Exploring how different modes of governance act across health system levels to influence primary healthcare facility managers' use of information in decision-making: experience from Cape Town, South Africa.

PubMed

Scott, Vera; Gilson, Lucy

2017-09-15

Governance, which includes decision-making at all levels of the health system, and information have been identified as key, interacting levers of health system strengthening. However there is an extensive literature detailing the challenges of supporting health managers to use formal information from health information systems (HISs) in their decision-making. While health information needs differ across levels of the health system there has been surprisingly little empirical work considering what information is actually used by primary healthcare facility managers in managing, and making decisions about, service delivery. This paper, therefore, specifically examines experience from Cape Town, South Africa, asking the question: How is primary healthcare facility managers' use of information for decision-making influenced by governance across levels of the health system? The research is novel in that it both explores what information these facility managers actually use in decision-making, and considers how wider governance processes influence this information use. An academic researcher and four facility managers worked as co-researchers in a multi-case study in which three areas of management were served as the cases. There were iterative cycles of data collection and collaborative analysis with individual and peer reflective learning over a period of three years. Central governance shaped what information and knowledge was valued - and, therefore, generated and used at lower system levels. The central level valued formal health information generated in the district-based HIS which therefore attracted management attention across the levels of the health system in terms of design, funding and implementation. This information was useful in the top-down practices of planning and management of the public health system. However, in facilities at the frontline of service delivery, there was a strong requirement for local, disaggregated information and experiential knowledge to make locally-appropriate and responsive decisions, and to perform the people management tasks required. Despite central level influences, modes of governance operating at the subdistrict level had influence over what information was valued, generated and used locally. Strengthening local level managers' ability to create enabling environments is an important leverage point in supporting informed local decision-making, and, in turn, translating national policies and priorities, including equity goals, into appropriate service delivery practices.

A decision support model to understand route choice decisions and siting of facilities in emergency evacuation.

DOT National Transportation Integrated Search

2013-10-01

In this research, we present the results of a behavior model to capture different routing strategies executed by evacuees : during hurricane evacuation by using a randomparameter logitbased modeling approach. To the best of our knowledge, : thi...

Facility Energy Decision System (FEDS) Assessment Report for Fort Buchanan, Puerto Rico

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

Chvala, William D.; Solana, Amy E.; Dixon, Douglas R.

2005-02-01

This report documents the findings of the Facility Energy Decision System (FEDS) assessment at Fort Buchanan, Puerto Rico, by a team of PNNL engineers under contract to the Installation Management Agency (IMA) Southeast Region Office (SERO). Funding support was also provided by the Department of Energy's Federal Energy Management Program. The purpose of the assessment was to determine how energy is consumed at Fort Buchanan, identify the most cost-effective energy retrofit measures, and calculate the potential energy and cost savings.

A multicriteria decision making model for assessment and selection of an ERP in a logistics context

NASA Astrophysics Data System (ADS)

Pereira, Teresa; Ferreira, Fernanda A.

2017-07-01

The aim of this work is to apply a methodology of decision support based on a multicriteria decision analyses (MCDA) model that allows the assessment and selection of an Enterprise Resource Planning (ERP) in a Portuguese logistics company by Group Decision Maker (GDM). A Decision Support system (DSS) that implements a MCDA - Multicriteria Methodology for the Assessment and Selection of Information Systems / Information Technologies (MMASSI / IT) is used based on its features and facility to change and adapt the model to a given scope. Using this DSS it was obtained the information system that best suited to the decisional context, being this result evaluated through a sensitivity and robustness analysis.

Factors related to the decision-making for moving the older adults into long-term care facilities in Taiwan.

PubMed

Hsieh, Yen-Ping; Huang, Ying-Chia; Lan, Shou-Jen; Ho, Ching-Sung

2017-09-01

To investigate the relationships between demographic characteristics of the elderly, type of long-term care (LTC) facilities, and the reasons for moving into LTC facilities. Research participants included people aged over 65 years, living in LTC facilities. A total of 1280 questionnaires were distributed to 111 LTC facilities in Taiwan; 480 questionnaires were retrieved, and 232 were included in the valid sample. The study used a non-linear canonical correlation analysis, which assesses the relationships among similar sets of categorical variables. The results showed that the older adults in quadrant I were characterized by being involved in the decision-making regarding the choice of LTC facilities and received economic support from their children. The older adults in quadrant II mainly lived in LTC facilities to receive medical care, whereas those in quadrant III typically included individuals with low income, who did not choose to live in LTC facilities. Furthermore, those in quadrant IV had positive cognitions associated with LTC facilities. We believe that the results of the present study will facilitate policy-making in the field of LTC, provide reference to the practitioners and the older adults, and identify the types of decisions older adults make when moving into LTC facilities, thus assisting older adults to improve their strategies regarding staying in LTC facilities. Geriatr Gerontol Int 2017; 17: 1319-1327. © 2016 Japan Geriatrics Society.

Why do women choose private over public facilities for family planning services? A qualitative study of post-partum women in an informal urban settlement in Kenya.

PubMed

Keesara, Sirina R; Juma, Pamela A; Harper, Cynthia C

2015-08-20

Nearly 40% of women in developing countries seek contraceptives services from the private sector. However, the reasons that contraceptive clients choose private or public providers are not well studied. We conducted six focus groups discussions and 51 in-depth interviews with postpartum women (n = 61) to explore decision-making about contraceptive use after delivery, including facility choice. When seeking contraceptive services, women in this study preferred private over public facilities due to convenience and timeliness of services. Women avoided public facilities due to long waits and disrespectful providers. Study participants reported, however, that they felt more confident about the technical medical quality in public facilities than in private, and believed that private providers prioritized profit over safe medical practice. Women reported that public facilities offered comprehensive counseling and chose these facilities when they needed contraceptive decision-support. Provision of comprehensive counseling and screening, including side effects counseling and management, determined perception of quality. Women believed private providers offered the advantages of convenience, efficiency and privacy, though they did not consistently offer high-quality care. Quality-improvement of contraceptive care at private facilities could include technical standardization and accreditation. Development of support and training for side effect management may be an important intervention to improve perceived quality of care.

Capacity planning for electronic waste management facilities under uncertainty: multi-objective multi-time-step model development.

PubMed

Poonam Khanijo Ahluwalia; Nema, Arvind K

2011-07-01

Selection of optimum locations for locating new facilities and decision regarding capacities at the proposed facilities is a major concern for municipal authorities/managers. The decision as to whether a single facility is preferred over multiple facilities of smaller capacities would vary with varying priorities to cost and associated risks such as environmental or health risk or risk perceived by the society. Currently management of waste streams such as that of computer waste is being done using rudimentary practices and is flourishing as an unorganized sector, mainly as backyard workshops in many cities of developing nations such as India. Uncertainty in the quantification of computer waste generation is another major concern due to the informal setup of present computer waste management scenario. Hence, there is a need to simultaneously address uncertainty in waste generation quantities while analyzing the tradeoffs between cost and associated risks. The present study aimed to address the above-mentioned issues in a multi-time-step, multi-objective decision-support model, which can address multiple objectives of cost, environmental risk, socially perceived risk and health risk, while selecting the optimum configuration of existing and proposed facilities (location and capacities).

Patient education and emotional support practices in abortion care facilities in the United States.

PubMed

Gould, Heather; Perrucci, Alissa; Barar, Rana; Sinkford, Danielle; Foster, Diana Greene

2012-01-01

Little is known about how patient education and emotional support is provided at abortion facilities. This pilot study documents 27 facilities' practices in this aspect of abortion care. We conducted confidential telephone interviews with staff from 27 abortion facilities about their practices. The majority of facilities reported they rely primarily on trained nonclinician staff to educate patients and provide emotional support. As part of their informed consent and counseling processes, facilities reported that staff always provide patients with information about the procedure (96%), assess the certainty of their abortion decisions (92%), assess their feelings and provide emotional support (74%), and provide contraceptive health education (92%). Time spent providing these components of care varied across facilities and patients. When describing their facility's care philosophy, many respondents expressed support for "patient-centered," "supportive," "nonjudgmental" care. Eighty-two percent agreed that it is the facility's role to provide counseling for emotional issues related to abortion. All facilities valued informed consent, patient education, and emotional support. Although the majority of facilities considered counseling for emotional issues to be a part of their role, some did not. Future research should examine patients' preferences regarding abortion care and counseling and how different approaches to care affect women's emotional well-being after having an abortion. This information is important in light of current, widespread legislative efforts that aim to regulate abortion counseling, which are being proposed without an understanding of patient needs or facility practices. Copyright © 2012 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Space station systems analysis study. Part 1, volume 1: Executive study

NASA Technical Reports Server (NTRS)

1976-01-01

Potential space station system options were examined for a permanent, manned, orbital space facility and to provide data to NASA program planners and decision makers for their use in future program planning. There were ten space station system objectives identified. These were categorized into five major objectives and five supporting objectives. The major objectives were to support the development of: (1) satellite power systems, (2) nuclear energy plants in space, (3) space processing, (4) earth services, and (5) space cosmological research and development. The five supporting objectives, to define space facilities which would be basic building blocks for future systems, were: (1) a multidiscipline science laboratory, (2) an orbital depot to maintain, fuel, and service orbital transfer vehicles, (3) cluster support systems to provide power and data processing for multiple orbital elements, (4) a sensor development facility, and (5) the facilities necessary to enhance man's living and working in space.

Waste management facility accident analysis (WASTE ACC) system: software for analysis of waste management alternatives

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

Kohout, E.F.; Folga, S.; Mueller, C.

1996-03-01

This paper describes the Waste Management Facility Accident Analysis (WASTE{underscore}ACC) software, which was developed at Argonne National Laboratory (ANL) to support the US Department of Energy`s (DOE`s) Waste Management (WM) Programmatic Environmental Impact Statement (PEIS). WASTE{underscore}ACC is a decision support and database system that is compatible with Microsoft{reg_sign} Windows{trademark}. It assesses potential atmospheric releases from accidents at waste management facilities. The software provides the user with an easy-to-use tool to determine the risk-dominant accident sequences for the many possible combinations of process technologies, waste and facility types, and alternative cases described in the WM PEIS. In addition, its structure willmore » allow additional alternative cases and assumptions to be tested as part of the future DOE programmatic decision-making process. The WASTE{underscore}ACC system demonstrates one approach to performing a generic, systemwide evaluation of accident risks at waste management facilities. The advantages of WASTE{underscore}ACC are threefold. First, the software gets waste volume and radiological profile data that were used to perform other WM PEIS-related analyses directly from the WASTE{underscore}MGMT system. Second, the system allows for a consistent analysis across all sites and waste streams, which enables decision makers to understand more fully the trade-offs among various policy options and scenarios. Third, the system is easy to operate; even complex scenario runs are completed within minutes.« less

77 FR 67013 - Decision To Evaluate a Petition To Designate a Class of Employees From the Battelle Laboratories...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-08

... evaluation, is as follows: Facility: Battelle Laboratories King Avenue Location: Columbus, Ohio. Job Titles and/or Job Duties: All Atomic Weapons Employees who worked at the King Avenue facility in Columbus...: Stuart L. Hinnefeld, Director, Division of Compensation Analysis and Support, National Institute for...

Taking a Fresh Look at Facilities Data: Lessons Learned

ERIC Educational Resources Information Center

Coburn, Kari C.

2007-01-01

This chapter highlights some important themes from the previous chapters in this volume that will assist institutional research professionals and other higher education leaders interested in expanding use of facilities data in planning and decision making: (1) What you don't know can hurt you; (2) Operational systems are not designed to support ad…

An Integrated Decision Support System for Planning and Measuring Institutional Efficiency. AIR 1992 Annual Forum Paper.

ERIC Educational Resources Information Center

Minnaar, Phil C.

This paper presents a model for obtaining and organizing managment information for decision making in university planning, developed by the Bureau for Management Information of the University of South Africa. The model identifies the fundamental entities of the university as environment, finance, physical facilities, assets, personnel, and…

Choice-Making among Medicaid HCBS and ICF/MR Recipients in Six States

ERIC Educational Resources Information Center

Lakin, K. Charlie; Doljanac, Robert; Byun, Soo-Yong; Stancliffe, Roger; Taub, Sarah; Chiri, Giuseppina

2008-01-01

Choice in everyday decisions and in support-related decisions was addressed among 2,398 adults with intellectual and developmental disabilities receiving Medicaid Home and Community Based Services (HCBS) and Intermediate Care Facility (ICF/MR) services and living in nonfamily settings in six states. Everyday choice in daily life and in…

Evaluating the Quality of Patient Decision-Making Regarding Post-Acute Care.

PubMed

Burke, Robert E; Jones, Jacqueline; Lawrence, Emily; Ladebue, Amy; Ayele, Roman; Leonard, Chelsea; Lippmann, Brandi; Matlock, Daniel D; Allyn, Rebecca; Cumbler, Ethan

2018-05-01

Despite a national focus on post-acute care brought about by recent payment reforms, relatively little is known about how hospitalized older adults and their caregivers decide whether to go to a skilled nursing facility (SNF) after hospitalization. We sought to understand to what extent hospitalized older adults and their caregivers are empowered to make a high-quality decision about utilizing an SNF for post-acute care and what contextual or process elements led to satisfaction with the outcome of their decision once in SNF. Qualitative inquiry using the Ottawa Decision Support Framework (ODSF), a conceptual framework that describes key components of high-quality decision-making. Thirty-two previously community-dwelling older adults (≥ 65 years old) and 22 caregivers interviewed at three different hospitals and three skilled nursing facilities. We used key components of the ODSF to identify elements of context and process that affected decision-making and to what extent the outcome was characteristic of a high-quality decision: informed, values based, and not associated with regret or blame. The most important contextual themes were the presence of active medical conditions in the hospital that made decision-making difficult, prior experiences with hospital readmission or SNF, relative level of caregiver support, and pressure to make a decision quickly for which participants felt unprepared. Patients described playing a passive role in the decision-making process and largely relying on recommendations from the medical team. Patients commonly expressed resignation and a perceived lack of choice or autonomy, leading to dissatisfaction with the outcome. Understanding and intervening to improve the quality of decision-making regarding post-acute care supports is essential for improving outcomes of hospitalized older adults. Our results suggest that simply providing information is not sufficient; rather, incorporating key contextual factors and improving the decision-making process for both patients and clinicians are also essential.

Differences in Experiences With Care Between Homeless and Nonhomeless Patients in Veterans Affairs Facilities With Tailored and Nontailored Primary Care Teams.

PubMed

Jones, Audrey L; Hausmann, Leslie R M; Kertesz, Stefan; Suo, Ying; Cashy, John P; Mor, Maria K; Schaefer, James H; Gundlapalli, Adi V; Gordon, Adam J

2018-05-12

Homeless patients describe poor experiences with primary care. In 2012, the Veterans Health Administration (VHA) implemented homeless-tailored primary care teams (Homeless Patient Aligned Care Team, HPACTs) that could improve the primary care experience for homeless patients. To assess differences in primary care experiences between homeless and nonhomeless Veterans receiving care in VHA facilities that had HPACTs available (HPACT facilities) and in VHA facilities lacking HPACTs (non-HPACT facilities). We used multivariable multinomial regressions to estimate homeless versus nonhomeless patient differences in primary care experiences (categorized as negative/moderate/positive) reported on a national VHA survey. We compared the homeless versus nonhomeless risk differences (RDs) in reporting negative or positive experiences in 25 HPACT facilities versus 485 non-HPACT facilities. Survey respondents from non-HPACT facilities (homeless: n=10,148; nonhomeless: n=309,779) and HPACT facilities (homeless: n=2022; nonhomeless: n=20,941). Negative and positive experiences with access, communication, office staff, provider rating, comprehensiveness, coordination, shared decision-making, and self-management support. In non-HPACT facilities, homeless patients reported more negative and fewer positive experiences than nonhomeless patients. However, these patterns of homeless versus nonhomeless differences were reversed in HPACT facilities for the domains of communication (positive experience RDs in non-HPACT versus HPACT facilities=-2.0 and 2.0, respectively); comprehensiveness (negative RDs=2.1 and -2.3), shared decision-making (negative RDs=1.2 and -1.8), and self-management support (negative RDs=0.1 and -4.5; positive RDs=0.5 and 8.0). VHA facilities with HPACT programs appear to offer a better primary care experience for homeless versus nonhomeless Veterans, reversing the pattern of relatively poor primary care experiences often associated with homelessness.

Political economy of decentralising HIV and AIDS treatment services to primary healthcare facilities in three Nigerian states.

PubMed

Mbachu, Chinyere; Onwujekwe, Obinna; Ezumah, Nkoli; Ajayi, Olayinka; Sanwo, Olusola; Uzochukwu, Benjamin

2016-09-01

Decentralisation is defined as the dispersion, distribution or transfer of resources, functions and decision-making power from a central authority to regional and local authorities. It is usually accompanied by assignment of accountability and responsibility for results. Fundamental to understanding decentralisation is learning what motivates central governments to give up power and resources to local governments, and the practical significance of this on their positions regarding decentralisation. This study examined key political and institutional influences on role-players' capacity to support decentralisation of HIV and AIDS treatment services to primary healthcare facilities, and implications for sustainability. In-depth interviews were conducted with 55 purposively selected key informants, drawn from three Nigerian states that were at different stages of decentralising HIV and AIDS treatment services to primary care facilities. Key informants represented different categories of role-players involved in HIV and AIDS control programmes. Thematic framework analysis of data was done. Support for decentralisation of HIV and AIDS treatment services to primary healthcare facilities was substantial among different categories of actors. Political factors such as the local and global agenda for health, political tenure and party affiliations, and institutional factors such as consolidation of decision-making power and improvements in career trajectories, influenced role-players support for decentralisation of HIV and AIDS treatment services. It is feasible and acceptable to decentralise HIV and AIDS treatment services to primary healthcare facilities, to help improve coverage. However, role-players' support largely depends on how well the reform aligns with political structures and current institutional practices.

75 FR 55792 - Decision To Evaluate a Petition To Designate a Class of Employees From the Wah Chang Facility...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-14

... warranted by the evaluation, is as follows: Facility: Wah Chang. Location: Albany, Oregon. Job Titles and/or Job Duties: All employees who worked in any buildings. Period of Employment: Operational period from... of Compensation Analysis and Support, National Institute for Occupational Safety and Health (NIOSH...

Use of information systems in Air Force medical treatment facilities in strategic planning and decision-making.

PubMed

Yap, Glenn A; Platonova, Elena A; Musa, Philip F

2006-02-01

An exploratory study used Ansoff's strategic planning model as a framework to assess perceived effectiveness of information systems in supporting strategic business plan development at Air Force medical treatment facilities (MTFs). Results showed information systems were most effective in supporting historical trend analysis, strategic business plans appeared to be a balance of operational and strategic plans, and facilities perceived a greater need for new clinical, vice administrative, information systems to support strategic planning processes. Administrators believed information systems should not be developed at the local level and perceived information systems have the greatest impact on improving clinical quality outcomes, followed by ability to deliver cost effective care and finally, ability to increase market share.

Community Support for a Gold Cyanide Process Mine: Resident and Leader Differences in Rural Montana

ERIC Educational Resources Information Center

Richards, Rebecca T.; Brod, Rodney L.

2004-01-01

Previous studies have established that community residents and leaders differ in their support for hazardous waste facility siting in rural areas (Spies et al. 1998). We examine whether these same differences exist in rural communities that face other high-risk development decisions by analyzing resident and leader support for a proposed gold…

Evolution Of USDOE Performance Assessments Over 20 Years

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

Seitz, Roger R.; Suttora, Linda C.

2013-02-26

Performance assessments (PAs) have been used for many years for the analysis of post-closure hazards associated with a radioactive waste disposal facility and to provide a reasonable expectation of the ability of the site and facility design to meet objectives for the protection of members of the public and the environment. The use of PA to support decision-making for LLW disposal facilities has been mandated in United States Department of Energy (USDOE) directives governing radioactive waste management since 1988 (currently DOE Order 435.1, Radioactive Waste Management). Prior to that time, PAs were also used in a less formal role. Overmore » the past 20+ years, the USDOE approach to conduct, review and apply PAs has evolved into an efficient, rigorous and mature process that includes specific requirements for continuous improvement and independent reviews. The PA process has evolved through refinement of a graded and iterative approach designed to help focus efforts on those aspects of the problem expected to have the greatest influence on the decision being made. Many of the evolutionary changes to the PA process are linked to the refinement of the PA maintenance concept that has proven to be an important element of USDOE PA requirements in the context of supporting decision-making for safe disposal of LLW. The PA maintenance concept represents the evolution of the graded and iterative philosophy and has helped to drive the evolution of PAs from a deterministic compliance calculation into a systematic approach that helps to focus on critical aspects of the disposal system in a manner designed to provide a more informed basis for decision-making throughout the life of a disposal facility (e.g., monitoring, research and testing, waste acceptance criteria, design improvements, data collection, model refinements). A significant evolution in PA modeling has been associated with improved use of uncertainty and sensitivity analysis techniques to support efficient implementation of the graded and iterative approach. Rather than attempt to exactly predict the migration of radionuclides in a disposal unit, the best PAs have evolved into tools that provide a range of results to guide decision-makers in planning the most efficient, cost effective, and safe disposal of radionuclides.« less

75 FR 23252 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-03

... Logistics Agency to gather business, industrial capability (employment, skills, facilities, equipment... assessments and to support DoD strategic planning and decisions. Such data is essential to the Department of...

Institutional Transformation Model

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

2015-10-19

Reducing the energy consumption of large institutions with dozens to hundreds of existing buildings while maintaining and improving existing infrastructure is a critical economic and environmental challenge. SNL's Institutional Transformation (IX) work integrates facilities and infrastructure sustainability technology capabilities and collaborative decision support modeling approaches to help facilities managers at Sandia National Laboratories (SNL) simulate different future energy reduction strategies and meet long term energy conservation goals.

Complying with Executive Order 13148 using the Enterprise Environmental Safety And Occupational Health Management Information System.

PubMed

McFarland, Michael J; Nelson, Tim M; Rasmussen, Steve L; Palmer, Glenn R; Olivas, Arthur C

2005-03-01

All U.S. Department of Defense (DoD) facilities are required under Executive Order (EO) 13148, "Greening the Government through Leadership in Environmental Management," to establish quality-based environmental management systems (EMSs) that support environmental decision-making and verification of continuous environmental improvement by December 31, 2005. Compliance with EO 13148 as well as other federal, state, and local environmental regulations places a significant information management burden on DoD facilities. Cost-effective management of environmental data compels DoD facilities to establish robust database systems that not only address the complex and multifaceted environmental monitoring, record-keeping, and reporting requirements demanded by these rules but enable environmental management decision-makers to gauge improvements in environmental performance. The Enterprise Environmental Safety and Occupational Health Management Information System (EESOH-MIS) is a new electronic database developed by the U.S. Air Force to manage both the data needs associated with regulatory compliance programs across its facilities as well as the non-regulatory environmental information that supports installation business practices. The U.S. Air Force, which has adopted the Plan-Do-Check-Act methodology as the EMS standard that it will employ to address EO 13148 requirements.

