future land users of the potential for encountering residual UXO hazards. The DOE, National Nuclear Security Administration Nevada Site Office, provides the following recommendations: • A Notice of Completion to the DOE, National Nuclear Security Administration Nevada Site Office, is requested from the Nevada Division of Environmental Protection for closure of CAU 408. • Corrective Action Unit 408 should be moved from Appendix III to Appendix IV of the Federal Facility Agreement and Consent Order.« less

Trends in the supply of inpatient rehabilitation facilities services: 1996 to 2004.

PubMed

Mallinson, Trudy R; Manheim, Larry M; Almagor, Orit; Demark, Holly M; Heinemann, Allen W

2008-11-01

Describe the supply of inpatient rehabilitation facilities (IRFs) services in 1996 and examine changes between 1996 and 2004, including the impact of the IRF prospective payment system (PPS) in 2002 on organizational trends. Retrospective pre-post design. Freestanding and subprovider (distinct-part units) IRFs. IRFs (N=1424), including 257 freestanding IRFs and 1167 IRF units reported in the Healthcare Cost Report Information System database, from years 1996 to 2004. Not applicable. Number of IRF openings, IRF closures, beds, and inpatient days. The number of IRFs grew from 1037 to 1183 between 1996 and 2001 and grew to 1235 between 2001 and 2004. The likelihood of IRF closures trended lower after PPS, and there was a significant increase in the likelihood of openings when PPS was introduced. For-profit, rural, and small IRFs were more likely to open over the entire period. There was a 12.9% increase in the number of total inpatient days, somewhat less than the 15.7% growth in IRF beds over the period. There was no impact of PPS on beds available but a significant decline in total inpatient days after PPS. Inpatient days rose under the Tax Equity and Fiscal Responsibility Act and declined after 2002. Yet the likelihood of openings and closures did not appear to respond to these changes, perhaps because they were modest compared with changes in local IRF markets. The IRF PPS did little to affect service distribution in less well-served areas, although we did find growth in rural areas. Occupancy rates in 2004 were close to rates at the start of the period (70%). This observation implies that IRFs were implementing strategies to recruit a sufficient number of patients, even though bed numbers were increasing and length of stay was declining. Consequently, policy that limits the potential of IRFs to increase patient admissions, such as the limits on admissions to IRFs of patients with conditions other than those included in the 75% rule, is likely to produce substantial decreases in total inpatient days.

Corrective Action Decision Document/Closure Report for Corrective Action Unit 252: Area 25 Engine Test Stand 1 Decontamination Pad, Nevada Test Site, Nevada

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

DOE /NV

This Corrective Action Decision Document/Closure Report (CADD/CR) has been prepared for Corrective Action Unit (CAU) 252: Area 25 Engine Test Stand-1 Decontamination Pad, in accordance with the Federal Facility Agreement and Consent Order (FFACO). Located at the Nevada Test Site in Nevada, CAU 252 consists of only one Corrective Action Site (25-07-04, Decontamination Pad). This CADD/CR identifies and rationalizes the U.S. Department of Energy, Nevada Operations Office's (DOE/NV's) recommendation that no corrective action is deemed necessary at CAU 252. The Corrective Action Decision Document and Closure Report have been combined into one report because the potential contaminants of concern weremore » either not detected during the corrective action investigation or were only present at naturally occurring concentrations. Based on the field results, neither corrective action or a corrective action plan is required at this site. A Notice of Completion to DOE/NV is being requested from the Nevada Division of Environmental Protection for closure of CAU 252, as well as a request that this site be moved from Appendix III to Appendix IV of the FFACO. Further, no use restrictions are required to be placed on this CAU.« less

No evidence that manual closure of the bronchial stump has a lower failure rate than mechanical stapler closure following anatomical lung resection

PubMed Central

Zakkar, Mustafa; Kanagasabay, Robin; Hunt, Ian

2014-01-01

A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether manual closure of the bronchial stump is safer with lower failure rates than mechanical closure using a stapling device following anatomical lung resection. One hundred and twenty-nine papers were identified using the search below. Eight papers presented the best evidence to answer the clinical question as they included sufficient number of patients to reach conclusions regarding the issues of interest for this review. Complications, complication rates and operation time were included in the assessment. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of the papers are tabulated. When looking at manual vs mechanical staples, it was noted that stapler failure can occur in around 4% of cases. The rate of bronchopleural fistula (BPF) development varied more in patients who underwent manual closure (1.5–12.5%) than in patients who underwent mechanical closure (1–5.7%). Although most of the studies reviewed showed no statistical differences between manual and mechanical closure in terms of BPF development, one study, however, showed that manual closure was significantly associated with lower numbers of postoperative BPF, while another study showed that mechanical closure is significantly associated with lower incidence of BPF. When looking at the role of the learning curve and training opportunities, it seems that the surgeon's inexperience when using mechanical staples can contribute to BPF development. A surgeon's experience can play a major role in the prevention of BPF development in patients having manual closure. Manual closure can provide a cheap and reliable technique when compared with costs incurred from using staplers, it is applicable in all situations and can be taught to surgeons in training with an acceptable risk. However, there is a lack of evidence to suggest that manual closure is better than mechanical stapler closure following anatomical lung resection. PMID:24351508

76 FR 38997 - Approval and Promulgation of Implementation Plans; State of Oregon; Regional Haze State...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-05

... economic blow that would result from an earlier closure and is an appropriate balance of environmental and... BART rules for the Boardman facility achieve the proper balance of environmental benefits, the cost to... secure greater environmental benefits with a better balance of cost and risk by transitioning the...

Estimating the effect of hospital closure on areawide inpatient hospital costs: a preliminary model and application.

PubMed Central

Shepard, D S

1983-01-01

A preliminary model is developed for estimating the extent of savings, if any, likely to result from discontinuing a specific inpatient service. By examining the sources of referral to the discontinued service, the model estimates potential demand and how cases will be redistributed among remaining hospitals. This redistribution determines average cost per day in hospitals that receive these cases, relative to average cost per day of the discontinued service. The outflow rate, which measures the proportion of cases not absorbed in other acute care hospitals, is estimated as 30 percent for the average discontinuation. The marginal cost ratio, which relates marginal costs of cases absorbed in surrounding hospitals to the average costs in those hospitals, is estimated as 87 percent in the base case. The model was applied to the discontinuation of all inpatient services in the 75-bed Chelsea Memorial Hospital, near Boston, Massachusetts, using 1976 data. As the precise value of key parameters is uncertain, sensitivity analysis was used to explore a range of values. The most likely result is a small increase ($120,000) in the area's annual inpatient hospital costs, because many patients are referred to more costly teaching hospitals. A similar situation may arise with other urban closures. For service discontinuations to generate savings, recipient hospitals must be low in costs, the outflow rate must be large, and the marginal cost ratio must be low. PMID:6668181

Post-Closure Inspection Report for the Tonopah Test Range, Nevada, for Calendar Year 2014

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

Silvas, A. J.; Lantow, Tiffany A.

This report provides the results of the annual post-closure inspections conducted at the closed Corrective Action Units (CAUs) located on the Tonopah Test Range (TTR), Nevada. This report covers calendar year 2014 and includes inspection and repair activities completed at the following CAUs; CAU 400: Bomblet Pit and Five Points Landfill (TTR); CAU 407: Roller Coaster RadSafe Area (TTR); CAU 424: Area 3 Landfill Complexes (TTR); CAU 453: Area 9 UXO Landfill (TTR); and CAU 487: Thunderwell Site (TTR) Inspections were conducted according to the post-closure plans in the approved Closure Reports and subsequent correspondence with the Nevada Division ofmore » Environmental Protection. The post-closure inspection plans and subsequent correspondence modifying the requirements for each CAU are included in Appendix B. The inspection checklists are included in Appendix C. Photographs taken during inspections are included in Appendix D. The annual post-closure inspections were conducted on May 28, 2014. Maintenance was required at CAU 407. Animal burrows were backfilled and erosion repairs were performed. Vegetation monitoring was performed at CAU 407 in June 2014. The vegetation monitoring report is included in Appendix E.« less

Early lens extraction with intraocular lens implantation for the treatment of primary angle closure glaucoma: an economic evaluation based on data from the EAGLE trial

PubMed Central

Javanbakht, Mehdi; Azuara-Blanco, Augusto; Burr, Jennifer M; Ramsay, Craig; Cooper, David; Cochran, Claire; Norrie, John; Scotland, Graham

2017-01-01

Objective To investigate the cost-effectiveness of early lens extraction with intraocular lens implantation for the treatment of primary angle closure glaucoma (PACG) compared to standard care. Design Cost-effectiveness analysis alongside a multicentre pragmatic two-arm randomised controlled trial. Patients were followed-up for 36 months, and data on health service usage and health state utility were collected and analysed within the trial time horizon. A Markov model was developed to extrapolate the results over a 5-year and 10-year time horizon. Setting 22 hospital eye services in the UK. Population Males and females aged 50 years or over with newly diagnosed PACG or primary angle closure (PAC). Interventions Lens extraction compared to standard care (ie, laser iridotomy followed by medical therapy and glaucoma surgery). Outcome measures Costs of primary and secondary healthcare usage (UK NHS perspective), quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER) for lens extraction versus standard care. Results The mean age of participants was 67.5 (8.42), 57.5% were women, 44.6% had both eyes eligible, 1.4% were of Asian ethnicity and 35.4% had PAC. The mean health service costs were higher in patients randomised to lens extraction: £2467 vs £1486. The mean adjusted QALYs were also higher with early lens extraction: 2.602 vs 2.533. The ICER for lens extraction versus standard care was £14 284 per QALY gained at three years. Modelling suggests that the ICER may drop to £7090 per QALY gained by 5 years and that lens extraction may be cost saving by 10 years. Our results are generally robust to changes in the key input parameters and assumptions. Conclusions We find that lens extraction has a 67–89% chance of being cost-effective at 3 years and that it may be cost saving by 10 years. Trial registration number ISRCTN44464607; Results. PMID:28087548

Impact of Different Standard Type A7A Drum Closure-Ring Practices on Gasket Contraction and Bolt Closure Distance– 15621

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

Ketusky, Edward; Blanton, Paul; Bobbitt, John H.

The Department of Energy, the Savannah River National Laboratory, several manufacturers of specification drums, and the United States Department of Transportation (DOT) are collaborating in the development of a guidance document for DOE contractors and vendors who wish to qualify containers to DOT 7A Type A requirements. Currently, the effort is focused on DOT 7A Type A 208-liter (55-gallons) drums with a standard 12-gauge bolted closure ring. The U.S. requirements, contained in Title 49, Part 178.350 “Specification 7A; general packaging, Type A specifies a competent authority review of the packaging is not required for the transport of (Class 7) radioactivemore » material containing less than Type A quantities of radioactive material. For Type AF drums, a 4 ft. regulatory free drop must be performed, such that the drum “suffers maximum damage.” Although the actual orientation is not defined by the specification, recent studies suggest that maximum damage would result from a shallow angle top impact, where kinetic energy is transferred to the lid, ultimately causing heavy damage to the lid, or even worse, causing the lid to come off. Since each vendor develops closure recommendations/procedures for the drums they manufacture, key parameters applied to drums during closing vary based on vendor. As part of the initial phase of the collaboration, the impact of the closure variants on the ability of the drum to suffer maximum damage is investigated. Specifically, closure testing is performed varying: 1) the amount of torque applied to the closure ring bolt; and, 2) stress relief protocol, including: a) weight of hammer; and, b) orientation that the hammer hits the closure ring. After closure, the amount of drum lid gasket contraction and the distance that the closure bolt moves through the closure ring is measured.« less

Post-Closure Inspection Letter Report for Corrective Action Units on the Nevada National Security Site

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

Boehleke, R. F.

2014-05-06

This letter serves as the post-closure inspection letter report for Corrective Action Units (CAUs) on the Nevada National Security Site for calendar year 2013. The inspections identified maintenance and repair is required at the following sites: sign and/or fence repair is necessary at CAUs 113, 137, 139, 140, 143, 262, 370, 371, 372, 374, 476, 478, 529, 542, and 560; animal burrows were identified at CAU 547; and erosion was identified at CAUs 366, 367, 383, 551, and 574. In addition, the following use restrictions were removed during 2013 and will no longer be inspected in 2014: 165, 357, andmore » 528.« less

Association of land use and beach closure in the United States

EPA Science Inventory

Swimming in natural waters (e.g., oceans, lakes, rivers) is one of most popular recreational activities in the United States. However, exposure to pathogens (e.g., Salmonella spp., Shigella spp., Cryptosporidium, Giardia, adenovirus, norovirus) in recreational waters can lead to ...

Communication strategies and timeliness of response to life critical telemetry alarms.

PubMed

Bonzheim, Kimberly A; Gebara, Rani I; O'Hare, Bridget M; Ellis, R Darin; Brand, Monique A; Balar, Salil D; Stockman, Rita; Sciberras, Annette M; Haines, David E

2011-05-01

A centralized electrocardiogram telemetry monitoring system (TMS) facilitates early identification of critical arrhythmias and acute medical decompensation. Timely intervention can only be performed if abnormalities are communicated rapidly to the direct caregiver. The study objectives were to measure effectiveness of bi-directional voice communication badges versus one-way alphanumeric pagers for telemetry alarm response and communication loop closure. A sequential observational pilot study of nursing response to TMS alarms compared communication technologies on four nursing units in a 1,061 bed tertiary care hospital with 264 TMS channels of telemetry over a 2-year period. Subsequently, the communication technologies were compared in a randomized fashion on a 68-bed progressive cardiac care unit. Caregivers were blinded to the protocol. All alarm responses were recorded during two periods using either pagers or voice communication devices. Alarm response time and closure of the communication loop were analyzed in a blinded fashion. The direct communication functionality of the badge significantly shortened the time to first contact, time to completion, and rate of closure of the communication loop in both the pilot and study phases. Median time to first contact with the communication badge was 0.5  min, compared to 1.6  min with pager communication (p < 0.0003). Communication loop closure was achieved in 100% of clinical alarms using the badge versus 19% with the pager (p < 0.0001). Communication badge technology reduced alarm time to first contact and completion as well as facilitated communication loop closures. Immediate two-way communication significantly impacted practice, alarm management, and resulted in faster bedside care.

Value of delayed duplex ultrasound assessment after endothermal ablation of the great saphenous vein.

PubMed

Ryer, Evan J; Elmore, James R; Garvin, Robert P; Cindric, Matthew C; Dove, James T; Kekulawela, Stephanie; Franklin, David P

2016-08-01

Endothermal ablation (ETA) of the great saphenous vein (GSV) is associated with a small but definite risk of endothermal heat-induced thrombosis (EHIT) extending into the common femoral vein. Follow-up duplex ultrasound imaging to detect EHIT after ETA is considered standard of care, although the exact timing of duplex ultrasound imaging to detect EHIT after ETA remains unclear. We hypothesized that an additional duplex ultrasound assessment 1 week after ETA would not identify a significant number of patients with EHIT and would significantly increase health care costs. This was a retrospective review of consecutive ETA GSV procedures from 2007 to 2014. All patients were evaluated with duplex ultrasound imaging on postprocedure day 1, and 79% of patients underwent a second ultrasound assessment 1 week postprocedure. EHIT was considered present when proximal GSV closure progressed to level ≥4, based on a six-tier classification system. From January 1, 2007, until December 31, 2014, 842 patients underwent GSV ETA. Patients with EHIT were more likely to have had a prior deep venous thrombosis (DVT; P = .002) and a larger GSV (P = .006). Forty-three procedures (5.1%) were classified as having EHIT requiring anticoagulation, based on a level ≥4 proximal closure level. Of the 43 patients with EHIT, 20 (47%) were found on the initial ultrasound assessment performed 24 hours postprocedure, but 19 patients (44%) with EHIT would not have been identified with a single postoperative ultrasound scan performed 24 hours after intervention. These 19 patients had a level ≤3 closure level at the duplex ultrasound scan performed 24 hours postprocedure and progressed to EHIT on the delayed duplex ultrasound scan. Lastly, thrombotic complications in four patients (9%), representing three late DVT and one DVT/pulmonary embolism presenting to another hospital, would not have been identified regardless of the postoperative surveillance strategy. Maximum GSV diameter was the only significant predictor of progression to EHIT on multivariate analysis (P = .007). Based on 2014 United States dollars, the two-ultrasound surveillance paradigm is associated with health care charges of $31,109 per identified delayed venous thromboembolism event. Delayed duplex ultrasound assessment after ETA of the GSV comes with associated health care costs but does yield a significant number of patients with progression to EHIT. Better understanding of the timing, risk factors, and significance of EHIT is needed to cost-effectively care for patients after ETA for varicose veins. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Association of land use and its change with beach closure in ...

EPA Pesticide Factsheets

Land use and its change have great influences on water quality. However, their impacts on microbial contamination of beach water have been rarely investigated and their relationship with beach closure is still unknown. Here, we analyzed beach closure data obtained from 2004 to 2013 for more than 500 beaches in the United States, and examined their associations with land use around beaches in 2006 and 2011, respectively, as well as the land use change between 2011 and 2006. The results show that the number of beach closures is negatively associated with the percentages of forest, barren land, grassland and wetland, while positively associated with the percentage of urban area. The results from multi-level models also indicate the negative association with forest area but positive association with urban area and agriculture. The examination of the change of land use and the number of beach closures between 2011 and 2006 indicates that the increase in the number of beach closures is positively associated with the increase in urban (β=1.612, p<0.05) and agricultural area including pasture (β=0.098, p<0.05), but negatively associated with the increase in forest area (β= -1.789, p<0.05). The study suggests that urbanization and agriculture development near beaches have adverse effects on beach microbial water quality, while afforestation may protect beach water quality and reduce the number of beach closures. To compare differences in beach closures across the US u

Closure Report for Corrective Action Unit 118: Area 27 Super Kukla Facility, Nevada Test Site, Nevada with ROTC 1, Revision 0

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

Mark Burmeister

2007-09-01

This CR provides documentation and justification for the closure of CAU 118 without further corrective action. This justification is based on process knowledge and the results of the investigative and closure activities conducted in accordance with the CAU 118 SAFER Plan: Streamlined Approach for Environmental Restoration (SAFER) Plan for CAU 118: Area 27 Super Kukla Facility, Nevada Test Site, Nevada (NNSA/NSO, 2006). The SAFER Plan provides information relating to site history as well as the scope and planning of the investigation. This CR also provides the analytical and radiological survey data to confirm that the remediation goals were met asmore » specified in the CAU 118 SAFER Plan (NNSA/NSO, 2006). The Nevada Division of Environmental Protection (NDEP) approved the CAU 118 SAFER Plan (Murphy, 2006), which recommends closure in place with use restrictions (URs).« less

Seasonal changes in the behaviour and respiration physiology of the freshwater duck mussel, Anodonta anatina.

PubMed

Lurman, Glenn; Walter, Johanna; Hoppeler, Hans H

2014-01-15

For low-energy organisms such as bivalves, the costs of thermal compensation of biological rates (synonymous with acclimation or acclimatization) may be higher than the benefits. We therefore conducted two experiments to examine the effect of seasonal temperature changes on behaviour and oxygen consumption. In the first experiment, we examined the effects of seasonal temperature changes on the freshwater bivalve Anodonta anatina, taking measurements each month for a year at the corresponding temperature for that time of year. There was no evidence for compensation of burrowing valve closure duration or frequency, or locomotory speed. In the second experiment, we compared A. anatina at summer and winter temperatures (24 and 4°C, respectively) and found no evidence for compensation of the burrowing rate, valve closure duration or frequency, or oxygen consumption rates during burrowing, immediately after valve closure or at rest. Within the experimental limits of this study, the evidence suggests that thermal compensation of biological rates is not a strategy employed by A. anatina. We argue that this is due to either a lack of evolutionary pressure to acclimatize, or evolutionary pressure to not acclimatize. Firstly, there is little incentive to increase metabolic rate to enhance predatory ability given that these are filter feeders. Secondly, maintained low energetic demand, enhanced at winter temperatures, is essential for predator avoidance, i.e. valve closure. Thus, we suggest that the costs of acclimatization outweigh the benefits in A. anatina.

Closure Plan for Corrective Action Unit 109: U-2bu Subsidence Crater Nevada Test Site, Nevada

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

Shannon Parsons

1999-03-01

The U-2bu subsidence crater, Corrective Action Unit 109, will be closed in accordance with the Resource Conservation and Recovery Act, the Nevada Division of Environmental Protection operational permit, and the Federal Facilities Agreement and Consent Order. The U-2bu subsidence crater is located in Area 2 of the Nevada Test Site. It was created in 1971 by an underground nuclear test with the name Miniata. The crater has a diameter of 288 meters (944 feet) and an approximate depth of 35 meters (115 feet). The subsidence crater was used as a land disposal unit for radioactive and hazardous waste from 1973more » to 1988. Site disposal history is supported by memorandums, letters, and personnel who worked at the Nevada Test Site at the time of active disposal. Closure activities will include the excavation and disposal of impacted soil form the tip of the crater. Upon completion of excavation, verification samples will be collected to show that lead has been removed to concentrations be low regulatory action level. The area will then be backfilled and a soil flood diversion berm will be constructed, and certified by an independent professional engineer as to having followed the approved Closure Plan.« less

Monitoring Potential Transport of Radioactive Contaminants in Shallow Ephemeral Channels: FY2013 and FY2014 (revised)

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

Mizell, Steve A.; Miller, Julianne J.; McCurdy, Greg D.

The Desert Research Institute (DRI) is conducting a field assessment of the potential for contaminated soil to be transported from the Smoky Contamination Area (CA) as a result of storm runoff, which supports National Nuclear Security Administration (NNSA) efforts to complete regulatory closure of the Soils Corrective Action Unit (CAU) contamination areas. The work is intended to confirm the likely mechanism of transport and determine the meteorological conditions that might cause movement of contaminated soils, as well as determine the particle size fraction that is most closely associated with transported radionuclide-contaminated soils. These data will facilitate the appropriate closure designmore » and post-closure monitoring program.« less

Cost Analysis of Cerebrospinal Fluid Leaks and Cerebrospinal Fluid Leak Prevention in Patients Undergoing Cerebellopontine Angle Surgery.

PubMed

Chern, Alexander; Hunter, Jacob B; Bennett, Marc L

2017-01-01

To determine if cranioplasty techniques following translabyrinthine approaches to the cerebellopontine angle are cost-effective. Retrospective case series. One hundred eighty patients with available financial data who underwent translabyrinthine approaches at a single academic referral center between 2005 and 2015. Cranioplasty with a dural substitute, layered fat graft, and a resorbable mesh plate secured with screws Main Outcome Measures: billing data was obtained for each patient's hospital course for translabyrinthine approaches and postoperative cerebrospinal fluid (CSF) leaks. One hundred nineteen patients underwent translabyrinthine approaches with an abdominal fat graft closure, with a median cost of $25759.89 (range, $15885.65-$136433.07). Sixty-one patients underwent translabyrinthine approaches with a dural substitute, abdominal fat graft, and a resorbable mesh for closure, with a median cost of $29314.97 (range, $17674.28-$111404.55). The median cost of a CSF leak was $50401.25 (range, $0-$384761.71). The additional cost of a CSF leak when shared by all patients who underwent translabyrinthine approaches is $6048.15. The addition of a dural substitute and a resorbable mesh plate after translabyrinthine approaches reduced the CSF leak from 12 to 1.9%, an 84.2% reduction, and a median savings per patient of $2932.23. Applying our cohort's billing data to previously published cranioplasty techniques, costs, and leak rate improvements after translabyrinthine approaches, all techniques were found to be cost-effective. Resorbable mesh cranioplasty is cost-effective at reducing CSF leaks after translabyrinthine approaches. Per our billing data and achieving the same CSF leak rate, cranioplasty costs exceeding $5090.53 are not cost-effective.

Closure Report (CR) for Corrective Action Unit (CAU) 91: Area 3 U-3fi Injection Well with Errata Sheet and Certification, Revision 0

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

Navarro Nevada Environmental Services

The closure report for CAU 91 has no Use Restriction Form or drawing/map included in the document to describe the use restricted area, however, Section 3.3.3 states that the site will be fenced and signage placed indicating the area as a Resource Conservation and Recovery Act (RCRA) Unit. The drawing that was placed in the FFACO indicating the use restricted area lists the coordinates for the RCRA Unit in Nevada State Plan Coordinates - North American Datum of 1983. In the ensuing years the reporting of coordinates has been standardized so that all coordinates are reported in the same manner,more » which is: NAD 27 UTM Zone 11 N, meters. This Errata Sheet updates the coordinate reporting to the currently accepted method and includes an aerial photo showing the RCRA Unit with the coordinates listed showing the use restricted area.« less

Understanding the Venus flytrap through mathematical modelling.

PubMed

Lehtinen, Sami

2018-05-07

Among carnivorous plants, the Venus flytrap is of particular interest for the rapid movement of its snap-traps and hypothesised prey selection, where small prey are allowed to escape from the traps. In this paper, we provide the first mathematical cost-benefit model for carnivory in the Venus flytrap. Specifically, we analyse the dynamics of prey capture; the costs and benefits of capturing and digesting its prey; and optimisation of trap size and prey selection. We fit the model to available data, making predictions regarding trap behaviour. In particular, we predict that non-prey sources, such as raindrops or wind, cause a large proportion of trap closures; only few trap closures result in a meal; most of the captured prey are allowed to escape; the closure mechanism of a trap is triggered about once every two days; and a trap has to wait more than a month for a meal. We also find that prey capture of traps of the Venus flytrap follows the Beddington-DeAngelis functional response. These predictions indicate that the Venus flytrap is highly selective in its prey capture. Copyright © 2018 The Author(s). Published by Elsevier Ltd.. All rights reserved.

The Case for Natural Gas Fueled Solid Oxide Fuel Cell Power Systems for Distributed Generation

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

Chick, Lawrence A.; Weimar, Mark R.; Whyatt, Greg A.

2015-02-01

Natural-gas-fueled solid oxide fuel cell (NGSOFC) power systems yield electrical conversion efficiencies exceeding 60% and may become a viable alternative for distributed generation (DG) if stack life and manufacturing economies of scale can be realized. Currently, stacks last approximately 2 years and few systems are produced each year because of the relatively high cost of electricity from the systems. If mass manufacturing (10,000 units per year) and a stack life of 15 years can be reached, the cost of electricity from an NGSOFC system is estimated to be about 7.7 ¢/kWh, well within the price of commercial and residential retailmore » prices at the national level (9.9-10¢/kWh and 11-12 ¢/kWh, respectively). With an additional 5 ¢/kWh in estimated additional benefits from DG, NGSOFC could be well positioned to replace the forecasted 59-77 gigawatts of capacity loss resulting from coal plant closures due to stricter emissions regulations and low natural gas prices.« less

Evaluation of Antimicrobial and Healing Activities of Frog Skin on Guinea Pigs Wounds

PubMed Central

Rezazade Bazaz, Mahere; Mashreghi, Mohammad; Mahdavi Shahri, Nasser; Mashreghi, Mansour; Asoodeh, Ahmad; Behnam Rassouli, Morteza

2015-01-01

Background: Frog skin secretions have potentials against a wide spectrum of bacteria. Also, frog skin compositions have healing properties. Objectives: The aim of this study was to investigate the antibacterial potentials along with healing properties of frog skin Rana ridibunda, a species which thoroughly lives in Iran marshes, as a biological dressing on wounds. Materials and Methods: In this study, excisional wounds, dressed with frog skin, were compared between experimental and control groups of guinea pigs. In the experimental groups, wounds were dressed with the dermal (FS) and epidermal (RFS) sides of fresh frog R. ridibunda skin, while only usual cotton gauze covered the wounds of the control group. Furthermore, microbial samples were taken on different days (0, 3, 5, and 7 days post injury) to count the number of the colony-forming units. Additionally, the microbial penetration test was performed on frog skin and then the progression of wound closure was evaluated. Results: In the microbial studies, the bacterial load considerably declined in the wounds treated with FS and RFS compared with the control wounds. On day 7 post injury, the numbers of the colony-forming units for the FS, RFS, and control groups were 6.75, 105, and 375, respectively. In the penetration test, fresh frog skin showed to be a bacterial resistant dressing. The results revealed that the rate of wound closure in the experimental groups significantly was accelerated in comparison with that in the control group. Conclusions: Our results demonstrated the antimicrobial properties of frog skin as a wound dressing, which has antimicrobial effects per se. This biological dressing shows promise as an effective biological wound dressing insofar as not only is it capable of resisting microbes and accelerating wound healing but also it is cost-effective and easy to use. PMID:26468364

Online Work Force Analyzes Social Media to Identify Consequences of an Unplanned School Closure - Using Technology to Prepare for the Next Pandemic.

PubMed

Rainey, Jeanette J; Kenney, Jasmine; Wilburn, Ben; Putman, Ami; Zheteyeva, Yenlik; O'Sullivan, Megan

During an influenza pandemic, the United States Centers for Disease Control and Prevention (CDC) may recommend school closures. These closures could have unintended consequences for students and their families. Publicly available social media could be analyzed to identify the consequences of an unplanned school closure. As a proxy for an unplanned, pandemic-related school closure, we used the district-wide school closure due to the September 10-18, 2012 teachers' strike in Chicago, Illinois. We captured social media posts about the school closure using the Radian6 social media-monitoring platform. An online workforce from Amazon Mechanical Turk categorized each post into one of two groups. The first group included relevant posts that described the impact of the closure on students and their families. The second group included irrelevant posts that described the political aspects of the strike or topics unrelated to the school closure. All relevant posts were further categorized as expressing a positive, negative, or neutral sentiment. We analyzed patterns of relevant posts and sentiment over time and compared our findings to household surveys conducted after other unplanned school closures. We captured 4,546 social media posts about the district-wide school closure using our search criteria. Of these, 930 (20%) were categorized as relevant by the online workforce. Of the relevant posts, 619 (67%) expressed a negative sentiment, 51 (5%) expressed a positive sentiment, and 260 (28%) were neutral. The number of relevant posts, and especially those with a negative sentiment, peaked on day 1 of the strike. Negative sentiment expressed concerns about childcare, missed school lunches, and the lack of class time for students. This was consistent with findings from previously conducted household surveys. Social media are publicly available and can readily provide information on the impact of an unplanned school closure on students and their families. Using social media to assess the impact of an unplanned school closure due to a public health event would be informative. An online workforce can effectively assist with the review process.

Online Work Force Analyzes Social Media to Identify Consequences of an Unplanned School Closure – Using Technology to Prepare for the Next Pandemic

PubMed Central

Rainey, Jeanette J.; Kenney, Jasmine; Wilburn, Ben; Putman, Ami; Zheteyeva, Yenlik; O’Sullivan, Megan

2016-01-01

Background During an influenza pandemic, the United States Centers for Disease Control and Prevention (CDC) may recommend school closures. These closures could have unintended consequences for students and their families. Publicly available social media could be analyzed to identify the consequences of an unplanned school closure. Methods As a proxy for an unplanned, pandemic-related school closure, we used the district-wide school closure due to the September 10–18, 2012 teachers’ strike in Chicago, Illinois. We captured social media posts about the school closure using the Radian6 social media-monitoring platform. An online workforce from Amazon Mechanical Turk categorized each post into one of two groups. The first group included relevant posts that described the impact of the closure on students and their families. The second group included irrelevant posts that described the political aspects of the strike or topics unrelated to the school closure. All relevant posts were further categorized as expressing a positive, negative, or neutral sentiment. We analyzed patterns of relevant posts and sentiment over time and compared our findings to household surveys conducted after other unplanned school closures. Results We captured 4,546 social media posts about the district-wide school closure using our search criteria. Of these, 930 (20%) were categorized as relevant by the online workforce. Of the relevant posts, 619 (67%) expressed a negative sentiment, 51 (5%) expressed a positive sentiment, and 260 (28%) were neutral. The number of relevant posts, and especially those with a negative sentiment, peaked on day 1 of the strike. Negative sentiment expressed concerns about childcare, missed school lunches, and the lack of class time for students. This was consistent with findings from previously conducted household surveys. Conclusion Social media are publicly available and can readily provide information on the impact of an unplanned school closure on students and their families. Using social media to assess the impact of an unplanned school closure due to a public health event would be informative. An online workforce can effectively assist with the review process. PMID:27655229

Effects of supplemental vibrational force on space closure, treatment duration, and occlusal outcome: A multicenter randomized clinical trial.

PubMed

DiBiase, Andrew T; Woodhouse, Neil R; Papageorgiou, Spyridon N; Johnson, Nicola; Slipper, Carmel; Grant, James; Alsaleh, Maryam; Khaja, Yousef; Cobourne, Martyn T

2018-04-01

A multicenter parallel 3-arm randomized clinical trial was carried out in 3 university hospitals in the United Kingdom to investigate the effect of supplemental vibratory force on space closure and treatment outcome with fixed appliances. Eighty-one subjects less than 20 years of age with mandibular incisor irregularity undergoing extraction-based fixed appliance treatment were randomly allocated to supplementary (20 minutes/day) use of an intraoral vibrational device (AcceleDent; OrthoAccel Technologies, Houston, Tex) (n = 29), an identical nonfunctional (sham) device (n = 25), or fixed-appliance only (n = 27). Space closure in the mandibular arch was measured from dental study casts taken at the start of space closure, at the next appointment, and at completion of space closure. Final records were taken at completion of treatment. Data were analyzed blindly on a per-protocol basis with descriptive statistics, 1-way analysis of variance, and linear regression modeling with 95% confidence intervals. Sixty-one subjects remained in the trial at start of space closure, with all 3 groups comparable for baseline characteristics. The overall median rate of initial mandibular arch space closure (primary outcome) was 0.89 mm per month with no difference for either the AcceleDent group (difference, -0.09 mm/month; 95% CI, -0.39 to 0.22 mm/month; P = 0.57) or the sham group (difference, -0.02 mm/month; 95% CI, -0.32 to 0.29 mm/month; P = 0.91) compared with the fixed only group. Similarly, no significant differences were identified between groups for secondary outcomes, including overall treatment duration (median, 18.6 months; P >0.05), number of visits (median, 12; P >0.05), and percentage of improvement in the Peer Assessment Rating (median, 90.0%; P >0.05). Supplemental vibratory force during orthodontic treatment with fixed appliances does not affect space closure, treatment duration, total number of visits, or final occlusal outcome. NCT02314975. The protocol was not published before trial commencement. AcceleDent units were donated by OrthoAccel Technologies; no contribution to the conduct or the writing of this study was made by the manufacturer. Copyright © 2017 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

Costs of a community-based glaucoma detection programme: analysis of the Philadelphia Glaucoma Detection and Treatment Project.

PubMed

Pizzi, Laura T; Waisbourd, Michael; Hark, Lisa; Sembhi, Harjeet; Lee, Paul; Crews, John E; Saaddine, Jinan B; Steele, Deon; Katz, L Jay

2018-02-01

Glaucoma is the foremost cause of irreversible blindness, and more than 50% of cases remain undiagnosed. Our objective was to report the costs of a glaucoma detection programme operationalised through Philadelphia community centres. The analysis was performed using a healthcare system perspective in 2013 US dollars. Costs of examination and educational workshops were captured. Measures were total programme costs, cost/case of glaucoma detected and cost/case of any ocular disease detected (including glaucoma). Diagnoses are reported at the individual level (therefore representing a diagnosis made in one or both eyes). Staff time was captured during site visits to 15 of 43 sites and included time to deliver examinations and workshops, supervision, training and travel. Staff time was converted to costs by applying wage and fringe benefit costs from the US Bureau of Labor Statistics. Non-staff costs (equipment and mileage) were collected using study logs. Participants with previously diagnosed glaucoma were excluded. 1649 participants were examined. Mean total per-participant examination time was 56 min (SD 4). Mean total examination cost/participant was $139. The cost/case of glaucoma newly identified (open-angle glaucoma, angle-closure glaucoma, glaucoma suspect, or primary angle closure) was $420 and cost/case for any ocular disease identified was $273. Glaucoma examinations delivered through this programme provided significant health benefit to hard-to-reach communities. On a per-person basis, examinations were fairly low cost, though opportunities exist to improve efficiency. Findings serve as an important benchmark for planning future community-based glaucoma examination programmes. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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

Wood, A.

Cyclohexane buyers, hit by a string of US plant closures, are breathing a sigh of relief at signs of an upswing in capacity. Phillips Petroleum has assured the future of a cyclohexane plant at its Guayama, PR site, while Kerr-McGee Chemical has confirmed it will acquire a mothballed 30-million gal/year unit from Unocal and restart it. Phillips deal is connected to an agreement to license Chevron Chemical's Aromax catalytic reforming technology for its Guayama refinery. The technology, which will cut the company's aromatics production costs, secures the future of Phillips petrochemical operations at the site, including the downstream 90-million gal/yearmore » cyclohexane plant. The Chevron process is said to boost yields of benzene, toluene, and xylene above those of conventional reforming processes. It relies on a zeolite catalyst to convert light paraffins into aromatics; conventional reforming converts higher-valued aromatic naphthas.« less

Laparoscopic common bile duct exploration. Lessons learned after 200 cases.

PubMed

Abellán Morcillo, Israel; Qurashi, Kamran; Abrisqueta Carrión, Jesús; Martinez Isla, Alberto

2014-05-01

Laparoscopic common bile duct exploration (LCBDE) is a reliable, reproducible and cost-effective treatment for common bile duct stones. Several techniques have been described for choledochotomy closure. To present our experience and the lessons learned in more than 200 cases of LCBDE. Between January 1999 and July 2012, 206 patients with common bile duct stones underwent LCBDE. At the beginning of the series, we performed the closure of the CBD over a T-tube (36 patients), subsequently we favoured closure over an antegrade stent (133 patients) but due to a high incidence of acute pancreatitis in the last 16 patients we have performed primary closure. The 3 closure groups were matched for age and sex. Jaundice was the most frequent presentation. A total of 185 (88,5%) patients underwent choledochotomy whereas in 17 (8,7%) patients the transcystic route was used. The group that underwent choledochotomy had a larger size of stones compared to the transcystic group (9,7 vs 7,6mm). In the stented group we found an 11,6% incidence of pancreatitis and 26,1% of hyperamylasemia. In the primary closure group we found a clear improvement of complications and hospital stay. The increased experience of the surgeon and age (younger than 75) had a positive impact on mortality and morbidity. Primary closure of the common bile duct after LCBDE seems to be superior to closure over a T tube and stents. The learning curve seems to have a positive impact on the outcomes making it a safe and reproducible technique especially for patients aged under 75. Copyright © 2013 AEC. Published by Elsevier Espana. All rights reserved.

Urethral pressure reflectometry during intra-abdominal pressure increase-an improved technique to characterize the urethral closure function in continent and stress urinary incontinent women.

PubMed

Saaby, Marie-Louise; Klarskov, Niels; Lose, Gunnar

2013-11-01

to assess the urethral closure function by urethral pressure reflectometry (UPR) during intra-abdominal pressure-increase in SUI and continent women. Twenty-five urodynamically proven SUI women and eight continent volunteer women were assessed by ICIQ-SF, pad-weighing test, incontinence diary, and UPR. UPR was conducted during resting and increased intra-abdominal pressure (P(Abd)) by straining. Related values of P(Abd) and urethral opening pressure (P(o)) were plotted into an abdomino-urethral pressuregram. Linear regression of the values was conducted, and the slope of the line ("APIR") and the intercept with the y-axis found. By the equation of the line, Po was calculated for various values of P(Abd), for example, 50 cm H2O (P(o-Abd 50)). The resting P(o) (P(o-rest)) and APIR, respectively, significantly differed in SUI and continent women but could not separate the two groups. The urethral closure equation (UCE) based on P(o-rest) and APIR provided a more detailed characterization of a woman's closure function based on the permanent closure forces (primarily generated by the urethral sphincteric unit) and the adjunctive closure forces (primarily generated by the support system). P(o-Abd 50) and UCE, respectively, which express the combined permanent and adjunctive closure forces and estimate the efficiency of the closure function, separated SUI and continent women and were highly significantly negatively correlated with ICIQ-SF, pad test, and the number of incontinence episodes. New parameters for characterization of the urethral closure function and possible dysfunctions and its efficiency were provided. P(o-Abd 50) and UCE may be used as diagnostic tests and severity measures. © 2013 Wiley Periodicals, Inc.

A Case Review Series of Christiana Care Health System's Experience with Negative Pressure Wound Therapy Instillation.

PubMed

Felte, Robert; Gallagher, Kathy E; Tinkoff, Glen H; Cipolle, Mark

2016-11-07

Acute and chronic wounds afflict a multitude of patients to varying degrees. Wound care treatment modalities span the spectrum of technological advancement and with that differ greatly in cost. Negative pressure wound therapy (NPWT) can now be combined with instillation and dwell time (NPWTi-d). This case review series of 11 patients in a community hospital setting provides support for the utilization of NPWTi-d. Additionally, current literature on the use of NPWTi-d in comparison to NPWT will be reviewed.  We highlight three specific cases. The first case is a 16-year-old male who was shot in the left leg. He suffered a pseudoaneurysm and resultant compartment syndrome. This required a fasciotomy and delayed primary closure. To facilitate this, NPWTi-d was employed and resulted in a total of four operative procedures before closure 13 days after admission. Next, a 61-year-old uncontrolled diabetic female presented with necrotizing fasciitis of the lower abdomen and pelvis. She underwent extensive debridement and placement of NPWTi-d with Dakin's solution. A total of four operative procedures were performed including delayed primary closure six days after admission. Finally, a 48-year-old female suffered a crush injury with internal degloving. NPWTi-d with saline was utilized until discharge home on postoperative day 12. NPWTi-d, when compared to NPWT, has been reported to lead to a decrease in time to operative closure, hospital length of stay, as well as operative procedures required. The cost-benefit analysis in one retrospective review noted a $1,400 savings when these factors were taken into account. This mode of wound care therapy has significant benefits that warrant the development of a prospective randomized controlled trial to further define the improvement in quality-of-life provided to the patient and the reduction of potential overall healthcare costs.

DISPOSITION PATHS FOR ROCKY FLATS GLOVEBOXES: EVALUATING OPTIONS

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

Lobdell, D.; Geimer, R.; Larsen, P.

2003-02-27

The Kaiser-Hill Company, LLC has the responsibility for closure activities at the Rocky Flats Environmental Technology Site (RFETS). One of the challenges faced for closure is the disposition of radiologically contaminated gloveboxes. Evaluation of the disposition options for gloveboxes included a detailed analysis of available treatment capabilities, disposal facilities, and lifecycle costs. The Kaiser-Hill Company, LLC followed several processes in determining how the gloveboxes would be managed for disposition. Currently, multiple disposition paths have been chosen to accommodate the needs of the varying styles and conditions of the gloveboxes, meet the needs of the decommissioning team, and to best managemore » lifecycle costs. Several challenges associated with developing a disposition path that addresses both the radiological and RCRA concerns as well as offering the most cost-effective solution were encountered. These challenges included meeting the radiological waste acceptance criteria of available disposal facilities, making a RCRA determination, evaluating treatment options and costs, addressing void requirements associated with disposal, and identifying packaging and transportation options. The varying disposal facility requirements affected disposition choices. Facility conditions that impacted decisions included radiological and chemical waste acceptance criteria, physical requirements, and measurement for payment options. The facility requirements also impacted onsite activities including management strategies, decontamination activities, and life-cycle cost.« less

Enterocutaneous Fistula: Different Surgical Intervention Techniques for Closure along with Comparative Evaluation of Aluminum Paint, Karaya Gum (Hollister) and Gum Acacia for Peristomal Skin Care

PubMed Central

Namrata; Ahmad, Shabi

2015-01-01

Introduction Gastrointestinal fistulas are serious complications and are associated with high morbidity and mortality rates. In majority of the patients, fistulas are treatable. However, the treatment is very complex and often multiple therapies are required. These highly beneficial treatment options which could shorten fistula closure time also result in considerable hospital cost savings. Aim This study was planned to study aetiology, clinical presentation, morbidity and mortality of enterocutaneous fistula and to evaluate the different surgical intervention techniques for closure of enterocutaneous fistula along with a comparative evaluation of different techniques for management of peristomal skin with special emphasis on aluminum paint, Karaya gum (Hollister) and Gum Acacia. Materials and Methods This prospective observational study was conducted in the Department of Surgery, M.L.N. Medical College, Allahabad and its associated hospital (S.R.N. Hospital, Allahabad) for a period of five years. Results Majority of enterocutaneous fistula were of small bowel and medium output fistulas (500-1000 ml/24hours). Most of the patients were treated with conservative treatment as compared to surgical intervention. Large bowel fistula has maximum spontaneous closure rate compare to small bowel and duodenum. Number of orifice whether single or multiple does not appear to play statistically significant role in spontaneous closure of fistula. Serum Albumin is a significantly important predictor of spontaneous fistula closure and mortality. Surgical management appeared to be the treatment of choice in distal bowel fistula. The application of karaya gum (Hollister kit), Gum Acacia and Aluminum Paint gave similar outcome. Conclusion Postoperative fistulas are the most common aetiology of enterocutaneous fistula and various factors do play role in management. Peristomal skin care done with Karaya Gum, Gum Acacia and Aluminum Paint has almost equal efficiency in management of skin excoriation. However, role of Gum Acacia was found to be good with inflamed, excoriated and ulcerative skin in comparison to Aluminum Paint and as efficacious as Karaya Gum but at much lower cost. PMID:26816943

Efficiently enforcing artisanal fisheries to protect estuarine biodiversity.

PubMed

Duarte de Paula Costa, Micheli; Mills, Morena; Richardson, Anthony J; Fuller, Richard A; Muelbert, José H; Possingham, Hugh P

2018-06-26

Artisanal fisheries support millions of livelihoods worldwide, yet ineffective enforcement can allow for continued environmental degradation due to overexploitation. Here, we use spatial planning to design an enforcement strategy for a pre-existing spatial closure for artisanal fisheries considering climate variability, existing seasonal fishing closures, representative conservation targets and enforcement costs. We calculated enforcement cost in three ways, based on different assumptions about who could be responsible for monitoring the fishery. We applied this approach in the Patos Lagoon estuary (Brazil), where we found three important results. First, spatial priorities for enforcement were similar under different climate scenarios. Second, we found that the cost and percentage of area enforced varied among scenarios tested by the conservation planning analysis, with only a modest increase in budget needed to incorporate climate variability. Third, we found that spatial priorities for enforcement depend on whether enforcement is carried out by a central authority or by the community itself. Here, we demonstrated a method that can be used to efficiently design enforcement plans, resulting in the conservation of biodiversity and estuarine resources. Also, cost of enforcement can be potentially reduced when fishers are empowered to enforce management within their fishing grounds. © 2018 by the Ecological Society of America.

Economic evaluation of Vacuum Assisted Closure® Therapy for the treatment of diabetic foot ulcers in France.

PubMed

Whitehead, Sarah J; Forest-Bendien, Véronique L; Richard, Jean-Louis; Halimi, Serge; Van, Georges Ha; Trueman, Paul

2011-02-01

The objective of the study was to assess the cost-effectiveness of Vacuum Assisted Closure® (V.A.C.®) Therapy compared with advanced wound care (AWC) for the treatment of diabetic foot ulcers (DFUs) in France. A cost-effectiveness model intended to reflect the management of DFUs was updated for the French setting. The Markov model follows the progression of 1000 hypothetical patients over a 1-year period. The model was populated with French-specific data, obtained from published sources and clinical experts. The analysis evaluated costs and health outcomes, in terms of quality-adjusted life-years (QALYs), wounds healed and amputations, from the perspective of the payer. The patients treated with V.A.C.® Therapy experienced more QALYs (0.787 versus 0.784) and improved healing rates (50.2% versus 48.5%) at a lower total cost of care (€24,881 versus €28,855 per patient per year) when compared with AWC. Sensitivity analyses conducted around key model parameters indicated that the results were affected by hospital resource use and costs. DFU treatment using V.A.C.® Therapy in France was associated with lower costs, additional QALYs, more healed ulcers and fewer amputations than treatment with AWC. V.A.C.® Therapy was therefore found to be the dominant treatment option. © 2010 The Authors. © 2010 Blackwell Publishing Ltd and Medicalhelplines.com Inc.

Military Bases: Opportunities Exist to Improve Future Base Realignment and Closure Rounds

DTIC Science & Technology

2013-03-01

Operational Army—realigns Fort Bliss , TX; Fort Hood, TX; Fort Riley, KS; Fort Campbell, KY; and Fort Sill, OK to include rebasing of units from overseas to...Committee on Appropriations United States Senate The Honorable Tim Johnson Chairman The Honorable Mark Kirk Ranking Member Subcommittee on Military

Corrective Action Management Unit Report of Post-Closure Care Activities Calendar Year 2016.

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

Ziock, Robert; Little, Bonnie Colleen

The Corrective Action Management Unit (CAMU) at Sandia National Laboratories, New Mexico (SNL/NM) consisted of a containment cell, two treatment systems, four associated waste staging and storage areas, and support areas; all were used for management of remediation wastes between 1997 and 2003.

77 FR 22678 - Fisheries of the Northeastern United States; Atlantic Mackerel, Squid, and Butterfish Fisheries...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-17

.... 110707371-2136-02] RIN 0648- XB145 Fisheries of the Northeastern United States; Atlantic Mackerel, Squid, and Butterfish Fisheries; Closure of the Trimester 1 Longfin Squid Fishery AGENCY: National Marine Fisheries Service (NMFS), National Oceanic and Atmospheric Administration (NOAA), Commerce. ACTION...

40 CFR 239.6 - Permitting requirements.

Code of Federal Regulations, 2012 CFR

2012-07-01

... CFR part 257, subpart B or 40 CFR part 258 federal revised criteria. (e) For municipal solid waste... solid waste landfill units shall have a permit incorporating the conditions identified in paragraph (e... solid waste landfill units which achieve compliance with 40 CFR part 258, subpart E; (vi) Closure and...

40 CFR 239.6 - Permitting requirements.

Code of Federal Regulations, 2014 CFR

2014-07-01

... CFR part 257, subpart B or 40 CFR part 258 federal revised criteria. (e) For municipal solid waste... solid waste landfill units shall have a permit incorporating the conditions identified in paragraph (e... solid waste landfill units which achieve compliance with 40 CFR part 258, subpart E; (vi) Closure and...

40 CFR 239.6 - Permitting requirements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... CFR part 257, subpart B or 40 CFR part 258 federal revised criteria. (e) For municipal solid waste... solid waste landfill units shall have a permit incorporating the conditions identified in paragraph (e... solid waste landfill units which achieve compliance with 40 CFR part 258, subpart E; (vi) Closure and...

A cost-benefit analysis of landfill mining and material recycling in China

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

Zhou, Chuanbin, E-mail: cbzhou@rcees.ac.cn; Gong, Zhe; Hu, Junsong

Highlights: • Assessing the economic feasibility of landfill mining. • We applied a cost-benefit analysis model for landfill mining. • Four material cycling and energy recovery scenarios were designed. • We used net present value to evaluate the cost-benefit efficiency. - Abstract: Landfill mining is an environmentally-friendly technology that combines the concepts of material recycling and sustainable waste management, and it has received a great deal of worldwide attention because of its significant environmental and economic potential in material recycling, energy recovery, land reclamation and pollution prevention. This work applied a cost-benefit analysis model for assessing the economic feasibility, whichmore » is important for promoting landfill mining. The model includes eight indicators of costs and nine indicators of benefits. Four landfill mining scenarios were designed and analyzed based on field data. The economic feasibility of landfill mining was then evaluated by the indicator of net present value (NPV). According to our case study of a typical old landfill mining project in China (Yingchun landfill), rental of excavation and hauling equipment, waste processing and material transportation were the top three costs of landfill mining, accounting for 88.2% of the total cost, and the average cost per unit of stored waste was 12.7 USD ton{sup −1}. The top three benefits of landfill mining were electricity generation by incineration, land reclamation and recycling soil-like materials. The NPV analysis of the four different scenarios indicated that the Yingchun landfill mining project could obtain a net positive benefit varying from 1.92 million USD to 16.63 million USD. However, the NPV was sensitive to the mode of land reuse, the availability of energy recovery facilities and the possibility of obtaining financial support by avoiding post-closure care.« less

Corrective Action Management Unit Report of Post-Closure Care Activities Calendar Year 2017.

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

Ziock, Robert; Little, Bonnie Colleen

The Corrective Action Management Unit (CAMU) at Sandia National Laboratories, New Mexico (SNL/NM) consists of a containment cell and ancillary systems that underwent regulatory closure in 2003 in accordance with the Closure Plan in Appendix D of the Class 3 Permit Modification (SNL/NM September 1997). The containment cell was closed with wastes in place. On January 27, 2015, the New Mexico Environment Department (NMED) issued the Hazardous Waste Facility Operating Permit (Permit) for Sandia National Laboratories (NMED January 2015). The Permit became effective February 26, 2015. The CAMU is undergoing post-closure care in accordance with the Permit, as revised andmore » updated. This CAMU Report of Post-Closure Care Activities documents all activities and results for Calendar Year (CY) 2017 as required by the Permit. The CAMU containment cell consists of engineered barriers including a cover system, a bottom liner with a leachate collection and removal system (LCRS), and a vadose zone monitoring system (VZMS). The VZMS provides information on soil conditions under the cell for early leak detection. The VZMS consists of three monitoring subsystems, which include the primary subliner (PSL), a vertical sensor array (VSA), and the Chemical Waste Landfill (CWL) sanitary sewer (CSS) line. The PSL, VSA, and CSS monitoring subsystems are monitored quarterly for soil moisture concentration, the VSA is monitored quarterly for soil temperature, and the VSA and CSS monitoring subsystems are monitored annually for volatile organic compound (VOC) concentrations in the soil vapor at various depths. Baseline data for the soil moisture, soil temperature, and soil vapor were established between October 2003 and September 2004.« less

Is size the only determinant of delayed abdominal closure in pediatric liver transplant?