Facility Design and Health Management Program at the Sinnhuber Aquatic Research Laboratory

PubMed Central

Barton, Carrie L.; Johnson, Eric W.

2016-01-01

Abstract The number of researchers and institutions moving to the utilization of zebrafish for biomedical research continues to increase because of the recognized advantages of this model. Numerous factors should be considered before building a new or retooling an existing facility. Design decisions will directly impact the management and maintenance costs. We and others have advocated for more rigorous approaches to zebrafish health management to support and protect an increasingly diverse portfolio of important research. The Sinnhuber Aquatic Research Laboratory (SARL) is located ∼3 miles from the main Oregon State University campus in Corvallis, Oregon. This facility supports several research programs that depend heavily on the use of adult, larval, and embryonic zebrafish. The new zebrafish facility of the SARL began operation in 2007 with a commitment to build and manage an efficient facility that diligently protects human and fish health. An important goal was to ensure that the facility was free of Pseudoloma neurophilia (Microsporidia), which is very common in zebrafish research facilities. We recognize that there are certain limitations in space, resources, and financial support that are institution dependent, but in this article, we describe the steps taken to build and manage an efficient specific pathogen-free facility. PMID:26981844

Facility Design and Health Management Program at the Sinnhuber Aquatic Research Laboratory.

PubMed

Barton, Carrie L; Johnson, Eric W; Tanguay, Robert L

2016-07-01

The number of researchers and institutions moving to the utilization of zebrafish for biomedical research continues to increase because of the recognized advantages of this model. Numerous factors should be considered before building a new or retooling an existing facility. Design decisions will directly impact the management and maintenance costs. We and others have advocated for more rigorous approaches to zebrafish health management to support and protect an increasingly diverse portfolio of important research. The Sinnhuber Aquatic Research Laboratory (SARL) is located ∼3 miles from the main Oregon State University campus in Corvallis, Oregon. This facility supports several research programs that depend heavily on the use of adult, larval, and embryonic zebrafish. The new zebrafish facility of the SARL began operation in 2007 with a commitment to build and manage an efficient facility that diligently protects human and fish health. An important goal was to ensure that the facility was free of Pseudoloma neurophilia (Microsporidia), which is very common in zebrafish research facilities. We recognize that there are certain limitations in space, resources, and financial support that are institution dependent, but in this article, we describe the steps taken to build and manage an efficient specific pathogen-free facility.

a Novel Approach to Support Majority Voting in Spatial Group Mcdm Using Density Induced Owa Operator for Seismic Vulnerability Assessment

NASA Astrophysics Data System (ADS)

Moradi, M.; Delavar, M. R.; Moshiri, B.; Khamespanah, F.

2014-10-01

Being one of the most frightening disasters, earthquakes frequently cause huge damages to buildings, facilities and human beings. Although the prediction of characteristics of an earthquake seems to be impossible, its loss and damage is predictable in advance. Seismic loss estimation models tend to evaluate the extent to which the urban areas are vulnerable to earthquakes. Many factors contribute to the vulnerability of urban areas against earthquakes including age and height of buildings, the quality of the materials, the density of population and the location of flammable facilities. Therefore, seismic vulnerability assessment is a multi-criteria problem. A number of multi criteria decision making models have been proposed based on a single expert. The main objective of this paper is to propose a model which facilitates group multi criteria decision making based on the concept of majority voting. The main idea of majority voting is providing a computational tool to measure the degree to which different experts support each other's opinions and make a decision regarding this measure. The applicability of this model is examined in Tehran metropolitan area which is located in a seismically active region. The results indicate that neglecting the experts which get lower degrees of support from others enables the decision makers to avoid the extreme strategies. Moreover, a computational method is proposed to calculate the degree of optimism in the experts' opinions.

Risk-based decision making for terrorism applications.

PubMed

Dillon, Robin L; Liebe, Robert M; Bestafka, Thomas

2009-03-01

This article describes the anti-terrorism risk-based decision aid (ARDA), a risk-based decision-making approach for prioritizing anti-terrorism measures. The ARDA model was developed as part of a larger effort to assess investments for protecting U.S. Navy assets at risk and determine whether the most effective anti-terrorism alternatives are being used to reduce the risk to the facilities and war-fighting assets. With ARDA and some support from subject matter experts, we examine thousands of scenarios composed of 15 attack modes against 160 facility types on two installations and hundreds of portfolios of 22 mitigation alternatives. ARDA uses multiattribute utility theory to solve some of the commonly identified challenges in security risk analysis. This article describes the process and documents lessons learned from applying the ARDA model for this application.

Assessment of Space Nuclear Thermal Propulsion Facility and Capability Needs

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

James Werner

The development of a Nuclear Thermal Propulsion (NTP) system rests heavily upon being able to fabricate and demonstrate the performance of a high temperature nuclear fuel as well as demonstrating an integrated system prior to launch. A number of studies have been performed in the past which identified the facilities needed and the capabilities available to meet the needs and requirements identified at that time. Since that time, many facilities and capabilities within the Department of Energy have been removed or decommissioned. This paper provides a brief overview of the anticipated facility needs and identifies some promising concepts to bemore » considered which could support the development of a nuclear thermal propulsion system. Detailed trade studies will need to be performed to support the decision making process.« less

Identification of design features to enhance utilization and acceptance of systems for Internet-based decision support at the point of care.

PubMed

Gadd, C S; Baskaran, P; Lobach, D F

1998-01-01

Extensive utilization of point-of-care decision support systems will be largely dependent on the development of user interaction capabilities that make them effective clinical tools in patient care settings. This research identified critical design features of point-of-care decision support systems that are preferred by physicians, through a multi-method formative evaluation of an evolving prototype of an Internet-based clinical decision support system. Clinicians used four versions of the system--each highlighting a different functionality. Surveys and qualitative evaluation methodologies assessed clinicians' perceptions regarding system usability and usefulness. Our analyses identified features that improve perceived usability, such as telegraphic representations of guideline-related information, facile navigation, and a forgiving, flexible interface. Users also preferred features that enhance usefulness and motivate use, such as an encounter documentation tool and the availability of physician instruction and patient education materials. In addition to identifying design features that are relevant to efforts to develop clinical systems for point-of-care decision support, this study demonstrates the value of combining quantitative and qualitative methods of formative evaluation with an iterative system development strategy to implement new information technology in complex clinical settings.

Logical design of a decision support system to forecast technology, prices and costs for the national communications system

NASA Astrophysics Data System (ADS)

Williams, K. A.; Partridge, E. C., III

1984-09-01

Originally envisioned as a means to integrate the many systems found throughout the government, the general mission of the NCS continues to be to ensure the survivability of communications during and subsequent to any national emergency. In order to accomplish this mission the NCS is an arrangement of heterogeneous telecommunications systems which are provided by their sponsor Federal agencies. The physical components of Federal telecommunications systems and networks include telephone and digital data switching facilities and primary common user communications centers; Special purpose local delivery message switching and exchange facilities; Government owned or leased radio systems; Technical control facilities which are under exclusive control of a government agency. This thesis describes the logical design of a proposed decision support system for use by the National Communications System in forecasting technology, prices, and costs. It is general in nature and only includes those forecasting models which are suitable for computer implementation. Because it is a logical design it can be coded and applied in many different hardware and/or software configurations.

Graphical User Interface Development and Design to Support Airport Runway Configuration Management

NASA Technical Reports Server (NTRS)

Jones, Debra G.; Lenox, Michelle; Onal, Emrah; Latorella, Kara A.; Lohr, Gary W.; Le Vie, Lisa

2015-01-01

The objective of this effort was to develop a graphical user interface (GUI) for the National Aeronautics and Space Administration's (NASA) System Oriented Runway Management (SORM) decision support tool to support runway management. This tool is expected to be used by traffic flow managers and supervisors in the Airport Traffic Control Tower (ATCT) and Terminal Radar Approach Control (TRACON) facilities.

75 FR 68334 - Record of Decision (ROD) for Training Range and Garrison Support Facilities Construction and...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-05

... for the protection of the environment, mission needs, and Soldier and Family quality of life... Preservation Office is complete. Moderate adverse impacts have been identified for soils, water quality...

77 FR 12593 - Decision To Evaluate a Petition To Designate a Class of Employees From the Ventron Corporation...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-01

...: Facility: Ventron Corporation. Location: Beverly, Massachusetts. Job Titles and/or Job Duties: All Atomic... FURTHER INFORMATION CONTACT: Stuart L. Hinnefeld, Director, Division of Compensation Analysis and Support...

Berkeley bicycle plan : draft for inclusion in the general plan

DOT National Transportation Integrated Search

1998-12-31

The City of Berkeley has long supported bicycling as an environmentally friendly, healthy, lowcost method of transportation and recreation. Frequently, roadway facility and funding decisions are made with little consideration for bicycling as a serio...

Promising adoption of an electronic clinical decision support system for antenatal and intrapartum care in rural primary healthcare facilities in sub-Saharan Africa: The QUALMAT experience.

PubMed

Sukums, Felix; Mensah, Nathan; Mpembeni, Rose; Massawe, Siriel; Duysburgh, Els; Williams, Afua; Kaltschmidt, Jens; Loukanova, Svetla; Haefeli, Walter E; Blank, Antje

2015-09-01

The QUALMAT project has successfully implemented an electronic clinical decision support system (eCDSS) for antenatal and intrapartum care in two sub-Saharan African countries. The system was introduced to facilitate adherence to clinical practice guidelines and to support decision making during client encounter to bridge the know-do gap of health workers. This study aimed to describe health workers' acceptance and use of the eCDSS for maternal care in rural primary health care (PHC) facilities of Ghana and Tanzania and to identify factors affecting successful adoption of such a system. This longitudinal study was conducted in Lindi rural district in Tanzania and Kassena-Nankana district in Ghana between October 2011 and December 2013 employing mixed methods. The study population included healthcare workers who were involved in the provision of maternal care in six rural PHC facilities from one district in each country where the eCDSS was implemented. All eCDSS users participated in the study with 61 and 56 participants at the midterm and final assessment, respectively. After several rounds of user training and support the eCDSS has been successfully adopted and constantly used during patient care in antenatal clinics and maternity wards. The eCDSS was used in 71% (2703/3798) and 59% (14,189/24,204) of all ANC clients in Tanzania and Ghana respectively, while it was also used in 83% (1185/1427) and 67% (1435/2144) of all deliveries in Tanzania and in Ghana, respectively. Several barriers reported to hinder eCDSS use were related to individual users, tasks, technology, and organization attributes. Implementation of an eCDSS in resource-constrained PHC facilities in sub-Saharan Africa was successful and the health workers accepted and continuously used the system for maternal care. Facilitators for eCDSS use included sufficient training and regular support whereas the challenges to sustained use were unreliable power supply and perceived high workload. However our study also shows that most of the perceived challenges did not substantially hinder adoption and utilization of the eCDSS during patient care. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Evolution of US DOE Performance Assessments Over 20 Years - 13597

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

Suttora, Linda C.; Seitz, Roger R.

2013-07-01

Performance assessments (PAs) have been used for many years for the analysis of post-closure hazards associated with a radioactive waste disposal facility and to provide a reasonable expectation of the ability of the site and facility design to meet objectives for the protection of members of the public and the environment. The use of PA to support decision-making for LLW disposal facilities has been mandated in United States Department of Energy (US DOE) directives governing radioactive waste management since 1988 (currently DOE Order 435.1, Radioactive Waste Management). Prior to that time, PAs were also used in a less formal role.more » Over the past 20+ years, the US DOE approach to conduct, review and apply PAs has evolved into an efficient, rigorous and mature process that includes specific requirements for continuous improvement and independent reviews. The PA process has evolved through refinement of a graded and iterative approach designed to help focus efforts on those aspects of the problem expected to have the greatest influence on the decision being made. Many of the evolutionary changes to the PA process are linked to the refinement of the PA maintenance concept that has proven to be an important element of US DOE PA requirements in the context of supporting decision-making for safe disposal of LLW. The PA maintenance concept is central to the evolution of the graded and iterative philosophy and has helped to drive the evolution of PAs from a deterministic compliance calculation into a systematic approach that helps to focus on critical aspects of the disposal system in a manner designed to provide a more informed basis for decision-making throughout the life of a disposal facility (e.g., monitoring, research and testing, waste acceptance criteria, design improvements, data collection, model refinements). A significant evolution in PA modeling has been associated with improved use of uncertainty and sensitivity analysis techniques to support efficient implementation of the graded and iterative approach. Rather than attempt to exactly predict the migration of radionuclides in a disposal unit, the best PAs have evolved into tools that provide a range of results to guide decision-makers in planning the most efficient, cost effective, and safe disposal of radionuclides. (authors)« less

Development of a Knowledge-Based System Approach for Decision Making in Construction Projects

DTIC Science & Technology

1992-05-01

a generic model for an administrative facility and medical facility with predefined fixed building systems based on Air Force criteria and past...MAINTENANCE HANGAR (MEDIUM BAY) CORROSION CONTROL HANGAR (HIGH BAY) FUEL SYSTEM MAINTENANCE HANGAR (MEDIUM BAY) MEDICAL MODEL 82 Table 5-1--continued...BUILDING SUPPORT MEDICAL LOGISTICS MEDICAL TOTAL 85 Table 5-2--continued MISSILE ASSEMBLY AND MAINTENANCE BUILDING TOTAL MISSILE LOADING AND UNLOADING

Experiencing cancer treatment decision-making in managed care.

PubMed

Wenzel, Jennifer; Shaha, Maya

2008-09-01

This paper is a report of a study to explore women's perceptions of and experiences with breast cancer treatment decision-making in managed care organizations (MCOs). Managed care organizations are the predominant form of employer-sponsored healthcare insurance in the United States of America. These healthcare financing entities minimize cost by streamlining healthcare delivery and may impose choice restrictions. The extent of these restrictions has not previously been studied from an in-depth patient perspective. A qualitative descriptive approach was adopted using interviews with a purposive sample of 14 managed care enrollees diagnosed with breast cancer at all stages. The data were collected between 2003 and 2005. Data analysis involved a reflexive process of transcript reading, categorization, data reduction and interpretation. The findings are presented as a single theme: 'decisional conflict in managed care', with two distinct categories: decisions regarding (1) the MCOs and (2) treatment. MCO selection was perceived to be limited by employer constraints, cost issues or healthcare plan providers. For study participants, selecting a MCO was less difficult than issues surrounding treatment decision-making. Women reported that their most important treatment-related decisions surrounded diagnosis and involved selecting a treatment facility and provider. Once a satisfactory facility and provider were selected, these women preferred to defer treatment decisions to their healthcare providers. Decision interventions should be focused on assisting women with provider and treatment facility selection early in diagnosis. Our findings might also serve as a basis for policy/practice changes to address healthcare financing limitations and to expand cancer treatment-related choices while providing desired treatment decision-making support.

Decision Rightness and Emotional Responses to Abortion in the United States: A Longitudinal Study.

PubMed

Rocca, Corinne H; Kimport, Katrina; Roberts, Sarah C M; Gould, Heather; Neuhaus, John; Foster, Diana G

2015-01-01

Arguments that abortion causes women emotional harm are used to regulate abortion, particularly later procedures, in the United States. However, existing research is inconclusive. We examined women's emotions and reports of whether the abortion decision was the right one for them over the three years after having an induced abortion. We recruited a cohort of women seeking abortions between 2008-2010 at 30 facilities across the United States, selected based on having the latest gestational age limit within 150 miles. Two groups of women (n=667) were followed prospectively for three years: women having first-trimester procedures and women terminating pregnancies within two weeks under facilities' gestational age limits at the same facilities. Participants completed semiannual phone surveys to assess whether they felt that having the abortion was the right decision for them; negative emotions (regret, anger, guilt, sadness) about the abortion; and positive emotions (relief, happiness). Multivariable mixed-effects models were used to examine changes in each outcome over time, to compare the two groups, and to identify associated factors. The predicted probability of reporting that abortion was the right decision was over 99% at all time points over three years. Women with more planned pregnancies and who had more difficulty deciding to terminate the pregnancy had lower odds of reporting the abortion was the right decision (aOR=0.71 [0.60, 0.85] and 0.46 [0.36, 0.64], respectively). Both negative and positive emotions declined over time, with no differences between women having procedures near gestational age limits versus first-trimester abortions. Higher perceived community abortion stigma and lower social support were associated with more negative emotions (b=0.45 [0.31, 0.58] and b=-0.61 [-0.93, -0.29], respectively). Women experienced decreasing emotional intensity over time, and the overwhelming majority of women felt that termination was the right decision for them over three years. Emotional support may be beneficial for women having abortions who report intended pregnancies or difficulty deciding.

Clinical Use of an Enterprise Data Warehouse

PubMed Central

Evans, R. Scott; Lloyd, James F.; Pierce, Lee A.

2012-01-01

The enormous amount of data being collected by electronic medical records (EMR) has found additional value when integrated and stored in data warehouses. The enterprise data warehouse (EDW) allows all data from an organization with numerous inpatient and outpatient facilities to be integrated and analyzed. We have found the EDW at Intermountain Healthcare to not only be an essential tool for management and strategic decision making, but also for patient specific clinical decision support. This paper presents the structure and two case studies of a framework that has provided us the ability to create a number of decision support applications that are dependent on the integration of previous enterprise-wide data in addition to a patient’s current information in the EMR. PMID:23304288

Data Mashups: Potential Contribution to Decision Support on Climate Change and Health

PubMed Central

Fleming, Lora E.; Haines, Andy; Golding, Brian; Kessel, Anthony; Cichowska, Anna; Sabel, Clive E.; Depledge, Michael H.; Sarran, Christophe; Osborne, Nicholas J.; Whitmore, Ceri; Cocksedge, Nicola; Bloomfield, Daniel

2014-01-01

Linking environmental, socioeconomic and health datasets provides new insights into the potential associations between climate change and human health and wellbeing, and underpins the development of decision support tools that will promote resilience to climate change, and thus enable more effective adaptation. This paper outlines the challenges and opportunities presented by advances in data collection, storage, analysis, and access, particularly focusing on “data mashups”. These data mashups are integrations of different types and sources of data, frequently using open application programming interfaces and data sources, to produce enriched results that were not necessarily the original reason for assembling the raw source data. As an illustration of this potential, this paper describes a recently funded initiative to create such a facility in the UK for use in decision support around climate change and health, and provides examples of suitable sources of data and the purposes to which they can be directed, particularly for policy makers and public health decision makers. PMID:24499879

Data mashups: potential contribution to decision support on climate change and health.

PubMed

Fleming, Lora E; Haines, Andy; Golding, Brian; Kessel, Anthony; Cichowska, Anna; Sabel, Clive E; Depledge, Michael H; Sarran, Christophe; Osborne, Nicholas J; Whitmore, Ceri; Cocksedge, Nicola; Bloomfield, Daniel

2014-02-04

Linking environmental, socioeconomic and health datasets provides new insights into the potential associations between climate change and human health and wellbeing, and underpins the development of decision support tools that will promote resilience to climate change, and thus enable more effective adaptation. This paper outlines the challenges and opportunities presented by advances in data collection, storage, analysis, and access, particularly focusing on "data mashups". These data mashups are integrations of different types and sources of data, frequently using open application programming interfaces and data sources, to produce enriched results that were not necessarily the original reason for assembling the raw source data. As an illustration of this potential, this paper describes a recently funded initiative to create such a facility in the UK for use in decision support around climate change and health, and provides examples of suitable sources of data and the purposes to which they can be directed, particularly for policy makers and public health decision makers.

Identification of design features to enhance utilization and acceptance of systems for Internet-based decision support at the point of care.

PubMed Central

Gadd, C. S.; Baskaran, P.; Lobach, D. F.

1998-01-01

Extensive utilization of point-of-care decision support systems will be largely dependent on the development of user interaction capabilities that make them effective clinical tools in patient care settings. This research identified critical design features of point-of-care decision support systems that are preferred by physicians, through a multi-method formative evaluation of an evolving prototype of an Internet-based clinical decision support system. Clinicians used four versions of the system--each highlighting a different functionality. Surveys and qualitative evaluation methodologies assessed clinicians' perceptions regarding system usability and usefulness. Our analyses identified features that improve perceived usability, such as telegraphic representations of guideline-related information, facile navigation, and a forgiving, flexible interface. Users also preferred features that enhance usefulness and motivate use, such as an encounter documentation tool and the availability of physician instruction and patient education materials. In addition to identifying design features that are relevant to efforts to develop clinical systems for point-of-care decision support, this study demonstrates the value of combining quantitative and qualitative methods of formative evaluation with an iterative system development strategy to implement new information technology in complex clinical settings. Images Figure 1 PMID:9929188

78 FR 41400 - Decision To Evaluate a Petition To Designate a Class of Employees From the Kansas City Plant in...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-10

...: Facility: Kansas City Plant. Location: Kansas City, Missouri. Job Titles and/or Job Duties: All employees... INFORMATION CONTACT: Stuart L. Hinnefeld, Director, Division of Compensation Analysis and Support, [[Page...

75 FR 4822 - Decision To Evaluate a Petition To Designate a Class of Employees for Linde Ceramics, Tonawanda...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-29

... evaluation, is as follows: Facility: Linde Ceramics. Location: Tonawanda, New York. Job Titles and/or Job... Analysis and Support, National Institute for Occupational Safety and Health (NIOSH), 4676 Columbia Parkway...

75 FR 27783 - Decision To Evaluate a Petition To Designate a Class of Employees From the Mound Site in...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-18

... evaluation, is as follows: Facility: Mound site. Location: Miamisburg, Ohio. Job Titles and/or Job Duties... Analysis and Support, National Institute for Occupational Safety and Health (NIOSH), 4676 Columbia Parkway...

Decision-making for delivery location and quality of care among slum-dwellers: a qualitative study in Uttar Pradesh, India.

PubMed

Sudhinaraset, May; Beyeler, Naomi; Barge, Sandhya; Diamond-Smith, Nadia

2016-07-07

In 2013, the Government of India launched the National Urban Health Mission (NUHM) in order to better address the health needs of urban populations, including the nearly 100 million living in slums. Maternal and neonatal health indicators remain poor in India. The objective of this study is to highlight the experiences of women, their husbands, and mothers-in-law related to maternal health services and delivery experiences. In total, we conducted 80 in-depth interviews, including 40 with recent mothers, 20 with their husbands, and 20 with their mothers-in-law. Purposeful sampling was conducted in order to obtain differences across delivery experiences (facility vs. home), followed by their family members. Major factors that influence decision-making about where to seek care included household dynamics and joint-decision-making with families, financial barriers, and perceived quality of care. Women perceived that private facilities were higher quality compared to public facilities, but also more expensive. Disrespectful care, bribes in the facility, and payment challenges were common in this population. A number of programmatic and policy recommendations are highlighted from this study. Future endeavors should include a greater focus on health education and public programs, including educating women on how to access programs, who is eligible, and how to obtain public funds. Families need to be educated on their rights and expectations in facilities. Future programs should consider the role of husbands and mothers-in-law in reproductive decision-making and support during deliveries. Triangulating information from multiple sources is important for future research efforts.