PubMed

Khorsandi, Shirin Elizabeth; Day, Arthur William Raven; Cortes, Miriam; Deep, Akash; Dhawan, Anil; Vilca-Melendez, Hector; Heaton, Nigel

2017-03-01

The aim was to determine the factors associated with the use of delayed abdominal closure in pediatric liver transplantation (LT) and whether this affected outcome. From a prospectively maintained database, transplants performed in children (≤18 years) were identified (October 2010 to March 2015). Primary abdominal closure was defined as mass closure performed at time of transplant. Delayed abdominal closure was defined as mass closure not initially performed at the same time as transplant; 230 children underwent LT. Of these, 176 (76.5%) had primary closure. Age was similar between the primary and delayed groups (5.0 ± 4.9 versus 3.9 ± 5.0 years; P = 0.13). There was no difference in the graft-to-recipient weight ratio (GRWR) in the primary and delayed groups (3.4 ± 2.8 versus 4.1 ± 2.1; P = 0.12). Children with acute liver failure (ALF) were more likely to experience delayed closure then those with chronic liver disease (CLD; P < 0.001). GRWR was similar between the ALF and CLD (3.4 ± 2.4 versus 3.6 ± 2.7; P = 0.68). Primary closure children had a shorter hospital stay (P < 0.001), spent fewer days in pediatric intensive care unit (PICU; P = 0.001), and required a shorter duration of ventilation (P < 0.001). Vascular complications (arterial and venous) were similar (primary 8.2% versus delayed 5.6%; P = 0.52). Graft (P = 0.42) and child survival (P = 0.65) in the primary and delayed groups were similar. Considering timing of mass closure after transplant, patients in the early delayed closure group (<6 weeks) were found to experience a shorter time of ventilation (P = 0.03) and in PICU (P = 0.003). In conclusion, ALF was the main determinant of delayed abdominal closure rather than GRWR. The optimal time for delayed closure is within 6 weeks. The use of delayed abdominal closure does not adversely affect graft/child survival. Liver Transplantation 23 352-360 2017 AASLD. © 2016 by the American Association for the Study of Liver Diseases.

77 FR 75823 - Closing of the Port of Whitetail, MT

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-26

...: January 25, 2013. FOR FURTHER INFORMATION CONTACT: Mr. Roger Kaplan, Office of Field Operations, U.S... goods and visit shops and restaurants. Another commenter stated that the closure would increase the cost...

Evaluation of a new tension relief system for securing wound closure: A single-centre, Chinese cohort study

PubMed Central

Huahui, Zhang; Dan, Xue; Hongfei, Jiang; Hang, Hu; Chunmao, Han; Haitao, Ren; Jianxin, Yu; Zhiping, Tao

2016-01-01

BACKGROUND Wounds that have been closed under excessive tension, and skin defects that cannot be closed primarily, pose a daily challenge for the reconstructive surgeon. OBJECTIVE To evaluate a new tension relief system (TRS) device for skin stretching and secure wound closure. METHODS From September 2013 to March 2014, a consecutive series of 41 Chinese patients with 43 wounds were enrolled for application of 50 cycles of TRS therapy. TRS was used for two main clinical applications: closure of a variety of surgical/traumatic wounds; and securing wound closure after high-tension suture closure. Basic information and details regarding this therapy and its complications were recorded. Follow-up visits were conducted three to six months after wound closure. RESULTS Mean residual wound width decreased approximately 20% every two days during cycles of TRS therapy. Infection was the most common complication (five cases). Other complications included dehiscence (two cases) and pressure ulcer (one case). At the six-month follow-up visit, (21 wounds in 20 patients), both the extent of healing and the scar were acceptable. DISCUSSION There are no absolute contraindications to TRS therapy. The authors have formulated instructions for the prevention and treatment of the most common complications. CONCLUSIONS The results demonstrate that TRS therapy is a simple, effective method for primary closure of difficult wounds, and large skin and soft-tissue defects. Larger randomized studies are required to further evaluate of the effectiveness, indications, complications and cost effectiveness of this innovative TRS therapy. PMID:28439506

A cost-benefit analysis of landfill mining and material recycling in China.

PubMed

Zhou, Chuanbin; Gong, Zhe; Hu, Junsong; Cao, Aixin; Liang, Hanwen

2015-01-01

Landfill mining is an environmentally-friendly technology that combines the concepts of material recycling and sustainable waste management, and it has received a great deal of worldwide attention because of its significant environmental and economic potential in material recycling, energy recovery, land reclamation and pollution prevention. This work applied a cost-benefit analysis model for assessing the economic feasibility, which is important for promoting landfill mining. The model includes eight indicators of costs and nine indicators of benefits. Four landfill mining scenarios were designed and analyzed based on field data. The economic feasibility of landfill mining was then evaluated by the indicator of net present value (NPV). According to our case study of a typical old landfill mining project in China (Yingchun landfill), rental of excavation and hauling equipment, waste processing and material transportation were the top three costs of landfill mining, accounting for 88.2% of the total cost, and the average cost per unit of stored waste was 12.7USDton(-1). The top three benefits of landfill mining were electricity generation by incineration, land reclamation and recycling soil-like materials. The NPV analysis of the four different scenarios indicated that the Yingchun landfill mining project could obtain a net positive benefit varying from 1.92 million USD to 16.63 million USD. However, the NPV was sensitive to the mode of land reuse, the availability of energy recovery facilities and the possibility of obtaining financial support by avoiding post-closure care. Copyright © 2014 Elsevier Ltd. All rights reserved.

Closure Report for Corrective Action Unit 356: Mud Pits and Disposal Sites, Nevada Test Site, Nevada with Errata Sheet

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

NNSA /NV

2002-11-12

This Closure Report (CR) has been prepared for Corrective Action Unit (CAU) 356, Mud Pits and Disposal Sites, in accordance with the Federal Facility Agreement and Consent Order. This CAU is located in Areas 3 and 20 of the Nevada Test Site (NTS) approximately 65 miles northwest of Las Vegas, Nevada. Corrective Action Unit 356 consists of seven Corrective Action Sites (CASs): 03-04-01, Area 3 Change House Septic System; 03-09-01, Mud Pit Spill Over; 03-09-03, Mud Pit; 03-09-04, Mud Pit; 03-09-05, Mud Pit; 20-16-01, Landfill; and 20-22-21, Drums. This CR identifies and rationalizes the U.S. Department of Energy (DOE), Nationalmore » Nuclear Security Administration Nevada Operations Office's (NNSA/NV's) recommendation that no further corrective action and closure in place is deemed necessary for CAU 356. This recommendation is based on the results of field investigation/closure activities conducted November 20, 2001, through January 3, 2002, and March 11 to 14, 2002. These activities were conducted in accordance with the Streamlined Approach for Environmental Restoration Plan (SAFER) for CAU 356. For CASs 03-09-01, 03-09-03, 20-16-01, and 22-20-21, analytes detected in soil during the corrective action investigation were evaluated against Preliminary Action Levels (PALs) and it was determined that no Contaminants of Concern (COCs) were present. Therefore, no further action is necessary for the soil at these CASs. For CASs 03-04-01, 03-09-04, and 03-09-05, analytes detected in soil during the corrective action investigation were evaluated against PALs and identifies total petroleum hydrocarbons (TPHs) and radionuclides (i.e., americium-241 and/or plutonium 239/240) as COCs. The nature, extent, and concentration of the TPH and radionuclide COCs were bounded by sampling and shown to be relatively immobile. Therefore, closure in place is recommended for these CASs in CAU 356. Further, use restrictions are not required at this CAU beyond the NTS use restrictions identified in the SAFER Plan. In addition, the septic tank associated with CAU 356 will be closed in accordance with applicable regulations.« less

Closure Report for Corrective Action Unit 544: Cellars, Mud Pits, and Oil Spills, Nevada National Security Site, Nevada, Revision 0

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

Mark Krauss and Catherine Birney

2011-05-01

This Closure Report (CR) presents information supporting the closure of Corrective Action Unit (CAU) 544: Cellars, Mud Pits, and Oil Spills, Nevada National Security Site, Nevada. This CR complies with the requirements of the Federal Facility Agreement and Consent Order that was agreed to by the State of Nevada; U.S. Department of Energy (DOE), Environmental Management; U.S. Department of Defense; and DOE, Legacy Management. The corrective action sites (CASs) within CAU 544 are located within Areas 2, 7, 9, 10, 12, 19, and 20 of the Nevada National Security Site. Corrective Action Unit 544 comprises the following CASs: • 02-37-08,more » Cellar & Mud Pit • 02-37-09, Cellar & Mud Pit • 07-09-01, Mud Pit • 09-09-46, U-9itsx20 PS #1A Mud Pit • 10-09-01, Mud Pit • 12-09-03, Mud Pit • 19-09-01, Mud Pits (2) • 19-09-03, Mud Pit • 19-09-04, Mud Pit • 19-25-01, Oil Spill • 19-99-06, Waste Spill • 20-09-01, Mud Pits (2) • 20-09-02, Mud Pit • 20-09-03, Mud Pit • 20-09-04, Mud Pits (2) • 20-09-06, Mud Pit • 20-09-07, Mud Pit • 20-09-10, Mud Pit • 20-25-04, Oil Spills • 20-25-05, Oil Spills The purpose of this CR is to provide documentation supporting the completed corrective actions and data confirming that the closure objectives for CASs within CAU 544 were met. To achieve this, the following actions were performed: • Review the current site conditions, including the concentration and extent of contamination. • Implement any corrective actions necessary to protect human health and the environment. • Properly dispose of corrective action and investigation wastes. • Document Notice of Completion and closure of CAU 544 issued by the Nevada Division of Environmental Protection.« less

Transcatheter closure of patent foramen ovale for secondary prevention of ischemic stroke: Quantitative synthesis of pooled randomized trial data.

PubMed

Hakeem, Abdul; Cilingiroglu, Mehmet; Katramados, Angelos; Boudoulas, Konstantinos Dean; Iliescu, Cezar; Gundogdu, Betul; Marmagkiolis, Konstantinos

2018-01-14

To evaluate the safety and efficacy of percutaneous device closure of patent foramen ovale (PFO) for secondary prevention of ischemic stroke BACKGROUND: Stroke remains the leading cause of serious long-term disability in the United States. The effectiveness of a percutaneous PFO closure in the prevention of recurrent cryptogenic strokes has not been established. We performed a literature search using PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Google Scholar, and Internet-based sources from January 2003 to September 2017. Randomized controlled trails (RCTs) comparing percutaneous PFO closure to medical therapy alone. Five RCTs (CLOSURE I, PC Trial, REDUCE, RESPECT, and CLOSE) with 1,829 patients in the device group and 1,611 patients in the medical group met inclusion criteria. The cumulative incidence of recurrent stroke was 2.02% in the PFO closure arm and 4.4% in the medical therapy group (RR 0.42, 95%CI 0.20, 0.91; P = 0.03). There was no difference in the incidence of death [0.7% vs. 0.9%; RR 0.76 (95% CI 0.35, 1.64), P = 0.49] or adverse events during the follow-up period [24.6% vs. 23.7% (RR 1.03; 95% CI 0.91, 1.16), P = 0.65] between the closure and medical therapy groups. Incidence of atrial fibrillation was significantly higher in closure group compared to medical therapy [4% vs. 0.6% (RR 4.73; 95% CI 2.09, 10.70), P = 0.0002]. The comparative effectiveness of PFO closure (compared to medical therapy) was significantly more pronounced in those younger than 45 years, males, larger shunts and disc design platforms (P < 0.05). Based on the results of this analysis of randomized trial data, percutaneous PFO closure appears to be a safe and effective therapeutic option for the secondary prevention of ischemic stroke in patients with PFO and cryptogenic stroke. © 2018 Wiley Periodicals, Inc.

Rubber dam isolation--key to success in diastema closure technique with direct composite resin.

PubMed

Barros de Campos, Paulo Ricardo; Maia, Rodrigo Rocha; Rodrigues de Menezes, Livia; Barbosa, Isabel Ferreira; Carneiro da Cunha, Amanda; da Silveira Pereira, Gisele Damiana

2015-01-01

The use of direct composite resin for diastema closure has technique advantages, including that the restorative procedure can be carried out in one appointment at a reasonable cost and without the removal of sound tooth structure. The use of a rubber dam for closing diastemas with composite resin is of paramount importance as it prevents moisture contamination and ensures increased gingival retraction compared to other techniques. This provides better access to the cervical area of the tooth, facilitating proper placement of resin to recreate the natural anatomical contours and contact point. Thus, there is a more natural adaptation of the restoration to the gingival tissue, avoiding a space between the papilla and the restored tooth. To illustrate the advantages of this technique, two diastema closure cases are presented using direct composite resin with rubber dam isolation.

A blinded, prospective, randomized controlled trial of topical negative pressure wound closure in India.

PubMed

Mody, Gita N; Nirmal, Ida Anita; Duraisamy, Sulochana; Perakath, Benjamin

2008-12-01

Wound closure using topical negative pressure (TNP) has been reported to be effective, but equipment costs can be prohibitive in resource-challenged countries. Because nonhealing wounds are exceedingly common in developing countries such as India, the ability to optimize wound care with limited resources is very important. To investigate the feasibility and efficacy of providing TNP in an Indian medical referral center, a randomized controlled trial comparing a locally constructed TNP device (treatment) to wet-to-dry gauze dressings (control) was conducted. Eligible study participants (N = 48) were recruited from the inpatient wards. Wound etiologies included diabetic foot ulcers (15), pressure ulcers (11), cellulitis/fasciitis (11), and "other" (11). Following enrollment, wound size was assessed using computer-aided measurements of digital photographs and block-randomized to the study arms using a concealed allocation table. Wounds in both treatment groups were débrided before dressing application and patients were followed until wound closure or being lost to follow-up for an average of 26.3 days (+/- 18.5) in the control and 33.1 days (+/- 37.3) in the treatment group. No statistically significant differences in time to closure between the two treatment groups were observed except in a subset analysis of pressure ulcers (mean 10 +/- 7.11 days for treatment and 27 +/- 10.6 days in control group, P = 0.05). Direct costs to close a pressure ulcer also were lower in the TNP than in the control group. A review of the literature suggests the outcomes obtained using a locally constructed TNP device are similar to those obtained using commercially available devices. As a result of this study, a dedicated tissue viability team has been established to identify wounds suitable for TNP, oversee treatment, monitor the need for surgical débridement, and employ wound healing principles and technology appropriately. These results suggest that inexpensive materials can be utilized for TNP wound closure in a developing country.

The Cost Effectiveness of Pandemic Influenza Interventions: A Pandemic Severity Based Analysis

PubMed Central

Milne, George J.; Halder, Nilimesh; Kelso, Joel K.

2013-01-01

Background The impact of a newly emerged influenza pandemic will depend on its transmissibility and severity. Understanding how these pandemic features impact on the effectiveness and cost effectiveness of alternative intervention strategies is important for pandemic planning. Methods A cost effectiveness analysis of a comprehensive range of social distancing and antiviral drug strategies intended to mitigate a future pandemic was conducted using a simulation model of a community of ∼30,000 in Australia. Six pandemic severity categories were defined based on case fatality ratio (CFR), using data from the 2009/2010 pandemic to relate hospitalisation rates to CFR. Results Intervention strategies combining school closure with antiviral treatment and prophylaxis are the most cost effective strategies in terms of cost per life year saved (LYS) for all severity categories. The cost component in the cost per LYS ratio varies depending on pandemic severity: for a severe pandemic (CFR of 2.5%) the cost is ∼$9 k per LYS; for a low severity pandemic (CFR of 0.1%) this strategy costs ∼$58 k per LYS; for a pandemic with very low severity similar to the 2009 pandemic (CFR of 0.03%) the cost is ∼$155 per LYS. With high severity pandemics (CFR >0.75%) the most effective attack rate reduction strategies are also the most cost effective. During low severity pandemics costs are dominated by productivity losses due to illness and social distancing interventions, while for high severity pandemics costs are dominated by hospitalisation costs and productivity losses due to death. Conclusions The most cost effective strategies for mitigating an influenza pandemic involve combining sustained social distancing with the use of antiviral agents. For low severity pandemics the most cost effective strategies involve antiviral treatment, prophylaxis and short durations of school closure; while these are cost effective they are less effective than other strategies in reducing the infection rate. PMID:23585906

Percutaneous closure of patent foramen ovale without echocardiographic guidance.

PubMed

Jamshidi, Peiman; Wahl, Andreas; Windecker, Stephan; Schwerzmann, Markus; Seiler, Christian; Meier, Bernhard

2007-01-01

A percutaneous patent foramen ovale (PFO) closure procedure includes transesophageal or intracardiac echocardiographic guidance at many centers. We investigated the feasibility and complications of the PFO closure without echocardiography. A total of 420 consecutive patients (185 women and 235 men, mean age 51 +/- 12 years) underwent percutaneous PFO closure without echocardiographic guidance using 7 different devices. Of these, 106 patients (25%) had an associated atrial septal aneurysm. The implantation was successful in 418 patients (99%). There were 12 procedural complications (3%), including embolization of the device or of parts of it with successful percutaneous removal in 5 cases, pericardial tamponade requiring pericardiocentesis in 1 patient, air embolism with transient symptoms in 3 patients, and vascular access problems in 3 patients. In none of the cases, echocardiography had to be summoned during the case or its lack was associated with acute or subsequent problems. The fluoroscopy time and procedure time were 5.4 +/- 2.7 and 25 +/- 17 minutes, respectively. Transthoracic contrast echocardiography, 24 hours after device implantation, detected a residual shunt in 19% of the patients. Percutaneous PFO closure with fluoroscopic guidance only is feasible and has low complication rates, especially with Amplatzer PFO Occluders. The added time and cost of echocardiography during the procedure is not warranted.

Intracardiac Echocardiography for Structural Heart and Electrophysiological Interventions.

PubMed

Basman, Craig; Parmar, Yuvrajsinh J; Kronzon, Itzhak

2017-09-06

With an increasing number of interventional procedures performed for structural heart disease and cardiac arrhythmias each year, echocardiographic guidance is necessary for safe and efficient results. The purpose of this review article is to overview the principles of intracardiac echocardiography (ICE) and describes the peri-interventional role of ICE in a variety of structural heart disease and electrophysiological interventions. Both transthoracic (TTE) and transesophageal echocardiography have limitations. ICE provides the advantage of imaging from within the heart, providing shorter image distances and higher resolution. ICE may be performed without sedation and avoids esophageal intubation as with transesophageal echocardiography (TEE). Limitations of ICE include the need for additional venous access with possibility of vascular complications, potentially higher costs, and a learning curve for new operators. Data supports the use of ICE in guiding device closure of interatrial shunts, transseptal puncture, and electrophysiologic procedures. This paper reviews the more recent reports that ICE may be used for primary guidance or as a supplement to TEE in patients undergoing left atrial appendage (LAA) closure, interatrial shunt closure, transaortic valve implantation (TAVI), percutaneous mitral valve repair (PMVR), paravalvular leak (PVL) closure, aortic interventions, transcatheter pulmonary valve replacement (tPVR), ventricular septal defect (VSD), and patent ductus arteriosus (PDA) closure. ICE imaging technology will continue to expand and help improve structural heart and electrophysiology interventions.

Multivariate moment closure techniques for stochastic kinetic models

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

Lakatos, Eszter, E-mail: e.lakatos13@imperial.ac.uk; Ale, Angelique; Kirk, Paul D. W.

2015-09-07

Stochastic effects dominate many chemical and biochemical processes. Their analysis, however, can be computationally prohibitively expensive and a range of approximation schemes have been proposed to lighten the computational burden. These, notably the increasingly popular linear noise approximation and the more general moment expansion methods, perform well for many dynamical regimes, especially linear systems. At higher levels of nonlinearity, it comes to an interplay between the nonlinearities and the stochastic dynamics, which is much harder to capture correctly by such approximations to the true stochastic processes. Moment-closure approaches promise to address this problem by capturing higher-order terms of the temporallymore » evolving probability distribution. Here, we develop a set of multivariate moment-closures that allows us to describe the stochastic dynamics of nonlinear systems. Multivariate closure captures the way that correlations between different molecular species, induced by the reaction dynamics, interact with stochastic effects. We use multivariate Gaussian, gamma, and lognormal closure and illustrate their use in the context of two models that have proved challenging to the previous attempts at approximating stochastic dynamics: oscillations in p53 and Hes1. In addition, we consider a larger system, Erk-mediated mitogen-activated protein kinases signalling, where conventional stochastic simulation approaches incur unacceptably high computational costs.« less

Evaluating the use of fibrin glue for sealing low-output enterocutaneous fistulas: study protocol for a randomized controlled trial.

PubMed

Wu, Xiuwen; Ren, Jianan; Wang, Gefei; Wang, Jianzhong; Wang, Feng; Fan, Yueping; Li, Yuanxin; Han, Gang; Zhou, Yanbing; Song, Xiaofei; Quan, Bin; Yao, Min; Li, Jieshou

2015-10-07

The management of an enterocutaneous fistula poses a significant challenge to surgeons and is often associated with a costly hospital stay and long-term discomfort. The use of fibrin glue in the fistula tract has been shown to promote closure of low output enterocutaneous fistulas. Our previous nonrandomized study demonstrated that autologous platelet-rich fibrin glue treatment significantly decreased time to fistula closure and promoted closure rates. However, there are several limitations in the study, which may lead to bias in our conclusion. Thus, a multicenter, randomized, controlled clinical trial is required. The study is designed as a randomized, open-label, three-arm, multicenter study in nine Chinese academic hospitals for evaluating the efficacy and safety of fibrin glue for sealing low-output fistulas. An established number of 171 fistula patients will undergo prospective random assignment to autologous fibrin glue, commercial porcine fibrin sealants or drainage cessation (1:1:1). The primary endpoint is fistula closure time (defined as the interval between the day of enrollment and day of fistula closure) during the 14-day treatment period. To our knowledge, this is the first study to evaluate the safety and efficacy of both autologous and commercial fibrin glue sealing for patients with low-output volume fistulas. NCT01828892 . Registration date: April 2013.

The Hanikoda Method: 3-layered Negative Pressure Wound Therapy in Wound Bed Preparation.

PubMed

Chik, Ian; Kelly, Enda G; Jarmin, Razman; Imran, Farrah-Hani

2016-10-01

Negative pressure wound therapy is a widely used method of wound dressing with various commercially available brands. The authors created the Hanikoda Method (HM) for effective wound bed preparation or definite wound closure. In this case series, the authors discuss 8 different wound cases that presented to their Plastics Unit from January 2014 to June 2015. Patients with traumatic or infected wounds were selected for treatment with the HM. Selected patients underwent multiple cycles of this method until their wounds were ready for definite wound closure or the wounds had closed by secondary closure. The purpose of any wound dressing is to encourage epithelization while ensuring no factors impede wound healing. An additional benefit is to reduce wound bed size so that it may close by secondary intention or require less skin graft coverage. Each layer of the dressing is described, along with its function in wound bed preparation or in closure. The HM facilitates reduction of wound size, wound bed preparation, and overall management.

Optimization and large scale computation of an entropy-based moment closure

NASA Astrophysics Data System (ADS)

Kristopher Garrett, C.; Hauck, Cory; Hill, Judith

2015-12-01

We present computational advances and results in the implementation of an entropy-based moment closure, MN, in the context of linear kinetic equations, with an emphasis on heterogeneous and large-scale computing platforms. Entropy-based closures are known in several cases to yield more accurate results than closures based on standard spectral approximations, such as PN, but the computational cost is generally much higher and often prohibitive. Several optimizations are introduced to improve the performance of entropy-based algorithms over previous implementations. These optimizations include the use of GPU acceleration and the exploitation of the mathematical properties of spherical harmonics, which are used as test functions in the moment formulation. To test the emerging high-performance computing paradigm of communication bound simulations, we present timing results at the largest computational scales currently available. These results show, in particular, load balancing issues in scaling the MN algorithm that do not appear for the PN algorithm. We also observe that in weak scaling tests, the ratio in time to solution of MN to PN decreases.

Optimization and large scale computation of an entropy-based moment closure

DOE PAGES

Hauck, Cory D.; Hill, Judith C.; Garrett, C. Kristopher

2015-09-10

We present computational advances and results in the implementation of an entropy-based moment closure, M N, in the context of linear kinetic equations, with an emphasis on heterogeneous and large-scale computing platforms. Entropy-based closures are known in several cases to yield more accurate results than closures based on standard spectral approximations, such as P N, but the computational cost is generally much higher and often prohibitive. Several optimizations are introduced to improve the performance of entropy-based algorithms over previous implementations. These optimizations include the use of GPU acceleration and the exploitation of the mathematical properties of spherical harmonics, which aremore » used as test functions in the moment formulation. To test the emerging high-performance computing paradigm of communication bound simulations, we present timing results at the largest computational scales currently available. Lastly, these results show, in particular, load balancing issues in scaling the M N algorithm that do not appear for the P N algorithm. We also observe that in weak scaling tests, the ratio in time to solution of M N to P N decreases.« less

A new cable-tie based sternal closure system: description of the device, technique of implantation and first clinical evaluation

PubMed Central

2012-01-01

Background Wire closure still remains the preferred technique despite reasonable disadvantages. Associated complications, such as infection and sternal instability, cause time- and cost-consuming therapies. We present a new tool for sternal closure with its first clinical experience and results. Methods The sternal ZipFixTM System is based on the cable-tie principle. It primarily consists of biocompatible Poly-Ether-Ether-Ketone implants and is predominantly used peristernally through the intercostal space. The system provides a large implant-to-bone contact for better force distribution and for avoiding bone cut through. Results 50 patients were closed with the ZipFixTM system. No sternal instability was observed at 30 days. Two patients developed a mediastinitis that necessitated the removal of the device; however, the ZipFixTM were intact and the sternum remained stable. Conclusions In our initial evaluation, the short-term results have shown that the sternal ZipFixTM can be used safely and effectively. It is fast, easy to use and serves as a potential alternative for traditional wire closure. PMID:22731778

40 CFR 267.115 - After I stop operating, how long until I must close?

Code of Federal Regulations, 2014 CFR

2014-07-01

... (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE FACILITIES...? (a) Within 90 days after the final volume of hazardous waste is sent to a unit, you must treat or remove from the unit all hazardous wastes following the approved closure plan. (b) You must complete...

40 CFR 267.115 - After I stop operating, how long until I must close?

Code of Federal Regulations, 2010 CFR

2010-07-01

... (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE FACILITIES...? (a) Within 90 days after the final volume of hazardous waste is sent to a unit, you must treat or remove from the unit all hazardous wastes following the approved closure plan. (b) You must complete...

40 CFR 267.115 - After I stop operating, how long until I must close?

Code of Federal Regulations, 2011 CFR

2011-07-01

... (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE FACILITIES...? (a) Within 90 days after the final volume of hazardous waste is sent to a unit, you must treat or remove from the unit all hazardous wastes following the approved closure plan. (b) You must complete...

77 FR 52262 - Fisheries of the Northeastern United States; Summer Flounder Fishery; Commercial Quota Harvested...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-29

.... 111220786-1781-01] RIN 0648-XC176 Fisheries of the Northeastern United States; Summer Flounder Fishery...; closure. SUMMARY: NMFS announces that the 2012 summer flounder commercial quota allocated to the... summer flounder fishery may not land summer flounder in Massachusetts for the remainder of calendar year...

75 FR 52890 - Fisheries of the Northeastern United States; Summer Flounder Fishery; Commercial Quota Harvested...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-30

.... 0908191244-91427ndash;02] RIN 0648-XY35 Fisheries of the Northeastern United States; Summer Flounder Fishery...; closure. SUMMARY: NMFS announces that the 2010 summer flounder commercial quota allocated to the... summer flounder fishery may not land summer flounder in Massachusetts for the remainder of calendar year...

78 FR 51096 - Fisheries of the Northeastern United States; Summer Flounder Fishery; Commercial Quota Harvested...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-20

.... 111220786-1781-01] RIN 0648-XC811 Fisheries of the Northeastern United States; Summer Flounder Fishery...; closure. SUMMARY: NMFS announces that the 2013 summer flounder commercial quota allocated to the... summer flounder fishery may not land summer flounder in Massachusetts for the remainder of calendar year...

75 FR 44144 - Washington: Final Authorization of State Hazardous Waste Management Program Revisions

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-28

....19. 400(3)(c)(xiii)(A) Correction--the 265.300 Subpart word N--Landfills, carbonaceous related... recycling Subpart G exception from related; closure and 264.140, financial 265.140 Subpart responsibility H...) Correction--chang 264.143. e ``resource reclamation units'' to ``recycling units''. 620(4)(d)(iv...

Corrective Action Decision Document/Closure Report for Corrective Action Unit 367: Area 10 Sedan, Ess and Uncle Unit Craters Nevada National Security Site, Nevada, Revision 0

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

Patrick Matthews

2011-06-01

Corrective Action Unit 367 comprises four corrective action sites (CASs): • 10-09-03, Mud Pit • 10-45-01, U-10h Crater (Sedan) • 10-45-02, Ess Crater Site • 10-45-03, Uncle Crater Site The purpose of this Corrective Action Decision Document/Closure Report is to provide justification and documentation of the corrective actions and site closure activities implemented at CAU 367. A corrective action of closure in place with use restrictions was completed at each of the three crater CASs (10-45-01, 10-45-02, and 10-45-03); corrective actions were not required at CAS 10-09-03. In addition, a limited soil removal corrective action was conducted at the locationmore » of a potential source material release. Based on completion of these correction actions, no additional corrective action is required at CAU 367, and site closure is considered complete. Corrective action investigation (CAI) activities were performed from February 2010 through March 2011, as set forth in the Corrective Action Investigation Plan for Corrective Action Unit 367: Area 10 Sedan, Ess and Uncle Unit Craters, Nevada Test Site, Nevada. The approach for the CAI was divided into two facets: investigation of the primary release of radionuclides, and investigation of non-test or other releases (e.g., migration in washes and potential source material). Based on the proximity of the Uncle, Ess, and Sedan craters, the impact of the Sedan test on the fallout deposited from the two earlier tests, and aerial radiological surveys, the CAU 367 investigation was designed to study the releases from the three crater CASs as one combined release (primary release). Corrective Action Site 10-09-03, Mud Pit, consists of two mud pits identified at CAU 367. The mud pits are considered non-test releases or other releases and were investigated independent of the three crater CASs. The purpose of the CAI was to fulfill data needs as defined during the data quality objective (DQO) process. The CAU 367 dataset of investigation results was evaluated based on a data quality assessment. This assessment demonstrated the dataset is complete and acceptable for use in fulfilling the DQO data needs. Analytes detected during the CAI were evaluated against final action levels (FALs) established in this document. For the primary release, radiological doses exceeding the FAL of 25 millirem per year were not found to be present in the surface or shallow subsurface soil outside the default contamination boundary. However, it was assumed that radionuclides are present in subsurface media within each of the three craters (Sedan, Ess, and Uncle) due to prompt injection of radionuclides from the tests. Based on the assumption of radiological dose exceeding the FAL, corrective actions were undertaken that consisted of implementing a use restriction and posting warning signs at each crater CAS. These use restrictions were recorded in the FFACO database; the U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office (NNSA/NSO) Facility Information Management System; and the NNSA/NSO CAU/CAS files. With regard to other releases, no contaminants of concern were identified at the mud pits or any of the other release locations, with one exception. Potential source material in the form of lead was found at one location. A corrective action of clean closure was implemented at this location, and verification samples indicated that no further action is necessary. Therefore, NNSA/NSO provides the following recommendations: • A Notice of Completion to NNSA/NSO is requested from the Nevada Division of Environmental Protection for closure of CAU 367. • Corrective Action Unit 367 should be promoted from Appendix III to Appendix IV of the FFACO.« less

Leadership by Fragmented Destruction after a Merger: An Example from a Facility of Acute Psychiatry

PubMed Central

Grimeland, Jorid

2013-01-01

Hospitals are labor intensive facilities based on highly skilled employees. A merger of hospitals is an effort to increase and rationalize this production. Decisions behind a merger are made at the top leadership level. How this might be done is demonstrated by examples from a 36 bed acute psychiatric facility. The aim of the study was to calculate the hidden costs of fragmented destruction of parts of a total hospital supply to patients after a merger. Fragmented destruction is the deliberate stopping of activities deemed not part of the core activities of the hospital without due consideration of the impact on core activities. The proposed changes to operational expenses at a single acute psychiatric hospital were materials for the study. The changes included activities as a reduction in local laboratory service, cleaning services, closure of physiotherapy unit, closing of cultural activities and reduced productivity. The selected activities are calculated as giving an imputed gain of € 630,000 as indicated by the leadership. The not calculated costs of reducing or removing the selected activities are estimated at € 1,955,640. The cost of staff disappointment after a merger is difficult to assess, but is probably higher than assumed in the present calculations. Imputed cost containment is not attained. The calculations indicate that implemented changes may increase cost, contrary to the belief of the leadership at both the hospital level and further up in the hospital trust. Arguments in favor of a merger have to be scrutinized thoroughly for optimistic neglect of uncalculated costs of mergers. Future hospital mergers and selected fragmentation of productive tasks at ward or hospital levels should include calculations of unavoidable costs as shown in the present paper. PMID:25478133

State institutions: thirty years of depopulation and closure.

PubMed

Anderson, L L; Lakin, K C; Mangan, T W; Prouty, R W

1998-12-01

Over the past 30 years, a number of social, political, and economic forces have influenced public policy decisions regarding residential services for persons with mental retardation and other developmental disabilities (MR/DD). One of the most striking outcomes of these forces has been a steady decrease of persons with MR/DD residing in state institutions. In this paper we show the changes over the past 30 years in state institutional populations, interstate variability, movement of individuals into and out of state institutions, costs of state institutional care, and state institution closures as a result of social policy.

Corrective Action Decision Document/Closure Report for Corrective Action Unit 371: Johnnie Boy Crater and Pin Stripe Nevada Test Site, Nevada, Revision 0

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

Patrick Matthews

This Corrective Action Decision Document/Closure Report has been prepared for Corrective Action Unit 371, Johnnie Boy Crater and Pin Stripe, located within Areas 11 and 18 at the Nevada Test Site, Nevada, in accordance with the Federal Facility Agreement and Consent Order (FFACO). Corrective Action Unit (CAU) 371 comprises two corrective action sites (CASs): • 11-23-05, Pin Stripe Contamination Area • 18-45-01, U-18j-2 Crater (Johnnie Boy) The purpose of this Corrective Action Decision Document/Closure Report is to provide justification and documentation supporting the recommendation that no further corrective action is needed for CAU 371 based on the implementation of correctivemore » actions. The corrective action of closure in place with administrative controls was implemented at both CASs. Corrective action investigation (CAI) activities were performed from January 8, 2009, through February 16, 2010, as set forth in the Corrective Action Investigation Plan for Corrective Action Unit 371: Johnnie Boy Crater and Pin Stripe. The approach for the CAI was divided into two facets: investigation of the primary release of radionuclides and investigation of other releases (migration in washes and chemical releases). The purpose of the CAI was to fulfill data needs as defined during the data quality objective (DQO) process. The CAU 371 dataset of investigation results was evaluated based on the data quality indicator parameters. This evaluation demonstrated the dataset is acceptable for use in fulfilling the DQO data needs. Analytes detected during the CAI were evaluated against final action levels (FALs) established in this document. Radiological doses exceeding the FAL of 25 millirem per year were not found to be present in the surface soil. However, it was assumed that radionuclides are present in subsurface media within the Johnnie Boy crater and the fissure at Pin Stripe. Due to the assumption of radiological dose exceeding the FAL, corrective actions were undertaken that consist of implementing a use restriction and posting warning signs at each site. These use restrictions were recorded in the FFACO database; the U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office (NNSA/NSO) Facility Information Management System; and the NNSA/NSO CAU/CAS files. Therefore, NNSA/NSO provides the following recommendations: • No further corrective actions are necessary for CAU 371. • A Notice of Completion to NNSA/NSO is requested from the Nevada Division of Environmental Protection for closure of CAU 371. • Corrective Action Unit 371 should be moved from Appendix III to Appendix IV of the FFACO.« less

Preliminary engineering study: Quick opening valve MSFC high Reynolds number wind tunnel

NASA Technical Reports Server (NTRS)

1983-01-01

FluiDyne Engineering Corporation has conducted a preliminary engineering study of a quick-opening valve for the MSFC High Reynolds Number Wind Tunnel under NASA Contract NAS8-35056. The subject valve is intended to replace the Mylar diaphragm system as the flow initiation device for the tunnel. Only valves capable of opening within 0.05 sec. and providing a minimum of 11.4 square feet of flow area were considered. Also, the study focused on valves which combined the quick-opening and tight shutoff features in a single unit. A ring sleeve valve concept was chosen for refinement and pricing. Sealing for tight shutoff, ring sleeve closure release and sleeve actuation were considered. The resulting cost estimate includes the valve and requisite modifications to the facility to accommodate the valve as well as the associated design and development work.

32 CFR 174.18 - Historic preservation.

Code of Federal Regulations, 2010 CFR

2010-07-01

... REVITALIZING BASE CLOSURE COMMUNITIES AND ADDRESSING IMPACTS OF REALIGNMENT Environmental Matters § 174.18... planning and zoning actions undertaken by units of State or local government; if so, working with such...

32 CFR 174.18 - Historic preservation.

Code of Federal Regulations, 2011 CFR

2011-07-01

... REVITALIZING BASE CLOSURE COMMUNITIES AND ADDRESSING IMPACTS OF REALIGNMENT Environmental Matters § 174.18... planning and zoning actions undertaken by units of State or local government; if so, working with such...

Closure Report for Corrective Action Unit 224: Decon Pad and Septic Systems, Nevada Test Site, Nevada

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

NSTec Environmental Restoration

Corrective Action Unit (CAU) 224 is located in Areas 02, 03, 05, 06, 11, and 23 of the Nevada Test Site, which is situated approximately 65 miles northwest of Las Vegas, Nevada. CAU 224 is listed in the Federal Facility Agreement and Consent Order (FFACO) of 1996 as Decon Pad and Septic Systems and is comprised of the following nine Corrective Action Sites (CASs): CAS 02-04-01, Septic Tank (Buried); CAS 03-05-01, Leachfield; CAS 05-04-01, Septic Tanks (4)/Discharge Area; CAS 06-03-01, Sewage Lagoons (3); CAS 06-05-01, Leachfield; CAS 06-17-04, Decon Pad and Wastewater Catch; CAS 06-23-01, Decon Pad Discharge Piping; CASmore » 11-04-01, Sewage Lagoon; and CAS 23-05-02, Leachfield. The Nevada Division of Environmental Protection (NDEP)-approved corrective action alternative for CASs 02-04-01, 03-05-01, 06-03-01, 11-04-01, and 23-05-02 is no further action. As a best management practice, the septic tanks and distribution box were removed from CASs 02-04-01 and 11-04-01 and disposed of as hydrocarbon waste. The NDEP-approved correction action alternative for CASs 05-04-01, 06-05-01, 06-17-04, and 06-23-01 is clean closure. Closure activities for these CASs included removing and disposing of radiologically and pesticide-impacted soil and debris. CAU 224 was closed in accordance with the NDEP-approved CAU 224 Corrective Action Plan (CAP). The closure activities specified in the CAP were based on the recommendations presented in the CAU 224 Corrective Action Decision Document (U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office, 2005). This Closure Report documents CAU 224 closure activities. During closure activities, approximately 60 cubic yards (yd3) of mixed waste in the form of soil and debris; approximately 70 yd{sup 3} of sanitary waste in the form of soil, liquid from septic tanks, and concrete debris; approximately 10 yd{sup 3} of hazardous waste in the form of pesticide-impacted soil; approximately 0.5 yd{sup 3} of universal waste in the form of fluorescent light bulbs; and approximately 0.5 yd{sup 3} of low-level waste in the form of a radiologically impacted fire hose rack were generated, managed, and disposed of appropriately. Waste minimization techniques, such as the utilization of laboratory analysis and field screening to guide the extent of excavations, were employed during the performance of closure work.« less

Jam proof closure assembly for lidded pressure vessels

DOEpatents

Cioletti, Olisse C.

1992-01-01

An expendable closure assembly is provided for use (in multiple units) with a lockable pressure vessel cover along its rim, such as of an autoclave. This assembly is suited to variable compressive contact and locking with the vessel lid sealing gasket. The closure assembly consists of a thick walled sleeve insert for retention in the under bores fabricated in the cover periphery and the sleeve is provided with internal threading only. A snap serves as a retainer on the underside of the sleeve, locking it into an under bore retention channel. Finally, a standard elongate externally threaded bolt is sized for mating cooperation with the so positioned sleeve, whereby the location of the bolt shaft in the cover bore hole determines its compressive contact on the underlying gasket.

Seismic-Resistant Connections between Precast Concrete Columns and Drilled Shafts

DOT National Transportation Integrated Search

2012-06-01

In most areas of the country traffic is becoming more congested, and delays, more common. Highway construction, and especially construction that requires lane closures, exacerbates the delays, and imposes costs that can be measured in dollars, wasted...

Polarization curling and flux closures in multiferroic tunnel junctions

NASA Astrophysics Data System (ADS)

Peters, Jonathan J. P.; Apachitei, Geanina; Beanland, Richard; Alexe, Marin; Sanchez, Ana M.

2016-11-01

Formation of domain walls in ferroelectrics is not energetically favourable in low-dimensional systems. Instead, vortex-type structures are formed that are driven by depolarization fields occurring in such systems. Consequently, polarization vortices have only been experimentally found in systems in which these fields are deliberately maximized, that is, in films between insulating layers. As such configurations are devoid of screening charges provided by metal electrodes, commonly used in electronic devices, it is wise to investigate if curling polarization structures are innate to ferroelectricity or induced by the absence of electrodes. Here we show that in unpoled Co/PbTiO3/(La,Sr)MnO3 ferroelectric tunnel junctions, the polarization in active PbTiO3 layers 9 unit cells thick forms Kittel-like domains, while at 6 unit cells there is a complex flux-closure curling behaviour resembling an incommensurate phase. Reducing the thickness to 3 unit cells, there is an almost complete loss of switchable polarization associated with an internal gradient.

Polarization curling and flux closures in multiferroic tunnel junctions

PubMed Central

Peters, Jonathan J. P.; Apachitei, Geanina; Beanland, Richard; Alexe, Marin; Sanchez, Ana M.

2016-01-01

Formation of domain walls in ferroelectrics is not energetically favourable in low-dimensional systems. Instead, vortex-type structures are formed that are driven by depolarization fields occurring in such systems. Consequently, polarization vortices have only been experimentally found in systems in which these fields are deliberately maximized, that is, in films between insulating layers. As such configurations are devoid of screening charges provided by metal electrodes, commonly used in electronic devices, it is wise to investigate if curling polarization structures are innate to ferroelectricity or induced by the absence of electrodes. Here we show that in unpoled Co/PbTiO3/(La,Sr)MnO3 ferroelectric tunnel junctions, the polarization in active PbTiO3 layers 9 unit cells thick forms Kittel-like domains, while at 6 unit cells there is a complex flux-closure curling behaviour resembling an incommensurate phase. Reducing the thickness to 3 unit cells, there is an almost complete loss of switchable polarization associated with an internal gradient. PMID:27848970

43 CFR 3809.431 - When must I modify my plan of operations?

Code of Federal Regulations, 2012 CFR

2012-10-01

... impacts from unanticipated events or conditions or newly discovered circumstances or information... units; (6) Providing for post-closure management; and (7) Eliminating hazards to public safety. ...

43 CFR 3809.431 - When must I modify my plan of operations?

Code of Federal Regulations, 2013 CFR

2013-10-01

... impacts from unanticipated events or conditions or newly discovered circumstances or information... units; (6) Providing for post-closure management; and (7) Eliminating hazards to public safety. ...

CORRECTIVE ACTION DECISION DOCUMENT FOR AREA 9 UXO LANDFILL, TONOPAH TEST RNGE, CAU 453, REVISION 0, MARCH 1998

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

none

1998-03-01

This Corrective Action Decision Document (CADD) has been prepared for the Area 9 Unexploded Ordnance (UXO) Landfill (Corrective Action Unit [CAU] 453) in accordance with the Federal Facility Agreement and Consent Order (FFACO) of 1996. Corrective Action Unit 453 is located at the Tonopah Test Range (TTR), Nevada, and is comprised of three individual landfill cells located northwest of Area 9. The cells are listed as one Corrective Action Site (CAS) 09-55-001-0952. The landfill cells have been designated as: � Cell A9-1 � Cell A9-2 � Cell A9-3 The purpose of this CADD is to identify and provide a rationalemore » for the selection of a recommended corrective action alternative for CAU 453. The scope of this CADD consists of the following tasks: � Develop corrective action objectives. � Identify corrective action alternative screening criteria. � Develop corrective action alternatives. � Perform detailed and comparative evaluations of the corrective action alternatives in relation to the corrective action objectives and screening criteria. � Recommend and justify a preferred corrective action alternative for the CAU. In June and July 1997, a corrective action investigation was performed that consisted of activities set forth in the Corrective Action Investigation Plan (CAIP) (DOE/NV, 1997). Subsurface investigation of the soils surrounding the cells revealed no contaminants of concern (COCs) above preliminary action levels. The cell contents were not investigated due to the potential for live UXO. Details concerning the analytical and investigation results can be found in Appendix A of this CADD. Based on the potential exposure pathways, the following corrective action objectives have been identified for CAU 453: � Prevent or mitigate human exposure to subsurface soils containing COCs, solid waste, and/or UXO. � Prevent adverse impacts to groundwater quality. Based on the review of existing data, future land use, and current operations at the TTR, the following alternatives have been developed for consideration at the Area 9 UXO Landfill CAU: � Alternative 1 - No Further Action � Alternative 2 - Closure in Place by Administrative Controls � Alternative 3 - Closure in Place by Capping � Alternative 4 - Clean Closure by Removal The corrective action alternatives were evaluated based on four general corrective action standards and five remedy selection decision factors. Based on the results of this evaluation, Alternative 2, Closure in Place by Administrative Controls, was selected as the preferred corrective action alternative. The preferred corrective action alternative was evaluated on its technical merits, focusing on performance, reliability, feasibility, and safety. The alternative was judged to meet all requirements for the technical components evaluated and to represent the most cost-effective corrective action. The alternative meets all applicable state and federal regulations for closure of the site and will reduce potential future exposure pathways to the contents of the landfill. During corrective action implementation, this alternative will present minimal potential threat to site workers. However, appropriate health and safety procedures will be developed and implemented.« less

Calendar Year 2007 Resource Conservation and Recovery Act Annual Monitoring Report for the U.S. Department of Energy Y-12 National Security Complex, Oak Ridge, Tennessee - RCRA Post-Closure Permit Nos. TNHW-113, TNHW-116, and TNHW-128

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

Elvado Environmental

2008-02-01

This report contains groundwater quality monitoring data obtained during calendar year (CY) 2007 at the following hazardous waste treatment, storage, and disposal (TSD) units located at the US Department of Energy (DOE) Y-12 National Security Complex (hereafter referenced as Y-12) in Oak Ridge, Tennessee; this S-3 Site, Oil Landfarm, Bear Creek Burial Grounds/Walk-In Pits (BCBG/WIP), Eastern S-3 Site Plume, Chestnut Ridge Security Pits (CRSP), Chestnut Ridge Sediment Disposal Baste (CRSDB), few Hollow Quarry (KHQ), and East Chestnut Ridge Waste Pile (ECRWP). Hit monitoring data were obtained in accordance with the applicable Resource Conservation and Recovery Act of 1976 (RCRA) hazardousmore » waste post-closure permit (PCP). The Tennessee Department of Environment and Conservation (TDEC) - Division of Solid Waste Management issued the PCPs to define the requirements for RCRA post-closure inspection, maintenance, and groundwater monitoring at the specified TSD units located within the Bear Creek Hydrogeologic Regime (PCP no. TNHW-116), Upper East Fork Poplar Creek Hydrogeologic Regime (PCP no. TNHW-113), and Chestnut Ridge Hydrogeologic Regime (PCP no. TNHW-128). Each PCP requires the Submittal of an annual RCRA groundwater monitoring report containing the groundwater sampling information and analytical results obtained at each applicable TSD unit during the preceding CY, along with an evaluation of groundwater low rates and directions and the analytical results for specified RCRA groundwater target compounds; this report is the RCRA annual groundwater monitoring report for CY 2007. The RCRA post-closure groundwater monitoring requirements specified in the above-referenced PCP for the Chestnut Ridge Regime replace those defined in the previous PCP (permit no. TNHW-088), which expired on September 18, 2005, but remained effective until the TDEC issued the new PCP in September 2006. The new PCP defines site-specific groundwater sampling and analysis requirements for the CRSDB, CRSP, and KHQ that differ from those established under the expired PCP, including modified suites of laboratory analytes (RCRA groundwater target compounds) for each site and annual rather than semiannual sampling frequencies for the CRSDB and KHQ. The new PCP also specifies the RCRA post-closure groundwater monitoring requirements for the ECRWP, a closed TSD unit that was not addressed in the expired PCP.« less

A field evaluation of the Eye-Closure Interview with witnesses of serious crimes.

PubMed

Vredeveldt, Annelies; Tredoux, Colin G; Nortje, Alicia; Kempen, Kate; Puljević, Cheneal; Labuschagne, Gérard N

2015-04-01

Laboratory research shows that eye-closure during memory retrieval improves both the amount and the factual accuracy of memory reports about witnessed events. Based on these findings, we developed the Eye-Closure Interview, and examined its feasibility (in terms of compliance with the instructions) and effectiveness (in terms of the quantity and quality of reported information) in eyewitness interviews conducted by the South African Police Service. Police interviewers from the Facial Identification Unit were randomly assigned to receive Eye-Closure Interview training or no training. We analyzed 95 interviews with witnesses of serious crimes (including robbery, rape, and murder), some of whom were instructed to close their eyes during salient parts of the interview. Witnesses in the control condition rarely spontaneously closed their eyes, but witnesses in the Eye-Closure Interview condition kept their eyes closed during 97% of their descriptions, suggesting that the Eye-Closure Interview would be easy to implement in a field setting. Although witnesses who closed their eyes did not remember more information overall, the information they provided was considered to be of significantly greater forensic relevance (as reflected in 2 independent blind assessments, 1 by a senior police expert and 1 by a senior researcher). Thus, based on the findings from this field study and from previous laboratory research, we conclude that implementation of the Eye-Closure Interview in witness interviews would help police interviewers to elicit more valuable information from witnesses, which could be relevant to the police investigation and/or in court. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

Impacts of Severe Weather, Climate Zone, and Energy Factors on Base Realignment and Closure (BRAC)

DTIC Science & Technology

2015-03-26

hydroelectric, solar photovoltaic , and wind power . Aside from locations and facilities that use electricity to heat, natural gas is the only...have large photovoltaic solar arrays with unique buy-back contracts or power -purchase agreements. These renewable energy projects benefit primarily...these costs, a Monte Carlo simulation is used to forecast annual costs and account for uncertainty with tornado and hurricane risks, along with

Corrective Action Decision Document/Closure Report for Corrective Action Unit 571: Area 9 Yucca Flat Plutonium Dispersion Sites, Nevada National Security Site, Nevada, Revision 0

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

Matthews, Patrick

2014-08-01

The purpose of this CADD/CR is to provide documentation and justification that no further corrective action is needed for the closure of CAU 571 based on the implementation of corrective actions. This includes a description of investigation activities, an evaluation of the data, and a description of corrective actions that were performed. The CAIP provides information relating to the scope and planning of the investigation. Therefore, that information will not be repeated in this document.

Post-Closure Inspection Report for the Tonopah Test Range, Nevada, for Calendar Year 2012

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

NSTec Environmental Restoration

2013-01-28

This report provides the results of the annual post-closure inspections conducted at the closed Corrective Action Units (CAUs) located on the Tonopah Test Range (TTR), Nevada. This report covers calendar year 2012 and includes inspection and repair activities completed at the following CAUs: · CAU 400: Bomblet Pit and Five Points Landfill (TTR) · CAU 407: Roller Coaster RadSafe Area (TTR) · CAU 424: Area 3 Landfill Complexes (TTR) · CAU 453: Area 9 UXO Landfill (TTR) · CAU 487: Thunderwell Site (TTR)

Update: independently owned pharmacy closures in rural America, 2003-2013.

PubMed

Ullrich, Fred; Mueller, Keith J

2014-06-01

Key Findings. (1) From March 2003 to December 2013, there was a loss of 924 (12.1%) independently owned rural pharmacies in the United States. The most drastic loss occurred between 2007 and 2009. From 2010-2013, the trend has been for more closures, although the decline is not as pronounced or clear as in earlier years. (2) Four hundred ninety rural communities that had one or more retail pharmacy (including independent, chain, or franchise pharmacy) in March 2003 had no retail pharmacy in December 2013.

Considering Value in Rectal Cancer Surgery: An Analysis of Costs and Outcomes Based on the Open, Laparoscopic, and Robotic Approach for Proctectomy.

PubMed

Silva-Velazco, Jorge; Dietz, David W; Stocchi, Luca; Costedio, Meagan; Gorgun, Emre; Kalady, Matthew F; Kessler, Hermann; Lavery, Ian C; Remzi, Feza H

2017-05-01

The aim of the study was to compare value (outcomes/costs) of proctectomy in patients with rectal cancer by 3 approaches: open, laparoscopic, and robotic. The role of minimally invasive proctectomy in rectal cancer is controversial. In the era of value-based medicine, costs must be considered along with outcomes. Primary rectal cancer patients undergoing curative intent proctectomy at our institution between 2010 and 2014 were included. Patients were grouped by approach [open surgery, laparoscopic surgery, and robotic surgery (RS)] on an intent-to-treat basis. Groups were compared by direct costs of hospitalization for the primary resection, 30-day readmissions, and ileostomy closure and for short-term outcomes. A total of 488 patients were evaluated; 327 were men (67%), median age was 59 (27-93) years, and restorative procedures were performed in 333 (68.2%). Groups were similar in demographics, tumor characteristics, and treatment details. Significant outcome differences between groups were found in operative and anesthesia times (longer in the RS group), and in estimated blood loss, intraoperative transfusion, length of stay, and postoperative complications (all higher in the open surgery group). No significant differences were found in short-term oncologic outcomes. Direct cost of the hospitalization for primary resection and total direct cost (including readmission/ileostomy closure hospitalizations) were significantly greater in the RS group. The laparoscopic and open approaches to proctectomy in patients with rectal cancer provide similar value. If robotic proctectomy is to be widely applied in the future, the costs of the procedure must be reduced.

A fast non-Fourier method for Landau-fluid operators

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

Dimits, A. M., E-mail: dimits1@llnl.gov; Joseph, I.; Umansky, M. V.