Injury severity and disability in the selection of next level of care following acute medical treatment for traumatic brain injury.

PubMed

Malec, James F; Mandrekar, Jayawant N; Brown, Allen W; Moessner, Anne M

2009-01-01

To evaluate the association of demographic factors, post-traumatic amnesia (PTA) and a standardized measure of ability limitations with clinical decisions for Next Level of Care following acute hospital treatment for moderate-severe traumatic brain injury (TBI). A TBI Clinical Nurse specialist recorded PTA for 212 individuals and rated 159 on the Ability and Adjustment Indices of the Mayo-Portland Adaptability Inventory (MPAI-4) for comparison with clinical decisions. Multivariate logistic regression analyses revealed that independent ratings on the MPAI-4 Ability Index and PTA were associated with the clinical decision to admit to Inpatient Rehabilitation vs discharge to Home in 92.7% of the sample; ratings on the Ability Index alone were associated with this decision in 92.2% of cases. Age over 65 was the only variable associated with discharge to a Skilled Nursing Facility, correctly predicting this decision in 64% of cases. Use of a standardized measure of ability limitations appears feasible to provide supportive documentation and potentially improve the consistency of decision-making in recommending Inpatient Rehabilitation vs discharge to Home. Although age is a significant factor in the decision to discharge to a Skilled Nursing Facility, this decision appears complex and merits further study.

Midlevel Maternity Providers' Preferences of a Childbirth Monitoring Tool in Low-Income Health Units in Uganda.

PubMed

Balikuddembe, Michael S; Wakholi, Peter K; Tumwesigye, Nazarius M; Tylleskär, Thorkild

2018-01-01

A third of women in childbirth are inadequately monitored, partly due to the tools used. Some stakeholders assert that the current labour monitoring tools are not efficient and need improvement to become more relevant to childbirth attendants. The study objective was to explore the expectations of maternity service providers for a mobile childbirth monitoring tool in maternity facilities in a low-income country like Uganda. Semi-structured interviews of purposively selected midwives and doctors in rural-urban childbirth facilities in Uganda were conducted before thematic data analysis. The childbirth providers expected a tool that enabled fast and secure childbirth record storage and sharing. They desired a tool that would automatically and conveniently register patient clinical findings, and actively provide interactive clinical decision support on a busy ward. The tool ought to support agreed upon standards for good pregnancy outcomes but also adaptable to the patient and their difficult working conditions. The tool functionality should include clinical data management and real-time decision support to the midwives, while the non-functional attributes include versatility and security.

Ranking of Business Process Simulation Software Tools with DEX/QQ Hierarchical Decision Model.

PubMed

Damij, Nadja; Boškoski, Pavle; Bohanec, Marko; Mileva Boshkoska, Biljana

2016-01-01

The omnipresent need for optimisation requires constant improvements of companies' business processes (BPs). Minimising the risk of inappropriate BP being implemented is usually performed by simulating the newly developed BP under various initial conditions and "what-if" scenarios. An effectual business process simulations software (BPSS) is a prerequisite for accurate analysis of an BP. Characterisation of an BPSS tool is a challenging task due to the complex selection criteria that includes quality of visual aspects, simulation capabilities, statistical facilities, quality reporting etc. Under such circumstances, making an optimal decision is challenging. Therefore, various decision support models are employed aiding the BPSS tool selection. The currently established decision support models are either proprietary or comprise only a limited subset of criteria, which affects their accuracy. Addressing this issue, this paper proposes a new hierarchical decision support model for ranking of BPSS based on their technical characteristics by employing DEX and qualitative to quantitative (QQ) methodology. Consequently, the decision expert feeds the required information in a systematic and user friendly manner. There are three significant contributions of the proposed approach. Firstly, the proposed hierarchical model is easily extendible for adding new criteria in the hierarchical structure. Secondly, a fully operational decision support system (DSS) tool that implements the proposed hierarchical model is presented. Finally, the effectiveness of the proposed hierarchical model is assessed by comparing the resulting rankings of BPSS with respect to currently available results.

Energy Systems Integration Facility (ESIF) Facility Stewardship Plan: Revision 2.1

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

Torres, Juan; Anderson, Art

The U.S. Department of Energy (DOE), Office of Energy Efficiency and Renewable Energy (EERE), has established the Energy Systems Integration Facility (ESIF) on the campus of the National Renewable Energy Laboratory (NREL) and has designated it as a DOE user facility. This 182,500-ft2 research facility provides state-of-the-art laboratory and support infrastructure to optimize the design and performance of electrical, thermal, fuel, and information technologies and systems at scale. This Facility Stewardship Plan provides DOE and other decision makers with information about the existing and expected capabilities of the ESIF and the expected performance metrics to be applied to ESIF operations.more » This plan is a living document that will be updated and refined throughout the lifetime of the facility.« less

Greening Federal Facilities: An Energy, Environmental, and Economic Resource Guide for Federal Facility Managers and Designers; Second Edition

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

Wilson, A.

2001-05-16

Greening Federal Facilities, Second Edition, is a nuts-and-bolts resource guide compiled to increase energy and resource efficiency, cut waste, and improve the performance of Federal buildings and facilities. The guide highlights practical actions that facility managers, design and construction staff, procurement officials, and facility planners can take to save energy and money, improve the comfort and productivity of employees, and benefit the environment. It supports a national effort to promote energy and environmental efficiency in the nation's 500,000 Federal buildings and facilities. Topics covered include current Federal regulations; environmental and energy decision-making; site and landscape issues; building design; energy systems;more » water and wastewater; materials; waste management, and recycling; indoor environmental quality; and managing buildings.« less

Corps of Engineers’ Acquisition of Fish Hatchery Proves Costly.

DTIC Science & Technology

1981-09-18

location, size, esti- mated cost, design , and construction timetables for facilities needed to meet the steelhead production requirements. To limit...hatchery "* * * is not recognized to be one of the more efficient and productive facilities in Idaho due to obvious con- straints in design , construction...agency’s decision to supply the product or service it- self because it would cost less must be supported by a comparativ , cost analysis. According to Corps

Trajectory-Based Takeoff Time Predictions Applied to Tactical Departure Scheduling: Concept Description, System Design, and Initial Observations

NASA Technical Reports Server (NTRS)

Engelland, Shawn A.; Capps, Alan

2011-01-01

Current aircraft departure release times are based on manual estimates of aircraft takeoff times. Uncertainty in takeoff time estimates may result in missed opportunities to merge into constrained en route streams and lead to lost throughput. However, technology exists to improve takeoff time estimates by using the aircraft surface trajectory predictions that enable air traffic control tower (ATCT) decision support tools. NASA s Precision Departure Release Capability (PDRC) is designed to use automated surface trajectory-based takeoff time estimates to improve en route tactical departure scheduling. This is accomplished by integrating an ATCT decision support tool with an en route tactical departure scheduling decision support tool. The PDRC concept and prototype software have been developed, and an initial test was completed at air traffic control facilities in Dallas/Fort Worth. This paper describes the PDRC operational concept, system design, and initial observations.

Infection prevention and control in the design of healthcare facilities.

PubMed

Farrow, Tye S; Black, Stephen M

2009-01-01

The lead paper, "Healthcare-Associated Infections as Patient Safety Indicators," written by Gardam, Lemieux, Reason, van Dijk and Goel, puts forward the design of healthcare facilities as one of many strategies to improve patient safety with respect to healthcare-associated infections. This commentary explores some of the issues in balancing infection prevention and control priorities with other needs and values brought to the design process. This balance is challenged not only by a lack of supporting evidence but also by the superficial nature in which infection prevention and control are often discussed within a design context. For the physical environment to support any patient safety initiative, the design of the processes must be developed in conjunction with that of the physical environment so that compliance can be natural and convenient. Finally, consideration is given to the value of documenting decision-making related to infection prevention and control in facility design and ongoing assessments of existing facilities.

75 FR 13542 - Decision To Evaluate a Petition To Designate a Class of Employees for the De Soto Facility in Los...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-22

... County, California. Job Titles and/or Job Duties: All employees of the Department of Energy, its... Compensation Analysis and Support, National Institute for Occupational Safety and Health (NIOSH), 4676 Columbia...

75 FR 13542 - Decision To Evaluate a Petition To Designate a Class of Employees for the Downey Facility in Los...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-22

... County, California. Job Titles and/or Job Duties: All employees of the Department of Energy, [[Page 13543..., Division of Compensation Analysis and Support, National Institute for Occupational Safety and Health (NIOSH...

Multi-criteria Decision Support System (DSS) for optimal locations of Soil Aquifer Treatment (SAT) facilities.

PubMed

Tsangaratos, P; Kallioras, A; Pizpikis, Th; Vasileiou, E; Ilia, I; Pliakas, F

2017-12-15

Managed Aquifer Recharge is a wide-spread well-established groundwater engineering method which is largely seen as sound and sustainable solution to water scarcity hydrologically sensitive areas, such as the Circum Mediterranean. The process of site selection for the installation of a MAR facility is of paramount importance for the feasibility and effectiveness of the project itself, especially when the facility will include the use of waters of impaired quality as a recharge source, as in the case of Soil-Aquifer-Treatment systems. The main objective of this study is to present the developed framework of a multi-criteria Decision Support System (DSS) that integrates within a dynamic platform the main groundwater engineering parameters associated with MAR applications together with the general geographical features which determine the effectiveness of such a project. The proposed system will provide an advanced coupled DSS-GIS tool capable of handling local MAR-related issues -such as hydrogeology, topography, soil, climate etc., and spatially distributed variables -such as societal, economic, administrative, legislative etc., with special reference to Soil-Aquifer-Treatment technologies. Copyright © 2017 Elsevier B.V. All rights reserved.

Spatial decision support system to evaluate crop residue energy potential by anaerobic digestion.

PubMed

Escalante, Humberto; Castro, Liliana; Gauthier-Maradei, Paola; Rodríguez De La Vega, Reynel

2016-11-01

Implementing anaerobic digestion (AD) in energy production from crop residues requires development of decision tools to assess its feasibility and sustainability. A spatial decision support system (SDSS) was constructed to assist decision makers to select appropriate feedstock according to biomethanation potential, identify the most suitable location for biogas facilities, determine optimum plant capacity and supply chain, and evaluate associated risks and costs. SDSS involves a spatially explicit analysis, fuzzy multi-criteria analysis, and statistical and optimization models. The tool was validated on seven crop residues located in Santander, Colombia. For example, fique bagasse generates about 0.21millionm(3)CH4year(-1) (0.329m(3)CH4kg(-1) volatile solids) with a minimum profitable plant of about 2000tonyear(-1) and an internal rate of return of 10.5%. SDSS can be applied to evaluate other biomass resources, availability periods, and co-digestion potential. Copyright © 2016. Published by Elsevier Ltd.

Interval-parameter semi-infinite fuzzy-stochastic mixed-integer programming approach for environmental management under multiple uncertainties.

PubMed

Guo, P; Huang, G H

2010-03-01

In this study, an interval-parameter semi-infinite fuzzy-chance-constrained mixed-integer linear programming (ISIFCIP) approach is developed for supporting long-term planning of waste-management systems under multiple uncertainties in the City of Regina, Canada. The method improves upon the existing interval-parameter semi-infinite programming (ISIP) and fuzzy-chance-constrained programming (FCCP) by incorporating uncertainties expressed as dual uncertainties of functional intervals and multiple uncertainties of distributions with fuzzy-interval admissible probability of violating constraint within a general optimization framework. The binary-variable solutions represent the decisions of waste-management-facility expansion, and the continuous ones are related to decisions of waste-flow allocation. The interval solutions can help decision-makers to obtain multiple decision alternatives, as well as provide bases for further analyses of tradeoffs between waste-management cost and system-failure risk. In the application to the City of Regina, Canada, two scenarios are considered. In Scenario 1, the City's waste-management practices would be based on the existing policy over the next 25 years. The total diversion rate for the residential waste would be approximately 14%. Scenario 2 is associated with a policy for waste minimization and diversion, where 35% diversion of residential waste should be achieved within 15 years, and 50% diversion over 25 years. In this scenario, not only landfill would be expanded, but also CF and MRF would be expanded. Through the scenario analyses, useful decision support for the City's solid-waste managers and decision-makers has been generated. Three special characteristics of the proposed method make it unique compared with other optimization techniques that deal with uncertainties. Firstly, it is useful for tackling multiple uncertainties expressed as intervals, functional intervals, probability distributions, fuzzy sets, and their combinations; secondly, it has capability in addressing the temporal variations of the functional intervals; thirdly, it can facilitate dynamic analysis for decisions of facility-expansion planning and waste-flow allocation within a multi-facility, multi-period and multi-option context. Copyright 2009 Elsevier Ltd. All rights reserved.

Budget-Minded Renovation Lights Up Students' Learning.

ERIC Educational Resources Information Center

McDaniel, Craig

1998-01-01

Provides considerations for educational facility lighting designs that support student learning while controlling costs. Lighting design decision factors include the types of classroom activities involved, the importance of properly using artificial and indirect lighting, the importance of color rendering, the positioning of windows and skylights,…

Alaska road weather project : technical performance assessment report Fairbanks field demonstration 2013-2014.

DOT National Transportation Integrated Search

2014-02-01

The Alaska Department of Transportation and Public Facilities began implementation of a Maintenance Decision Support System in an : effort to improve snow and ice control in the Fairbanks area. As part of the project the reliability of the weather fo...

HOLISTIC APPROACH TO ENVIRONMENTAL MANAGEMENT OF MUNICIPAL SOLID WASTE

EPA Science Inventory

The paper presents results from the application of a new municipal solid waste (MSW) management planning aid to EPA's new facility in the Research Triangle Park, NC. This planning aid, or decision support tool, is computer software that analyzes the cost and environmental impact ...

Linking Resource Decisions to Planning

ERIC Educational Resources Information Center

Saunders, Laura

2014-01-01

This chapter explores the relationship between strategic planning and budgeting. It describes how community college leaders can use strategic and foundational plans (academic, facilities, technology, and financial) to drive budgets and resource allocations in support of institutional goals and objectives. Finally, it identifies challenges of doing…

A Renovation Decision-Support Model for Evaluating the Functional Condition of Army Facilities

DTIC Science & Technology

1994-04-01

PAGES Buildings--Remodeling for others use cost effectiveness 90 Army facilities RENMOD 16 . PRICE CODE 17. SECURITY CLASSIFICATION 18. SECURITY...7540-01-280-5500 StndWd Form 296 (Rev. 2-80) Preaus by ANSI 80 23.- 16 2010 FOREWORD This research was conducted for the Assistant Chief of Staff for...it means any home improvement. To an economist, it is any investment designed to forestall the capital depreciation of a structure. To an architect

Adequate Facilities for All: Reforming New York State's System for Providing Building Aid to School Districts and for Meeting Schools' Urgent Capital Needs. Part II. [Sound Basic Education Task Force Proposal

ERIC Educational Resources Information Center

Campaign for Fiscal Equity, Inc., 2004

2004-01-01

In recent years, court mandates in education adequacy cases have resulted in substantial increases in state-level support for local building needs in a number of states. The Court of Appeals' decision in "CFE v. State of New York" has made clear that extensive facilities deficiencies in New York City constitute a major constitutional…

DCDS: A Real-time Data Capture and Personalized Decision Support System for Heart Failure Patients in Skilled Nursing Facilities.

PubMed

Zhu, Wei; Luo, Lingyun; Jain, Tarun; Boxer, Rebecca S; Cui, Licong; Zhang, Guo-Qiang

2016-01-01

Heart disease is the leading cause of death in the United States. Heart failure disease management can improve health outcomes for elderly community dwelling patients with heart failure. This paper describes DCDS, a real-time data capture and personalized decision support system for a Randomized Controlled Trial Investigating the Effect of a Heart Failure Disease Management Program (HF-DMP) in Skilled Nursing Facilities (SNF). SNF is a study funded by the NIH National Heart, Lung, and Blood Institute (NHLBI). The HF-DMP involves proactive weekly monitoring, evaluation, and management, following National HF Guidelines. DCDS collects a wide variety of data including 7 elements considered standard of care for patients with heart failure: documentation of left ventricular function, tracking of weight and symptoms, medication titration, discharge instructions, 7 day follow up appointment post SNF discharge and patient education. We present the design and implementation of DCDS and describe our preliminary testing results.

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.

Use of decision support systems as a drought management tool

USGS Publications Warehouse

Frevert, D.; Lins, H.; ,

2005-01-01

Droughts present a unique challenge to water managers throughout the world and the current drought in the western United States is taxing facilities to the limit. Coping with this severe drought requires state of the art decision support systems including efficient and accurate hydrologic process models, detailed hydrologic data bases and effective river systems management modeling frameworks. This paper will outline a system of models developed by the Bureau of Reclamation, the US Geological Survey, the University of Colorado and a number of other governmental and university partners. The application of the technology to drought management in several key western river basins will be discussed.

A business man views commercial ventures in space.

NASA Technical Reports Server (NTRS)

Scarff, D. D.; Bloom, H. L.

1973-01-01

Paper reviews technical, resource planning and marketing steps an industrial organization must perform in arriving at a decision to undertake space development and production of commercial products or services for Users on the ground. Technical elements are supported by particular examples. Analysis of required resources emphasizes facility and financial inter-relationships between commercial organizations and NASA. Marketing planning covers elements of profitability. Paper addresses questions related to protection of corporate stockholders and public interest, investment decision timing, budget variations. Paper concludes with observations on timeliness of planning shuttle-based commercial ventures and on key industry/NASA problems and decisions.

Logistics support economy and efficiency through consolidation and automation

NASA Technical Reports Server (NTRS)

Savage, G. R.; Fontana, C. J.; Custer, J. D.

1985-01-01

An integrated logistics support system, which would provide routine access to space and be cost-competitive as an operational space transportation system, was planned and implemented to support the NSTS program launch-on-time goal of 95 percent. A decision was made to centralize the Shuttle logistics functions in a modern facility that would provide office and training space and an efficient warehouse area. In this warehouse, the emphasis is on automation of the storage and retrieval function, while utilizing state-of-the-art warehousing and inventory management technology. This consolidation, together with the automation capabilities being provided, will allow for more effective utilization of personnel and improved responsiveness. In addition, this facility will be the prime support for the fully integrated logistics support of the operations era NSTS and reduce the program's management, procurement, transportation, and supply costs in the operations era.

Ranking of Business Process Simulation Software Tools with DEX/QQ Hierarchical Decision Model

PubMed Central

2016-01-01

The omnipresent need for optimisation requires constant improvements of companies’ business processes (BPs). Minimising the risk of inappropriate BP being implemented is usually performed by simulating the newly developed BP under various initial conditions and “what-if” scenarios. An effectual business process simulations software (BPSS) is a prerequisite for accurate analysis of an BP. Characterisation of an BPSS tool is a challenging task due to the complex selection criteria that includes quality of visual aspects, simulation capabilities, statistical facilities, quality reporting etc. Under such circumstances, making an optimal decision is challenging. Therefore, various decision support models are employed aiding the BPSS tool selection. The currently established decision support models are either proprietary or comprise only a limited subset of criteria, which affects their accuracy. Addressing this issue, this paper proposes a new hierarchical decision support model for ranking of BPSS based on their technical characteristics by employing DEX and qualitative to quantitative (QQ) methodology. Consequently, the decision expert feeds the required information in a systematic and user friendly manner. There are three significant contributions of the proposed approach. Firstly, the proposed hierarchical model is easily extendible for adding new criteria in the hierarchical structure. Secondly, a fully operational decision support system (DSS) tool that implements the proposed hierarchical model is presented. Finally, the effectiveness of the proposed hierarchical model is assessed by comparing the resulting rankings of BPSS with respect to currently available results. PMID:26871694

Multi-year Content Analysis of User Facility Related Publications

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

Patton, Robert M; Stahl, Christopher G; Hines, Jayson

2013-01-01

Scientific user facilities provide resources and support that enable scientists to conduct experiments or simulations pertinent to their respective research. Consequently, it is critical to have an informed understanding of the impact and contributions that these facilities have on scientific discoveries. Leveraging insight into scientific publications that acknowledge the use of these facilities enables more informed decisions by facility management and sponsors in regard to policy, resource allocation, and influencing the direction of science as well as more effectively understand the impact of a scientific user facility. This work discusses preliminary results of mining scientific publications that utilized resources atmore » the Oak Ridge Leadership Computing Facility (OLCF) at Oak Ridge National Laboratory (ORNL). These results show promise in identifying and leveraging multi-year trends and providing a higher resolution view of the impact that a scientific user facility may have on scientific discoveries.« less

76 FR 26301 - Decision To Evaluate a Petition To Designate a Class of Employees From the Y-12 Plant in Oak...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-06

... evaluation, is as follows: Facility: Y-12 Plant. Location: Oak Ridge, TN. Job Titles and/or Job Duties: All... Analysis and Support, National Institute for Occupational Safety and Health (NIOSH), 4676 Columbia Parkway...

75 FR 1615 - Amended Record of Decision: Idaho High-Level Waste and Facilities Disposition Final Environmental...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-12

... DEPARTMENT OF ENERGY Amended Record of Decision: Idaho High-Level Waste and Facilities Disposition...-Level Waste and Facilities Disposition Final Environmental Impact Statement. This document corrects an... Record of Decision: Idaho High-Level Waste and Facilities [[Page 1616

Moving data off the shelf and into action: an intervention to improve data-informed decision making in Côte d'Ivoire.

PubMed

Nutley, Tara; Gnassou, Léontine; Traore, Moussa; Bosso, Abitche Edwige; Mullen, Stephanie

2014-01-01

Improving a health system requires data, but too often they are unused or under-used by decision makers. Without interventions to improve the use of data in decision making, health systems cannot meet the needs of the populations they serve. In 2008, in Côte d'Ivoire, data were largely unused in health decision-making processes. To implement and evaluate an intervention to improve the use of data in decision making in Cote d'Ivoire. From 2008 to 2012, Cote d'Ivoire sought to improve the use of national health data through an intervention that broadens participation in and builds links between data collection and decision-making processes; identifies information needs; improves data quality; builds capacity to analyze, synthesize, and interpret data; and develops policies to support data use. To assess the results, a Performance of Routine Information System Management Assessment was conducted before and after the intervention using a combination of purposeful and random sampling. In 2008, the sample consisted of the central level, 12 districts, and 119 facilities, and in 2012, the sample consisted of the central level, 20 districts, and 190 health facilities. To assess data use, we developed dichotomous indicators: discussions of analysis findings, decisions taken based on the analysis, and decisions referred to upper management for action. We aggregated the indicators to generate a composite, continuous index of data use. From 2008 to 2012, the district data-use score increased from 40 to 70%; the facility score remained the same - 38%. The central score is not reported, because of a methodological difference in the two assessments. The intervention improved the use of data in decision making at the district level in Côte d'Ivoire. This study provides an example of, and guidance for, implementing a large-scale intervention to improve data-informed decision making.