An efficient and versatile non-Fourier method for the computation of Landau-fluid (LF) closure operators [Hammett and Perkins, Phys. Rev. Lett. 64, 3019 (1990)] is presented, based on an approximation by a sum of modified-Helmholtz-equation solves (SMHS) in configuration space. This method can yield fast-Fourier-like scaling of the computational time requirements and also provides a very compact data representation of these operators, even for plasmas with large spatial nonuniformity. As a result, the method can give significant savings compared with direct application of “delocalization kernels” [e.g., Schurtz et al., Phys. Plasmas 7, 4238 (2000)], both in terms of computational cost andmore » memory requirements. The method is of interest for the implementation of Landau-fluid models in situations where the spatial nonuniformity, particular geometry, or boundary conditions render a Fourier implementation difficult or impossible. Systematic procedures have been developed to optimize the resulting operators for accuracy and computational cost. The four-moment Landau-fluid model of Hammett and Perkins has been implemented in the BOUT++ code using the SMHS method for LF closure. Excellent agreement has been obtained for the one-dimensional plasma density response function between driven initial-value calculations using this BOUT++ implementation and matrix eigenvalue calculations using both Fourier and SMHS non-Fourier implementations of the LF closures. The SMHS method also forms the basis for the implementation, which has been carried out in the BOUT++ code, of the parallel and toroidal drift-resonance LF closures. The method is a key enabling tool for the extension of gyro-Landau-fluid models [e.g., Beer and Hammett, Phys. Plasmas 3, 4046 (1996)] to codes that treat regions with strong profile variation, such as the tokamak edge and scrapeoff-layer.« less

North American Bats and Mines Project: A cooperative approach for integrating bat conservation and mine-land reclamation

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

Ducummon, S.L.

Inactive underground mines now provide essential habitat for more than half of North America`s 44 bat species, including some of the largest remaining populations. Thousands of abandoned mines have already been closed or are slated for safety closures, and many are destroyed during renewed mining in historic districts. The available evidence suggests that millions of bats have already been lost due to these closures. Bats are primary predators of night-flying insects that cost American farmers and foresters billions of dollars annually, therefore, threats to bat survival are cause for serious concern. Fortunately, mine closure methods exist that protect both batsmore » and humans. Bat Conservation International (BCI) and the USDI-Bureau of Land Management founded the North American Bats and Mines Project to provide national leadership and coordination to minimize the loss of mine-roosting bats. This partnership has involved federal and state mine-land and wildlife managers and the mining industry. BCI has trained hundreds of mine-land and wildlife managers nationwide in mine assessment techniques for bats and bat-compatible closure methods, published technical information on bats and mine-land management, presented papers on bats and mines at national mining and wildlife conferences, and collaborated with numerous federal, state, and private partners to protect some of the most important mine-roosting bat populations. Our new mining industry initiative, Mining for Habitat, is designed to develop bat habitat conservation and enhancement plans for active mining operations. It includes the creation of cost-effective artificial underground bat roosts using surplus mining materials such as old mine-truck tires and culverts buried beneath waste rock.« less

A fast non-Fourier method for Landau-fluid operatorsa)

NASA Astrophysics Data System (ADS)

Dimits, A. M.; Joseph, I.; Umansky, M. V.

2014-05-01

An efficient and versatile non-Fourier method for the computation of Landau-fluid (LF) closure operators [Hammett and Perkins, Phys. Rev. Lett. 64, 3019 (1990)] is presented, based on an approximation by a sum of modified-Helmholtz-equation solves (SMHS) in configuration space. This method can yield fast-Fourier-like scaling of the computational time requirements and also provides a very compact data representation of these operators, even for plasmas with large spatial nonuniformity. As a result, the method can give significant savings compared with direct application of "delocalization kernels" [e.g., Schurtz et al., Phys. Plasmas 7, 4238 (2000)], both in terms of computational cost and memory requirements. The method is of interest for the implementation of Landau-fluid models in situations where the spatial nonuniformity, particular geometry, or boundary conditions render a Fourier implementation difficult or impossible. Systematic procedures have been developed to optimize the resulting operators for accuracy and computational cost. The four-moment Landau-fluid model of Hammett and Perkins has been implemented in the BOUT++ code using the SMHS method for LF closure. Excellent agreement has been obtained for the one-dimensional plasma density response function between driven initial-value calculations using this BOUT++ implementation and matrix eigenvalue calculations using both Fourier and SMHS non-Fourier implementations of the LF closures. The SMHS method also forms the basis for the implementation, which has been carried out in the BOUT++ code, of the parallel and toroidal drift-resonance LF closures. The method is a key enabling tool for the extension of gyro-Landau-fluid models [e.g., Beer and Hammett, Phys. Plasmas 3, 4046 (1996)] to codes that treat regions with strong profile variation, such as the tokamak edge and scrapeoff-layer.

Connection details for prefabricated bridge elements and systems.

DOT National Transportation Integrated Search

2009-03-30

Prefabricated components of a bridge produced off-site can be assembled quickly, and can reduce design time and cost, minimizing forming, minimize lane closure time and/or possibly eliminate the need for a temporary bridge. This document has been dev...

Cost-benefit analysis of sequential warning lights in nighttime work zone tapers.

DOT National Transportation Integrated Search

2011-06-01

Improving safety at nighttime work zones is important because of the extra visibility concerns. The deployment of sequential lights is an innovative method for improving driver recognition of lane closures and work zone tapers. Sequential lights are ...

10 CFR 61.52 - Land disposal facility operation and disposal site closure.

Code of Federal Regulations, 2013 CFR

2013-01-01

... meters below the top surface of the cover or must be disposed of with intruder barriers that are designed... mapped by means of a land survey. Near-surface disposal units must be marked in such a way that the boundaries of each unit can be easily defined. Three permanent survey marker control points, referenced to...

10 CFR 61.52 - Land disposal facility operation and disposal site closure.

Code of Federal Regulations, 2014 CFR

2014-01-01

... meters below the top surface of the cover or must be disposed of with intruder barriers that are designed... mapped by means of a land survey. Near-surface disposal units must be marked in such a way that the boundaries of each unit can be easily defined. Three permanent survey marker control points, referenced to...

10 CFR 61.52 - Land disposal facility operation and disposal site closure.

Code of Federal Regulations, 2010 CFR

2010-01-01

... meters below the top surface of the cover or must be disposed of with intruder barriers that are designed... mapped by means of a land survey. Near-surface disposal units must be marked in such a way that the boundaries of each unit can be easily defined. Three permanent survey marker control points, referenced to...

10 CFR 61.52 - Land disposal facility operation and disposal site closure.

Code of Federal Regulations, 2011 CFR

2011-01-01

... meters below the top surface of the cover or must be disposed of with intruder barriers that are designed... mapped by means of a land survey. Near-surface disposal units must be marked in such a way that the boundaries of each unit can be easily defined. Three permanent survey marker control points, referenced to...

10 CFR 61.52 - Land disposal facility operation and disposal site closure.

Code of Federal Regulations, 2012 CFR

2012-01-01

... meters below the top surface of the cover or must be disposed of with intruder barriers that are designed... mapped by means of a land survey. Near-surface disposal units must be marked in such a way that the boundaries of each unit can be easily defined. Three permanent survey marker control points, referenced to...

The Learned Report on Teacher Education: A Vision Delayed

ERIC Educational Resources Information Center

Imig, David; Imig, Scott

2005-01-01

Ninety-five years ago, the Carnegie Foundation for the Advancement of Teaching released Bulletin #4, otherwise known as The Flexner Report on Medical Education in the United States and Canada, a report on the education of physicians in the United States and Canada that lead to closure of half the medical schools in the country and determine the…

Development of a Korean reference HLW disposal system under the Korean representative geologic conditions

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

Choi, Heui-Joo; Lee, Jong Youl; Choi, Jongwon

2007-07-01

The development of a Korean Reference disposal System for the spent fuels from PWR and CANDU reactors is outlined in this paper. Around 36,000 tU of spent fuels are being projected based on the lifetimes of 28 nuclear power reactors in Korea. Since the site for the geological disposal has not yet been decided, a hypothetical site with representative Korean geologic conditions is proposed for the conceptual design of the repository. The disposal rates of the spent fuels are determined according to the total operation time of 55 years. The canisters are optimized by considering natural Korean conditions, and themore » buffer is designed with domestic Ca-bentonite. The depth of the repository is determined to be 500 m below the ground's surface. The canister separation distances are determined through a thermal analysis. The main features of the repository are presented from the layout to the closure. A computer program has been developed to calculate and analyze the volume and the area of the disposal system to help in the cost analysis. The final output of the design is presented as a unit disposal cost, US $315 /kgU. (authors)« less

75 FR 54656 - Government-Owned Inventions, Available for Licensing

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-08

... Aeronautics and Space Administration, have been filed in the United States Patent and Trademark office, and...; (281) 483-6936 [Facsimile]. NASA Case No. MSC-24238-1: Microwave Tissue Welding for Wound Closure...

31 CFR 413.2 - Coordination with other authorities.

Code of Federal Regulations, 2014 CFR

2014-07-01

...) SECRET SERVICE, DEPARTMENT OF THE TREASURY CLOSURE OF STREETS NEAR THE WHITE HOUSE § 413.2 Coordination... Secretary of the Interior, the Secretary of the Treasury or the Director, United States Secret Service. ...

31 CFR 413.2 - Coordination with other authorities.

Code of Federal Regulations, 2010 CFR

2010-07-01

...) SECRET SERVICE, DEPARTMENT OF THE TREASURY CLOSURE OF STREETS NEAR THE WHITE HOUSE § 413.2 Coordination... Secretary of the Interior, the Secretary of the Treasury or the Director, United States Secret Service. ...

31 CFR 413.2 - Coordination with other authorities.

Code of Federal Regulations, 2011 CFR

2011-07-01

...) SECRET SERVICE, DEPARTMENT OF THE TREASURY CLOSURE OF STREETS NEAR THE WHITE HOUSE § 413.2 Coordination... Secretary of the Interior, the Secretary of the Treasury or the Director, United States Secret Service. ...

31 CFR 413.2 - Coordination with other authorities.

Code of Federal Regulations, 2013 CFR

2013-07-01

...) SECRET SERVICE, DEPARTMENT OF THE TREASURY CLOSURE OF STREETS NEAR THE WHITE HOUSE § 413.2 Coordination... Secretary of the Interior, the Secretary of the Treasury or the Director, United States Secret Service. ...

31 CFR 413.2 - Coordination with other authorities.

Code of Federal Regulations, 2012 CFR

2012-07-01

...) SECRET SERVICE, DEPARTMENT OF THE TREASURY CLOSURE OF STREETS NEAR THE WHITE HOUSE § 413.2 Coordination... Secretary of the Interior, the Secretary of the Treasury or the Director, United States Secret Service. ...

The Impact of Hospital Closures and Hospital and Population Characteristics on Increasing Emergency Department Volume: A Geographic Analysis.

PubMed

Lee, David C; Carr, Brendan G; Smith, Tony E; Tran, Van C; Polsky, Daniel; Branas, Charles C

2015-12-01

Emergency visits are rising nationally, whereas the number of emergency departments is shrinking. However, volume has not increased uniformly at all emergency departments. It is unclear what factors account for this variability in emergency volume growth rates. The objective of this study was to test the association of hospital and population characteristics and the effect of hospital closures with increases in emergency department volume. The study team analyzed emergency department volume at New York State hospitals from 2004 to 2010 using data from cost reports and administrative databases. Multivariate regression was used to evaluate characteristics associated with emergency volume growth. Spatial analytics and distances between hospitals were used in calculating the predicted impact of hospital closures on emergency department use. Among the 192 New York hospitals open from 2004 to 2010, the mean annual increase in emergency department visits was 2.7%, but the range was wide (-5.5% to 11.3%). Emergency volume increased nearly twice as fast at tertiary referral centers (4.8%) and nonurban hospitals (3.7% versus urban at 2.1%) after adjusting for other characteristics. The effect of hospital closures also strongly predicted variation in growth. Emergency volume is increasing faster at specific hospitals: tertiary referral centers, nonurban hospitals, and those near hospital closures. This study provides an understanding of how emergency volume varies among hospitals and predicts the effect of hospital closures in a statewide region. Understanding the impact of these factors on emergency department use is essential to ensure that these populations have access to critical emergency services.

Coaptive film versus subcuticular suture: comparing skin closure time following identical, single-session, bilateral limb surgery in children.

PubMed

Rebello, Gleeson; Parikh, Ravi; Grottkau, Brian

2009-09-01

This study is a randomized controlled trial comparing skin closure time between coaptive film and subcuticular monocryl sutures in children undergoing identical single session, bilateral limb multiple soft tissue releases. Eight children less than 18 years of age (mean 14.5) with cerebral palsy underwent identical, single session bilateral multiple soft tissue releases in the lower limb from August 2005 to March 2007. There were 50 incisions in all in which 25 incisions were closed with 4-0 intracuticular monocryl sutures and 25 were closed with coaptive film (Steri Strip S; 3M company). Time taken for closure using either technique was recorded. A blinded plastic surgeon used a visual analog scale to assess the cosmetic results at the end of a 3 month follow-up. The average length of incisions closed with coaptive film was almost identical to the corresponding incision on the contralateral limb that was closed with subcuticular monocryl suture (4.45 and 4.81 cm, P=0.66). The average time for skin closure using monocryl sutures was 167.04 seconds compared with the average time of 79.36 seconds when using coaptive film (P <0.0001). There was no significant difference in the cosmetic results or the number of wound complications using either technique. Coaptive film is an attractive and cost-effective option for skin closure after pediatric surgery. The time saved, comparable cosmetic results and lack of complications makes coaptive film an attractive option for skin closure in the pediatric age group.

Capacity and road user cost analysis of selected freeway work zones in Texas.

DOT National Transportation Integrated Search

2009-09-01

This research was developed to produce usable and meaningful estimates for work zone capacities under a variety of roadway and traffic conditions, work zone configurations, and lane closure scenarios within Texas. Using data collected at eighteen wor...

40 CFR 265.142 - Cost estimate for closure.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Section 265.142 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) INTERIM STATUS STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE TREATMENT, STORAGE, AND... salvage value that may be realized with the sale of hazardous wastes, or non-hazardous wastes if...

40 CFR 265.142 - Cost estimate for closure.

Code of Federal Regulations, 2012 CFR

2012-07-01

... Section 265.142 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) INTERIM STATUS STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE TREATMENT, STORAGE, AND... salvage value that may be realized with the sale of hazardous wastes, or non-hazardous wastes if...

40 CFR 265.142 - Cost estimate for closure.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Section 265.142 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) INTERIM STATUS STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE TREATMENT, STORAGE, AND... salvage value that may be realized with the sale of hazardous wastes, or non-hazardous wastes if...

Cost-Aware Design of a Discrimination Strategy for Unexploded Ordnance Cleanup

DTIC Science & Technology

2011-02-25

Acronyms ANN: Artificial Neural Network AUC: Area Under the Curve BRAC: Base Realignment And Closure DLRT: Distance Likelihood Ratio Test EER...Discriminative Aggregate Nonparametric [25] Artificial Neural Network ANN Discriminative Aggregate Parametric [33] 11 Results and Discussion Task #1

78 FR 48851 - Wireline Competition Bureau Announces Closing of the Bureau's Cost Model Virtual Workshop

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-12

... questions through Public Notice. DATES: Virtual workshop closure effective August 12, 2013. ADDRESSES: You.... The filing hours are 8:00 a.m. to 7:00 p.m. All hand deliveries must be held together with rubber...

Managing hospitals in turbulent times: do organizational changes improve hospital survival?

PubMed Central

Lee, S Y; Alexander, J A

1999-01-01

OBJECTIVE: To examine (1) the degree to which organizational changes affected hospital survival; (2) whether core and peripheral organizational changes affected hospital survival differently; and (3) how simultaneous organizational changes affected hospital survival. DATA SOURCES: AHA Hospital Surveys, the Area Resource File, and the AHA Hospital Guides, Part B: Multihospital Systems. STUDY DESIGN: The study employed a longitudinal panel design. We followed changes in all community hospitals in the continental United States from 1981 through 1994. The dependent variable, hospital closure, was examined as a function of multiple changes in a hospital's core and peripheral structures as well as the hospital's organizational and environmental characteristics. Cox regression models were used to test the expectations that core changes increased closure risk while peripheral changes decreased such risk, and that simultaneous core and peripheral changes would lead to higher risk of closure. PRINCIPAL FINDINGS: Results indicated more peripheral than core changes in community hospitals. Overall, findings contradicted our expectations. Change in specialty, a core change, was beneficial for hospitals, because it reduced closure risk. The two most frequent peripheral changes, downsizing and leadership change, were positively associated with closure. Simultaneous organizational changes displayed a similar pattern: multiple core changes reduced closure risk, while multiple peripheral changes increased the risk. These patterns held regardless of the level of uncertainty in hospital environments. CONCLUSIONS: Organizational changes are not all beneficial for hospitals, suggesting that hospital leaders should be both cautious and selective in their efforts to turn their hospitals around. PMID:10536977

SEAL FOR HIGH SPEED CENTRIFUGE

DOEpatents

Skarstrom, C.W.

1957-12-17

A seal is described for a high speed centrifuge wherein the centrifugal force of rotation acts on the gasket to form a tight seal. The cylindrical rotating bowl of the centrifuge contains a closure member resting on a shoulder in the bowl wall having a lower surface containing bands of gasket material, parallel and adjacent to the cylinder wall. As the centrifuge speed increases, centrifugal force acts on the bands of gasket material forcing them in to a sealing contact against the cylinder wall. This arrangememt forms a simple and effective seal for high speed centrifuges, replacing more costly methods such as welding a closure in place.

Challenges Achieved By Innovative Technologies Our Link to a Safer, Cleaner, Healthier Tomorrow - 12369

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

Henderson, Heidi; Shoffner, Peggy; Lagos, Leonel E.

2012-07-01

The River Corridor Closure Project is the nation's largest environmental cleanup closure project where innovative technologies are being utilized to overcome DOE's environmental clean-up challenges. DOE provides a Technology Needs Statement that specifies their on-site challenges and the criteria to overcome those challenges. This allows for both the private sector and federally funded organizations to respond with solutions that meet their immediate needs. DOE selects the company based on their ability to reduce risk to human health and the environment, improve efficiency of the cleanup, and lower costs. These technologies are our link to a cleaner, safer, healthier tomorrow. (authors)

Sixteen-week analysis of unaltered elastomeric chain relating in-vitro force degradation with in-vivo extraction space tooth movement.

PubMed

Evans, Kristin S; Wood, Cory M; Moffitt, Allen H; Colgan, John A; Holman, J Kevin; Marshall, Steven D; Pope, D Spencer; Sample, Lew B; Sherman, Stephen L; Sinclair, Peter M; Trulove, Tim S

2017-04-01

The purposes of this study were to evaluate whether unaltered elastomeric chain can continue to move teeth for 16 weeks and to relate it to the amount of force remaining for the same batch of elastomeric chains. The in-vivo portion of the study had a sample of 30 paired extraction space sites from 22 subjects who were measured for closure of the space every 28 days. The altered side elastomeric chain served as the control and was replaced at 28-day intervals whereas the experimental side remained unaltered. In the in-vitro portion of the study, 100 each of 2-unit and 3-unit segments of the same batch of elastomeric chains were placed in a water bath, and the force was measured for 20 of each segment length at the 28-day measurement points. Statistically significant amounts of space closure occurred at both the altered and unaltered sites at all measurement time points. The mean space closure at the altered sites was minimally greater than that observed at the paired unaltered sites. The mean differences of space closure between the altered and unaltered sites ranged from a minimum of -0.05 mm at 4 weeks to a maximum of -0.14 mm at 8 weeks. The elastomeric chain force degraded rapidly by 4 weeks but continued a gradual diminution of force to 86 g at 16 weeks. Unaltered elastomeric chain continued to move teeth into extraction spaces for 16 weeks in this sample from both statistically and clinically significant standpoints. There were minimal and statistically insignificant differences in the mean space closure measurements between the paired altered and unaltered sites. The elastomeric chain force at 16 weeks was less than 100 g, yet at the same time point, teeth continued to move clinically. Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

NUCLEAR CLEANUP: Progress Made at Rocky Flats, but Closure by 2006 Is Unlikely, and Costs May Increase

DTIC Science & Technology

2001-02-01

liquids or residues from process pipes and tanks. The contractor also dismantled plutonium - processing furnaces, stripped out contaminated process...Soil Cleanup Levels on the Scope and Cost of the 903 Pad Cleanup 30 Figures Figure 1: Workers in Protective Clothing Handling Plutonium - Contaminated ...activities—shipping nuclear materials such as plutonium - contaminated metals and powders—is expected to be completed in 2002. Another activity

Optimization of Highway Work Zone Decisions Considering Short-Term and Long-Term Impacts

DTIC Science & Technology

2010-01-01

strategies which can minimize the one-time work zone cost. Considering the complex and combinatorial nature of this optimization problem, a heuristic...combination of lane closure and traffic control strategies which can minimize the one-time work zone cost. Considering the complex and combinatorial nature ...zone) NV # the number of vehicle classes NPV $ Net Present Value p’(t) % Adjusted traffic diversion rate at time t p(t) % Natural diversion rate

Department of the Navy FY 1993 Budget Estimates, DoD Base Closure and Realignment Program 2. Justification Data Submitted to Congress January 1992

DTIC Science & Technology

1992-01-01

DESIGN WAS MOST RECENTLY USED: (3) TOTAL COST (C) - (A) + (B) OR (0) + ( E ): (SO0O) (A) PRODUCTION OF PLANS AND SPECIFICATIONS ......... _1: (B) ALL... E ) IN-HOUSE . . . . . . . . . . . . . . . . . . . . . . . . (4) CONSTRUCTION START .................... .. - (MONTH AND...Z. (2) BASIS: (A) STANDARD OR DEFINITIVE DESIGN: YES__NO.. _ (B) WHERE DESIGN WAS MOST RECENTLY USED: (3) TOTAL COST (C) - (A) + (B) OR (D) + ( E

50 CFR 648.101 - Closures.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., DEPARTMENT OF COMMERCE FISHERIES OF THE NORTHEASTERN UNITED STATES Management Measures for the Summer... fishing for summer flounder by commercial vessels for the remainder of the calendar year by publishing... available for landing summer flounder in that state. ...

A simple technique of laparoscopic port closure.

PubMed

Aziz, Homayara Haque

2013-01-01

Laparoscopic and robotic surgery is widely practiced in modern medicine. The operative procedure is not complete until the port sites are closed with a fascial suture. We report a simple new technique that is easy, cost-effective, and quick to apply using 2 S-retractors for suture placement under direct visualization to secure the abdominal wall fascia and peritoneum. As a prospective consecutive case series, this technique was used for fascial closure after laparoscopy ports > 8 mm using 2 S-retractors. One S-retractor is used as a barrier protecting the contents of the abdominal cavity, reducing the risk of visceral injuries. The second S-retractor allows us to directly visualize the different layers, exposing the needle tip during its course through the fascia. This method was used in 100 patients with no intraoperative incidents, additional operative time, or need to access costly instruments. Currently, this technique is also used by many surgeons in our institution without any difficulty. No bowel injuries or port-site hernias were reported during a mean follow-up of 6 wk postoperation and 12-mo annual follow-up. The procedure is simple, easy, cost-effective, and quick to apply.

[Application of skin adhesives in head and neck surgery: analysis of cosmetic results, applicability and cost-effectiveness of cyanoacrylate-based adhesives].

PubMed

Graefe, H; Wollenberg, B; Brocks, C

2008-09-01

In this work cyanoacrylate-based skin adhesives used in Germany for skin closure in head and neck surgery are compared with respect to ease of application, cost-effectiveness and cosmetic results. We compared 25 wounds sealed with a skin adhesive with 25 suture-sealed wounds. Bonding of surgical wounds with glue had a high level of acceptance in all patients. The tedious, time-consuming and sometimes painful postoperative removal of many sutures in patients is omitted. Patients can shower soon afterwards without additional protection as the adhesive provides a waterproof barrier. Problems of wound healing can immediately be detected through the transparent skin adhesive. Cosmetic long-term results of skin closure by adhesives are comparable to suture-sealed wounds. The adhesives available on the market differ mainly in the form of the applicator, the viscosity on application, as well as the strength after hardening. The application is easy to implement and significantly faster than conventional suturing. Apart from the cost savings of materials compared to the use of skin sutures and investment of Steri-Strips, expensive anesthesia and surgical time can also be saved.

Streamlined Approach for Environmental Restoration Plan for Corrective Action Unit 489: WWII UXO Sites, Tonopah Test Range, Nevada; May 2005

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

Bechtel Nevada; U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office

2005-05-01

This Streamlined Approach for Environmental Restoration Plan provides the details for the closure of Corrective Action Unit (CAU) 489: WWII UXO Sites, Tonopah Test Range. CAU 489 is located at the Tonopah Test Range and is currently listed in Appendix III of the Federal Facility Agreement and Consent Order of 1996.

33 CFR 165.164 - Regulated Navigation Areas, Security Zones: Dignitary Arrival/Departure and United Nations...

Code of Federal Regulations, 2014 CFR

2014-07-01

... regulated navigation areas (RNA) or security zones: (1) Wall Street Heliport RNA. All waters of the East... northwest corner of Pier 2 North, Brooklyn (NAD 1983). (2) Randalls and Wards Islands RNA: All waters of the..., and all waters south of the Queensboro Bridge (NAD 1983). (6) United Nations Full River Closure RNA...

Nickel titanium springs versus stainless steel springs: A randomized clinical trial of two methods of space closure.

PubMed

Norman, Noraina Hafizan; Worthington, Helen; Chadwick, Stephen Mark

2016-09-01

To compare the clinical performance of nickel titanium (NiTi) versus stainless steel (SS) springs during orthodontic space closure. Two-centre parallel group randomized clinical trial. Orthodontic Department University of Manchester Dental Hospital and Orthodontic Department Countess of Chester Hospital, United Kingdom. Forty orthodontic patients requiring fixed appliance treatment were enrolled, each being randomly allocated into either NiTi (n = 19) or SS groups (n = 21). Study models were constructed at the start of the space closure phase (T0) and following the completion of space closure (T1). The rate of space closure achieved for each patient was calculated by taking an average measurement from the tip of the canine to the mesiobuccal groove on the first permanent molar of each quadrant. The study was terminated early due to time constraints. Only 30 patients completed, 15 in each study group. There was no statistically significant difference between the amounts of space closed (mean difference 0.17 mm (95%CI -0.99 to 1.34; P = 0.76)). The mean rate of space closure for NiTi coil springs was 0.58 mm/4 weeks (SD 0.24) and 0.85 mm/4 weeks (SD 0.36) for the stainless steel springs. There was a statistically significant difference between the two groups (P = 0.024), in favour of the stainless steel springs, when the mean values per patient were compared. Our study shows that stainless steel springs are clinically effective; these springs produce as much space closure as their more expensive rivals, the NiTi springs.

Framed by Technology

ERIC Educational Resources Information Center

Loke, Swee-Kin

2013-01-01

Academic developers in New Zealand, including many specialising in educational technology, have recently been asked to demonstrate their value to the Tertiary Education Commission in view of a new funding model (Prebble, 2011). Cost-cutting measures in other countries, including the 2010 closure of UK's agency for information and communication…

40 CFR 264.142 - Cost estimate for closure.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Section 264.142 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE TREATMENT, STORAGE, AND DISPOSAL FACILITIES... may be realized with the sale of hazardous wastes, or non-hazardous wastes if applicable under § 264...

40 CFR 264.142 - Cost estimate for closure.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Section 264.142 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE TREATMENT, STORAGE, AND DISPOSAL FACILITIES... may be realized with the sale of hazardous wastes, or non-hazardous wastes if applicable under § 264...

40 CFR 264.142 - Cost estimate for closure.

Code of Federal Regulations, 2012 CFR

2012-07-01

... Section 264.142 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE TREATMENT, STORAGE, AND DISPOSAL FACILITIES... may be realized with the sale of hazardous wastes, or non-hazardous wastes if applicable under § 264...