Exploring Factors Affecting Emergency Medical Services Staffs' Decision about Transporting Medical Patients to Medical Facilities.

PubMed

Ebrahimian, Abbasali; Seyedin, Hesam; Jamshidi-Orak, Roohangiz; Masoumi, Gholamreza

2014-01-01

Transfer of patients in medical emergency situations is one of the most important missions of emergency medical service (EMS) staffs. So this study was performed to explore affecting factors in EMS staffs' decision during transporting of patients in medical situations to medical facilities. The participants in this qualitative study consisted of 18 EMS staffs working in prehospital care facilities in Tehran, Iran. Data were gathered through semistructured interviews. The data were analyzed using a content analysis approach. The data analysis revealed the following theme: "degree of perceived risk in EMS staffs and their patients." This theme consisted of two main categories: (1) patient's condition' and (2) the context of the EMS mission'. The patent's condition category emerged from "physical health statuses," "socioeconomic statuses," and "cultural background" subcategories. The context of the EMS mission also emerged from two subcategories of "characteristics of the mission" and EMS staffs characteristics'. EMS system managers can consider adequate technical, informational, financial, educational, and emotional supports to facilitate the decision making of their staffs. Also, development of an effective and user-friendly checklist and scoring system was recommended for quick and easy recognition of patients' needs for transportation in a prehospital situation.

Filter membrane-based automated therapeutic plasma exchange: a report of two cases from Nigeria.

PubMed

Arogundade, Fatiu A; Sanusi, Abubakr A; Akinbodewa, Akinwunmi A; Hassan, Muzamil O; Omotosho, Bolanle O; Balogun, Rasheed A; Akinsola, Adewale

2013-02-01

These case reports demonstrated the diagnostic dilemma encountered in patients with systemic lupus erythematosus and thrombotic thrombocytopenic purpura particularly in settings with limited diagnostic facilities and laboratory support. The similarities in the diagnostic criteria for both conditions make clear distinction as well as management decisions difficult. We present the difficulties encountered with both the diagnosis and the management of these two patients that were managed in our facility. Copyright © 2013 Wiley Periodicals, Inc.

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

Nichols, Will E.; Mehta, Sunil

The updated Hanford Site Composite Analysis will provide an all-pathways dose projection to a hypothetical future member of the public from all planned low-level radioactive waste disposal facilities and potential contributions from all other projected end-state sources of radioactive material left at Hanford following site closure. Its primary purpose is to support the decision-making process of the U.S. Department of Energy (DOE) under DOE O 435.1-1, Radioactive Waste Management (DOE, 2001), related to managing low-level waste disposal facilities at the Hanford Site.

Multi-criteria decision making to support waste management: A critical review of current practices and methods.

PubMed

Goulart Coelho, Lineker M; Lange, Liséte C; Coelho, Hosmanny Mg

2017-01-01

Solid waste management is a complex domain involving the interaction of several dimensions; thus, its analysis and control impose continuous challenges for decision makers. In this context, multi-criteria decision-making models have become important and convenient supporting tools for solid waste management because they can handle problems involving multiple dimensions and conflicting criteria. However, the selection of the multi-criteria decision-making method is a hard task since there are several multi-criteria decision-making approaches, each one with a large number of variants whose applicability depends on information availability and the aim of the study. Therefore, to support researchers and decision makers, the objectives of this article are to present a literature review of multi-criteria decision-making applications used in solid waste management, offer a critical assessment of the current practices, and provide suggestions for future works. A brief review of fundamental concepts on this topic is first provided, followed by the analysis of 260 articles related to the application of multi-criteria decision making in solid waste management. These studies were investigated in terms of the methodology, including specific steps such as normalisation, weighting, and sensitivity analysis. In addition, information related to waste type, the study objective, and aspects considered was recorded. From the articles analysed it is noted that studies using multi-criteria decision making in solid waste management are predominantly addressed to problems related to municipal solid waste involving facility location or management strategy.

Countering Threat Networks

DTIC Science & Technology

2016-12-21

PLANNING TO COUNTER THREAT NETWORKS  Joint Intelligence Preparation of the Operational Environment and Threat Networks...Army Expeditionary Forensic Facility in Afghanistan ........ E-9 E-4 Exploitation Support to Intelligence Fusion and Decision Making ......... E-10...Approach The groundwork for successful countering threat networks activities starts with information and intelligence to develop an understanding

78 FR 17633 - Notice of Request for Extension of a Currently Approved Information Collection

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-22

... DEPARTMENT OF AGRICULTURE Rural Housing Service Notice of Request for Extension of a Currently... Support Staff, Housing and Community Facilities Programs, U.S. Department of Agriculture, Stop 0761, 1400... on the quality of the human environment during agency planning and decision-making processes. For...

THE NGA-DOE GRANT TO EXAMINE CRITICAL ISSUES RELATED TO RADIOACTIVE WASTE AND MATERIALS DISPOSITION INVOLVING DOE FACILITIES

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

NONE

1998-04-01

Through the National Governors' Association (NGA) project ''Critical Issues Related to Radioactive Waste and Materials Disposition Involving DOE Facilities'' NGA brings together Governors' policy advisors, state regulators, and DOE officials to examine critical issues related to the cleanup and operation of DOE nuclear weapons and research facilities. Topics explored through this project include: Decisions involving disposal of mixed, low-level, and transuranic (TRU) waste and disposition of nuclear materials. Decisions involving DOE budget requests and their effect on environmental cleanup and compliance at DOE facilities. Strategies to treat mixed, low-level, and transuranic (TRU) waste and their effect on individual sites inmore » the complex. Changes to the FFCA site treatment plans as a result of proposals in DOE's Accelerating Cleanup: Paths to Closure strategy and contractor integration analysis. Interstate waste and materials shipments. Reforms to existing RCRA and CERCLA regulations/guidance to address regulatory overlap and risks posed by DOE wastes. The overarching theme of this project is to help the Department improve coordination of its major program decisions with Governors' offices and state regulators and to ensure such decisions reflect input from these key state officials and stakeholders. This report summarizes activities conducted during the quarter from December 31, 1997 through April 30, 1998 under the NGA project. The work accomplished by the NGA project team during the past four months can be categorized as follows: maintained open communication with DOE on a variety of activities and issues within the DOE environmental management complex; and provided ongoing support to state-DOE interactions in preparation for the March 30-31, 1998 NGA Federal Facilities Compliance Task Force Meeting with DOE. maintained communication with NGA Federal Facilities Compliance Task Force members regarding DOE efforts to formulate a configuration for mixed low-level waste and low-level treatment and disposal, DOE's Environmental Management Budget, and DOE's proposed Intersite Discussions.« less

Quality and rural-urban comparison of tuberculosis care in Rivers State, Nigeria.

PubMed

Tobin-West, Charles Ibiene; Isodje, Anastasia

2016-01-01

Nigeria ranks among countries with the highest burden of tuberculosis. Yet evidence continues to indicate poor treatment outcomes which have been attributed to poor quality of care. This study aims to identify some of the systemic problems in order to inform policy decisions for improved quality of services and treatment outcomes in Nigeria. A comparative assessment of the quality of TB care in rural and urban health facilities was carried out between May and June 2013, employing the Donabedian model of quality assessment. Data was analysed using the SPSS software package version 20.0. The level of significance was set at p < 0.05. Health facility infrastructures were more constrained in the urban than rural settings. Both the urban and rural facilities lacked adequate facilities for infection control such as, running water, air filter respirators, hand gloves and extractor fans. Health education and HIV counselling and testing (HCT) were limited in rural facilities compared to urban facilities. Although anti-TB drugs were generally available in both settings, the DOTS strategy in patient care was completely ignored. Finally, laboratory support for diagnosis and patient monitoring was limited in the rural facilities. The study highlights suboptimal quality of TB care in Rivers State with limitations in health education and HCT of patients for HIV as well as laboratory support for TB care in rural health facilities. We, therefore, recommend that adequate infection control measures, strict observance of the DOTS strategy and sufficient laboratory support be provided to TB clinics in the State.

The contractor`s role in low-level waste disposal facility application review and licensing

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

Serie, P.J.; Dressen, A.L.

1991-12-31

The California Department of Health Services will soon reach a licensing decision on the proposed Ward Valley low-level radioactive waste disposal facility. As the first regulatory agency in the country to address the 10 CFR Part 61 requirements for a new disposal facility, California`s program has broken new ground in its approach. Throughout the review process, the Department has relied on contractor support to augment its technical and administrative staff. A team consisting of Roy F. Weston, Inc., supported by ERM-Program Management Corp., Environmental Issues Management, Inc., and Rogers and Associates Engineering Corporation, has worked closely with the Department inmore » a staff extension role. The authors have been involved with the project in contractor project management roles since 1987, and continue to support the Department`s program as it proceeds to finalize its licensing process. This paper describes the selection process used to identify a contractor team with the needed skills and experience, and the makeup of team capabilities. It outlines the management, communication, and technical approaches used to assure a smooth agency-contractor function and relationship. It describes the techniques used to ensure that decisions and documents represented the Department credibly in its role as the regulatory and licensing agency under the Nuclear Regulatory Commission (NRC) Agreement State program. The paper outlines the license application review process and activities, through preparation of licensing documentation and responses to public comments. Lessons learned in coordination of an agency-contractor team effort to review and license a low-level waste disposal facility are reviewed and suggestions made for approaching a similar license application review and licensing situation.« less

Decision support system for the optimal location of electrical and electronic waste treatment plants: a case study in greece.

PubMed

Achillas, Ch; Vlachokostas, Ch; Moussiopoulos, Nu; Banias, G

2010-05-01

Environmentally sound end-of-life management of Electrical and Electronic Equipment has been realised as a top priority issue internationally, both due to the waste stream's continuously increasing quantities, as well as its content in valuable and also hazardous materials. In an effort to manage Waste Electrical and Electronic Equipment (WEEE), adequate infrastructure in treatment and recycling facilities is considered a prerequisite. A critical number of such plants are mandatory to be installed in order: (i) to accommodate legislative needs, (ii) decrease transportation cost, and (iii) expand reverse logistics network and cover more areas. However, WEEE recycling infrastructures require high expenditures and therefore the decision maker need to be most precautious. In this context, special care should be given on the viability of infrastructure which is heavily dependent on facilities' location. To this end, a methodology aiming towards optimal location of Units of Treatment and Recycling is developed, taking into consideration economical together with social criteria, in an effort to interlace local acceptance and financial viability. For the decision support system's needs, ELECTRE III is adopted as a multicriteria analysis technique. The methodology's applicability is demonstrated with a real-world case study in Greece. Copyright (c) 2010 Elsevier Ltd. All rights reserved.

Air Traffic Management Research at NASA Ames Research Center

NASA Technical Reports Server (NTRS)

Lee, Katharine

2005-01-01

Since the late 1980's, NASA Ames researchers have been investigating ways to improve the air transportation system through the development of decision support automation. These software advances, such as the Center-TRACON Automation System (eTAS) have been developed with teams of engineers, software developers, human factors experts, and air traffic controllers; some ASA Ames decision support tools are currently operational in Federal Aviation Administration (FAA) facilities and some are in use by the airlines. These tools have provided air traffic controllers and traffic managers the capabilities to help reduce overall delays and holding, and provide significant cost savings to the airlines as well as more manageable workload levels for air traffic service providers. NASA is continuing to collaborate with the FAA, as well as other government agencies, to plan and develop the next generation of decision support tools that will support anticipated changes in the air transportation system, including a projected increase to three times today's air-traffic levels by 2025. The presentation will review some of NASA Ames' recent achievements in air traffic management research, and discuss future tool developments and concepts currently under consideration.

Decision Support System For Management Of Low-Level Radioactive Waste Disposal At The Nevada Test Site

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

Shott, G.; Yucel, V.; Desotell, L.

2006-07-01

The long-term safety of U.S. Department of Energy (DOE) low-level radioactive disposal facilities is assessed by conducting a performance assessment -- a systematic analysis that compares estimated risks to the public and the environment with performance objectives contained in DOE Manual 435.1-1, Radioactive Waste Management Manual. Before site operations, facilities design features such as final inventory, waste form characteristics, and closure cover design may be uncertain. Site operators need a modeling tool that can be used throughout the operational life of the disposal site to guide decisions regarding the acceptance of problematic waste streams, new disposal cell design, environmental monitoringmore » program design, and final site closure. In response to these needs the National Nuclear Security Administration Nevada Site Office (NNSA/NSO) has developed a decision support system for the Area 5 Radioactive Waste Management Site in Frenchman Flat on the Nevada Test Site. The core of the system is a probabilistic inventory and performance assessment model implemented in the GoldSim{sup R} simulation platform. The modeling platform supports multiple graphic capabilities that allow clear documentation of the model data sources, conceptual model, mathematical implementation, and results. The combined models have the capability to estimate disposal site inventory, contaminant concentrations in environmental media, and radiological doses to members of the public engaged in various activities at multiple locations. The model allows rapid assessment and documentation of the consequences of waste management decisions using the most current site characterization information, radionuclide inventory, and conceptual model. The model is routinely used to provide annual updates of site performance, evaluate the consequences of disposal of new waste streams, develop waste concentration limits, optimize the design of new disposal cells, and assess the adequacy of environmental monitoring programs. (authors)« less

THE FLUIDS AND COMBUSTION FACILITY: ENABLING THE EXPLORATION OF SPACE

NASA Technical Reports Server (NTRS)

Weiland, Karen J.; Gati, Frank G.; Hill, Myron E.; OMalley, Terence; Zurawski, Robert L.

2005-01-01

The Fluids and Combustion Facility (FCF) is an International Space Station facility designed to support physical and biological research as well as technology experiments in space. The FCF consists of two racks called the Combustion Integrated Rack (CIR) and the Fluids Integrated Rack (FIR). The capabilities of the CIR and the FIR and plans for their utilization will support the President s vision for space exploration. The CIR will accommodate physical research and technology experiments that address needs in the areas of spacecraft fire prevention, detection and suppression, incineration of solid wastes, and power generation. Initial experiments will provide data to support design decisions for exploration spacecraft. The CIR provides a large sealed chamber in a near-weightless environment. The chamber supports many simulated atmospheres including lunar or Martian environments. The FIR will accommodate experiments that address needs for advanced life support, power, propulsion, and spacecraft thermal control systems. The FIR can also serve as a platform for experiments that address human health and performance, medical technologies, and biological sciences. The FIR provides a large volume for payload hardware, reconfigurable diagnostics, customizable software, active rack-level vibration isolation, and data acquisition and management in a nearly uniform temperature environment.

The Fluids and Combustion Facility: Enabling the Exploration of Space

NASA Technical Reports Server (NTRS)

Weiland, Karen J.; Gati, Frank G.; Hill, Myron E.; O'Malley Terence F.; Zurawski, Robert L.

2005-01-01

The Fluids and Combustion Facility (FCF) is an International Space Station facility designed to support physical and biological research as well as technology experiments in space. The FCF consists of two racks called the Combustion Integrated Rack (CIR) and the Fluids Integrated Rack (FIR). The capabilities of the CIR and the FIR and plans for their utilization will support the President's vision for space exploration. The CIR will accommodate physical research and technology experiments that address needs in the areas of spacecraft fire prevention, detection and suppression, incineration of solid wastes, and power generation. Initial experiments will provide data to support design decisions for exploration spacecraft. The CIR provides a large sealed chamber in a near-weightless environment. The chamber supports many simulated atmospheres including lunar or Martian environments. The FIR will accommodate experiments that address needs for advanced life support, power, propulsion, and spacecraft thermal control systems. The FIR can also serve as a platform for experiments that address human health and performance, medical technologies, and biological sciences. The FIR provides a large volume for payload hardware, reconfigurable diagnostics, customizable software, active rack-level vibration isolation, and data acquisition and management in a nearly uniform temperature environment.

A multiobjective modeling approach to locate multi-compartment containers for urban-sorted waste

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

Tralhao, Lino, E-mail: lmlrt@inescc.p; Coutinho-Rodrigues, Joao, E-mail: coutinho@dec.uc.p; Alcada-Almeida, Luis, E-mail: alcada@inescc.p

2010-12-15

The location of multi-compartment sorted waste containers for recycling purposes in cities is an important problem in the context of urban waste management. The costs associated with those facilities and the impacts placed on populations are important concerns. This paper introduces a mixed-integer, multiobjective programming approach to identify the locations and capacities of such facilities. The approach incorporates an optimization model in a Geographical Information System (GIS)-based interactive decision support system that includes four objectives. The first objective minimizes the total investment cost; the second one minimizes the average distance from dwellings to the respective multi-compartment container; the last twomore » objectives address the 'pull' and 'push' characteristics of the decision problem, one by minimizing the number of individuals too close to any container, and the other by minimizing the number of dwellings too far from the respective multi-compartment container. The model determines the number of facilities to be opened, the respective container capacities, their locations, their respective shares of the total waste of each type to be collected, and the dwellings assigned to each facility. The approach proposed was tested with a case study for the historical center of Coimbra city, Portugal, where a large urban renovation project, addressing about 800 buildings, is being undertaken. This paper demonstrates that the models and techniques incorporated in the interactive decision support system (IDSS) can be used to assist a decision maker (DM) in analyzing this complex problem in a realistically sized urban application. Ten solutions consisting of different combinations of underground containers for the disposal of four types of sorted waste in 12 candidate sites, were generated. These solutions and tradeoffs among the objectives are presented to the DM via tables, graphs, color-coded maps and other graphics. The DM can then use this information to 'guide' the IDSS in identifying additional solutions of potential interest. Nevertheless, this research showed that a particular solution with a better objective balance can be identified. The actual sequence of additional solutions generated will depend upon the objectives and preferences of the DM in a specific application.« less

The Value of Electronic Medical Record Implementation in Mental Health Care: A Case Study

PubMed Central

Fischler, Ilan; Stuckey, Melanie I; Klassen, Philip E; Chen, John

2017-01-01

Background Electronic medical records (EMR) have been implemented in many organizations to improve the quality of care. Evidence supporting the value added to a recovery-oriented mental health facility is lacking. Objective The goal of this project was to implement and customize a fully integrated EMR system in a specialized, recovery-oriented mental health care facility. This evaluation examined the outcomes of quality improvement initiatives driven by the EMR to determine the value that the EMR brought to the organization. Methods The setting was a tertiary-level mental health facility in Ontario, Canada. Clinical informatics and decision support worked closely with point-of-care staff to develop workflows and documentation tools in the EMR. The primary initiatives were implementation of modules for closed loop medication administration, collaborative plan of care, clinical practice guidelines for schizophrenia, restraint minimization, the infection prevention and control surveillance status board, drug of abuse screening, and business intelligence. Results Medication and patient scan rates have been greater than 95% since April 2014, mitigating the adverse effects of medication errors. Specifically, between April 2014 and March 2015, only 1 moderately severe and 0 severe adverse drug events occurred. The number of restraint incidents decreased 19.7%, which resulted in cost savings of more than Can $1.4 million (US $1.0 million) over 2 years. Implementation of clinical practice guidelines for schizophrenia increased adherence to evidence-based practices, standardizing care across the facility. Improved infection prevention and control surveillance reduced the number of outbreak days from 47 in the year preceding implementation of the status board to 7 days in the year following. Decision support to encourage preferential use of the cost-effective drug of abuse screen when clinically indicated resulted in organizational cost savings. Conclusions EMR implementation allowed Ontario Shores Centre for Mental Health Sciences to use data analytics to identify and select appropriate quality improvement initiatives, supporting patient-centered, recovery-oriented practices and providing value at the clinical, organizational, and societal levels. PMID:28057607

Governing therapy choices: power/knowledge in the treatment of progressive renal failure.

PubMed

Holmes, Dave; Perron, Amélie M; Savoie, Marc

2006-12-04

This article outlines the struggle between the power of the health care professional and the rights of the individual to choose freely a modality of treatment. Nurses are instrumental in assisting patients in making the best decision for a therapy they will have to assume for the rest of their lives. In guiding patients' decision, nurses must take into account these unavoidable contingencies: changes in lifestyle, nutritional restrictions, level of acceptance, compliance issues, ease of training and availability of support/facilities. Ensuring that the patient makes an informed decision is therefore an ongoing challenge for nurses as they are taking part in a delicate balancing act between not directly influencing the patient's decision while making sure the patient is accurately informed.

Governing therapy choices: Power/Knowledge in the treatment of progressive renal failure

PubMed Central

Holmes, Dave; Perron, Amélie M; Savoie, Marc

2006-01-01

This article outlines the struggle between the power of the health care professional and the rights of the individual to choose freely a modality of treatment. Nurses are instrumental in assisting patients in making the best decision for a therapy they will have to assume for the rest of their lives. In guiding patients' decision, nurses must take into account these unavoidable contingencies: changes in lifestyle, nutritional restrictions, level of acceptance, compliance issues, ease of training and availability of support/facilities. Ensuring that the patient makes an informed decision is therefore an ongoing challenge for nurses as they are taking part in a delicate balancing act between not directly influencing the patient's decision while making sure the patient is accurately informed. PMID:17144913

77 FR 29644 - Decision To Evaluate a Petition To Designate a Class of Employees From Joslyn Manufacturing and...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-18

... as follows: Facility: Joslyn Manufacturing and Supply Co. Location: Ft. Wayne, Indiana. Job Titles and/or Job Duties: All employees. Period of Employment: January 1, 1944 to December 31, 1952. FOR FURTHER INFORMATION CONTACT: Stuart L. Hinnefeld, Director, Division of Compensation Analysis and Support...

El Camino College Master Plan.

ERIC Educational Resources Information Center

El Camino Coll., Torrance, CA.

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

The Method for Assigning Priority Levels (MAPLe): A new decision-support system for allocating home care resources

PubMed Central

Hirdes, John P; Poss, Jeff W; Curtin-Telegdi, Nancy

2008-01-01

Background Home care plays a vital role in many health care systems, but there is evidence that appropriate targeting strategies must be used to allocate limited home care resources effectively. The aim of the present study was to develop and validate a methodology for prioritizing access to community and facility-based services for home care clients. Methods Canadian and international data based on the Resident Assessment Instrument – Home Care (RAI-HC) were analyzed to identify predictors for nursing home placement, caregiver distress and for being rated as requiring alternative placement to improve outlook. Results The Method for Assigning Priority Levels (MAPLe) algorithm was a strong predictor of all three outcomes in the derivation sample. The algorithm was validated with additional data from five other countries, three other provinces, and an Ontario sample obtained after the use of the RAI-HC was mandated. Conclusion The MAPLe algorithm provides a psychometrically sound decision-support tool that may be used to inform choices related to allocation of home care resources and prioritization of clients needing community or facility-based services. PMID:18366782

Computational biomedicine: a challenge for the twenty-first century.

PubMed

Coveney, Peter V; Shublaq, Nour W

2012-01-01

With the relentless increase of computer power and the widespread availability of digital patient-specific medical data, we are now entering an era when it is becoming possible to develop predictive models of human disease and pathology, which can be used to support and enhance clinical decision-making. The approach amounts to a grand challenge to computational science insofar as we need to be able to provide seamless yet secure access to large scale heterogeneous personal healthcare data in a facile way, typically integrated into complex workflows-some parts of which may need to be run on high performance computers-in a facile way that is integrated into clinical decision support software. In this paper, we review the state of the art in terms of case studies drawn from neurovascular pathologies and HIV/AIDS. These studies are representative of a large number of projects currently being performed within the Virtual Physiological Human initiative. They make demands of information technology at many scales, from the desktop to national and international infrastructures for data storage and processing, linked by high performance networks.

Catching the right wave: evaluating wave energy resources and potential compatibility with existing marine and coastal uses.

PubMed

Kim, Choong-Ki; Toft, Jodie E; Papenfus, Michael; Verutes, Gregory; Guerry, Anne D; Ruckelshaus, Marry H; Arkema, Katie K; Guannel, Gregory; Wood, Spencer A; Bernhardt, Joanna R; Tallis, Heather; Plummer, Mark L; Halpern, Benjamin S; Pinsky, Malin L; Beck, Michael W; Chan, Francis; Chan, Kai M A; Levin, Phil S; Polasky, Stephen

2012-01-01

Many hope that ocean waves will be a source for clean, safe, reliable and affordable energy, yet wave energy conversion facilities may affect marine ecosystems through a variety of mechanisms, including competition with other human uses. We developed a decision-support tool to assist siting wave energy facilities, which allows the user to balance the need for profitability of the facilities with the need to minimize conflicts with other ocean uses. Our wave energy model quantifies harvestable wave energy and evaluates the net present value (NPV) of a wave energy facility based on a capital investment analysis. The model has a flexible framework and can be easily applied to wave energy projects at local, regional, and global scales. We applied the model and compatibility analysis on the west coast of Vancouver Island, British Columbia, Canada to provide information for ongoing marine spatial planning, including potential wave energy projects. In particular, we conducted a spatial overlap analysis with a variety of existing uses and ecological characteristics, and a quantitative compatibility analysis with commercial fisheries data. We found that wave power and harvestable wave energy gradually increase offshore as wave conditions intensify. However, areas with high economic potential for wave energy facilities were closer to cable landing points because of the cost of bringing energy ashore and thus in nearshore areas that support a number of different human uses. We show that the maximum combined economic benefit from wave energy and other uses is likely to be realized if wave energy facilities are sited in areas that maximize wave energy NPV and minimize conflict with existing ocean uses. Our tools will help decision-makers explore alternative locations for wave energy facilities by mapping expected wave energy NPV and helping to identify sites that provide maximal returns yet avoid spatial competition with existing ocean uses.

Catching the Right Wave: Evaluating Wave Energy Resources and Potential Compatibility with Existing Marine and Coastal Uses

PubMed Central

Kim, Choong-Ki; Toft, Jodie E.; Papenfus, Michael; Verutes, Gregory; Guerry, Anne D.; Ruckelshaus, Marry H.; Arkema, Katie K.; Guannel, Gregory; Wood, Spencer A.; Bernhardt, Joanna R.; Tallis, Heather; Plummer, Mark L.; Halpern, Benjamin S.; Pinsky, Malin L.; Beck, Michael W.; Chan, Francis; Chan, Kai M. A.; Levin, Phil S.; Polasky, Stephen

2012-01-01

Many hope that ocean waves will be a source for clean, safe, reliable and affordable energy, yet wave energy conversion facilities may affect marine ecosystems through a variety of mechanisms, including competition with other human uses. We developed a decision-support tool to assist siting wave energy facilities, which allows the user to balance the need for profitability of the facilities with the need to minimize conflicts with other ocean uses. Our wave energy model quantifies harvestable wave energy and evaluates the net present value (NPV) of a wave energy facility based on a capital investment analysis. The model has a flexible framework and can be easily applied to wave energy projects at local, regional, and global scales. We applied the model and compatibility analysis on the west coast of Vancouver Island, British Columbia, Canada to provide information for ongoing marine spatial planning, including potential wave energy projects. In particular, we conducted a spatial overlap analysis with a variety of existing uses and ecological characteristics, and a quantitative compatibility analysis with commercial fisheries data. We found that wave power and harvestable wave energy gradually increase offshore as wave conditions intensify. However, areas with high economic potential for wave energy facilities were closer to cable landing points because of the cost of bringing energy ashore and thus in nearshore areas that support a number of different human uses. We show that the maximum combined economic benefit from wave energy and other uses is likely to be realized if wave energy facilities are sited in areas that maximize wave energy NPV and minimize conflict with existing ocean uses. Our tools will help decision-makers explore alternative locations for wave energy facilities by mapping expected wave energy NPV and helping to identify sites that provide maximal returns yet avoid spatial competition with existing ocean uses. PMID:23144824

Radiological emergency response for community agencies with cognitive task analysis, risk analysis, and decision support framework.

PubMed

Meyer, Travis S; Muething, Joseph Z; Lima, Gustavo Amoras Souza; Torres, Breno Raemy Rangel; del Rosario, Trystyn Keia; Gomes, José Orlando; Lambert, James H

2012-01-01

Radiological nuclear emergency responders must be able to coordinate evacuation and relief efforts following the release of radioactive material into populated areas. In order to respond quickly and effectively to a nuclear emergency, high-level coordination is needed between a number of large, independent organizations, including police, military, hazmat, and transportation authorities. Given the complexity, scale, time-pressure, and potential negative consequences inherent in radiological emergency responses, tracking and communicating information that will assist decision makers during a crisis is crucial. The emergency response team at the Angra dos Reis nuclear power facility, located outside of Rio de Janeiro, Brazil, presently conducts emergency response simulations once every two years to prepare organizational leaders for real-life emergency situations. However, current exercises are conducted without the aid of electronic or software tools, resulting in possible cognitive overload and delays in decision-making. This paper describes the development of a decision support system employing systems methodologies, including cognitive task analysis and human-machine interface design. The decision support system can aid the coordination team by automating cognitive functions and improving information sharing. A prototype of the design will be evaluated by plant officials in Brazil and incorporated to a future trial run of a response simulation.

Metering Best Practices Applied in the National Renewable Energy Laboratory's Research Support Facility: A Primer to the 2011 Measured and Modeled Energy Consumption Datasets

DOE Data Explorer

Sheppy, Michael; Beach, A.; Pless, Shanti

2016-08-09

Modern buildings are complex energy systems that must be controlled for energy efficiency. The Research Support Facility (RSF) at the National Renewable Energy Laboratory (NREL) has hundreds of controllers -- computers that communicate with the building's various control systems -- to control the building based on tens of thousands of variables and sensor points. These control strategies were designed for the RSF's systems to efficiently support research activities. Many events that affect energy use cannot be reliably predicted, but certain decisions (such as control strategies) must be made ahead of time. NREL researchers modeled the RSF systems to predict how they might perform. They then monitor these systems to understand how they are actually performing and reacting to the dynamic conditions of weather, occupancy, and maintenance.

DATA QUALITY OBJECTIVE SUMMARY REPORT FOR THE 105 K EAST ION EXCHANGE COLUMN MONOLITH

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

JOCHEN, R.M.

2007-08-02

The 105-K East (KE) Basin Ion Exchange Column (IXC) cells, lead caves, and the surrounding vault are to be removed as necessary components in implementing ''Hanford Federal Facility Agreement and Consent Order'' (Ecology et al. 2003) milestone M-034-32 (Complete Removal of the K East Basin Structure). The IXCs consist of six units located in the KE Basin, three in operating positions in cells and three stored in a lead cave. Methods to remove the IXCs from the KE Basin were evaluated in KBC-28343, ''Disposal of K East Basin Ion Exchange Column Evaluation''. The method selected for removal was grouting themore » six IXCs into a single monolith for disposal at the Environmental Restoration Disposal Facility (ERDF). Grout will be added to the IXC cells, IXC lead caves containing spent IXCs, and in the spaces between the lead cave walls and metal skin, to immobilize the contaminants, provide self-shielding, minimize void space, and provide a structurally stable waste form. The waste to be offered for disposal is the encapsulated monolith defined by the exterior surfaces of the vault and the lower surface of the underlying slab. This document presents summary of the data quality objective (DQO) process establishing the decisions and data required to support decision-making activities for the disposition of the IXC monolith. The DQO process is completed in accordance with the seven-step planning process described in EPA QA/G-4, ''Guidance for the Data Quality Objectives Process'', which is used to clarify and study objectives; define the appropriate type, quantity, and quality of data; and support defensible decision-making. The DQO process involves the following steps: (1) state the problem; (2) identify the decision; (3) identify the inputs to the decision; (4) define the boundaries of the study; (5) develop a decision rule (DR); (6) specify tolerable limits on decision errors; and (7) optimize the design for obtaining data.« less

Noneconomic factors influencing scrap metal disposition decisions at DOE and NRC-licensed nuclear facilities

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

Ewen, M.D.; Robinson, L.A.

1997-02-01

The U.S. Environmental Protection Agency (EPA) is currently developing radiation protection standards for scrap metal, which will establish criteria for the unconditional clearance of scrap from nuclear facilities. In support of this effort, Industrial Economics, Incorporated is assessing the costs and benefits attributable to the rulemaking. The first step in this analysis is to develop an in-depth understanding of the factors influencing scrap disposition decisions, so that one can predict current and future practices under existing requirements and compare them to the potential effects of EPA`s rulemaking. These baseline practices are difficult to predict due to a variety of factors.more » First, because decommissioning activities are just beginning at many sites, current practices do not necessarily provide an accurate indicator of how these practices may evolve as site managers gain experience with related decisions. Second, a number of different regulations and policies apply to these decisions, and the interactive effects of these requirements can be difficult to predict. Third, factors other than regulatory constraints and costs may have a significant effect on related decisions, such as concerns about public perceptions. In general, research suggests that these factors tend to discourage the unconditional clearance of scrap metal.« less

A framework for multi-stakeholder decision-making and ...

EPA Pesticide Factsheets

We propose a decision-making framework to compute compromise solutions that balance conflicting priorities of multiple stakeholders on multiple objectives. In our setting, we shape the stakeholder dis-satisfaction distribution by solving a conditional-value-at-risk (CVaR) minimization problem. The CVaR problem is parameterized by a probability level that shapes the tail of the dissatisfaction distribution. The proposed approach allows us to compute a family of compromise solutions and generalizes multi-stakeholder settings previously proposed in the literature that minimize average and worst-case dissatisfactions. We use the concept of the CVaR norm to give a geometric interpretation to this problem +and use the properties of this norm to prove that the CVaR minimization problem yields Pareto optimal solutions for any choice of the probability level. We discuss a broad range of potential applications of the framework that involve complex decision-making processes. We demonstrate the developments using a biowaste facility location case study in which we seek to balance stakeholder priorities on transportation, safety, water quality, and capital costs. This manuscript describes the methodology of a new decision-making framework that computes compromise solutions that balance conflicting priorities of multiple stakeholders on multiple objectives as needed for SHC Decision Science and Support Tools project. A biowaste facility location is employed as the case study

Community Response to Concentrating Solar Power in the San Luis Valley: October 9, 2008 - March 31, 2010

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

Farhar, B. C.; Hunter, L. M.; Kirkland, T. M.

2010-06-01

This report is about the social acceptance of utility-scale concentrating solar power (CSP) plants in the San Luis Valley, approximately 200 miles southwest of Denver, Colorado. The research focused on social factors that may facilitate and impede the adoption and implementation of CSP. During the winter of 2008-2009, interviews were conducted with a purposive sample of 25 CSP-related stakeholders inside and outside the Valley. Interviews focused on the perceived advantages and disadvantages of siting a hypothetical 100-MW CSP facility in the Valley, the level of community support and opposition to CSP development, and related issues, such as transmission. State policymore » recommendations based on the findings include developing education programs for Valley residents, integrating Valley decision makers into an energy-water-land group, providing training for Valley decision makers, offering workforce training, evaluating models of taxation, and forming landholder energy associations. In addition, the SLV could become a laboratory for new approaches to CSP facility and transmission siting decision-making. The author recommends that outside stakeholders address community concerns and engage Valley residents in CSP decisions. Engaging the residents in CSP and transmission decisions, the author says, should take parallel significance with the investment in solar technology.« less

Quality and rural-urban comparison of tuberculosis care in Rivers State, Nigeria

PubMed Central

Tobin-West, Charles Ibiene; Isodje, Anastasia

2016-01-01

Introduction Nigeria ranks among countries with the highest burden of tuberculosis. Yet evidence continues to indicate poor treatment outcomes which have been attributed to poor quality of care. This study aims to identify some of the systemic problems in order to inform policy decisions for improved quality of services and treatment outcomes in Nigeria. Methods A comparative assessment of the quality of TB care in rural and urban health facilities was carried out between May and June 2013, employing the Donabedian model of quality assessment. Data was analysed using the SPSS software package version 20.0. The level of significance was set at p < 0.05. Results Health facility infrastructures were more constrained in the urban than rural settings. Both the urban and rural facilities lacked adequate facilities for infection control such as, running water, air filter respirators, hand gloves and extractor fans. Health education and HIV counselling and testing (HCT) were limited in rural facilities compared to urban facilities. Although anti-TB drugs were generally available in both settings, the DOTS strategy in patient care was completely ignored. Finally, laboratory support for diagnosis and patient monitoring was limited in the rural facilities. Conclusion The study highlights suboptimal quality of TB care in Rivers State with limitations in health education and HCT of patients for HIV as well as laboratory support for TB care in rural health facilities. We, therefore, recommend that adequate infection control measures, strict observance of the DOTS strategy and sufficient laboratory support be provided to TB clinics in the State. PMID:27642401

Siting a municipal solid waste disposal facility, part II: the effects of external criteria on the final decision.

PubMed

Korucu, M Kemal; Karademir, Aykan

2014-02-01

The procedure of a multi-criteria decision analysis supported by the geographic information systems was applied to the site selection process of a planning municipal solid waste management practice based on twelve different scenarios. The scenarios included two different decision tree modes and two different weighting models for three different area requirements. The suitability rankings of the suitable sites obtained from the application of the decision procedure for the scenarios were assessed by a factorial experimental design concerning the effect of some external criteria on the final decision of the site selection process. The external criteria used in the factorial experimental design were defined as "Risk perception and approval of stakeholders" and "Visibility". The effects of the presence of these criteria in the decision trees were evaluated in detail. For a quantitative expression of the differentiations observed in the suitability rankings, the ranking data were subjected to ANOVA test after a normalization process. Then the results of these tests were evaluated by Tukey test to measure the effects of external criteria on the final decision. The results of Tukey tests indicated that the involvement of the external criteria into the decision trees produced statistically meaningful differentiations in the suitability rankings. Since the external criteria could cause considerable external costs during the operation of the disposal facilities, the presence of these criteria in the decision tree in addition to the other criteria related to environmental and legislative requisites could prevent subsequent external costs in the first place.

A Framework for Multi-Stakeholder Decision-Making and ...

EPA Pesticide Factsheets

This contribution describes the implementation of the conditional-value-at-risk (CVaR) metric to create a general multi-stakeholder decision-making framework. It is observed that stakeholder dissatisfactions (distance to their individual ideal solutions) can be interpreted as random variables. We thus shape the dissatisfaction distribution and find an optimal compromise solution by solving a CVaR minimization problem parameterized in the probability level. This enables us to generalize multi-stakeholder settings previously proposed in the literature that minimizes average and worst-case dissatisfactions. We use the concept of the CVaR norm to give a geometric interpretation to this problem and use the properties of this norm to prove that the CVaR minimization problem yields Pareto optimal solutions for any choice of the probability level. We discuss a broad range of potential applications of the framework. We demonstrate the framework in a bio-waste processing facility location case study, where we seek compromise solutions (facility locations) that balance stakeholder priorities on transportation, safety, water quality, and capital costs. This conference presentation abstract explains a new decision-making framework that computes compromise solution alternatives (reach consensus) by mitigating dissatisfactions among stakeholders as needed for SHC Decision Science and Support Tools project.

Choice-making among Medicaid HCBS and ICF/MR recipients in six states.

PubMed

Lakin, K Charlie; Doljanac, Robert; Byun, Soo-Yong; Stancliffe, Roger; Taub, Sarah; Chiri, Giuseppina

2008-09-01

Choice in everyday decisions and in support-related decisions was addressed among 2,398 adults with intellectual and developmental disabilities receiving Medicaid Home and Community Based Services (HCBS) and Intermediate Care Facility (ICF/MR) services and living in non family settings in six states. Everyday choice in daily life and in support-related choice was considerably higher on average for HCBS than for ICF/MR recipients, but after controlling for level of intellectual disability, medical care needs, mobility, behavioral and psychiatric conditions, and self-reporting, we found that choice was more strongly associated with living in a congregate setting than whether that setting was HCBS- or ICF/MR-financed. Marked differences in choice were also evident between states.

THE NGA-DOE GRANT TO EXAMINE CRITICAL ISSUES RELATED TO RADIOACTIVE WASTE AND MATERIALS DISPOSITION INVOLVING DOE FACILITIES

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

NONE

1998-07-01

Through the National Governors' Association (NGA) project ''Critical Issues Related to Radioactive Waste and Materials Disposition Involving DOE Facilities'' NGA brings together Governors' policy advisors, state regulators, and DOE officials to examine critical issues related to the cleanup and operation of DOE nuclear weapons and research facilities. Topics explored through this project include: Decisions involving disposal of mixed, low-level, and transuranic (TRU) waste and disposition of nuclear materials. Decisions involving DOE budget requests and their effect on environmental cleanup and compliance at DOE facilities. Strategies to treat mixed, low-level, and transuranic (TRU) waste and their effect on individual sites inmore » the complex. Changes to the FFCA site treatment plans as a result of proposals in DOE's Accelerating Cleanup: Paths to Closure strategy and contractor integration analysis. Interstate waste and materials shipments. Reforms to existing RCRA and CERCLA regulations/guidance to address regulatory overlap and risks posed by DOE wastes. The overarching theme of this project is to help the Department improve coordination of its major program decisions with Governors' offices and state regulators and to ensure such decisions reflect input from these key state officials and stakeholders. This report summarizes activities conducted during the quarter from April 30, 1998 through June 30, 1998 under the NGA project. The work accomplished by the NGA project team during the past four months can be categorized as follows: maintained open communication with DOE on a variety of activities and issues within the DOE environmental management complex; and provided ongoing support to state-DOE interactions. maintained communication with NGA Federal Facilities Compliance Task Force members regarding DOE efforts to formulate a configuration for mixed low-level waste and low-level treatment and disposal, DOE's Environmental Management Budget, and DOE's proposed Intersite Discussions.« less

Safeguards-by-Design:Guidance for High Temperature Gas Reactors (HTGRs) With Prismatic Fuel

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

Mark Schanfein; Casey Durst

2012-11-01

Introduction and Purpose The following is a guidance document from a series prepared for the U.S. Department of Energy (DOE) National Nuclear Security Administration (NNSA), under the Next Generation Safeguards Initiative (NGSI), to assist facility designers and operators in implementing international Safeguards-by-Design (SBD). SBD has two main objectives: (1) to avoid costly and time consuming redesign work or retrofits of new nuclear fuel cycle facilities and (2) to make the implementation of international safeguards more effective and efficient at such facilities. In the long term, the attainment of these goals would save industry and the International Atomic Energy Agency (IAEA)more » time, money, and resources and be mutually beneficial. This particular safeguards guidance document focuses on prismatic fuel high temperature gas reactors (HTGR). The purpose of the IAEA safeguards system is to provide credible assurance to the international community that nuclear material and other specified items are not diverted from peaceful nuclear uses. The safeguards system consists of the IAEA’s statutory authority to establish safeguards; safeguards rights and obligations in safeguards agreements and additional protocols; and technical measures implemented pursuant to those agreements. Of foremost importance is the international safeguards agreement between the country and the IAEA, concluded pursuant to the Treaty on the Non-Proliferation of Nuclear Weapons (NPT). According to a 1992 IAEA Board of Governors decision, countries must: notify the IAEA of a decision to construct a new nuclear facility as soon as such decision is taken; provide design information on such facilities as the designs develop; and provide detailed design information based on construction plans at least 180 days prior to the start of construction, and on "as-built" designs at least 180 days before the first receipt of nuclear material. Ultimately, the design information will be captured in an IAEA Design Information Questionnaire (DIQ), prepared by the facility operator, typically with the support of the facility designer. The IAEA will verify design information over the life of the project. This design information is an important IAEA safeguards tool. Since the main interlocutor with the IAEA in each country is the State Regulatory Authority/SSAC (or Regional Regulatory Authority, e.g. EURATOM), the responsibility for conveying this design information to the IAEA falls to the State Regulatory Authority/SSAC. For the nuclear industry to reap the benefits of SBD (i.e. avoid cost overruns and construction schedule slippages), nuclear facility designers and operators should work closely with the State Regulatory Authority and IAEA as soon as a decision is taken to build a new nuclear facility. Ideally, this interaction should begin during the conceptual design phase and continue throughout construction and start-up of a nuclear facility. Such early coordination and planning could influence decisions on the design of the nuclear material processing flow-sheet, material storage and handling arrangements, and facility layout (including safeguards equipment), etc.« less

75 FR 24958 - Decision To Evaluate a Petition To Designate a Class of Employees From the Hanford Site, Richland...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-06

... warranted by the evaluation, is as follows: Facility: Hanford site. Location: Richland, Washington. Job Titles and/or Job Duties: All personnel who were internally monitored (urine or fecal), who worked at the... Analysis and Support, National Institute for Occupational Safety and Health (NIOSH), 4676 Columbia Parkway...

78 FR 51219 - Biweekly Notice; Applications and Amendments to Facility Operating Licenses and Combined Licenses...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-20

... support unlisted software, and the NRC Meta System Help Desk will not be able to offer assistance in using...'s Agencywide Documents Access and Management System (ADAMS): You may access publicly-available... proceeding; and (4) the possible effect of any decision or order which may be entered in the proceeding on...

78 FR 21164 - Applications and Amendments to Facility Operating Licenses and Combined Licenses Involving...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-09

... system does not support unlisted software, and the NRC Meta System Help Desk will not be able to offer... Docket ID NRC-2013-0059. NRC's Agencywide Documents Access and Management System (ADAMS): You may access..., financial, or other interest in the proceeding; and (4) the possible effect of any decision or order which...