40 CFR 264.142 - Cost estimate for closure.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Section 264.142 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE TREATMENT, STORAGE, AND DISPOSAL FACILITIES... may be realized with the sale of hazardous wastes, or non-hazardous wastes if applicable under § 264...

10 CFR 960.5-2-10 - Hydrology.

Code of Federal Regulations, 2014 CFR

2014-01-01

... OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Preclosure Guidelines Ease and Cost of Siting, Construction, Operation, and Closure § 960.5-2-10... site will (1) be compatible with the activities required for repository construction, operation, and...

10 CFR 960.5-2-10 - Hydrology.

Code of Federal Regulations, 2011 CFR

2011-01-01

... OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Preclosure Guidelines Ease and Cost of Siting, Construction, Operation, and Closure § 960.5-2-10... site will (1) be compatible with the activities required for repository construction, operation, and...

10 CFR 960.5-2-10 - Hydrology.

Code of Federal Regulations, 2013 CFR

2013-01-01

... OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Preclosure Guidelines Ease and Cost of Siting, Construction, Operation, and Closure § 960.5-2-10... site will (1) be compatible with the activities required for repository construction, operation, and...

10 CFR 960.5-2-10 - Hydrology.

Code of Federal Regulations, 2012 CFR

2012-01-01

... OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Preclosure Guidelines Ease and Cost of Siting, Construction, Operation, and Closure § 960.5-2-10... site will (1) be compatible with the activities required for repository construction, operation, and...

Biodiversity Offsets: A Cost-Effective Interim Solution to Seabird Bycatch in Fisheries?

PubMed Central

Pascoe, Sean; Wilcox, Chris; Donlan, C. Josh

2011-01-01

The concept of biodiversity offsets is well established as an approach to environmental management. The concept has been suggested for environmental management in fisheries, particularly in relation to the substantial numbers of non-target species—seabirds in particular—caught and killed as incidental bycatch during fishing activities. Substantial areas of fisheries are being closed to protect these species at great cost to the fishing industry. However, other actions may be taken to offset the impact of fishing on these populations at lower cost to the fishing industry. This idea, however, has attracted severe criticism largely as it does not address the underlying externality problems created by the fishing sector, namely seabird fishing mortality. In this paper, we re-examine the potential role of compensatory mitigation as a fisheries management tool, although from the perspective of being an interim management measure while more long-lasting solutions to the problem are found. We re-model an example previously examined by both proponents and opponents of the approach, namely the cost effectiveness of rodent control relative to fishery area closures for the conservation of a seabird population adversely affected by an Australian tuna fishery. We find that, in the example being examined, invasive rodent eradication is at least 10 times more cost effective than area closures. We conclude that, while this does not solve the actual bycatch problem, it may provide breathing space for both the seabird species and the industry to find longer term means of reducing bycatch. PMID:22039422

Pdf prediction of supersonic hydrogen flames

NASA Technical Reports Server (NTRS)

Eifler, P.; Kollmann, W.

1993-01-01

A hybrid method for the prediction of supersonic turbulent flows with combustion is developed consisting of a second order closure for the velocity field and a multi-scalar pdf method for the local thermodynamic state. It is shown that for non-premixed flames and chemical equilibrium mixture fraction, the logarithm of the (dimensionless) density, internal energy per unit mass and the divergence of the velocity have several advantages over other sets of scalars. The closure model is applied to a supersonic non-premixed flame burning hydrogen with air supplied by a supersonic coflow and the results are compared with a limited set of experimental data.

The Economic Impact of Closed-Incision Negative-Pressure Therapy in High-Risk Abdominal Incisions: A Cost-Utility Analysis.

PubMed

Chopra, Karan; Gowda, Arvind U; Morrow, Chris; Holton, Luther; Singh, Devinder P

2016-04-01

Complex abdominal wall reconstruction is beset by postoperative complications. A recent meta-analysis comparing the use of closed-incision negative-pressure therapy to standard dressings found a statistically significant reduction in surgical-site infection. The use of closed-incision negative-pressure therapy is gaining acceptance in this population; however, the economic impact of this innovative dressing remains unknown. In this study, a cost-utility analysis was performed assessing closed-incision negative-pressure therapy and standard dressings following closure of abdominal incisions in high-risk patients. Cost-utility methodology involved reviewing literature related to closed-incision negative-pressure therapy in abdominal wall surgery, obtaining utility estimates to calculate quality-adjusted life-year scores for successful surgery and surgery complicated by surgical-site infection, summing costs using Medicare Current Procedural Terminology codes, and creating a decision tree illuminating the most cost-effective dressing strategy. One-way sensitivity analysis was performed to assess the robustness of the results. The aforementioned meta-analysis comparing closed-incision negative-pressure therapy to standard dressings included a subset of five studies assessing abdominal wall surgery in 829 patients (260 closed-incision negative-pressure therapy and 569 standard dressings). Decision tree analysis revealed an estimated savings of $1546.52 and a gain of 0.0024 quality-adjusted life-year with closed-incision negative-pressure therapy compared with standard dressings; therefore, closed-incision negative-pressure therapy is a dominant treatment strategy. One-way sensitivity analysis revealed that closed-incision negative-pressure therapy is a cost-effective option when the surgical-site infection rate is greater than 16.39 percent. The use of closed-incision negative-pressure therapy is cost-saving following closure of abdominal incisions in high-risk patients.

Corrective Action Decision Document/Closure Report for Corrective Action Unit 372: Area 20 Cabriolet/Palanquin Unit Craters, Nevada National Security Site, Nevada, Revision 0

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

Matthews, Patrick and Sloop, Christy

2011-04-01

This Corrective Action Decision Document (CADD)/Closure Report (CR) has been prepared for Corrective Action Unit (CAU) 372, Area 20 Cabriolet/Palanquin Unit Craters, located within Areas 18 and 20 at the Nevada National Security Site, Nevada, in accordance with the Federal Facility Agreement and Consent Order (FFACO). Corrective Action Unit 372 comprises four corrective action sites (CASs): • 18-45-02, Little Feller I Surface Crater • 18-45-03, Little Feller II Surface Crater • 20-23-01, U-20k Contamination Area • 20-45-01, U-20L Crater (Cabriolet) The purpose of this CADD/CR is to provide justification and documentation supporting the recommendation that no further corrective action ismore » needed for CAU 372 based on the implementation of the corrective action of closure in place with administrative controls at all CASs. Corrective action investigation (CAI) activities were performed from November 9, 2009, through December 10, 2010, as set forth in the Corrective Action Investigation Plan for Corrective Action Unit 372: Area 20 Cabriolet/Palanquin Unit Craters. The approach for the CAI was divided into two facets: investigation of the primary release of radionuclides and investigation of other releases (migration in washes and chemical releases). The purpose of the CAI was to fulfill data needs as defined during the data quality objective (DQO) process. The CAU 372 dataset of investigation results was evaluated based on a data quality assessment. This assessment demonstrated the dataset is acceptable for use in fulfilling the DQO data needs. Investigation results were evaluated against final action levels (FALs) established in this document. A radiological dose FAL was established of 25 millirem per year based on the Remote Work Area exposure scenario (336 hours of annual exposure). Radiological doses exceeding the FAL were found to be present at all four CASs. It is assumed that radionuclide levels present within the Little Feller I and Cabriolet high contamination areas and within the craters at Palanquin and Cabriolet exceed the FAL. It is also assumed that potential source material in the form of lead bricks at Little Feller I and lead-acid batteries at Palanquin and Cabriolet exceed the FAL. Therefore, corrective actions were undertaken that consist of removing potential source material, where present, and implementing a use restriction and posting warning signs at each CAS. These use restrictions were recorded in the FFACO database; the U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office (NNSA/NSO) Facility Information Management System; and the NNSA/NSO CAU/CAS files. Therefore, NNSA/NSO provides the following recommendations: • No further corrective actions are necessary for CAU 372. • A Notice of Completion to NNSA/NSO is requested from the Nevada Division of Environmental Protection for closure of CAU 372. • Corrective Action Unit 372 should be moved from Appendix III to Appendix IV of the FFACO.« less

Closure Report for Corrective Action Unit 574: Neptune, Nevada National Security Site, Nevada

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

NSTec Environmental Restoration

Corrective Action Unit (CAU) 574 is identified in the Federal Facility Agreement and Consent Order (FFACO) as 'Neptune' and consists of the following two Corrective Action Sites (CASs), located in Area 12 of the Nevada National Security Site: (1) CAS 12-23-10, U12c.03 Crater (Neptune); and (2) CAS 12-45-01, U12e.05 Crater (Blanca). This Closure Report presents information supporting closure of CAU 574 according to the FFACO (FFACO, 1996 [as amended March 2010]) and the Streamlined Approach for Environmental Restoration Plan for CAU 574 (U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office [NNSA/NSO], 2011). The following activities were performedmore » to support closure of CAU 574: (1) In situ external dose rate measurements were collected using thermoluminescent dosimeters at CAS 12-45-01, U12e.05 Crater (Blanca). (2) Total effective dose rates were determined at both sites by summing the internal and external dose rate components. (3) A use restriction (UR) was implemented at CAS 12-23-10, U12c.03 Crater (Neptune). Areas that exceed the final action level (FAL) of 25 millirems per year (mrem/yr) based on the Occasional Use Area exposure scenario are within the existing use restricted area for CAU 551. The 25-mrem/yr FAL is not exceeded outside the existing CAU 551 UR for any of the exposure scenarios (Industrial Area, Remote Work Area, and Occasional Use Area). Therefore, the existing UR for CAU 551 is sufficient to bound contamination that exceeds the FAL. (4) An administrative UR was implemented at CAS 12-45-01, U12e.05 Crater (Blanca) as a best management practice (BMP). The 25-mrem/yr FAL was not exceeded for the Remote Work Area or Occasional Use Area exposure scenarios; therefore, a UR is not required. However, because the 25-mrem/yr FAL was exceeded for the Industrial Area exposure scenario, an administrative UR was established as a BMP. UR documentation is included as Appendix B. The UR at CAS 12-23-10, U12c.03 Crater (Neptune), is within the existing UR for CAU 551. Additional postings were not installed, and annual post-closure inspections will be performed in conjunction with the inspections performed for CAU 551. At CAS 12-45-01, U12e.05 Crater (Blanca), the administrative UR does not require postings or inspections. NNSA/NSO requests the following: (1) A Notice of Completion from the Nevada Division of Environmental Protection to NNSA/NSO for closure of CAU 574; and (2) The transfer of CAU 574 from Appendix III to Appendix IV, Closed Corrective Action Units, of the FFACO« less

Commercial Submersible Mixing Pump For SRS Tank Waste Removal - 15223

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

Hubbard, Mike; Herbert, James E.; Scheele, Patrick W.

The Savannah River Site Tank Farms have 45 active underground waste tanks used to store and process nuclear waste materials. There are 4 different tank types, ranging in capacity from 2839 m 3 to 4921 m 3 (750,000 to 1,300,000 gallons). Eighteen of the tanks are older style and do not meet all current federal standards for secondary containment. The older style tanks are the initial focus of waste removal efforts for tank closure and are referred to as closure tanks. Of the original 51 underground waste tanks, six of the original 24 older style tanks have completed waste removalmore » and are filled with grout. The insoluble waste fraction that resides within most waste tanks at SRS requires vigorous agitation to suspend the solids within the waste liquid in order to transfer this material for eventual processing into glass filled canisters at the Defense Waste Processing Facility (DWPF). SRS suspends the solid waste by use of recirculating mixing pumps. Older style tanks generally have limited riser openings which will not support larger mixing pumps, since the riser access is typically 58.4 cm (23 inches) in diameter. Agitation for these tanks has been provided by four long shafted standard slurry pumps (SLP) powered by an above tank 112KW (150 HP) electric motor. The pump shaft is lubricated and cooled in a pressurized water column that is sealed from the surrounding waste in the tank. Closure of four waste tanks has been accomplished utilizing long shafted pump technology combined with heel removal using multiple technologies. Newer style waste tanks at SRS have larger riser openings, allowing the processing of waste solids to be accomplished with four large diameter SLPs equipped with 224KW (300 HP) motors. These tanks are used to process the waste from closure tanks for DWPF. In addition to the SLPs, a 224KW (300 HP) submersible mixer pump (SMP) has also been developed and deployed within older style tanks. The SMPs are product cooled and product lubricated canned motor pumps designed to fit within available risers and have significant agitation capabilities to suspend waste solids. Waste removal and closure of two tanks has been accomplished with agitation provided by 3 SMPs installed within the tanks. In 2012, a team was assembled to investigate alternative solids removal technologies to support waste removal for closing tanks. The goal of the team was to find a more cost effective approach that could be used to replace the current mixing pump technology. This team was unable to identify an alternative technology outside of mixing pumps to support waste agitation and removal from SRS waste tanks. However, the team did identify a potentially lower cost mixing pump compared to the baseline SLPs and SMPs. Rather than using the traditional procurement using an engineering specification, the team proposed to seek commercially available submersible mixer pumps (CSMP) as alternatives to SLPs and SMPs. SLPs and SMPs have a high procurement cost and the actual cost of moving pumps between tanks has shown to be significantly higher than the original estimates that justified the reuse of SMPs and SLPs. The team recommended procurement of “off-the-shelf” industry pumps which may be available for significant savings, but at an increased risk of failure and reduced operating life in the waste tank. The goal of the CSMP program is to obtain mixing pumps that could mix from bulk waste removal through tank closure and then be abandoned in place as part of tank closure. This paper will present the development, progress and relative advantages of the CSMP.« less

Historical trends in creel limits, length-based limits, and season restrictions for black basses in the United States and Canada

USGS Publications Warehouse

Paukert, C.; McInerny, M.; Schultz, Ronald

2007-01-01

We determined for largemouth bass (Micropterus salmoides), smallmouth bass (M. dolomeui), and spotted bass (M. punctulatus) historical trends in state- and province-wide creel limits, length limits, and season closures along with the rationale justifying these regulations. Based on data gathered via mail surveys and the Internet, 55 jurisdictions had state- or province-wide creel limits, minimum length limits, or season closures, with each regulation type enacted as early as pre-1900. Most early regulations were established to protect spawning bass, but providing equitable distribution of harvest and increasing the quality of bass catch or harvest were the most common rationales for current regulations. Spatial and temporal trends in regulations were similar among species, were affected by geographic location, were not affected by angler preference except for season closures, and were frequently uninfluenced by advances in scientific knowledge of black bass biology.

Pediatric lower extremity mower injuries.

PubMed

Hill, Sean M; Elwood, Eric T

2011-09-01

Lawn mower injuries in children represent an unfortunate common problem to the plastic reconstructive surgeon. There are approximately 68,000 per year reported in the United States. Compounding this problem is the fact that a standard treatment algorithm does not exist. This study follows a series of 7 pediatric patients treated for lower extremity mower injuries by a single plastic surgeon. The extent of soft tissue injury varied. All patients were treated with negative pressure wound therapy as a bridge to definitive closure. Of the 7 patients, 4 required skin grafts, 1 required primary closure, 1 underwent a lower extremity amputation secondary to wounds, and 1 was repaired using a cross-leg flap. Function limitations were minimal for all of our patients after reconstruction. Our basic treatment algorithm is presented with initial debridement followed by the simplest method possible for wound closure using negative pressure wound therapy, if necessary.

OMC Compressor Case

NASA Technical Reports Server (NTRS)

Humphrey, W. Donald

1997-01-01

This report summarizes efforts expended in the development of an all-composite compressor case. Two pre-production units have been built, one utilizing V-CAP and one utilizing AFR-700B resin systems. Both units have been rig tested at elevated temperatures well above design limit loads. This report discusses the manufacturing processes, test results, and Finite Element Analysis performed. The V-CAP unit was funded by NASA-Lewis Research Center in 1994 under contract number NAS3- 27442 for Development of an All-Composite OMC Compressor Case. This contract was followed by an Air Force study in 1996 to build and identical unit using the AFR-700B resin system in place of the V-CAP system. The second compressor case was funded under U.S. Air Force contract F33615-93-D-5326, Advanced Materials for Aerospace Structures Special Studies (AMAS3), Delivery Order 0021 entitled "Advanced Polymeric Composite Materials and Structures Technology for Advanced High Temperature Gas Turbine Engines.' Initial studies using the V-CAP resin system were undertaken in 1993 under a NASA Lewis contract (NAS3-26829). A first prototype unit was developed in a joint program between Textron-Lycoming (now Allied Signal) and Brunswick (now Lincoln Composites). This unit included composite end closures using low density, high temperature molded end closures. The units was similar in size and shape to a titanium case currently used on the PT-21 0 engine and was funded as part of the integrated High Performance Turbine Engine Technology (EHPTET) initiative of DOD and NASA.

ICPP tank farm closure study. Volume 2: Engineering design files

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

NONE

1998-02-01

Volume 2 contains the following topical sections: Tank farm heel flushing/pH adjustment; Grouting experiments for immobilization of tank farm heel; Savannah River high level waste tank 20 closure; Tank farm closure information; Clean closure of tank farm; Remediation issues; Remote demolition techniques; Decision concerning EIS for debris treatment facility; CERCLA/RCRA issues; Area of contamination determination; Containment building of debris treatment facility; Double containment issues; Characterization costs; Packaging and disposal options for the waste resulting from the total removal of the tank farm; Take-off calculations for the total removal of soils and structures at the tank farm; Vessel off-gas systems; Jet-groutedmore » polymer and subsurface walls; Exposure calculations for total removal of tank farm; Recommended instrumentation during retrieval operations; High level waste tank concrete encasement evaluation; Recommended heavy equipment and sizing equipment for total removal activities; Tank buoyancy constraints; Grout and concrete formulas for tank heel solidification; Tank heel pH requirements; Tank cooling water; Evaluation of conservatism of vehicle loading on vaults; Typical vault dimensions and approximately tank and vault void volumes; Radiological concerns for temporary vessel off-gas system; Flushing calculations for tank heels; Grout lift depth analysis; Decontamination solution for waste transfer piping; Grout lift determination for filling tank and vault voids; sprung structure vendor data; Grout flow properties through a 2--4 inch pipe; Tank farm load limitations; NRC low level waste grout; Project data sheet calculations; Dose rates for tank farm closure tasks; Exposure and shielding calculations for grout lines; TFF radionuclide release rates; Documentation of the clean closure of a system with listed waste discharge; and Documentation of the ORNL method of radionuclide concentrations in tanks.« less

Associations with duration of compensation following whiplash sustained in a motor vehicle crash.

PubMed

Casey, Petrina P; Feyer, Anne Marie; Cameron, Ian D

2015-09-01

Continued exposure to compensation systems has been reported as deleterious to the health of participants. Understanding the associations with time to claim closure could allow for targeted interventions aimed at minimising the time participants are exposed to the compensation system. To identify the associations of extended time receiving compensation benefits with the aim of developing a prognostic model that predicts time to claim closure. Prospective cohort study in people with whiplash associated disorder. Time to claim closure, in a privately underwritten fault based third party traffic crash insurance scheme in New South Wales, Australia. Cox proportional hazard regression modelling. Of the 246 participants, 25% remained in the compensation system longer than 24 months with 15% remaining longer than three years. Higher initial disability (Functional Rating Index≥25 at baseline) (HRR: 95% CI, 1.916: 1.324-2.774, p<0.001); and lower initial mental health as measured by SF-36 Mental Component Score (HRR: 95% CI, 0.973: 0.960-0.987, p<0.001) were significantly and independently associated with an increased time-to-claim closure. Shorter time to claim closure was associated with having no legal involvement (HRR: 95% CI, 1.911: 1.169-3.123, p=0.009); and, not having a prior claim for compensation (HRR: 95% CI, 1.523: 1.062-2.198, p=0.022). Health and insurance related factors are independently associated with time to claim closure. Both factors need to be considered by insurers in their assessment of complexity of claims. Interventions aimed at minimising the impact of these factors could reduce claimants' exposure to the compensation system. In turn insurers can potentially reduce claims duration and cost, while improving the health outcomes of claimants. Copyright © 2015 Elsevier Ltd. All rights reserved.

Prediction of left ventricular dysfunction after device closure of patent ductus arteriosus: proposal for a new functional classification.

PubMed

Kiran, Viralam S; Tiwari, Ashish

2018-04-06

The aims of this study were to determine the incidence and correlates of left ventricular (LV) dysfunction amongst percutaneous patent ductus arteriosus (PDA) device closure patients, and to propose an indexed parameter for predicting LV dysfunction. In a retrospective cross-sectional analysis of 30 months duration, 447 patients who underwent PDA device closure were studied. The diameter of the PDA at the pulmonary artery end was measured in the angiograms in all patients and was indexed for their body surface area. The indexed PDA size was categorised into group A (1-2.9 mm/m², 35/447), B (3-5.9 mm/m², 254/447), C (6-8.9 mm/m², 66/447) and D (>9 mm/m², 35/447). Systolic LV function was evaluated using echocardiography at frequent intervals. Overall, 62.63% of the patients were female (280/447). At baseline, all 447 patients had normal LV function. LV dysfunction was seen in 102/447 (22.8%) patients with 2.8% in category A (1/35), 10.6% in category B (27/254), 34.1% in category C (42/123) and 91.4% in category D (32/35) after PDA device closure. Correlation of indexed PDA size and LV dysfunction was statistically significant (p<0.05). Accurate prediction of LV dysfunction is important in risk stratification, ICU management and counselling in PDA device closures. Indexed PDA size correlates well with post-procedural LV dysfunction. The authors propose a new classification of PDA utilising this accurate, reproducible and easy to perform parameter, which does not involve any extra cost, for risk stratification and early management in device closure of PDA.

303-K Storage Facility closure plan. Revision 2

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

Not Available

1993-12-15

Recyclable scrap uranium with zircaloy-2 and copper silicon alloy, uranium-titanium alloy, beryllium/zircaloy-2 alloy, and zircaloy-2 chips and fines were secured in concrete billets (7.5-gallon containers) in the 303-K Storage Facility, located in the 300 Area. The beryllium/zircaloy-2 alloy and zircaloy-2 chips and fines are designated as mixed waste with the characteristic of ignitability. The concretion process reduced the ignitability of the fines and chips for safe storage and shipment. This process has been discontinued and the 303-K Storage Facility is now undergoing closure as defined in the Resource Conservation and Recovery Act (RCRA) of 1976 and the Washington Administrative Codemore » (WAC) Dangerous Waste Regulations, WAC 173-303-040. This closure plan presents a description of the 303-K Storage Facility, the history of materials and waste managed, and the procedures that will be followed to close the 303-K Storage Facility. The 303-K Storage Facility is located within the 300-FF-3 (source) and 300-FF-5 (groundwater) operable units, as designated in the Hanford Federal Facility Agreement and Consent Order (Tri-Party Agreement) (Ecology et al. 1992). Contamination in the operable units 300-FF-3 and 300-FF-5 is scheduled to be addressed through the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) of 1980 remedial action process. Therefore, all soil remedial action at the 304 Facility will be conducted as part of the CERCLA remedial action of operable units 300-FF-3 and 300-FF-5.« less

The Installation Funding Dilemma

DTIC Science & Technology

2008-04-04

role in supporting the Army’s plans for supporting base realignment and closure (BRAC) requirements, global defense posture realignment ( GDPR ...relation to their affect on installation management funding. First, the initiative known as the GDPR will return many units to the United States from...three initiatives ( GDPR , BRAC and Modularity) and certain other restationing moves, the Army expects a net gain of about 154,000 personnel at its domestic

Physician Education on Controllable Costs Significantly Reduces Cost of Laparoscopic Hysterectomy.

PubMed

Croft, Katherine; Mattingly, Patricia J; Bosse, Patrick; Naumann, R Wendel

2017-01-01

To determine whether educating surgeons about their controllable instrumentation costs by providing cost data on total laparoscopic hysterectomy (LH) would reduce the cost of this procedure. Prospective cohort study (Canadian Task Force classification III). Academic-affiliated community hospital. Patients who underwent LH between April 2014 and March 2015 with surgeons who performed at least 10 LHs during that time period, along with a second group who underwent LH with the same cohort of surgeons between July 2015 and September 2015. The cost of LH was calculated for all surgeons who performed more than 10 LHs between April 2014 and March 2015. Itemized cost data were collected. The individual costs, as well as a summary of the data, were shared with all of the physicians to highlight areas of potential cost savings. The costs were then measured for 3 months after the educational intervention (July-September 2015) to gauge the impact of physician cost education. Thirteen surgeons met the criteria for inclusion in this analysis. Together, they performed 271 hysterectomies, with an average instrumentation cost of $1539.47 ± $294.16 and an average operating room time of 178 ± 26 minutes. Bipolar instrument choice represented 37% of the baseline costs, followed by 10% for trocar, 9% for cuff closure, and 8% for uterine manipulator. This same group of surgeons performed a total of 69 hysterectomies in the 3-month follow-up period of July-September 2015, with an average instrumentation cost of $1282.62 ± $235.03 and an average operating room time of 163 ± 50 minutes. There was statistically significant cost reduction of $256.85 ± $190.69 (p = .022), with no significant change in operating room time. Bipolar instrument cost decreased significantly, by $130.02 ± $125.02 (p = .021), representing 51% of the total cost savings. Trocar, cuff closure, and uterine manipulator costs were not significant sources of cost savings on average, but did represent sources of cost savings for some surgeons individually. Given adequate education about the products available for use in their institution, surgeons make informed decisions regarding the choice of instrumentation, allowing them to directly impact the cost of total LH, resulting in cost savings. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

On-orbit demonstration of automated closure and capture using ESA-developed proximity operations technologies and an existing, serviceable NASA Explorer Platform spacecraft

NASA Technical Reports Server (NTRS)

Hohwiesner, Bill; Claudinon, Bernard

1991-01-01

The European Space Agency (ESA) has been working to develop an autonomous rendezvous and docking capability since 1984 to enable Hermes to automatically dock with Columbus. As a result, ESA with Matra, MBB, and other space companies have developed technologies that are also directly supportive of the current NASA initiative for Automated Rendezvous and Capture. Fairchild and Matra would like to discuss the results of the applicable ESA/Matra rendezvous and capture developments, and suggest how these capabilities could be used, together with an existing NASA Explorer Platform satellite, to minimize new development and accomplish a cost effective automatic closure and capture demonstration program. Several RV sensors have been developed at breadboard level for the Hermes/Columbus program by Matra, MBB, and SAAB. Detailed algorithms for automatic rendezvous, closure, and capture have been developed by ESA and CNES for application with Hermes to Columbus rendezvous and docking, and they currently are being verified with closed-loop software simulation. The algorithms have multiple closed-loop control modes and phases starting at long range using GPS navigation. Differential navigation is used for coast/continuous thrust homing, holdpoint acquisition, V-bar hopping, and station point acquisition. The proximity operation sensor is used for final closure and capture. A subset of these algorithms, comprising the proximity operations algorithms, could easily be extracted and tailored to a limited objective closure and capture flight demonstration.

RCRA, superfund and EPCRA hotline training module. Introduction to: Land disposal units (40 cfr parts 264/265, subparts k, l, m, n) updated July 1996

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

NONE

1996-07-01

The module provides an overview of the requirements for landfills, surface impoundments, waste piles, and land treatment units. It summarizes the differences between interim status (Part 265) and permitted (Part 264) standards for land disposal units. It defines `surface impoundment` and distinguishes surface impoundments from tanks and describes surface impoundment retrofitting and retrofitting variance procedures. It explains the connection between land disposal standards, post-closure, and groundwater monitoring.