ISERV Pathfinder. The ISS SERVIR Environmental Research and Visualization System

NASA Technical Reports Server (NTRS)

Howell, Burgess

2011-01-01

SERVIR integrates Earth observations (e.g., space imagery), predictive models, and in situ data to provide timely information products to support environmental decision makers. ISERV propoesed development -- ISERV-W: Internal Visible/Near-Infrared (VNIR), attached to ISS via Window Observational Research Facility (WORF), ISERV-E: External Visible/Broad-Infrared (V/IR) and ISERV-PM: External Passive Microwave.

75 FR 38093 - ConocoPhillips Alaska Natural Gas Corporation and Marathon Oil Company; Application for Blanket...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-01

... regasification terminal; and use of the existing terminal for exports to support the economic viability of a... LNG shipping at economic rates; and (3) strategic decisions regarding the future role of the Kenai LNG... Facility provides local economic benefits, including as an employer and as a source of royalties and taxes...

School-Based Clinics: A Guide for Advocates. Developing Policy Statements, Educating Decision Makers, Enlisting Local Support.

ERIC Educational Resources Information Center

Center for Population Options, Washington, DC.

School-based clinics (SBCs) are comprehensive primary health care facilities located within or on the grounds of middle, junior, or senior high schools. Varying in size and organizational structure, SBCs have emerged as an effective model for advancing adolescent health. They have gained attention because of their potential for treating problems…

Strategic and integrated planning for healthy, connected cities: Chattanooga case study.

PubMed

Elwell Bostrom, Holly; Shulaker, Bianca; Rippon, Jasmin; Wood, Rick

2017-02-01

The United States is facing unprecedented health challenges - such as obesity and cardiovascular disease - many of which are related to a lack of or insufficient physical activity. Maintaining or creating parks and other public recreation facilities that promote physical activity is particularly important for combating these. This brief describes a strategic planning initiative, known as "Healthy, Connected Chattanooga." The City of Chattanooga, Tennessee, partnered with The Trust for Public Land, a national nonprofit organization, to analyze the city for physical activity opportunities and identify areas where interventions were of highest need. Interventions include the creation of new parks and the activation of existing ones through the installation of fitness facilities known as Fitness Zones®. Maps and an on-line decision-support tool (web portal) were developed between 2013 and 2015, and are being used by the city to make strategic investment decisions. The decision-support analysis described in this brief has engaged a wide variety of stakeholders, opened the door to a broader base of funding sources for health-related interventions, and provided evidence for discussions about equity, access to resources, and prioritization of future projects. This brief presents a framework for integrating scientific models with community and social metrics, enabling more complete and accurate understanding of cities and the identification of more equitable, strategic, and investable solutions to current and pressing challenges. Copyright © 2016 Elsevier Inc. All rights reserved.

Clinical Decision Support to Efficiently Identify Patients Eligible for Advanced Heart Failure Therapies.

PubMed

Evans, R Scott; Kfoury, Abdallah G; Horne, Benjamin D; Lloyd, James F; Benuzillo, Jose; Rasmusson, Kismet D; Roberts, Colleen; Lappé, Donald L

2017-10-01

Patients who need and receive timely advanced heart failure (HF) therapies have better long-term survival. However, many of these patients are not identified and referred as soon as they should be. A clinical decision support (CDS) application sent secure email notifications to HF patients' providers when they transitioned to advanced disease. Patients identified with CDS in 2015 were compared with control patients from 2013 to 2014. Kaplan-Meier methods and Cox regression were used in this intention-to-treat analysis to compare differences between visits to specialized and survival. Intervention patients were referred to specialized heart facilities significantly more often within 30 days (57% vs 34%; P < .001), 60 days (69% vs 44%; P < .0001), 90 days (73% vs 49%; P < .0001), and 180 days (79% vs 58%; P < .0001). Age and sex did not predict heart facility visits, but renal disease did and patients of nonwhite race were less likely to visit specialized heart facilities. Significantly more intervention patients were found to be alive at 30 (95% vs 92%; P = .036), 60 (95% vs 90%; P = .0013), 90 (94% vs 87%; P = .0002), and 180 days (92% vs 84%; P = .0001). Age, sex, and some comorbid diseases were also predictors of mortality, but race was not. We found that CDS can facilitate the early identification of patients needing advanced HF therapy and that its use was associated with significantly more patients visiting specialized heart facilities and longer survival. Copyright © 2017 Elsevier Inc. All rights reserved.

Home monitoring and decision support for international liver transplant children.

PubMed

Song, Bianying; Schulze, Mareike; Goldschmidt, Imeke; Haux, Reinhold; Baumann, Ulrich; Marschollek, Michael

2013-01-01

Complications may occur after a liver transplantation, therefore proper monitoring and care in the post-operation phase plays a very important role. Sometimes, monitoring and care for patients from abroad is difficult due to a variety of reasons, e.g., different care facilities. The objective of our research for this paper is to design, implement and evaluate a home monitoring and decision support infrastructure for international children who underwent liver transplant operation. A point-of-care device and the PedsQL questionnaire were used in patients' home environment for measuring the blood parameters and assessing quality of life. By using a tablet PC and a specially developed software, the measured results were able to be transmitted to the health care providers via internet. So far, the developed infrastructure has been evaluated with four international patients/families transferring 38 records of blood test. The evaluation showed that the home monitoring and decision support infrastructure is technically feasible and is able to give timely alarm in case of abnormal situation as well as may increase parent's feeling of safety for their children.

The Enterprise Data Trust at Mayo Clinic: a semantically integrated warehouse of biomedical data

PubMed Central

Beck, Scott A; Fisk, Thomas B; Mohr, David N

2010-01-01

Mayo Clinic's Enterprise Data Trust is a collection of data from patient care, education, research, and administrative transactional systems, organized to support information retrieval, business intelligence, and high-level decision making. Structurally it is a top-down, subject-oriented, integrated, time-variant, and non-volatile collection of data in support of Mayo Clinic's analytic and decision-making processes. It is an interconnected piece of Mayo Clinic's Enterprise Information Management initiative, which also includes Data Governance, Enterprise Data Modeling, the Enterprise Vocabulary System, and Metadata Management. These resources enable unprecedented organization of enterprise information about patient, genomic, and research data. While facile access for cohort definition or aggregate retrieval is supported, a high level of security, retrieval audit, and user authentication ensures privacy, confidentiality, and respect for the trust imparted by our patients for the respectful use of information about their conditions. PMID:20190054

Design and evaluation of a disaster preparedness logistics tool.

PubMed

Neches, Robert; Ryutov, Tatyana; Kichkaylo, Tatiana; Burke, Rita V; Claudius, Ilene A; Upperman, Jeffrey S

2009-01-01

The purpose of this article is to describe the development and testing of the Pediatric Emergency Decision Support System (PEDSS), a dynamic tool for pediatric victim disaster planning. This is a descriptive article outlining an innovative automated approach to pediatric decision support and disaster planning. Disaster Resource Centers and umbrella hospitals in Los Angeles County. The authors use a model set of hypothetical patients for our pediatric disaster planning approach. The authors developed the PEDSS software to accomplish two goals: (a) core that supports user interaction and data management requirements (e.g., accessing demographic information about a healthcare facility's catchment area) and (b) set of modules each addressing a critical disaster preparation issue. The authors believe the PEDSS tool will help hospital disaster response personnel produce and maintain disaster response plans that apply best practice pediatric recommendations to their particular local conditions and requirements.

The Enterprise Data Trust at Mayo Clinic: a semantically integrated warehouse of biomedical data.

PubMed

Chute, Christopher G; Beck, Scott A; Fisk, Thomas B; Mohr, David N

2010-01-01

Mayo Clinic's Enterprise Data Trust is a collection of data from patient care, education, research, and administrative transactional systems, organized to support information retrieval, business intelligence, and high-level decision making. Structurally it is a top-down, subject-oriented, integrated, time-variant, and non-volatile collection of data in support of Mayo Clinic's analytic and decision-making processes. It is an interconnected piece of Mayo Clinic's Enterprise Information Management initiative, which also includes Data Governance, Enterprise Data Modeling, the Enterprise Vocabulary System, and Metadata Management. These resources enable unprecedented organization of enterprise information about patient, genomic, and research data. While facile access for cohort definition or aggregate retrieval is supported, a high level of security, retrieval audit, and user authentication ensures privacy, confidentiality, and respect for the trust imparted by our patients for the respectful use of information about their conditions.

A Distributed Ensemble Approach for Mining Healthcare Data under Privacy Constraints

PubMed Central

Li, Yan; Bai, Changxin; Reddy, Chandan K.

2015-01-01

In recent years, electronic health records (EHRs) have been widely adapted at many healthcare facilities in an attempt to improve the quality of patient care and increase the productivity and efficiency of healthcare delivery. These EHRs can accurately diagnose diseases if utilized appropriately. While the EHRs can potentially resolve many of the existing problems associated with disease diagnosis, one of the main obstacles in effectively using them is the patient privacy and sensitivity of the medical information available in the EHR. Due to these concerns, even if the EHRs are available for storage and retrieval purposes, sharing of the patient records between different healthcare facilities has become a major concern and has hampered some of the effective advantages of using EHRs. Due to this lack of data sharing, most of the facilities aim at building clinical decision support systems using limited amount of patient data from their own EHR systems to provide important diagnosis related decisions. It becomes quite infeasible for a newly established healthcare facility to build a robust decision making system due to the lack of sufficient patient records. However, to make effective decisions from clinical data, it is indispensable to have large amounts of data to train the decision models. In this regard, there are conflicting objectives of preserving patient privacy and having sufficient data for modeling and decision making. To handle such disparate goals, we develop two adaptive distributed privacy-preserving algorithms based on a distributed ensemble strategy. The basic idea of our approach is to build an elegant model for each participating facility to accurately learn the data distribution, and then can transfer the useful healthcare knowledge acquired on their data from these participators in the form of their own decision models without revealing and sharing the patient-level sensitive data, thus protecting patient privacy. We demonstrate that our approach can successfully build accurate and robust prediction models, under privacy constraints, using the healthcare data collected from different geographical locations. We demonstrate the performance of our method using the Type-2 diabetes EHRs accumulated from multiple sources from all fifty states in the U.S. Our method was evaluated on diagnosing diabetes in the presence of insufficient number of patient records from certain regions without revealing the actual patient data from other regions. Using the proposed approach, we also discovered the important biomarkers, both universal and region-specific, and validated the selected biomarkers using the biomedical literature. PMID:26681811

A Distributed Ensemble Approach for Mining Healthcare Data under Privacy Constraints.

PubMed

Li, Yan; Bai, Changxin; Reddy, Chandan K

2016-02-10

In recent years, electronic health records (EHRs) have been widely adapted at many healthcare facilities in an attempt to improve the quality of patient care and increase the productivity and efficiency of healthcare delivery. These EHRs can accurately diagnose diseases if utilized appropriately. While the EHRs can potentially resolve many of the existing problems associated with disease diagnosis, one of the main obstacles in effectively using them is the patient privacy and sensitivity of the medical information available in the EHR. Due to these concerns, even if the EHRs are available for storage and retrieval purposes, sharing of the patient records between different healthcare facilities has become a major concern and has hampered some of the effective advantages of using EHRs. Due to this lack of data sharing, most of the facilities aim at building clinical decision support systems using limited amount of patient data from their own EHR systems to provide important diagnosis related decisions. It becomes quite infeasible for a newly established healthcare facility to build a robust decision making system due to the lack of sufficient patient records. However, to make effective decisions from clinical data, it is indispensable to have large amounts of data to train the decision models. In this regard, there are conflicting objectives of preserving patient privacy and having sufficient data for modeling and decision making. To handle such disparate goals, we develop two adaptive distributed privacy-preserving algorithms based on a distributed ensemble strategy. The basic idea of our approach is to build an elegant model for each participating facility to accurately learn the data distribution, and then can transfer the useful healthcare knowledge acquired on their data from these participators in the form of their own decision models without revealing and sharing the patient-level sensitive data, thus protecting patient privacy. We demonstrate that our approach can successfully build accurate and robust prediction models, under privacy constraints, using the healthcare data collected from different geographical locations. We demonstrate the performance of our method using the Type-2 diabetes EHRs accumulated from multiple sources from all fifty states in the U.S. Our method was evaluated on diagnosing diabetes in the presence of insufficient number of patient records from certain regions without revealing the actual patient data from other regions. Using the proposed approach, we also discovered the important biomarkers, both universal and region-specific, and validated the selected biomarkers using the biomedical literature.

To Stay or to Leave: Factors Influencing Victims' Decisions to Stay or Leave a Domestic Violence Emergency Shelter.

PubMed

Fisher, Elisa M; Stylianou, Amanda M

2016-04-28

Domestic violence (DV) emergency shelters play a vital role in supporting victims who seek to leave abusive partners and gain independence. Research indicates that numerous positive outcomes for victims and their children are associated with utilization of DV shelter programs. Yet, research also suggests that DV shelter programs may be unable to comprehensively meet the needs of all victims, and many choose to leave shelters soon after their arrival. To better understand the ways in which DV shelter programs support victims but also fail to meet their needs, this article explores the factors that influence victims' decisions to stay or leave a DV emergency shelter program through qualitative interviews with 33 DV shelter residents. Study participants indicate that three types of factors influence their decision to stay or leave the shelter program: (a) contextual factors, (b) partner or family relationship factors, and (c) shelter-specific factors. Shelter-specific factors cited as important contributors to satisfaction or dissatisfaction with shelter living include policies, staff and services, displacement from one's home community, and facilities. Findings provide information from the perspective of victims on the factors that influence one's decision to stay or leave a DV program and can be used to support service providers and advocates in building programs that are both supportive of victims' needs and conductive to longer shelter stays. © The Author(s) 2016.

The North American model and captive cervid facilities—What is the threat?

USGS Publications Warehouse

Organ, John F.; Decker, Thomas A.; Lama, Tanya M.

2016-01-01

The North American Model of Wildlife Conservation represents the key principles that in combination resulted in a distinct form of wildlife conservation in the United States and Canada. How and to what extent captive cervid facilities comport with or conflict with these principles has implications for wildlife conservation. Greatest threats appear to be toward principles of public ownership of wildlife, allocation of wildlife by law, and in policy decisions based on science. Captive cervid facilities have potential to contribute to erosion of the underlying principles of the Model and could undermine public support for conservation initiatives.

Optimization-based decision support to assist in logistics planning for hospital evacuations.

PubMed

Glick, Roger; Bish, Douglas R; Agca, Esra

2013-01-01

The evacuation of the hospital is a very complex process and evacuation planning is an important part of a hospital's emergency management plan. There are numerous factors that affect the evacuation plan including the nature of threat, availability of resources and staff the characteristics of the evacuee population, and risk to patients and staff. The safety and health of patients is of fundamental importance, but safely moving patients to alternative care facilities while under threat is a very challenging task. This article describes the logistical issues and complexities involved in planning and execution of hospital evacuations. Furthermore, this article provides examples of how optimization-based decision support tools can help evacuation planners to better plan for complex evacuations by providing real-world solutions to various evacuation scenarios.

KSC-98pc786

NASA Image and Video Library

1998-07-06

James W. Tibble (pointing at engine), an Engine Systems/Ground Support Equipment team manager for Rocketdyne, discusses the operation of a Space Shuttle Main Engine with Robert B. Sieck, director of Shuttle Processing; U.S. Congressman Dave Weldon; and KSC Center Director Roy D. Bridges Jr. Following the ribbon cutting ceremony for KSC's new 34,600-square-foot Space Shuttle Main Engine Processing Facility (SSMEPF), KSC employees and media explored the facility. A major addition to the existing Orbiter Processing Facility Bay 3, the SSMEPF replaces the Shuttle Main Engine Shop located in the Vehicle Assembly Building (VAB). The decision to move the shop out of the VAB was prompted by safety considerations and recent engine processing improvements. The first three main engines to be processed in the new facility will fly on Shuttle Endeavour's STS-88 mission in December 1998

The SSMEPF opens with a ribbon-cutting ceremony

NASA Technical Reports Server (NTRS)

1998-01-01

James W. Tibble (pointing at engine), an Engine Systems/Ground Support Equipment team manager for Rocketdyne, discusses the operation of a Space Shuttle Main Engine with Robert B. Sieck, director of Shuttle Processing; U.S. Congressman Dave Weldon; and KSC Center Director Roy D. Bridges Jr. Following the ribbon cutting ceremony for KSC's new 34,600-square-foot Space Shuttle Main Engine Processing Facility (SSMEPF), KSC employees and media explored the facility. A major addition to the existing Orbiter Processing Facility Bay 3, the SSMEPF replaces the Shuttle Main Engine Shop located in the Vehicle Assembly Building (VAB). The decision to move the shop out of the VAB was prompted by safety considerations and recent engine processing improvements. The first three main engines to be processed in the new facility will fly on Shuttle Endeavour's STS-88 mission in December 1998.

Development of a support tool for complex decision-making in the provision of rural maternity care.

PubMed

Hearns, Glen; Klein, Michael C; Trousdale, William; Ulrich, Catherine; Butcher, David; Miewald, Christiana; Lindstrom, Ronald; Eftekhary, Sahba; Rosinski, Jessica; Gómez-Ramírez, Oralia; Procyk, Andrea

2010-02-01

Decisions in the organization of safe and effective rural maternity care are complex, difficult, value laden and fraught with uncertainty, and must often be based on imperfect information. Decision analysis offers tools for addressing these complexities in order to help decision-makers determine the best use of resources and to appreciate the downstream effects of their decisions. To develop a maternity care decision-making tool for the British Columbia Northern Health Authority (NH) for use in low birth volume settings. Based on interviews with community members, providers, recipients and decision-makers, and employing a formal decision analysis approach, we sought to clarify the influences affecting rural maternity care and develop a process to generate a set of value-focused objectives for use in designing and evaluating rural maternity care alternatives. Four low-volume communities with variable resources (with and without on-site births, with or without caesarean section capability) were chosen. Physicians (20), nurses (18), midwives and maternity support service providers (4), local business leaders, economic development officials and elected officials (12), First Nations (women [pregnant and non-pregnant], chiefs and band members) (40), social workers (3), pregnant women (2) and NH decision-makers/administrators (17). We developed a Decision Support Manual to assist with assessing community needs and values, context for decision-making, capacity of the health authority or healthcare providers, identification of key objectives for decision-making, developing alternatives for care, and a process for making trade-offs and balancing multiple objectives. The manual was deemed an effective tool for the purpose by the client, NH. Beyond assisting the decision-making process itself, the methodology provides a transparent communication tool to assist in making difficult decisions. While the manual was specifically intended to deal with rural maternity issues, the NH decision-makers feel the method can be easily adapted to assist decision-making in other contexts in medicine where there are conflicting objectives, values and opinions. Decisions on the location of new facilities or infrastructure, or enhancing or altering services such as surgical or palliative care, would be examples of complex decisions that might benefit from this methodology.

Development of a Support Tool for Complex Decision-Making in the Provision of Rural Maternity Care

PubMed Central

Hearns, Glen; Klein, Michael C.; Trousdale, William; Ulrich, Catherine; Butcher, David; Miewald, Christiana; Lindstrom, Ronald; Eftekhary, Sahba; Rosinski, Jessica; Gómez-Ramírez, Oralia; Procyk, Andrea

2010-01-01

Context: Decisions in the organization of safe and effective rural maternity care are complex, difficult, value laden and fraught with uncertainty, and must often be based on imperfect information. Decision analysis offers tools for addressing these complexities in order to help decision-makers determine the best use of resources and to appreciate the downstream effects of their decisions. Objective: To develop a maternity care decision-making tool for the British Columbia Northern Health Authority (NH) for use in low birth volume settings. Design: Based on interviews with community members, providers, recipients and decision-makers, and employing a formal decision analysis approach, we sought to clarify the influences affecting rural maternity care and develop a process to generate a set of value-focused objectives for use in designing and evaluating rural maternity care alternatives. Setting: Four low-volume communities with variable resources (with and without on-site births, with or without caesarean section capability) were chosen. Participants: Physicians (20), nurses (18), midwives and maternity support service providers (4), local business leaders, economic development officials and elected officials (12), First Nations (women [pregnant and non-pregnant], chiefs and band members) (40), social workers (3), pregnant women (2) and NH decision-makers/administrators (17). Results: We developed a Decision Support Manual to assist with assessing community needs and values, context for decision-making, capacity of the health authority or healthcare providers, identification of key objectives for decision-making, developing alternatives for care, and a process for making trade-offs and balancing multiple objectives. The manual was deemed an effective tool for the purpose by the client, NH. Conclusions: Beyond assisting the decision-making process itself, the methodology provides a transparent communication tool to assist in making difficult decisions. While the manual was specifically intended to deal with rural maternity issues, the NH decision-makers feel the method can be easily adapted to assist decision-making in other contexts in medicine where there are conflicting objectives, values and opinions. Decisions on the location of new facilities or infrastructure, or enhancing or altering services such as surgical or palliative care, would be examples of complex decisions that might benefit from this methodology. PMID:21286270

Use of Service-Learning to Teach Health Literacy with Online Graduate Nursing Students.

PubMed

George, Tracy P; DeCristofaro, Claire

To meet Healthy People 2020 goals, health literacy must be included in health care program curricula. In a fully online graduate nursing course, an innovative service-learning activity asked students to collaborate in the creation of low-literacy patient education pamphlets for practice partners at a community rehabilitation facility. Involvement with community stakeholders such as support groups and interprofessional team members enhanced interdisciplinary educational outcomes. Through this innovative project-based activity, students were able to meet the clinical education and decision support needs of rehabilitation patients while translating academic coursework to support actual community needs.

The Effects of Inadequate Component Inspection on Facility Repair Projects

DTIC Science & Technology

1988-06-01

inspection costs). These cases will also be analyzed 5 10 , 0 -1 to see if they support the validity of the framework and show that it is useful in...to improve the decisions surrounding site 0 18 -~ % - investigation procedures [3][4][ 5 ]. This thesis will attempt to look at these same decisions...Estimated Quant (SY) Actual Quant (SY) Bridge Class 1 Class 2 TOAL Class 1 Class 2 TTAL 58A 5 79 84 0 720 720 S 65A 9 164 173 0 130 130 15N/S 4 54 58 0 8 8

Assessment of wastewater treatment plant design for small communities: environmental and economic aspects.

PubMed

Molinos-Senante, M; Garrido-Baserba, M; Reif, R; Hernández-Sancho, F; Poch, M

2012-06-15

The preliminary design and economic assessment of small wastewater treatment plants (less than 2000 population equivalent) are issues of particular interest since wastewaters from most of these agglomerations are not covered yet. This work aims to assess nine different technologies set-up for the secondary treatment in such type of facilities embracing both economic and environmental parameters. The main novelty of this work is the combination of an innovative environmental decision support system (EDSS) with a pioneer approach based on the inclusion of the environmental benefits derived from wastewater treatment. The integration of methodologies based on cost-benefit analysis tools with the vast amount of knowledge from treatment technologies contained in the EDSS was applied in nine scenarios comprising different wastewater characteristics and reuse options. Hence, a useful economic feasibility indicator is obtained for each technology including internal and external costs and, for the first time, benefits associated with the environmental damage avoided. This new methodology proved to be crucial for supporting the decision process, contributing to improve the sustainability of new treatment facilities and allows the selection of the most feasible technologies of a wide set of possibilities. Copyright © 2012 Elsevier B.V. All rights reserved.

A DECISION SUPPORT TOOL (DST) FOR DISPOSAL OF ...

EPA Pesticide Factsheets

Symposium Paper AFTER A BUILDING OR WATER TREATMENT/DISTRIBUTION FACILITY HAS GONE THROUGH DECONTAMINATION ACTIVITIES FOLLOWING A CONTAMINATION EVENT WITH CHEMICAL/BIOLOGICAL WARFARE AGENTS OR TOXIC INDUSTRIAL CHEMICAL, THERE WILL BE A SIGNIFICANT AMOUNT OF RESIDUAL MATERIAL AND WASTE TO BE DISPOSED. A CONTAMINATION EVENT COULD OCCUR FROM TERRORIST ACTIVITY OR FROM A NATURAL DISASTER SUCH AS THE RECENT HURRICANE EVENTS IN THE GULF COAST WHERE MOLD AND POLLUTANTS FROM DAMAGED CHEMICAL AND INDUSTRIAL FACILITIES HAVE RESULTED IN SIGNIFICANT QUANTITIES OF CONTAMINATED MATERIALS. IT iS LIKELY THAT MUCH OF THIS MATERIAL WILL BE DISPOSED OF IN PERMITTED LANDFILLS OR HIGH TEMPERATURE THERMAL INCINERATION FACILITIES. DATA HAS BEEN COLLECTED FROM THE OPEN LITERATURE, FROM STATE AND FEDERAL REGULATORY AGENCIES, AND FROM WASTE MANAGEMENT AND WATER UTILITY INDUSTRY STAKEHOLDER GROUPS, TO DEVELOP TECHNICAL GUIDANCE FOR DISPOSAL OF THESe RESIDUES. THE INFORMATION BECOMES AVAILABLE, AND OLD INFORMATION (SUCH AS CONTACT INFORMATION FOR KEY PERSONNEL) CHANGES. THE PRiMARY AUDIENCE FOR THIS TOOL WILL BE: 1) EMERGENCY RESPONSE AUTHORITIES WHO HAVE TO DECIDE THE MOST APPROPRIATE DECONTAMINATION METHODS AND DISPOSAL OF THE RESULTING RESIDUES; 2)STATE AND LOCAL PERMITTING AGENCIES, WHO HAVE TO MAKE DECISIONS ABOUT WHICH FACILITIES WILL BE ALLOWED TO DISPOSE OF THE MATERIALS: AND 3) THE WASTE MANAGEMENT AND WATER UTILITY INDUSTRY, THAT NEEDS TO SAFELY DISPOSE OF DECONTAMINATION RESIDUE

New FEDS Software Helps You Design for Maximum Energy Efficiency, Minimum Cost

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

Gilbride, Theresa L.

2003-01-30

This article was written for the Partner Update a newsletter put out by Potomac Communications for DOE's Rebuild America program. The article describes the FEDS (Federal Energy Decision System) software, the official analytical tool of the Rebuild America program. This software, developed by PNNL with support from DOE, FEMP and Rebuild, helps government entities and contractors make informed decisions about which energy efficiency improvements are the most cost effective for their facilities. FEDS churns thru literally thousands of calculations accounting for energy uses, costs, and interactions from different types of HVAC systems, lighting types, insulation levels, building types, occupancy levelsmore » and times. FEDS crunchs the numbers so decision makers can get fast reliable answers on which alternatives are the best for their particular building. In this article, we're touting the improvements in the latest upgrade of FEDS, which is available free to Rebuild America partners. We tell partners what FEDS does, how to order it, and even where to get tech support and training.« less

The Value of Electronic Medical Record Implementation in Mental Health Care: A Case Study.

PubMed

Riahi, Sanaz; Fischler, Ilan; Stuckey, Melanie I; Klassen, Philip E; Chen, John

2017-01-05

Electronic medical records (EMR) have been implemented in many organizations to improve the quality of care. Evidence supporting the value added to a recovery-oriented mental health facility is lacking. The goal of this project was to implement and customize a fully integrated EMR system in a specialized, recovery-oriented mental health care facility. This evaluation examined the outcomes of quality improvement initiatives driven by the EMR to determine the value that the EMR brought to the organization. The setting was a tertiary-level mental health facility in Ontario, Canada. Clinical informatics and decision support worked closely with point-of-care staff to develop workflows and documentation tools in the EMR. The primary initiatives were implementation of modules for closed loop medication administration, collaborative plan of care, clinical practice guidelines for schizophrenia, restraint minimization, the infection prevention and control surveillance status board, drug of abuse screening, and business intelligence. Medication and patient scan rates have been greater than 95% since April 2014, mitigating the adverse effects of medication errors. Specifically, between April 2014 and March 2015, only 1 moderately severe and 0 severe adverse drug events occurred. The number of restraint incidents decreased 19.7%, which resulted in cost savings of more than Can $1.4 million (US $1.0 million) over 2 years. Implementation of clinical practice guidelines for schizophrenia increased adherence to evidence-based practices, standardizing care across the facility. Improved infection prevention and control surveillance reduced the number of outbreak days from 47 in the year preceding implementation of the status board to 7 days in the year following. Decision support to encourage preferential use of the cost-effective drug of abuse screen when clinically indicated resulted in organizational cost savings. EMR implementation allowed Ontario Shores Centre for Mental Health Sciences to use data analytics to identify and select appropriate quality improvement initiatives, supporting patient-centered, recovery-oriented practices and providing value at the clinical, organizational, and societal levels. ©Sanaz Riahi, Ilan Fischler, Melanie I Stuckey, Philip E Klassen, John Chen. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 05.01.2017.

25 CFR 700.291 - Petitions for amendment: Time limits for processing.

Code of Federal Regulations, 2010 CFR

2010-04-01

... decision on a petition may be extended if the official responsible for making a decision on the petition... collected from facilities other than the facility at which the official responsible for making the decision is located. (2) If the official responsible for making a decision on the petition determines that an...

43 CFR 2.73 - Petitions for amendments: Time limits for processing.

Code of Federal Regulations, 2010 CFR

2010-10-01

... processing the request. (2) If the official responsible for making a decision on the petition determines that... decision on a petition may be extended if the official responsible for making a decision on the petition... collected from facilities other than the facility at which the official responsible for making the decision...

Experiences of an Engineer working in Reactor Safety and Emergency Response

NASA Astrophysics Data System (ADS)

Osborn, Douglas

2015-04-01

The U.S. Department of Energy's Federal Radiological Monitoring and Assessment Center Consequence Management Home Team (FRMAC/CMHT) Assessment Scientist's roles, responsibilities incorporate the FRMAC with other federal, state, and local agencies during a nuclear/radiological emergency. Before the Consequence Management Response Team arrives on-site, the FRMAC/CMHT provides technical and logistical support to the FRMAC and to state, local, and tribal authorities following a nuclear/radiological event. The FRMAC/CMHT support includes analyzing event data, evaluating hazards that relate to protection of the public, and providing event information and data products to protective action decision makers. The Assessment Scientist is the primary scientist responsible for performing calculations and analyses and communicating results to the field during any activation of the FRMAC/CMHT assets. As such, the FRMAC/CMHT Assessment Scientist has a number of different roles and responsibilities to fill depending upon the type of response that is required. Additionally, the Sandia National Laboratories (SNL) Consequence Assessment Team (CAT) Consequence Assessor roles, responsibilities involve hazardous materials operational emergency at SNL New Mexico facilities (SNL/NM) which include loss of control over radioactive, chemical, or explosive hazardous materials. When a hazardous materials operational emergency occurs, key decisions must be made in order to regain control over the hazards, protect personnel from the effects of the hazards, and mitigate impacts on operations, facilities, property, and the environment. Many of these decisions depend in whole or in part on the evaluation of potential consequences from a loss of control over the hazards. As such, the CAT has a number of different roles and responsibilities to fill depending upon the type of response that is required. Primary consequence-based decisions supported by the CAT during a hazardous materials operational emergency at SNL/NM include: (1) Onsite Protective Actions (2) Offsite Protective Action Recommendations (3) Event categorization (4) Event classification Other consequence-based decisions supported by the CAT include: (1) Response planning and operations (2) Event termination (3) Reentry planning and operations (4) Recovery planning and operations Sandia National Laboratories is a multi-program laboratory managed and operated by Sandia Corporation, a wholly owned subsidiary of Lockheed Martin Corporation, for the U.S. Department of Energy's National Nuclear Security Administration.

A web platform for integrated surface water - groundwater modeling and data management

NASA Astrophysics Data System (ADS)

Fatkhutdinov, Aybulat; Stefan, Catalin; Junghanns, Ralf

2016-04-01

Model-based decision support systems are considered to be reliable and time-efficient tools for resources management in various hydrology related fields. However, searching and acquisition of the required data, preparation of the data sets for simulations as well as post-processing, visualization and publishing of the simulations results often requires significantly more work and time than performing the modeling itself. The purpose of the developed software is to combine data storage facilities, data processing instruments and modeling tools in a single platform which potentially can reduce time required for performing simulations, hence decision making. The system is developed within the INOWAS (Innovative Web Based Decision Support System for Water Sustainability under a Changing Climate) project. The platform integrates spatially distributed catchment scale rainfall - runoff, infiltration and groundwater flow models with data storage, processing and visualization tools. The concept is implemented in a form of a web-GIS application and is build based on free and open source components, including the PostgreSQL database management system, Python programming language for modeling purposes, Mapserver for visualization and publishing the data, Openlayers for building the user interface and others. Configuration of the system allows performing data input, storage, pre- and post-processing and visualization in a single not disturbed workflow. In addition, realization of the decision support system in the form of a web service provides an opportunity to easily retrieve and share data sets as well as results of simulations over the internet, which gives significant advantages for collaborative work on the projects and is able to significantly increase usability of the decision support system.

SLUDGE TREATMENT PROJECT KOP CONCEPTUAL DESIGN CONTROL DECISION REPORT

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

CARRO CA

2010-03-09

This control decision addresses the Knock-Out Pot (KOP) Disposition KOP Processing System (KPS) conceptual design. The KPS functions to (1) retrieve KOP material from canisters, (2) remove particles less than 600 {micro}m in size and low density materials from the KOP material, (3) load the KOP material into Multi-Canister Overpack (MCO) baskets, and (4) stage the MCO baskets for subsequent loading into MCOs. Hazard and accident analyses of the KPS conceptual design have been performed to incorporate safety into the design process. The hazard analysis is documented in PRC-STP-00098, Knock-Out Pot Disposition Project Conceptual Design Hazard Analysis. The accident analysismore » is documented in PRC-STP-CN-N-00167, Knock-Out Pot Disposition Sub-Project Canister Over Lift Accident Analysis. Based on the results of these analyses, and analyses performed in support of MCO transportation and MCO processing and storage activities at the Cold Vacuum Drying Facility (CVDF) and Canister Storage Building (CSB), control decision meetings were held to determine the controls required to protect onsite and offsite receptors and facility workers. At the conceptual design stage, these controls are primarily defined by their safety functions. Safety significant structures, systems, and components (SSCs) that could provide the identified safety functions have been selected for the conceptual design. It is anticipated that some safety SSCs identified herein will be reclassified based on hazard and accident analyses performed in support of preliminary and detailed design.« less

Insect pest management decisions in food processing facilities

USDA-ARS?s Scientific Manuscript database

Pest management decision making in food processing facilities such as flour mills, rice mills, human and pet food manufacturing facilities, distribution centers and warehouses, and retail stores is a challenging undertaking. Insect pest management programs require an understanding of the food facili...

77 FR 31895 - Energy Northwest, Columbia Generating Station; Record of Decision and Issuance of Renewed...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-30

... no-action alternative. The factors considered in the record of decision can be found in the final... Generating Station; Record of Decision and Issuance of Renewed Facility Operating License for an Additional... the record of decision for the renewal of facility operating license No. NPF-21, consistent with the...

Human factors in spacecraft design

NASA Technical Reports Server (NTRS)

Harrison, Albert A.; Connors, Mary M.

1990-01-01

This paper describes some of the salient implications of evolving mission parameters for spacecraft design. Among the requirements for future spacecraft are new, higher standards of living, increased support of human productivity, and greater accommodation of physical and cultural variability. Design issues include volumetric allowances, architecture and layouts, closed life support systems, health maintenance systems, recreational facilities, automation, privacy, and decor. An understanding of behavioral responses to design elements is a precondition for critical design decisions. Human factors research results must be taken into account early in the course of the design process.

Assessment of Wearable Technology for Integrated Decision Support

DTIC Science & Technology

2016-05-01

absorption of red  light by oxygen‐bound (or unbound)  hemoglobin   in the blood (see figure 9).  The measurement  is achieved by  shining both  red  light...Leadership  &  Education , Personnel, and Facilities (DOTMLPF) assessment. There may, however, be a clear  value  in keeping these decision support tools closer...Soldier mission sets.  The “Signature TrRacking for Optimized  Nutrition  and traininG” (STRONG) Lab at Air Force Research Labs at Wright Patterson Air

Human Factors Report: TMA Operational Evaluations 1996 and 1998

NASA Technical Reports Server (NTRS)

Lee, Katharine K.; Quinn, Cheryl M.; Hoang, Ty; Sanford, Beverly D.

2000-01-01

The Traffic Management Advisor (TMA) is a component of the Center-TRACON Automation System (CTAS), a suite of decision-support tools for the air traffic control (ATC) environment which is being developed at NASA Ames Research Center. TMA has been operational at the ATC facilities in Dallas/Fort Worth, Texas, since an operational field evaluation in 1996. The Operational Evaluation demonstrated significant benefits, including an approximately 5 percent increase in airport capacity. This report describes the human factors results from the 1996 Operational Evaluation and an investigation of TMA usage performed two years later, during the 1998 TMA Daily Use Field Survey. The results described are instructive for CTAS focused development, and provide valuable lessons for future research in ATC decision-support tools where it is critical to merge a well-defined, complex work environment with advanced automation.

Using Computational Modeling to Assess the Impact of Clinical Decision Support on Cancer Screening within Community Health Centers

PubMed Central

Carney, Timothy Jay; Morgan, Geoffrey P.; Jones, Josette; McDaniel, Anna M.; Weaver, Michael; Weiner, Bryan; Haggstrom, David A.

2014-01-01

Our conceptual model demonstrates our goal to investigate the impact of clinical decision support (CDS) utilization on cancer screening improvement strategies in the community health care (CHC) setting. We employed a dual modeling technique using both statistical and computational modeling to evaluate impact. Our statistical model used the Spearman’s Rho test to evaluate the strength of relationship between our proximal outcome measures (CDS utilization) against our distal outcome measure (provider self-reported cancer screening improvement). Our computational model relied on network evolution theory and made use of a tool called Construct-TM to model the use of CDS measured by the rate of organizational learning. We employed the use of previously collected survey data from community health centers Cancer Health Disparities Collaborative (HDCC). Our intent is to demonstrate the added valued gained by using a computational modeling tool in conjunction with a statistical analysis when evaluating the impact a health information technology, in the form of CDS, on health care quality process outcomes such as facility-level screening improvement. Significant simulated disparities in organizational learning over time were observed between community health centers beginning the simulation with high and low clinical decision support capability. PMID:24953241

Propulsion Ground Testing: Planning for the Future

NASA Technical Reports Server (NTRS)

Bruce, Robert

2003-01-01

Advanced planners are constantly being asked to plan for the provision of future test capability. Historically, this capability is provided either by substantial investment in new test facility capabilities, or in the substantial investment in the modification of pre-exiting test facilities. The key words in the previous sentence are 'substantial investment.' In the evolving environment of increasingly constrained resources, how is an advanced planner to plan for the provisions of such capabilities? Additionally, the conundrum exists that program formulation decisions are being made based on both life cycle cost decisions in an environment in which the more immediate challenge of front-end capital investment oftentimes is the linchpin upon which early decisions are made. In such an environment, how are plans and decisions made? This paper cites examples of decisions made in the past in the area of both major test facility upgrades, as well as major new test facility investment.

Comprehensive integrated planning: A process for the Oak Ridge Reservation, Oak Ridge, Tennessee

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

NONE

1998-05-01

The Oak Ridge Comprehensive Integrated Plan is intended to assist the US Department of Energy (DOE) and contractor personnel in implementing a comprehensive integrated planning process consistent with DOE Order 430.1, Life Cycle Asset Management and Oak Ridge Operations Order 430. DOE contractors are charged with developing and producing the Comprehensive Integrated Plan, which serves as a summary document, providing information from other planning efforts regarding vision statements, missions, contextual conditions, resources and facilities, decision processes, and stakeholder involvement. The Comprehensive Integrated Plan is a planning reference that identifies primary issues regarding major changes in land and facility use andmore » serves all programs and functions on-site as well as the Oak Ridge Operations Office and DOE Headquarters. The Oak Ridge Reservation is a valuable national resource and is managed on the basis of the principles of ecosystem management and sustainable development and how mission, economic, ecological, social, and cultural factors are used to guide land- and facility-use decisions. The long-term goals of the comprehensive integrated planning process, in priority order, are to support DOE critical missions and to stimulate the economy while maintaining a quality environment.« less

Participatory monitoring and evaluation approaches that influence decision-making: lessons from a maternal and newborn study in Eastern Uganda.

PubMed

Kananura, Rornald Muhumuza; Ekirapa-Kiracho, Elizabeth; Paina, Ligia; Bumba, Ahmed; Mulekwa, Godfrey; Nakiganda-Busiku, Dinah; Oo, Htet Nay Lin; Kiwanuka, Suzanne Namusoke; George, Asha; Peters, David H

2017-12-28

The use of participatory monitoring and evaluation (M&E) approaches is important for guiding local decision-making, promoting the implementation of effective interventions and addressing emerging issues in the course of implementation. In this article, we explore how participatory M&E approaches helped to identify key design and implementation issues and how they influenced stakeholders' decision-making in eastern Uganda. The data for this paper is drawn from a retrospective reflection of various M&E approaches used in a maternal and newborn health project that was implemented in three districts in eastern Uganda. The methods included qualitative and quantitative M&E techniques such as  key informant interviews, formal surveys and supportive supervision, as well as participatory approaches, notably participatory impact pathway analysis. At the design stage, the M&E approaches were useful for identifying key local problems and feasible local solutions and informing the activities that were subsequently implemented. During the implementation phase, the M&E approaches provided evidence that informed decision-making and helped identify emerging issues, such as weak implementation by some village health teams, health facility constraints such as poor use of standard guidelines, lack of placenta disposal pits, inadequate fuel for the ambulance at some facilities, and poor care for low birth weight infants. Sharing this information with key stakeholders prompted them to take appropriate actions. For example, the sub-county leadership constructed placenta disposal pits, the district health officer provided fuel for ambulances, and health workers received refresher training and mentorship on how to care for newborns. Diverse sources of information and perspectives can help researchers and decision-makers understand and adapt evidence to contexts for more effective interventions. Supporting districts to have crosscutting, routine information generating and sharing platforms that bring together stakeholders from different sectors is therefore crucial for the successful implementation of complex development interventions.

'They never talked to me about... ': Perspectives on aged care resident transfer to emergency departments.

PubMed

Arendts, Glenn; Popescu, Aurora; Howting, Denise; Quine, Susan; Howard, Kirsten

2015-06-01

To explore perspectives of three groups concerning transfers from aged care facilities to emergency departments. We sought to reveal factors influencing transfer decisions; how active each group was in making decisions; and to what extent groups ceded decision-making to others. Semi-structured interviews of 11 residents, 14 relatives and 17 staff with content analysis of interview transcripts. The three groups substantially differed in their involvement with initiating, and attitudes towards, transfer. Residents were least likely to be involved in the decision, yet most likely to support transfer. Staff felt conflicted between their desire to provide optimal treatment for one ill resident, and their obligations to other residents under care. Staff perspectives were largely consistent with published data, but we describe new results for other informant groups. Group expectations and preferences differ substantially. Service delivery to meet all preferences presents a challenge for health service design. © 2013 ACOTA.

Hardware Progress Made in the Early Flight Fission Test Facilities (EFF-TF) To Support Near-Term Space Fission Systems

NASA Astrophysics Data System (ADS)

Van Dyke, Melissa; Martin, James

2005-02-01

The NASA Marshall Space Flight Center's Early Flight Fission Test Facility (EFF-TF), provides a facility to experimentally evaluate nuclear reactor related thermal hydraulic issues through the use of non-nuclear testing. This facility provides a cost effective method to evaluate concepts/designs and support mitigation of developmental risk. Electrical resistance thermal simulators can be used to closely mimic the heat deposition of the fission process, providing axial and radial profiles. A number of experimental and design programs were underway in 2004 which include the following. Initial evaluation of the Department of Energy Los Alamos National Laboratory 19 module stainless steel/sodium heat pipe reactor with integral gas heat exchanger was operated at up to 17.5 kW of input power at core temperatures of 1000 K. A stainless steel sodium heat pipe module was placed through repeated freeze/thaw cyclic testing accumulating over 200 restarts to a temperature of 1000 K. Additionally, the design of a 37- pin stainless steel pumped sodium/potassium (NaK) loop was finalized and components procured. Ongoing testing at the EFF-TF is geared towards facilitating both research and development necessary to support future decisions regarding potential use of space nuclear systems for space exploration. All efforts are coordinated with DOE laboratories, industry, universities, and other NASA centers. This paper describes some of the 2004 efforts.

Applying of Decision Tree Analysis to Risk Factors Associated with Pressure Ulcers in Long-Term Care Facilities.

PubMed

Moon, Mikyung; Lee, Soo-Kyoung

2017-01-01

The purpose of this study was to use decision tree analysis to explore the factors associated with pressure ulcers (PUs) among elderly people admitted to Korean long-term care facilities. The data were extracted from the 2014 National Inpatient Sample (NIS)-data of Health Insurance Review and Assessment Service (HIRA). A MapReduce-based program was implemented to join and filter 5 tables of the NIS. The outcome predicted by the decision tree model was the prevalence of PUs as defined by the Korean Standard Classification of Disease-7 (KCD-7; code L89 * ). Using R 3.3.1, a decision tree was generated with the finalized 15,856 cases and 830 variables. The decision tree displayed 15 subgroups with 8 variables showing 0.804 accuracy, 0.820 sensitivity, and 0.787 specificity. The most significant primary predictor of PUs was length of stay less than 0.5 day. Other predictors were the presence of an infectious wound dressing, followed by having diagnoses numbering less than 3.5 and the presence of a simple dressing. Among diagnoses, "injuries to the hip and thigh" was the top predictor ranking 5th overall. Total hospital cost exceeding 2,200,000 Korean won (US $2,000) rounded out the top 7. These results support previous studies that showed length of stay, comorbidity, and total hospital cost were associated with PUs. Moreover, wound dressings were commonly used to treat PUs. They also show that machine learning, such as a decision tree, could effectively predict PUs using big data.