78 FR 16573 - Fisheries of the Northeastern United States; Atlantic Sea Scallop Fishery and Northeast...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-15

... (Framework Adjustment 49). Framework 24 also continues the closures of the Delmarva and Elephant Trunk... 25). Framework 24 would close both the Elephant Trunk (ET) area and the Delmarva Access Area (DMV...

50 CFR 648.231 - Closures.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Dogfish Monitoring Committee shall identify and review the relevant sources of management uncertainty to... management uncertainty that were considered, technical approaches to mitigating these sources of uncertainty..., DEPARTMENT OF COMMERCE FISHERIES OF THE NORTHEASTERN UNITED STATES Management Measures for the Spiny Dogfish...

40 CFR 264.603 - Post-closure care.

Code of Federal Regulations, 2011 CFR

2011-07-01

....603 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE TREATMENT, STORAGE, AND DISPOSAL FACILITIES... treatment or storage unit has contaminated soils or ground water that cannot be completely removed or...

Understanding the Risk Factors of Trauma Center Closures

PubMed Central

Shen, Yu-Chu; Hsia, Renee Y.; Kuzma, Kristen

2011-01-01

Objectives We analyze whether hazard rates of shutting down trauma centers are higher due to financial pressures or in areas with vulnerable populations (such as minorities or the poor). Materials and Methods This is a retrospective study of all hospitals with trauma center services in urban areas in the continental US between 1990 and 2005, identified from the American Hospital Association Annual Surveys. These data were linked with Medicare cost reports, and supplemented with other sources, including the Area Resource File. We analyze the hazard rates of trauma center closures among several dimensions of risk factors using discrete-time proportional hazard models. Results The number of trauma center closures increased from 1990 to 2005, with a total of 339 during this period. The hazard rate of closing trauma centers in hospitals with a negative profit margin is 1.38 times higher than those hospitals without the negative profit margin (P < 0.01). Hospitals receiving more generous Medicare reimbursements face a lower hazard of shutting down trauma centers (ratio: 0.58, P < 0.01) than those receiving below average reimbursement. Hospitals in areas with higher health maintenance organizations penetration face a higher hazard of trauma center closure (ratio: 2.06, P < 0.01). Finally, hospitals in areas with higher shares of minorities face a higher risk of trauma center closure (ratio: 1.69, P < 0.01). Medicaid load and uninsured populations, however, are not risk factors for higher rates of closure after we control for other financial and community characteristics. Conclusions Our findings give an indication on how the current proposals to cut public spending could exacerbate the trauma closure particularly among areas with high shares of minorities. In addition, given the negative effect of health maintenance organizations on trauma center survival, the growth of Medicaid managed care population should be monitored. Finally, high shares of Medicaid or uninsurance by themselves are not independent risk factors for higher closure as long as financial pressures are mitigated. Targeted policy interventions and further research on the causes, are needed to address these systems-level disparities. PMID:19704354

Understanding the risk factors of trauma center closures: do financial pressure and community characteristics matter?

PubMed

Shen, Yu-Chu; Hsia, Renee Y; Kuzma, Kristen

2009-09-01

We analyze whether hazard rates of shutting down trauma centers are higher due to financial pressures or in areas with vulnerable populations (such as minorities or the poor). This is a retrospective study of all hospitals with trauma center services in urban areas in the continental US between 1990 and 2005, identified from the American Hospital Association Annual Surveys. These data were linked with Medicare cost reports, and supplemented with other sources, including the Area Resource File. We analyze the hazard rates of trauma center closures among several dimensions of risk factors using discrete-time proportional hazard models. The number of trauma center closures increased from 1990 to 2005, with a total of 339 during this period. The hazard rate of closing trauma centers in hospitals with a negative profit margin is 1.38 times higher than those hospitals without the negative profit margin (P < 0.01). Hospitals receiving more generous Medicare reimbursements face a lower hazard of shutting down trauma centers (ratio: 0.58, P < 0.01) than those receiving below average reimbursement. Hospitals in areas with higher health maintenance organizations penetration face a higher hazard of trauma center closure (ratio: 2.06, P < 0.01). Finally, hospitals in areas with higher shares of minorities face a higher risk of trauma center closure (ratio: 1.69, P < 0.01). Medicaid load and uninsured populations, however, are not risk factors for higher rates of closure after we control for other financial and community characteristics. Our findings give an indication on how the current proposals to cut public spending could exacerbate the trauma closure particularly among areas with high shares of minorities. In addition, given the negative effect of health maintenance organizations on trauma center survival, the growth of Medicaid managed care population should be monitored. Finally, high shares of Medicaid or uninsurance by themselves are not independent risk factors for higher closure as long as financial pressures are mitigated. Targeted policy interventions and further research on the causes, are needed to address these systems-level disparities.

Secondary plastic closure of gastroschisis is associated with a lower incidence of mechanical ventilation.

PubMed

Dariel, Anne; Poocharoen, Wannisa; de Silva, Nicole; Pleasants, Hazel; Gerstle, Justin Ted

2015-02-01

Nonsurgical closure after primary silo placement, secondary plastic closure (SPC), has been used as an alternative to secondary surgical closure (SSC) in gastroschisis. The benefits described were closure without formal surgical procedure, cosmetic aspect, and minimization of intra-abdominal pressures. This study compared requirements for mechanical ventilation and general anesthesia, nutritional care, and outcomes between SPC and SSC. We included patients with primary staged-silo reduction with a 1-year minimum follow-up. SPC was performed at bedside with sedation using a nonadherent dressing. SSC was performed in operating room under general anesthesia using standard surgical techniques. This retrospective study included 64 patients, 23 SPC and 41 SSC. The characteristics of the two groups were comparable. Mechanical ventilation was used for 15 SPC and 41 SSC (p=0.0001) with a comparable median duration (5.5 and 6.0 days, not significant [NS]). General anesthesia was required for 9 SPC and 41 SSC (p<0.0001). Complications included one SPC and six SSC with necrotizing enterocolitis, zero SPC and four SSC with intestinal atresia, two SPC and four SSC with small bowel obstruction, zero SPC and one SSC with abdominal compartment syndrome resulting in a short bowel syndrome (NS). Median duration of parenteral nutrition (30 and 27 days), time to first feeds (14 and 14 days), time at or above minimal enteral feeding (22 and 17 days), time to full feeds (31 and 28 days), length of stay (LOS) in neonatal intensive care unit (24 and 23.5 days) and overall hospital LOS (37 and 36 days) were not statistically different between SPC and SSC patients without complications, respectively. These data were comparable for SPC and SSC patients with complications. Five SPC and six SSC developed an umbilical hernia (NS); two patients in each group required a surgical repair (NS). Plastic closure of gastroschisis after primary silo reduction is simple, safe, reproducible, and associated with a significant lower incidence of mechanical ventilation. Nutritional management and length of hospital stay were similar to conventional surgical closure for patients. Plastic closure allows nonoperative management without general anesthesia at patient's bedside, in comparison with surgical closure that must be performed under general anesthesia in the operating room. Plastic closure does not appear to be associated with more umbilical hernias in this retrospective study. Georg Thieme Verlag KG Stuttgart · New York.

A tensegrity model for hydrogen bond networks in proteins.

PubMed

Bywater, Robert P

2017-05-01

Hydrogen-bonding networks in proteins considered as structural tensile elements are in balance separately from any other stabilising interactions that may be in operation. The hydrogen bond arrangement in the network is reminiscent of tensegrity structures in architecture and sculpture. Tensegrity has been discussed before in cells and tissues and in proteins. In contrast to previous work only hydrogen bonds are studied here. The other interactions within proteins are either much stronger - covalent bonds connecting the atoms in the molecular skeleton or weaker forces like the so-called hydrophobic interactions. It has been demonstrated that the latter operate independently from hydrogen bonds. Each category of interaction must, if the protein is to have a stable structure, balance out. The hypothesis here is that the entire hydrogen bond network is in balance without any compensating contributions from other types of interaction. For sidechain-sidechain, sidechain-backbone and backbone-backbone hydrogen bonds in proteins, tensegrity balance ("closure") is required over the entire length of the polypeptide chain that defines individually folding units in globular proteins ("domains") as well as within the repeating elements in fibrous proteins that consist of extended chain structures. There is no closure to be found in extended structures that do not have repeating elements. This suggests an explanation as to why globular domains, as well as the repeat units in fibrous proteins, have to have a defined number of residues. Apart from networks of sidechain-sidechain hydrogen bonds there are certain key points at which this closure is achieved in the sidechain-backbone hydrogen bonds and these are associated with demarcation points at the start or end of stretches of secondary structure. Together, these three categories of hydrogen bond achieve the closure that is necessary for the stability of globular protein domains as well as repeating elements in fibrous proteins.

Letter Report to Address Comments on the Closure Report for Corrective Action Unit 224: Decon Pad and Septic Systems, Nevada Test Site, Nevada, Revision 0, March 2008

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

NSTec Environmental Restoration

2008-03-17

The Closure Report (CR) for Corrective Action Unit (CAU) 224, Decon Pad and Septic Systems, was approved by the Nevada Department of Environmental Protection (NDEP) on November 01, 2007. The approval letter contained the following two comments: Comment 1--For 06-05-01, 06-17-04, 06-23-01 provide evidence that the 6 inch VCP pipe originating from building CP-2 is no longer active and sealed to prevent possible future contamination. Comment 2--For the area that includes 06-03-01, provide evidence that active lines are no longer feeding the North and South lagoons and have been sealed to prevent possible future contamination. To address these comments, closuremore » documentation was reviewed, and site visits were conducted to locate and document the areas of concern. Additional fieldwork was conducted in March 2008 to seal the lines and openings described in the two comments. Photographs were taken of the closed drains and lines to document that the NDEP comments were adequately addressed and potential inadvertent discharge to the environment has been eliminated. Investigation and closure documentation was reviewed to identify the locations of potential drains, lines, and other features that could receive and/or transmit liquid. Based on the investigation findings and subsequent closure activities, no openings, distribution boxes, or other features (excluding known floor drains at CP-2) that could receive liquid were found at the CP-2 location (Figure 1), and potential manholes for the north and south sewage lagoons were identified for Corrective Action Site (CAS) 06-03-01 (Figure 2). The distribution box identified in Figure 1 was not located during the investigation and was assumed to have been previously removed.« less

Control of extended-spectrum β-lactamase-producing Enterobacteriaceae nosocomial acquisition in an intensive care unit: A time series regression analysis.

PubMed

Boyer, Alexandre; Couallier, Vincent; Clouzeau, Benjamin; Lasheras, Agnes; M'zali, Fatima; Kann, Michael; Rogues, Anne-Marie; Gruson, Didier

2015-12-01

This study was undertaken to determine the temporal relationship between implementation of different interventions in an intensive care unit (ICU) and control of endemic nosocomial acquisition of extended-spectrum β-lactamase Enterobacteriaceae (ESBLE). This was a prospective observational study with time-series analysis of the monthly incidence of ESBLE and its predictors. In November 2007, after a 14-month baseline period, an intervention consisting of restriction of third-generation cephalosporins (3 GC) and increased use of alcohol-based hand rubs was implemented. In January 2008, an increased health care worker (HCW):patient ratio was also implemented. In March 2010, the ICU was closed, and patients were moved to a clean ICU. The first intervention resulted in global reduction in 3 GC and increased use of alcohol-based hand rub. A significant change in ESBLE incidence was observed in a full segmented univariate regression analysis (mean change in level, -0.91 ± 0.19; P < .0001). After ICU closure, there was a dramatic reduction in ESBLE acquisition. According to the multivariate model, the ICU closure was the main protective factor. Before ICU closure, an increase in the HCW:patient ratio of 0.1 point tended to be associated with a decreased risk of ESBLE acquisition (relative risk, 0.28; 95% confidence interval, 0.06-1.25; P = .09). This study shows that ICU closure was associated with, but not necessarily the reason for, control of ESBLE cross-transmission in a nonoutbreak setting. Environmental ESBE sources may play a role in cross-transmission. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Decision Rules Used in Academic Program Closure: Where the Rubber Meets the Road.

ERIC Educational Resources Information Center

Eckel, Peter D.

2002-01-01

Adopted a decision/action rationality framework to explore the criteria used to close academic programs at four universities. Findings suggested that decisions are based upon criteria other than those usually stated (e.g., cost, quality, and centrality), and that process leads to criteria generation. (EV)

Celebrating Success: EPA Region 3 Greener Cleanup and Sustainable Reuse Award Winner: Aberdeen Proving Ground Federal Facility Superfund Site

EPA Pesticide Factsheets

Greener Cleanup practices were implemented as part of a successful Time-Critical Removal Action (TCRA) completed at the APG Former NIKE Missile Site which has resulted in a reduced environmental footprint, accelerated site closure, and a cost savings.

The Costs of Closing Nuclear Power Plants,

DTIC Science & Technology

1985-02-01

National Academy of Sciences warn that the " greenhouse effect " may already have begun to warm up the planet. These studies recommend that means be found to...lower our reliance on fossil fuels, the burning of which is thought to contribute to the greenhouse effect . Closure of nuclear generating facilities

Invisible Cost Effective Mechanics for Anterior Space Closure.

PubMed

Jumle, Aatish Vinod; Bagrecha, Saurabh; Gharat, Ninad; Misal, Abhijit; Toshniwal, N G

2015-01-01

The shifting paradigm towards invisible orthodontic treatment and also awareness in patients has allured their focus towards the most esthetic treatment approach. Also the lingual treatment is proved successful and is very well accepted by the patients. The problem that persist is its high expenses, which is not affordable by all patients. This article is a effort to treat a simple Class I malocclusion with anterior spacing using a simple, esthetic, Cost effective approach with acceptable results when esthetics plays a priority role.

Closure Report for Corrective Action Unit 5: Landfills, Nevada Test Site, Nevada, Revision 0 with Errata Sheet and ROTC 1

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

None, None

The purpose of this CR is to document that the closure of CAU 5 complied with the NDEP-approved CAP closure requirements (NNSA/NSO, 2004). The closure activities specified in the CAP were based on the recommendations presented in the corrective action decision document (CADD) (NNSA/NSO, 2003). ROTC 1: The UR form was updated to the current format to include a. more detailed description of the UR and maintenance requirements. Information was edited due to the change of UR signs at the site to UR monuments/signs. The maintenance frequency was changed to annually because sign damage due to high winds was evidencedmore » during recent site inspections. The coordinates for the UR were originally based on NAD 27 and were modified to NAD 83 to comply with the most recent M&O database requirements. The modifications identified in this ROTC will supersede the existing posting requirements for the UR at CASs 06-1S-02 and 06-15-03 as identified in the CAU 5 CADD; CAU 5 CR; and the UR form associated with CASs 06-15-02 and 06-15-03.« less

Axiomatic Design of Space Life Support Systems

NASA Technical Reports Server (NTRS)

Jones, Harry W.

2017-01-01

Systems engineering is an organized way to design and develop systems, but the initial system design concepts are usually seen as the products of unexplained but highly creative intuition. Axiomatic design is a mathematical approach to produce and compare system architectures. The two axioms are:- Maintain the independence of the functional requirements.- Minimize the information content (or complexity) of the design. The first axiom generates good system design structures and the second axiom ranks them. The closed system human life support architecture now implemented in the International Space Station has been essentially unchanged for fifty years. In contrast, brief missions such as Apollo and Shuttle have used open loop life support. As mission length increases, greater system closure and increased recycling become more cost-effective.Closure can be gradually increased, first recycling humidity condensate, then hygiene wastewater, urine, carbon dioxide, and water recovery brine. A long term space station or planetary base could implement nearly full closure, including food production. Dynamic systems theory supports the axioms by showing that fewer requirements, fewer subsystems, and fewer interconnections all increase system stability. If systems are too complex and interconnected, reliability is reduced and operations and maintenance become more difficult. Using axiomatic design shows how the mission duration and other requirements determine the best life support system design including the degree of closure.

Atomistic Simulations of Pore Formation and Closure in Lipid Bilayers

PubMed Central

Bennett, W. F. Drew; Sapay, Nicolas; Tieleman, D. Peter

2014-01-01

Cellular membranes separate distinct aqueous compartments, but can be breached by transient hydrophilic pores. A large energetic cost prevents pore formation, which is largely dependent on the composition and structure of the lipid bilayer. The softness of bilayers and the disordered structure of pores make their characterization difficult. We use molecular-dynamics simulations with atomistic detail to study the thermodynamics, kinetics, and mechanism of pore formation and closure in DLPC, DMPC, and DPPC bilayers, with pore formation free energies of 17, 45, and 78 kJ/mol, respectively. By using atomistic computer simulations, we are able to determine not only the free energy for pore formation, but also the enthalpy and entropy, which yields what is believed to be significant new insights in the molecular driving forces behind membrane defects. The free energy cost for pore formation is due to a large unfavorable entropic contribution and a favorable change in enthalpy. Changes in hydrogen bonding patterns occur, with increased lipid-water interactions, and fewer water-water hydrogen bonds, but the total number of overall hydrogen bonds is constant. Equilibrium pore formation is directly observed in the thin DLPC lipid bilayer. Multiple long timescale simulations of pore closure are used to predict pore lifetimes. Our results are important for biological applications, including the activity of antimicrobial peptides and a better understanding of membrane protein folding, and improve our understanding of the fundamental physicochemical nature of membranes. PMID:24411253

78 FR 27088 - Fisheries of the Northeastern United States; Atlantic Sea Scallop Fishery and Northeast...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-09

...). Framework 24 also continues the closures of the Delmarva and Elephant Trunk scallop access areas, refines... Scallop Access Areas Framework 24 closes both the Elephant Trunk (ET) area and the Delmarva Access Area...

50 CFR 648.141 - Closure.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Bass Monitoring Committee shall identify and review the relevant sources of management uncertainty to... sources of management uncertainty that were considered, technical approaches to mitigating these sources..., DEPARTMENT OF COMMERCE FISHERIES OF THE NORTHEASTERN UNITED STATES Management Measures for the Black Sea Bass...

50 CFR 648.121 - Closures.

Code of Federal Regulations, 2011 CFR

2011-10-01

... management uncertainty to recommend ACTs for the commercial and recreational fishing sectors as part of the... sources of management uncertainty that were considered, technical approaches to mitigating these sources..., DEPARTMENT OF COMMERCE FISHERIES OF THE NORTHEASTERN UNITED STATES Management Measures for the Scup Fishery...

BACTERIA, BEACHES AND SWIMMABLE WATERS: INTRODUCING VIRTUAL BEACH

EPA Science Inventory

Safe beaches meet water quality standards and are valued for their aesthetics and the recreational opportunities that they afford. In the United States recreational water quality assessments and beach closure decisions are presently based on samples of enterococci or Escherichia ...

Corrective Action Decision Document/Corrective Action Plan for Corrective Action Unit 413: Clean Slate II Plutonium Dispersion (TTR) Tonopah Test Range, Nevada. Revision 0

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

Matthews, Patrick

This Corrective Action Decision Document/Corrective Action Plan provides the rationale and supporting information for the selection and implementation of corrective actions at Corrective Action Unit (CAU) 413, Clean Slate II Plutonium Dispersion (TTR). CAU 413 is located on the Tonopah Test Range and includes one corrective action site, TA-23-02CS. CAU 413 consists of the release of radionuclides to the surface and shallow subsurface from the Clean Slate II (CSII) storage–transportation test conducted on May 31, 1963. The CSII test was a non-nuclear detonation of a nuclear device located inside a concrete bunker covered with 2 feet of soil. To facilitatemore » site investigation and the evaluation of data quality objectives decisions, the releases at CAU 413 were divided into seven study groups: 1 Undisturbed Areas 2 Disturbed Areas 3 Sedimentation Areas 4 Former Staging Area 5 Buried Debris 6 Potential Source Material 7 Soil Mounds Corrective action investigation (CAI) activities, as set forth in the CAU 413 Corrective Action Investigation Plan, were performed from June 2015 through May 2016. Radionuclides detected in samples collected during the CAI were used to estimate total effective dose using the Construction Worker exposure scenario. Corrective action was required for areas where total effective dose exceeded, or was assumed to exceed, the radiological final action level (FAL) of 25 millirem per year. The results of the CAI and the assumptions made in the data quality objectives resulted in the following conclusions: The FAL is exceeded in surface soil in SG1, Undisturbed Areas; The FAL is assumed to be exceeded in SG5, Buried Debris, where contaminated debris and soil were buried after the CSII test; The FAL is not exceeded at SG2, SG3, SG4, SG6, or SG7. Because the FAL is exceeded at CAU 413, corrective action is required and corrective action alternatives (CAAs) must be evaluated. For CAU 413, three CAAs were evaluated: no further action, clean closure, and closure in place. The CAAs were evaluated on technical merit focusing on performance, reliability, feasibility, safety, and cost. Based on the evaluation of analytical data from the CAI, review of future and current operations at CAU 413, and the detailed and comparative analysis of CAAs, clean closure was selected as the preferred CAA for CAU 413 by the U.S. Air Force, Nevada Division of Environmental Protection, and U.S. Department of Energy at the CAA meeting held on August 24, 2016.« less

Beyond Antitrust: Health Care And Health Insurance Market Trends And The Future Of Competition.

PubMed

Glied, Sherry A; Altman, Stuart H

2017-09-01

The United States relies on competition to balance costs and quality in the health care system. But concentration is increasing throughout the hospital, physician, and insurer markets. Midsize community hospitals face declining demand and growing competition from both larger hospitals and smaller freestanding diagnostic and surgical centers, leaving the midsize hospitals vulnerable to closure or merger with other facilities. Competition among insurers has been limited by the development of hospital systems that extend the bargaining power of "must-have" hospitals (those perceived to provide the best care for complex and less common conditions) across local health care markets. Government antitrust enforcement could play an important role in maintaining competition in both the hospital and insurer markets, but in many markets, the impact of that enforcement has been limited to date. Policy makers should consider supplementing antitrust activities with strategies that combine competition and regulation-for example, by regulating selected prices and structuring competition to cover entire insurance markets. Project HOPE—The People-to-People Health Foundation, Inc.

Economic Impact of Food Safety Outbreaks on Food Businesses

PubMed Central

Hussain, Malik Altaf; Dawson, Christopher O.

2013-01-01

A globalized food trade, extensive production and complex supply chains are contributing toward an increased number of microbiological food safety outbreaks. Moreover, the volume of international food trade has increased to become very large. All of these factors are putting pressure on the food companies to meet global demand in order to be competitive. This scenario could force manufacturers to be lenient toward food safety control intentionally, or unintentionally, and result in a major foodborne outbreak that causes health problems and economic loss. The estimated cost of food safety incidents for the economy of the United States is around $7 billion per year which comes from notifying consumers, removing food from shelves, and paying damages as a result of lawsuits. Most other countries similarly have economic losses. Much of these losses represent lost markets, loss of consumer demand, litigation and company closures. Concrete steps are needed to improve safety of foods produced for local or overseas markets to avoid unexpected food scandals and economic losses. PMID:28239140

Post-Closure Report for Closed Resource Conservation and Recovery Act Corrective Action Units, Nevada National Security Site, Nevada, for Fiscal Year 2014

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

Silvas, Alissa J.

2015-01-01

This report serves as the combined annual report for post-closure activities for several Corrective Action Units (CAUs). The locations of the sites are shown in Figure 1. This report covers fiscal year 2014 (October 2013–September 2014). The post-closure requirements for these sites are described in Resource Conservation and Recovery Act Permit Number NEV HW0101 and summarized in each CAU-specific section in Section 1.0 of this report. The results of the inspections, a summary of maintenance activities, and an evaluation of monitoring data are presented in this report. Site inspections are conducted semiannually at CAUs 90 and 91 and quarterly atmore » CAUs 92, 110, 111, and 112. Additional inspections are conducted at CAU 92 if precipitation occurs in excess of 0.50 inches (in.) in a 24-hour period and at CAU 111 if precipitation occurs in excess of 1.0 in. in a 24-hour period. Inspections include an evaluation of the condition of the units, including covers, fences, signs, gates, and locks. In addition to visual inspections, soil moisture monitoring, vegetation evaluations, and subsidence surveys are conducted at CAU 110. At CAU 111, soil moisture monitoring, vegetation evaluations, subsidence surveys, direct radiation monitoring, air monitoring, radon flux monitoring, and groundwater monitoring are conducted. The results of the vegetation surveys and an analysis of the soil moisture monitoring data at CAU 110 are presented in this report. Results of additional monitoring at CAU 111 are documented annually in the Nevada National Security Site Waste Management Monitoring Report Area 3 and Area 5 Radioactive Waste Management Sites and in the Nevada National Security Site Data Report: Groundwater Monitoring Program Area 5 Radioactive Waste Management Site, which will be prepared in approximately June 2015. All required inspections, maintenance, and monitoring were conducted in accordance with the post-closure requirements of the permit. It is recommended to continue inspections and monitoring as scheduled.« less

Tissue expanders with a focus on extremity reconstruction.

PubMed

Arain, Abdul R; Cole, Keegan; Sullivan, Christopher; Banerjee, Samik; Kazley, Jillian; Uhl, Richard L

2018-02-01

Acute traumatic or surgical wounds that cannot be primarily closed often cause substantial morbidity and mortality. This often leads to increased costs from higher material expenses, more involved nursing care, and longer hospital stays. Advancements in soft tissue expansion has made it a popular alternative to facilitate early closure without the need for more complicated plastic surgical procedures. Areas covered: In this review, we briefly elaborate on the history and biomechanics of tissue expansion and provide comprehensive descriptions of traditional internal tissue expanders and a variety of contemporary external tissue expanders. We describe their uses, advantages, disadvantages, and clinical outcomes. The majority of articles reviewed include case series with level IV evidence. Outcome data was collected for studies after 1990 using PubMed database. Expert commentary: An overall reduction in cost, time-to-wound closure, hospital length-of-stay, and infection rate may be expected with most tissue expanders. However, further studies comparing outcomes and cost-effectiveness of various expanders may be beneficial. Surgeons should be aware of the wide array of tissue expanders that are commercially available to individualize treatment based on thorough understanding of their advantages and disadvantages to optimize outcomes. We predict the use of external expanders to increase in the future and the need for more invasive procedures such as flaps to decrease.

Retrospective cost adaptive Reynolds-averaged Navier-Stokes k-ω model for data-driven unsteady turbulent simulations

NASA Astrophysics Data System (ADS)

Li, Zhiyong; Hoagg, Jesse B.; Martin, Alexandre; Bailey, Sean C. C.

2018-03-01

This paper presents a data-driven computational model for simulating unsteady turbulent flows, where sparse measurement data is available. The model uses the retrospective cost adaptation (RCA) algorithm to automatically adjust the closure coefficients of the Reynolds-averaged Navier-Stokes (RANS) k- ω turbulence equations to improve agreement between the simulated flow and the measurements. The RCA-RANS k- ω model is verified for steady flow using a pipe-flow test case and for unsteady flow using a surface-mounted-cube test case. Measurements used for adaptation of the verification cases are obtained from baseline simulations with known closure coefficients. These verification test cases demonstrate that the RCA-RANS k- ω model can successfully adapt the closure coefficients to improve agreement between the simulated flow field and a set of sparse flow-field measurements. Furthermore, the RCA-RANS k- ω model improves agreement between the simulated flow and the baseline flow at locations at which measurements do not exist. The RCA-RANS k- ω model is also validated with experimental data from 2 test cases: steady pipe flow, and unsteady flow past a square cylinder. In both test cases, the adaptation improves agreement with experimental data in comparison to the results from a non-adaptive RANS k- ω model that uses the standard values of the k- ω closure coefficients. For the steady pipe flow, adaptation is driven by mean stream-wise velocity measurements at 24 locations along the pipe radius. The RCA-RANS k- ω model reduces the average velocity error at these locations by over 35%. For the unsteady flow over a square cylinder, adaptation is driven by time-varying surface pressure measurements at 2 locations on the square cylinder. The RCA-RANS k- ω model reduces the average surface-pressure error at these locations by 88.8%.

The Slow Moving Threat of Groundwater Salinization: Mechanisms, Costs, and Adaptation Strategies

NASA Astrophysics Data System (ADS)

Pauloo, R.; Guo, Z.; Fogg, G. E.

2016-12-01

Population growth, the Green Revolution, and climate uncertainties have accelerated overdraft in groundwater basins worldwide, which in some regions is converting these basins into closed hydrologic systems, where the dominant exits for water are evapotranspiration and pumping. Irrigated agricultural basins are particularly at risk to groundwater salinization, as naturally occurring (i.e., sodium, potassium, chloride) and anthropogenic (i.e., nitrate fertilizers) salts leach back into the water table through the root zone, while a large portion of pumped groundwater leaves the system as it is evapotranspired by crops. Decreasing water quality associated with increases in Total Dissolved Solids (TDS) has been documented in aquifers across the United States in the past half century. This study suggests that the increase in TDS in aquifers can be partially explained by closed basin hydrogeology and rock-water interactions leading to groundwater salinization. This study will present: (1) a report on historical water quality in the Tulare basin, (2) a forward simulation of salt balance in Tulare Basin based on the Department of Water Resources numerical model C2VSim, and a simple mixing model, (3) an economic analysis forecasting the cost of desalination under varying degrees of managed groundwater recharge where the basin is gradually filled, avoiding hydraulic closure.

Phase dependence of transport-aperture coordination variability reveals control strategy of reach-to-grasp movements.

PubMed

Rand, Miya K; Shimansky, Y P; Hossain, Abul B M I; Stelmach, George E

2010-11-01

Based on an assumption of movement control optimality in reach-to-grasp movements, we have recently developed a mathematical model of transport-aperture coordination (TAC), according to which the hand-target distance is a function of hand velocity and acceleration, aperture magnitude, and aperture velocity and acceleration (Rand et al. in Exp Brain Res 188:263-274, 2008). Reach-to-grasp movements were performed by young adults under four different reaching speeds and two different transport distances. The residual error magnitude of fitting the above model to data across different trials and subjects was minimal for the aperture-closure phase, but relatively much greater for the aperture-opening phase, indicating considerable difference in TAC variability between those phases. This study's goal is to identify the main reasons for that difference and obtain insights into the control strategy of reach-to-grasp movements. TAC variability within the aperture-opening phase of a single trial was found minimal, indicating that TAC variability between trials was not due to execution noise, but rather a result of inter-trial and inter-subject variability of motor plan. At the same time, the dependence of the extent of trial-to-trial variability of TAC in that phase on the speed of hand transport was sharply inconsistent with the concept of speed-accuracy trade-off: the lower the speed, the larger the variability. Conversely, the dependence of the extent of TAC variability in the aperture-closure phase on hand transport speed was consistent with that concept. Taking into account recent evidence that the cost of neural information processing is substantial for movement planning, the dependence of TAC variability in the aperture-opening phase on task performance conditions suggests that it is not the movement time that the CNS saves in that phase, but the cost of neuro-computational resources and metabolic energy required for TAC regulation in that phase. Thus, the CNS performs a trade-off between that cost and TAC regulation accuracy. It is further discussed that such trade-off is possible because, due to a special control law that governs optimal switching from aperture opening to aperture closure, the inter-trial variability of the end of aperture opening does not affect the high accuracy of TAC regulation in the subsequent aperture-closure phase.

76 FR 50186 - Surplus Properties

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-12

... Report, as approved, and following screening with Federal agencies and Department of Defense components... DEPARTMENT OF DEFENSE Department of the Army Surplus Properties AGENCY: Department of the Army, Do... have been determined surplus to the United States needs in accordance with the Defense Base Closure and...

Cost-effectiveness of community screening for glaucoma in rural India: a decision analytical model.

PubMed

John, D; Parikh, R

2018-02-01

Studies in several countries have demonstrated the cost-effectiveness of population-based screening for glaucoma when targeted at high-risk groups such as older adults and with familial history of disease. This study conducts a cost-effective analysis of a hypothetical community screening and subsequent treatment programme in comparison to opportunistic case finding for glaucoma in rural India. A hypothetical screening programme for both primary open-angle glaucoma and angle-closure disease was built for a population aged between 40 and 69 years in rural areas of India. A decision analytical model was built to model events, costs and treatment pathways with and without a hypothetical screening programme for glaucoma for a rural-based population aged between 40 and 69 years in India. The treatment pathway included both primary open-angle glaucoma and angle-closure disease. The data on costs of screening and treatment were provided by an administrator of a tertiary eye hospital in Eastern India. The probabilities for the screening and treatment pathway were derived from published literature and a glaucoma specialist. The glaucoma prevalence rates were adapted from the Chennai Glaucoma Study findings. An incremental cost-effectiveness ratio value of ₹7292.30 per quality-adjusted life-year was calculated for a community-screening programme for glaucoma in rural India. The community screening for glaucoma would treat an additional 2872 cases and prevent 2190 person-years of blindness over a 10-year period. Community screening for glaucoma in rural India appears to be cost-effective when judged by a ratio of willingness-to-pay thresholds as per WHO-CHOICE guidelines. For community screening to be cost-effective, adequate resources, such as trained medical personnel and equipment would need to be made available. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Multicenter review of robotic versus laparoscopic ventral hernia repair: is there a role for robotics?

PubMed

Walker, Peter A; May, Audriene C; Mo, Jiandi; Cherla, Deepa V; Santillan, Monica Rosales; Kim, Steven; Ryan, Heidi; Shah, Shinil K; Wilson, Erik B; Tsuda, Shawn

2018-04-01

The utilization of robotic platforms for general surgery procedures such as hernia repair is growing rapidly in the United States. A limited amount of data are available evaluating operative outcomes in comparison to standard laparoscopic surgery. We completed a retrospective review comparing robotic and laparoscopic ventral hernia repair to provide safety and outcomes data to help design a future prospective trial design. A retrospective review of 215 patients undergoing ventral hernia repair (142 robotic and 73 laparoscopic) was completed at two large academic centers. Primary outcome measure evaluated was recurrence. Secondary outcomes included incidence of primary fascial closure, and surgical site occurrences. Propensity for treatment match comparison demonstrated that robotic repair was associated with a decreased incidence of recurrence (2.1 versus 4.2%, p < 0.001) and surgical site occurrence (4.2 versus 18.8%, p < 0.001). This may be because robotic repair was associated with increased incidence of primary fascial closure (77.1 versus 66.7%, p < 0.01). Analysis of baseline patient populations showed that robotic repairs were completed on patients with lower body mass index (28.1 ± 3.6 versus 34.2 ± 6.4, p < 0.001) and fewer comorbidities. Our retrospective data show that robotic repair was associated with decreased recurrence and surgical site occurrence. However, the differences noted in the patient populations limit the interpretability of these results. As adoption of robotic ventral hernia repair increases, prospective trials need to be designed in order to investigate the efficacy, safety, and cost effectiveness of this evolving technique.

Open abdomen with vacuum-assisted wound closure and mesh-mediated fascial traction in patients with complicated diffuse secondary peritonitis: A single-center 8-year experience.

PubMed

Tolonen, Matti; Mentula, Panu; Sallinen, Ville; Rasilainen, Suvi; Bäcklund, Minna; Leppäniemi, Ari

2017-06-01

Open abdomen (OA) treatment in patients with peritonitis is increasing worldwide. Various temporary abdominal closure devices are being used. This study included patients with complicated diffuse secondary peritonitis, OA, and vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM). The aim of this study was to describe mortality and major morbidity in terms of delayed primary fascial closure and enteroatmospheric fistula rates. This was a single-academic-center retrospective study of consecutive patients with diffuse peritonitis, OA, and VAWCM between years 2008 and 2016. Descriptive and univariate analyses were performed. Forty-one patients were identified and analyzed. Median age was 59 years, preoperative septic shock was diagnosed in 54% (n = 22), and 59% (n = 24) had a postoperative peritonitis. Mortality was 29% (n = 12), and 76% (n = 31) of patients were admitted in the intensive care unit. The median duration of OA was 7 days with a median of two dressing changes. Delayed primary fascial closure rate among survivors was 92% (n = 33), and enteroatmospheric fistulas developed in 7% (n = 3). In a subgroup analysis, patients with OA in the primary laparotomy for peritonitis (n = 27) were compared with patients with OA in the subsequent laparotomies (n = 14). There were no significant differences between groups. The VAWCM technique in patients with complicated secondary diffuse peritonitis and OA yields excellent results in terms of delayed primary fascial closure rate and a low number of enteroatmospheric fistulas. It seems to be safe to close the abdomen at the index laparotomy, if possible, even if there is a risk of a need of OA later. Therapeutic/care management study, level IV.

Post-Closure Inspection Report for the Tonopah Test Range, Nevada. For Calendar Year 2015, Revision 0

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

Matthews, Patrick; Petrello, Jaclyn

This report provides the results of the annual post-closure inspections conducted at the closed corrective action units (CAUs) located on the Tonopah Test Range (TTR), Nevada. This report covers calendar year 2015 and includes inspection and repair activities completed at the following CAUs; CAU 400: Bomblet Pit and Five Points Landfill (TTR); CAU 407: Roller Coaster RadSafe Area (TTR); CAU 424: Area 3 Landfill Complexes (TTR); CAU 453: Area 9 UXO Landfill (TTR); and CAU 487: Thunderwell Site (TTR) Inspections were conducted according to the post-closure plans in the approved closure reports and subsequent correspondence with the Nevada Division ofmore » Environmental Protection. The post-closure inspection plans and subsequent correspondence modifying the requirements for each CAU are included in Appendix B. The inspection checklists are included in Appendix C. Field notes are included in Appendix D. The annual post-closure inspections were conducted on May 12, 2015. Maintenance was required at CAU 453. Cracking along the north trench was repaired. One monument is missing at CAU 424; it will be replaced in 2016. Postings at CAUs 407, 424, 453, and 487 contain contact information for TTR Security. It was noted that protocols may not be in place to ensure that the U.S. Department of Energy, National Nuclear Security Administration Nevada Field Office (NNSA/NFO) is notified if access is needed at these sites. NNSA/NFO is working with the U.S. Air Force and Sandia to determine whether more appropriate contact information or new protocols are warranted for each CAU. Based on these inspections, there has not been a significant change in vegetation, and vegetation monitoring was not recommended at CAU 400 or CAU 407 in 2015.« less

Post-Closure Inspection Report for the Tonopah Test Range, Nevada, for Calendar Year 2013

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

Silvas, A. J.

2014-03-03

This report provides the results of the annual post-closure inspections conducted at the closed Corrective Action Units (CAUs) located on the Tonopah Test Range (TTR), Nevada. This report covers calendar year 2013 and includes inspection and repair activities completed at the following CAUs: • CAU 400: Bomblet Pit and Five Points Landfill (TTR) • CAU 407: Roller Coaster RadSafe Area (TTR) • CAU 424: Area 3 Landfill Complexes (TTR) • CAU 453: Area 9 UXO Landfill (TTR) • CAU 487: Thunderwell Site (TTR) Inspections were conducted according to the post-closure plans in the approved Closure Reports and subsequent correspondence withmore » the Nevada Division of Environmental Protection. The post-closure inspection plans and subsequent correspondence modifying the requirements for each CAU are included in Appendix B. The inspection checklists are included in Appendix C. Field notes are included in Appendix D. Photographs taken during inspections are included in Appendix E. The annual post-closure inspections were conducted on May 14, 2013. Maintenance was performed at CAU 400, CAU 424, and CAU 453. At CAU 400, animal burrows were backfilled. At CAU 424, erosion repairs were completed at Landfill Cell A3-3, subsidence was repaired at Landfill Cell A3-4, and additional lava rock was placed in high-traffic areas to mark the locations of the surface grade monuments at Landfill Cell A3-3 and Landfill Cell A3-8. At CAU 453, two areas of subsidence were repaired and animal burrows were backfilled. Vegetation monitoring was performed at the CAU 400 Five Points Landfill and CAU 407 in June 2013. The vegetation monitoring report is included in Appendix F.« less

Patent foramen ovale closure following cryptogenic stroke or transient ischaemic attack: Long-term follow-up of 301 cases.

PubMed

Mirzaali, Mikaeil; Dooley, Maureen; Wynne, Dylan; Cooter, Nina; Lee, Lorraine; Haworth, Peter; Saha, Romi; Gainsborough, Nicola; Hildick-Smith, David

2015-11-15

Patent foramen ovale has been identified as a conduit for paradoxical embolism resulting in cryptogenic stroke or transient ischemic attack (TIA). We aimed to establish rates of death, recurrent stroke or TIA among patients undergoing PFO closure for stroke or TIA at our unit. A retrospective analysis of all PFO closure patients was performed between May 2004 and January 2013. Follow up was performed by mortality tracing using the Medical Research Information Service of the Office of National Statistics. With regard to stroke or TIA recurrence, written consent forms and questionnaires were mailed with follow up telephone calls. Medical notes and imaging records were consulted where adverse events were noted. 301 patients aged 48.6 ± 11.0 years, 54.4% male, with ≥1 thromboembolic neurovascular event had percutaneous PFO closure with one of eight devices, with successful implantation in 99% of cases. Follow-up duration was 40.2 ± 26.2 months (range 1.3-105.3); complete in 301 patients for mortality (100%) and 283 patients (94.0%) for neurovascular events. Two patients died during follow-up (respiratory failure n = 1; road traffic accident n = 1). Recurrent stroke (MRI or CT confirmed) was observed in five patients (0.5%; 0.55 per 100 person-years) and TIA in 9 (1.1%; 0.98 per 100 person-years). Atrial fibrillation requiring treatment was documented in 14 patients (1.7%). Percutaneous PFO closure in patients with cryptogenic stroke or TIA is a safe treatment with a low incidence of procedural complications and recurrent neurovascular events. Registry data like these may help to demonstrate the utility of PFO closure in stroke. © 2015 Wiley Periodicals, Inc.

Post-Closure Report for Closed Resource Conservation and Recovery Act Corrective Action Units, Nevada National Security Site, Nevada: For Calendar Year 2017, Revision 0

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

Matthews, Patrick; Alvarado, Juan

This report serves as the combined annual report for post-closure activities for the following closed corrective action units (CAUs): CAU 90, Area 2 Bitcutter Containment CAU 91, Area 3 U-3fi Injection Well CAU 92, Area 6 Decon Pond Facility CAU 110, Area 3 WMD U-3ax/bl Crater CAU 111, Area 5 WMD Retired Mixed Waste Pits CAU 112, Area 23 Hazardous Waste Trenches The results of the inspections, a summary of maintenance activities, and an evaluation of monitoring data are presented in this report. Site inspections are conducted annually at CAUs 90, 91, and 112; semiannually at CAUs 92 and 110;more » and quarterly at CAU 111. Additional inspections are conducted at CAU 92 if precipitation occurs in excess of 1.0 inches in a 24-hour period and at CAU 111 if precipitation occurs in excess of 1.0 inch in a 24-hour period. Inspections include an evaluation of the condition of the units, including covers, fences, signs, gates, and locks. At CAU 110, soil moisture monitoring, vegetation evaluations, and subsidence surveys are conducted in addition to the visual inspections. At CAU 111, soil moisture monitoring, vegetation evaluations, subsidence surveys, direct radiation monitoring, air monitoring, radon flux monitoring, and groundwater monitoring are conducted. This report will address all monitoring items notes above except groundwater monitoring. Groundwater monitoring is documented in the Nevada National Security Site Data Report: Groundwater Monitoring Program Area 5 Radioactive Waste Management Site. All required inspections, maintenance, and monitoring were conducted in accordance with the post-closure requirements of the permit. Revision 4 of Permit NEV HW0101 was issued effective December 10, 2015, and remains in effect until December 10, 2020.« less

State Environmental Policy Act (SEPA) environmental checklist forms for 304 Concretion Facility Closure Plan. Revision 2

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

Not Available

The 300 Area of the Hanford Site contains reactor fuel manufacturing facilities and several research and development laboratories. Recyclable scrap uranium with zircaloy-2 and copper silicon alloy, uranium-titanium alloy, beryllium/zircaloy-2 alloy, and zircaloy-2 chips and fines were secured in concrete billets (7.5-gallon containers) in the 304 Facility, located in the 300 Area. The beryllium/zircaloy-2 alloy and zircaloy-2 chips and fines are designated as mixed waste with the characteristic of ignitability. The concretion process reduced the ignitability of the fines and chips for safe storage and shipment. This process has been discontinued and the 304 Facility is now undergoing closure asmore » defined in the Resource Conservation and Recovery Act (RCRA) of 1976 and the Washington Administrative Code (WAC) Dangerous Waste Regulations, WAC 173-303-040. This closure plan presents a description of the 304 Facility, the history of materials and waste managed, and the procedures that will be followed to close the 304 Facility. The 304 Facility is located within the 300-FF-3 (source) and 300-FF-5 (groundwater) operable units, as designated in the Hanford Federal Facility Agreement and Consent Order (Tri-Party Agreement) (Ecology et al. 1992). Contamination in the operable units 300-FF-3 and 300-FF-5 is scheduled to be addressed through the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) of 1980 remedial action process. Therefore, all soil remedial action at the 304 Facility will be conducted as part of the CERCLA remedial action of operable units 300-FF-3 and 300-FF-5.« less

Streamlined Approach for Environmental Restoration (SAFER) Plan for Corrective Action Unit 544: Cellars, Mud Pits, and Oil Spills, Nevada Test Site, Nevada, Revision 0

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

Mark Krauss

2010-07-01

This Streamlined Approach for Environmental Restoration (SAFER) Plan addresses the actions needed to achieve closure for Corrective Action Unit (CAU) 544, Cellars, Mud Pits, and Oil Spills, identified in the Federal Facility Agreement and Consent Order (FFACO). Corrective Action Unit 544 comprises the following 20 corrective action sites (CASs) located in Areas 2, 7, 9, 10, 12, 19, and 20 of the Nevada Test Site (NTS): • 02-37-08, Cellar & Mud Pit • 02-37-09, Cellar & Mud Pit • 07-09-01, Mud Pit • 09-09-46, U-9itsx20 PS #1A Mud Pit • 10-09-01, Mud Pit • 12-09-03, Mud Pit • 19-09-01, Mudmore » Pits (2) • 19-09-03, Mud Pit • 19-09-04, Mud Pit • 19-25-01, Oil Spill • 19-99-06, Waste Spill • 20-09-01, Mud Pits (2) • 20-09-02, Mud Pit • 20-09-03, Mud Pit • 20-09-04, Mud Pits (2) • 20-09-06, Mud Pit • 20-09-07, Mud Pit • 20-09-10, Mud Pit • 20-25-04, Oil Spills • 20-25-05, Oil Spills This plan provides the methodology for field activities needed to gather the necessary information for closing each CAS. There is sufficient information and process knowledge from historical documentation and investigations of similar sites regarding the expected nature and extent of potential contaminants to recommend closure of CAU 544 using the SAFER process. Using the approach approved for previous mud pit investigations (CAUs 530–535), 14 mud pits have been identified that • are either a single mud pit or a system of mud pits, • are not located in a radiologically posted area, and • have no evident biasing factors based on visual inspections. These 14 mud pits are recommended for no further action (NFA), and further field investigations will not be conducted. For the sites that do not meet the previously approved closure criteria, additional information will be obtained by conducting a field investigation before selecting the appropriate corrective action for each CAS. The results of the field investigation will support a defensible recommendation for closure of the remaining CASs in CAU 544. This will be presented in a closure report (CR) that will be prepared and submitted to the Nevada Division of Environmental Protection (NDEP) for review and approval. The sites will be investigated based on the data quality objectives (DQOs) developed on April 27, 2010, by representatives of NDEP and the U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Site Office (NNSA/NSO). The DQO process was used to identify and define the type, amount, and quality of data needed to determine and implement appropriate corrective actions for each CAS in CAU 544. The DQO process developed for this CAU identified the following expected closure options: (1) investigation and confirmation that no contamination exists above the final action levels (FALs) leading to an NFA declaration, (2) characterization of the nature and extent of contamination leading to closure in place with use restrictions, (3) clean closure by remediation and verification, (4) closure in place with use restrictions with no investigation if CASs are in crater areas that have been determined to be unsafe to enter, or (5) NFA if the mud pit CAS meets the criteria established during the CAUs 530–535 SAFER investigation. The following summarizes the SAFER activities that will support the closure of CAU 544: • Perform visual inspection of all CASs. • Perform site preparation activities (e.g., utilities clearances, construction of temporary site exclusion zones). • Removal of easily managed, nonhazardous, and nonradioactive debris, including vegetation (e.g., tumbleweeds), at various CASs that interfere with sampling, if required to inspect soil surface or collect soil sample. • Collect environmental samples from designated target populations (e.g., mud pits, cellars, stained soil) to confirm or disprove the presence of contaminants of concern (COCs) as necessary to supplement existing information. • If no COCs are present at a CAS, establish NFA as the corrective action. • If COCs exist, collect environmental samples from designated target populations (e.g., clean soil adjacent to contaminated soil) and submit for laboratory analyses to define the extent of COC contamination. • If a COC is present at a CAS, either - Establish clean closure as the corrective action. The material to be remediated will be removed, disposed of as waste, and verification samples will be collected from remaining soil, or - Establish closure in place as the corrective action and implement the appropriate use restrictions. • Confirm the preferred closure option is sufficient to protect human health and the environment.« less

SGS Closure Methodology for Surface-layer Rough-wall Turbulence.

NASA Astrophysics Data System (ADS)

Brasseur, James G.; Juneja, Anurag

1998-11-01

As reported in another abstract, necessary under-resolution and anisotropy of integral scales near the surface in LES of rough-wall boundary layers cause errors in the statistical structure of the modeled subgrid-scale (SGS) acceleration using eddy viscosity and similarity closures. The essential difficulty is an overly strong coupling between the modeled SGS stress tensor and predicted resolved velocity u^r. Specific to this problem, we propose a class of SGS closures in which subgrid scale velocities u^s1 between an explicit filter scale Δ and the grid scale δ are estimated from the solution to a separate prognostic equation, and the SGS stress tensor is formed using u^s1 as a surrogate for subgrid velocity u^s. The method is currently under development for pseudo-spectral LES where a filter at scales δ < Δ is explicit. The exact evolution equation for u^s1 contains dynamical interactions between u^r and u^s1 which can be calculated directly, and a term which is modeled to capture energy flux from the s1 scales without altering u^s1 structure. Three levels of closure for SGS stress are possible at different levels of accuracy and computational expense. The cheapest model has been tested with DNS and LES of anisotropic buoyancy-driven turbulence. Preliminary results show major improvement in the structure of the predicted SGS acceleration with much of the spurious coupling between u^r and SGS stress removed. Performance, predictions and cost of the three levels of closure are under analysis.

75 FR 76873 - Fisheries of the Caribbean, Gulf of Mexico, and South Atlantic; Snapper-Grouper Fishery Off the...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-09

... closure for South Atlantic snapper-grouper that extends from southern Georgia to northern Florida where harvest and possession of all snapper-grouper species is prohibited (except when fishing with black sea... regulations, recent fisheries regulations, and other circumstances other than regulations (rise in fuel costs...

40 CFR 270.290 - What general types of information must I keep at my facility?

Code of Federal Regulations, 2011 CFR

2011-07-01

... and power outages, (5) Prevent undue exposure of personnel to hazardous waste (for example, requiring.... (n) [Reserved] (o) The most recent closure cost estimate for your facility prepared under 40 CFR 267... land uses (residential, commercial, agricultural, recreational). (5) A wind rose (i.e., prevailing wind...

40 CFR 270.290 - What general types of information must I keep at my facility?

Code of Federal Regulations, 2010 CFR

2010-07-01

... and power outages, (5) Prevent undue exposure of personnel to hazardous waste (for example, requiring.... (n) [Reserved] (o) The most recent closure cost estimate for your facility prepared under 40 CFR 267... land uses (residential, commercial, agricultural, recreational). (5) A wind rose (i.e., prevailing wind...

Eye care for patients receiving neuromuscular blocking agents or propofol during mechanical ventilation.

PubMed

Lenart, S B; Garrity, J A

2000-05-01

The presence of a corneal reflex and the ability to maintain eye closure are instrumental in protecting the cornea. Use of neuromuscular blocking agents or propofol can result in impaired eyelid closure and loss of corneal reflex, leading to corneal exposure. The cornea is then at risk for drying, infection, and scarring, which may lead to permanent visual loss. To determine whether applying artificial tear ointment to the eyes of paralyzed or heavily sedated patients receiving mechanical ventilation decreases the prevalence of exposure keratitis more than does passive closure of the eyelid. A prospective, randomized control trial was done. The sample was 50 patients in the intensive care unit receiving either neuromuscular blocking agents or propofol during mechanical ventilation. In each patient, artificial tear ointment was applied to one eye; passive closure of the eyelid was used for the other eye (control eye). Nine patients had evidence of exposure keratitis in the untreated eye, and 2 had corneal abrasions in both the treated and the control eyes. The remaining 39 patients did not have corneal abrasions in either eye. Use of the artificial tear ointment was more effective in preventing corneal exposure than was passive eyelid closure (P = .004). Eye care with a lubricating ointment on a regular, set schedule can effectively reduce the prevalence of corneal abrasions in patients who are either paralyzed or heavily sedated and thus can help prevent serious complications such as corneal ulceration, infection, and visual loss.

A ten-year review of enterocutaneous fistulas after laparotomy for trauma.

PubMed

Fischer, Peter E; Fabian, Timothy C; Magnotti, Louis J; Schroeppel, Thomas J; Bee, Tiffany K; Maish, George O; Savage, Stephanie A; Laing, Ashley E; Barker, Andrew B; Croce, Martin A

2009-11-01

In the era of open abdomen management, the complication of enterocutaneous fistula (ECF) seems to be increasing in frequency. In nontrauma patients, reported mortality rates are 7% to 20%, and spontaneous closure rates are approximately 25%. This study is the largest series of ECFs reported exclusively caused by trauma and examines the characteristics unique to this population. Trauma patients with an ECF at a single regional trauma center over a 10-year period were reviewed. Parameters studied included fistula output, site, nutritional status, operative history, and fistula resolution (spontaneous vs. operative). Approximately 2,224 patients received a trauma laparotomy and survived longer than 4 days. Of these, 43 patients (1.9%) had ECF. The rate of ECF in men was 2.22% and 0.74% in women. Patients with open abdomen had a higher ECF incidence (8% vs. 0.5%) and lower rate of spontaneous closure (37% vs. 45%). Spontaneous closure occurred in 31% with high-output fistulas, 13% with medium output, and 55% with low output. The mortality rate of ECF was 14% after an average stay of 59 days in the intensive care unit. With damage-control laparotomies, the traumatic ECF rate is increasing and is a different entity than nontraumatic ECF. Although the two populations have similar mortality rates, the trauma cohort demonstrates higher spontaneous closure rates and a curiously higher rate of development in men. Fistula output was not predictive of spontaneous closure.