SARDA: An Integrated Concept for Airport Surface Operations Management

NASA Technical Reports Server (NTRS)

Gupta, Gautam; Hoang, Ty; Jung, Yoon Chul

2013-01-01

The Spot and Runway Departure Advisor (SARDA) is an integrated decision support tool for airlines and air traffic control tower enabling surface collaborative decision making (CDM) and departure metering in order to enhance efficiency of surface operations at congested airports. The presentation describes the concept and architecture of the SARDA as a CDM tool, and the results from a human-in-the-loop simulation of the tool conducted in 2012 at the FutureFlight Central, the tower simulation facility. Also, presented is the current activities and future plan for SARDA development. The presentation was given at the meeting with the FAA senior advisor of the Surface Operations Office.

Key Decision Record Creation and Approval Module

NASA Technical Reports Server (NTRS)

Hebert, Barrt; Messer, Elizabeth A.; Albasini, Colby; Le, Thang; ORourke, William, Sr.; Stiglets, Tim; Strain, Ted

2012-01-01

Retaining good key decision records is critical to ensuring the success of a project or operation. Having adequately documented decisions with supporting documents and rationale can greatly reduce the amount of rework or reinvention over a project's, vehicle's, or facility's lifecycle. Stennis Space Center developed and uses a software tool that automates the Key Decision Record (KDR) process for its engineering and test projects. It provides the ability for a user to log key decisions that are made during the course of a project. By customizing Parametric Technology Corporation's (PTC) Windchill product, the team was able to log all information about a decision, and electronically route that information for approval. Customizing the Windchill product allowed the team to directly connect these decisions to the engineering data that it might affect and notify data owners of the decision. The user interface was created in JSP and Javascript, within the OOTB (Out of the Box) Windchill product, allowing users to create KDRs. Not only does this interface allow users to create and track KDRs, but it also plugs directly into the OOTB ability to associate these decision records with other relevant engineering data such as drawings, designs, models, requirements, or specifications

School Mapping and Geospatial Analysis of the Schools in Jasra Development Block of India

NASA Astrophysics Data System (ADS)

Agrawal, S.; Gupta, R. D.

2016-06-01

GIS is a collection of tools and techniques that works on the geospatial data and is used in the analysis and decision making. Education is an inherent part of any civil society. Proper educational facilities generate the high quality human resource for any nation. Therefore, government needs an efficient system that can help in analysing the current state of education and its progress. Government also needs a system that can support in decision making and policy framing. GIS can serve the mentioned requirements not only for government but also for the general public. In order to meet the standards of human development, it is necessary for the government and decision makers to have a close watch on the existing education policy and its implementation condition. School mapping plays an important role in this aspect. School mapping consists of building the geospatial database of schools that supports in the infrastructure development, policy analysis and decision making. The present research work is an attempt for supporting Right to Education (RTE) and Sarv Sikha Abhiyaan (SSA) programmes run by Government of India through the use of GIS. School mapping of the study area is performed which is followed by the geospatial analysis. This research work will help in assessing the present status of educational infrastructure in Jasra block of Allahabad district, India.

Use of the Homeland-Defense Operational Planning System (HOPS) for Emergency Management

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

Durling, Jr., R L; Price, D E

2005-12-16

The Homeland-Defense Operational Planning System (HOPS), is a new operational planning tool leveraging Lawrence Livermore National Laboratory's expertise in weapons systems and in sparse information analysis to support the defense of the U.S. homeland. HOPS provides planners with a basis to make decisions to protect against acts of terrorism, focusing on the defense of facilities critical to U.S. infrastructure. Criticality of facilities, structures, and systems is evaluated on a composite matrix of specific projected casualty, economic, and sociopolitical impact bins. Based on these criteria, significant unidentified vulnerabilities are identified and secured. To provide insight into potential successes by malevolent actors,more » HOPS analysts strive to base their efforts mainly on unclassified open-source data. However, more cooperation is needed between HOPS analysts and facility representatives to provide an advantage to those whose task is to defend these facilities. Evaluated facilities include: refineries, major ports, nuclear power plants and other nuclear licensees, dams, government installations, convention centers, sports stadiums, tourist venues, and public and freight transportation systems. A generalized summary of analyses of U.S. infrastructure facilities will be presented.« less

Risk Assessment Using The Homeland-Defense Operational Planning System (HOPS)

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

Price, D E; Durling, R L

2005-10-10

The Homeland-Defense Operational Planning System (HOPS), is a new operational planning tool leveraging Lawrence Livermore National Laboratory's expertise in weapons systems and in sparse information analysis to support the defense of the U.S. homeland. HOPS provides planners with a basis to make decisions to protect against acts of terrorism, focusing on the defense of facilities critical to U.S. infrastructure. Criticality of facilities, structures, and systems is evaluated on a composite matrix of specific projected casualty, economic, and sociopolitical impact bins. Based on these criteria, significant unidentified vulnerabilities are identified and secured. To provide insight into potential successes by malevolent actors,more » HOPS analysts strive to base their efforts mainly on unclassified open-source data. However, more cooperation is needed between HOPS analysts and facility representatives to provide an advantage to those whose task is to defend these facilities. Evaluated facilities include: refineries, major ports, nuclear power plants and other nuclear licensees, dams, government installations, convention centers, sports stadiums, tourist venues, and public and freight transportation systems. A generalized summary of analyses of U.S. infrastructure facilities will be presented.« less

Facing the Issue of Facilities Maintenance in California Public Higher Education.

ERIC Educational Resources Information Center

California State Postsecondary Education Commission, Sacramento.

The decision to defer facilities maintenance obligations in California higher education and the extent to which maintenance has been deferred are discussed. Attention is also directed to the educational and fiscal context in which this decision has been made nationally. The policies and procedures governing facilities maintenance and deferral in…

Decision Rightness and Emotional Responses to Abortion in the United States: A Longitudinal Study

PubMed Central

Rocca, Corinne H.; Kimport, Katrina; Roberts, Sarah C. M.; Gould, Heather; Neuhaus, John; Foster, Diana G.

2015-01-01

Background Arguments that abortion causes women emotional harm are used to regulate abortion, particularly later procedures, in the United States. However, existing research is inconclusive. We examined women’s emotions and reports of whether the abortion decision was the right one for them over the three years after having an induced abortion. Methods We recruited a cohort of women seeking abortions between 2008-2010 at 30 facilities across the United States, selected based on having the latest gestational age limit within 150 miles. Two groups of women (n=667) were followed prospectively for three years: women having first-trimester procedures and women terminating pregnancies within two weeks under facilities’ gestational age limits at the same facilities. Participants completed semiannual phone surveys to assess whether they felt that having the abortion was the right decision for them; negative emotions (regret, anger, guilt, sadness) about the abortion; and positive emotions (relief, happiness). Multivariable mixed-effects models were used to examine changes in each outcome over time, to compare the two groups, and to identify associated factors. Results The predicted probability of reporting that abortion was the right decision was over 99% at all time points over three years. Women with more planned pregnancies and who had more difficulty deciding to terminate the pregnancy had lower odds of reporting the abortion was the right decision (aOR=0.71 [0.60, 0.85] and 0.46 [0.36, 0.64], respectively). Both negative and positive emotions declined over time, with no differences between women having procedures near gestational age limits versus first-trimester abortions. Higher perceived community abortion stigma and lower social support were associated with more negative emotions (b=0.45 [0.31, 0.58] and b=-0.61 [-0.93, -0.29], respectively). Conclusions Women experienced decreasing emotional intensity over time, and the overwhelming majority of women felt that termination was the right decision for them over three years. Emotional support may be beneficial for women having abortions who report intended pregnancies or difficulty deciding. PMID:26154386

Performance Assessment Program for the Savannah River Site Liquid Waste Facilities - 13610

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

Rosenberger, Kent H.

2013-07-01

The Liquid Waste facilities at the U.S. Department of Energy's (DOE) Savannah River Site (SRS) are operated by Liquid Waste Operations contractor Savannah River Remediation LLC (SRR). A separate Performance Assessment (PA) is prepared to support disposal operations at the Saltstone Disposal Facility and closure evaluations for the two liquid waste tank farm facilities at SRS, F-Tank Farm and H-Tank Farm. A PA provides the technical basis and results to be used in subsequent documents to demonstrate compliance with the pertinent requirements identified in operations and closure regulatory guidance. The Saltstone Disposal Facility is subject to a State of Southmore » Carolina industrial solid waste landfill permit and the tank farms are subject to a state industrial waste water permit. The three Liquid Waste facilities are also subject to a Federal Facility Agreement approved by the State, DOE and the Environmental Protection Agency (EPA). Due to the regulatory structure, a PA is a key technical document reviewed by the DOE, the State of South Carolina and the EPA. As the waste material disposed of in the Saltstone Disposal Facility and the residual material in the closed tank farms is also subject to reclassification prior to closure via a waste determination pursuant to Section 3116 of the Ronald W. Reagan National Defense Authorization Act of Fiscal Year 2005, the U.S. Nuclear Regulatory Commission (NRC) is also a reviewing agency for the PAs. Pursuant to the Act, the NRC also has a continuing role to monitor disposal actions to assess compliance with stated performance objectives. The Liquid Waste PA program at SRS represents a continual process over the life of the disposal and closure operations. When the need for a PA or PA revision is identified, the first step is to develop a conceptual model to best represent the facility conditions. The conceptual model will include physical dimensions of the closed system, both the engineered and natural system, and modeling input parameters associated with the modeled features, both initial values (at the time of facility closure) and degradation rates/values. During the development of the PA, evaluations are conducted to reflect not only the results associated with the best available information at the time but also to evaluate potential uncertainties and sensitivities associated with the modeled system. While the PA will reflect the modeled system results from the best available information, it will also identify areas for future work to reduce overall PA uncertainties moving forward. DOE requires a PA Maintenance Program such that work continues to reduce model uncertainties, thus bolstering confidence in PA results that support regulatory decisions. This maintenance work may include new Research and Development activities or modeling as informed by previous PA results and other new information that becomes available. As new information becomes available, it is evaluated against previous PAs and appropriate actions are taken to ensure continued confidence in the regulatory decisions. Therefore, the PA program is a continual process that is not just the development of a PA but seeks to incorporate new information to reduce overall model uncertainty and provide continuing confidence in regulatory decisions. (author)« less

75 FR 137 - Amended Record of Decision: Idaho High-Level Waste and Facilities Disposition Final Environmental...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-04

... DEPARTMENT OF ENERGY Amended Record of Decision: Idaho High-Level Waste and Facilities Disposition Final Environmental Impact Statement Revised by State 12/ 21/09 AGENCY: Department of Energy. ACTION: Amended Record of Decision. SUMMARY: The U.S. Department of Energy (DOE) is amending its initial Record of...

Characterizing uncertain sea-level rise projections to support investment decisions.

PubMed

Sriver, Ryan L; Lempert, Robert J; Wikman-Svahn, Per; Keller, Klaus

2018-01-01

Many institutions worldwide are considering how to include uncertainty about future changes in sea-levels and storm surges into their investment decisions regarding large capital infrastructures. Here we examine how to characterize deeply uncertain climate change projections to support such decisions using Robust Decision Making analysis. We address questions regarding how to confront the potential for future changes in low probability but large impact flooding events due to changes in sea-levels and storm surges. Such extreme events can affect investments in infrastructure but have proved difficult to consider in such decisions because of the deep uncertainty surrounding them. This study utilizes Robust Decision Making methods to address two questions applied to investment decisions at the Port of Los Angeles: (1) Under what future conditions would a Port of Los Angeles decision to harden its facilities against extreme flood scenarios at the next upgrade pass a cost-benefit test, and (2) Do sea-level rise projections and other information suggest such conditions are sufficiently likely to justify such an investment? We also compare and contrast the Robust Decision Making methods with a full probabilistic analysis. These two analysis frameworks result in similar investment recommendations for different idealized future sea-level projections, but provide different information to decision makers and envision different types of engagement with stakeholders. In particular, the full probabilistic analysis begins by aggregating the best scientific information into a single set of joint probability distributions, while the Robust Decision Making analysis identifies scenarios where a decision to invest in near-term response to extreme sea-level rise passes a cost-benefit test, and then assembles scientific information of differing levels of confidence to help decision makers judge whether or not these scenarios are sufficiently likely to justify making such investments. Results highlight the highly-localized and context dependent nature of applying Robust Decision Making methods to inform investment decisions.

Characterizing uncertain sea-level rise projections to support investment decisions

PubMed Central

Lempert, Robert J.; Wikman-Svahn, Per; Keller, Klaus

2018-01-01

Many institutions worldwide are considering how to include uncertainty about future changes in sea-levels and storm surges into their investment decisions regarding large capital infrastructures. Here we examine how to characterize deeply uncertain climate change projections to support such decisions using Robust Decision Making analysis. We address questions regarding how to confront the potential for future changes in low probability but large impact flooding events due to changes in sea-levels and storm surges. Such extreme events can affect investments in infrastructure but have proved difficult to consider in such decisions because of the deep uncertainty surrounding them. This study utilizes Robust Decision Making methods to address two questions applied to investment decisions at the Port of Los Angeles: (1) Under what future conditions would a Port of Los Angeles decision to harden its facilities against extreme flood scenarios at the next upgrade pass a cost-benefit test, and (2) Do sea-level rise projections and other information suggest such conditions are sufficiently likely to justify such an investment? We also compare and contrast the Robust Decision Making methods with a full probabilistic analysis. These two analysis frameworks result in similar investment recommendations for different idealized future sea-level projections, but provide different information to decision makers and envision different types of engagement with stakeholders. In particular, the full probabilistic analysis begins by aggregating the best scientific information into a single set of joint probability distributions, while the Robust Decision Making analysis identifies scenarios where a decision to invest in near-term response to extreme sea-level rise passes a cost-benefit test, and then assembles scientific information of differing levels of confidence to help decision makers judge whether or not these scenarios are sufficiently likely to justify making such investments. Results highlight the highly-localized and context dependent nature of applying Robust Decision Making methods to inform investment decisions. PMID:29414978

Use of the Decision Support System for VA cost-effectiveness research.

PubMed

Barnett, P G; Rodgers, J H

1999-04-01

The Department of Veterans Affairs is adopting the Decision Support System (DSS), computer software and databases which include a cost-accounting system which determines the cost of health care products and patient encounters. A system for providing cost data for cost-effectiveness analysis should be provide valid, detailed, and comprehensive data that can be aggregated. The design of DSS is described and compared with those criteria. Utilization data from DSS was compared with other VA utilization data. Aggregate DSS cost data from 35 medical centers was compared with relative resource weights developed for the Medicare program. Data on hospital stays at 3 facilities found that 3.7% of the stays in DSS were not in the VA discharge database, whereas 7.6% of the stays in the discharge data were not in DSS. DSS reported between 68.8% and 97.1% of the outpatient encounters reported by six facilities in the ambulatory care data base. Relative weights for each Diagnosis Related Group based on DSS data from 35 VA facilities correlated with Medicare weights (correlation coefficient of .853). DSS will be useful for research if certain problems are overcome. It is difficult to distinguish long-term from acute hospital care. VA does not have a complete database of all inpatient procedures, so DSS has not assigned them a specific cost. The authority to access encounter-level DSS data needs to be centralized. Researchers can provide the feedback needed to improve DSS cost estimates. A comprehensive encounter-level extract would facilitate use of DSS for research.

Development of a case tool to support decision based software development

NASA Technical Reports Server (NTRS)

Wild, Christian J.

1993-01-01

A summary of the accomplishments of the research over the past year are presented. Achievements include: made demonstrations with DHC, a prototype supporting decision based software development (DBSD) methodology, for Paramax personnel at ODU; met with Paramax personnel to discuss DBSD issues, the process of integrating DBSD and Refinery and the porting process model; completed and submitted a paper describing DBSD paradigm to IFIP '92; completed and presented a paper describing the approach for software reuse at the Software Reuse Workshop in April 1993; continued to extend DHC with a project agenda, facility necessary for a better project management; completed a primary draft of the re-engineering process model for porting; created a logging form to trace all the activities involved in the process of solving the reengineering problem, and developed a primary chart with the problems involved by the reengineering process.

A high resolution agent-based model to support walk-bicycle infrastructure investment decisions: A case study with New York City

DOE PAGES

Aziz, H. M. Abdul; Park, Byung H.; Morton, April M.; ...

2017-11-24

Active transportation modes--walk and bicycle--are central for low carbon transport, healthy living, and complete streets initiative. Building a community with amenable walk and bicycle facilities asks for smart planning and investments. It is critical to investigate the impact of infrastructure building or expansion on the overall walk and bicycle mode usage prior to making investment choices utilizing public tax money. This research developed an agent-based model to support investment decisions that allows to assess the impact of changes in walk-bike infrastructures at a high spatial resolution (e.g., block group level). The agent-based model (ABM) utilizes data from a synthetic populationmore » simulator generating agents with corresponding socio-demographic characteristics, and integrates facility attributes regarding walking and bicycling (e.g., sidewalk width, bike lane length) into the mode choice decision making process. Moreover, the ABM accounts for the effect of social interactions among agents who live and work at the same geographic locations. Finally, GIS-based maps are developed at block group resolution that allows exploring the effect of walk-bike infrastructure related investments. The results from New York City case study indicate that infrastructure investments such as widening sidewalk and increasing bike lane network can positively influence the active transportation mode choices. In addition, the level of impact varies with geographic locations--different boroughs of New York City will have different impacts. Lastly, social promotions resulting in higher social interaction among agents can reinforce the impacts of infrastructure changes.« less

A high resolution agent-based model to support walk-bicycle infrastructure investment decisions: A case study with New York City

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

Aziz, H. M. Abdul; Park, Byung H.; Morton, April M.

Active transportation modes--walk and bicycle--are central for low carbon transport, healthy living, and complete streets initiative. Building a community with amenable walk and bicycle facilities asks for smart planning and investments. It is critical to investigate the impact of infrastructure building or expansion on the overall walk and bicycle mode usage prior to making investment choices utilizing public tax money. This research developed an agent-based model to support investment decisions that allows to assess the impact of changes in walk-bike infrastructures at a high spatial resolution (e.g., block group level). The agent-based model (ABM) utilizes data from a synthetic populationmore » simulator generating agents with corresponding socio-demographic characteristics, and integrates facility attributes regarding walking and bicycling (e.g., sidewalk width, bike lane length) into the mode choice decision making process. Moreover, the ABM accounts for the effect of social interactions among agents who live and work at the same geographic locations. Finally, GIS-based maps are developed at block group resolution that allows exploring the effect of walk-bike infrastructure related investments. The results from New York City case study indicate that infrastructure investments such as widening sidewalk and increasing bike lane network can positively influence the active transportation mode choices. In addition, the level of impact varies with geographic locations--different boroughs of New York City will have different impacts. Lastly, social promotions resulting in higher social interaction among agents can reinforce the impacts of infrastructure changes.« less

Are insurance companies liable under the Americans with Disabilities Act?

PubMed

Manning, J S

2000-03-01

Federal courts have split on the question of the applicability of the Americans with Disabilities Act to insurance coverage decisions that insurance companies make on the basis of disability; they have similarly split on other issues pertaining to the scope of that Act's application. In deciding whether to read the Act as prohibiting discrimination in insurance decisions that are often crucial in the lives of people with disabilities, courts have faced two problems. First, where it prohibits discrimination in the equal enjoyment of the goods and services of places of public accommodation, the Act's area of concern may be limited to the ability of people with disabilities to gain physical access to facilities; or that area may extend to all forms of disability-based discrimination in the provision of goods and services. This Comment argues that the language and legislative history of the Act are consistent only with the latter view. Second, the provision limiting the Act's applicability to insurance may create an exemption for all insurance decisions; or it may protect only the ability of an insurance company to make an insurance decision to the disadvantage of an insured with a disability where actuarial data support the decision. This comment argues that the ambiguous language of the limiting provision should be resolved in favor of the latter view. Legislative history and the broader background of the history of insurance discrimination law support this resolution. Consequently, the Act should be interpreted as prohibiting disability-based discrimination by insurance companies in selling insurance policies and as defining discrimination as making disability-based insurance decisions without the support of actuarial data. By accepting this interpretation, courts can help stop the pattern of judicial narrowing of the Act's application through inappropriately restrictive statutory construction.

77 FR 38822 - Notice of Availability: Record of Decision for KRoad Moapa Solar Facility

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-29

....ER0000 LVRWF1103400] Notice of Availability: Record of Decision for KRoad Moapa Solar Facility AGENCY... Moapa Solar Facility located in Clark County, Nevada. The Secretary of the Interior approved the ROD on... applicant, KRoad Moapa Solar, LLC, (KRoad) filed two right-of-way (ROW) applications to construct a 500 kV...

Covering the Last Kilometer: Using GIS to Scale-Up Voluntary Medical Male Circumcision Services in Iringa and Njombe Regions, Tanzania.

PubMed

Mahler, Hally; Searle, Sarah; Plotkin, Marya; Kulindwa, Yusuph; Greenberg, Seth; Mlanga, Erick; Njeuhmeli, Emmanuel; Lija, Gissenje

2015-09-01

Based on the established protective effect of voluntary medical male circumcision (VMMC) in reducing female-to-male HIV transmission, Tanzania's Ministry of Health and Social Welfare (MOHSW) embarked on the scale-up of VMMC services in 2009. The Maternal and Child Health Integrated Project (MCHIP) supported the MOHSW to roll out VMMC services in Iringa and Njombe, 2 regions of Tanzania with among the highest HIV and lowest circumcision prevalence. With ambitious targets of reaching 264,990 males aged 10-34 years with VMMC in 5 years, efficient and innovative program approaches were necessary. Outreach campaigns, in which mobile teams set up temporary services in facilities or non-facility settings, are used to reach lesser-served areas with VMMC. In 2012, MCHIP began using geographic information systems (GIS) to strategically plan the location of outreach campaigns. MCHIP gathered geocoded data on variables such as roads, road conditions, catchment population, staffing, and infrastructure for every health facility in Iringa and Njombe. These data were uploaded to a central database and overlaid with various demographic and service delivery data in order to identify the VMMC needs of the 2 regions. MCHIP used the interactive digital maps as decision-making tools to extend mobile VMMC outreach to "the last kilometer." As of September 2014, the MOHSW with MCHIP support provided VMMC to 267,917 men, 259,144 of whom were men were aged 10-34 years, an achievement of 98% of the target of eligible males in Iringa and Njombe. The project reached substantially more men through rural dispensaries and non-health care facilities each successive year after GIS was introduced in 2012, jumping from 48% of VMMCs performed in rural areas in fiscal year 2011 to 88% in fiscal year 2012 and to 93% by the end of the project in 2014. GIS was an effective tool for making strategic decisions about where to prioritize VMMC service delivery, particularly for mobile and outreach services. Donors may want to consider funding mapping initiatives that support numerous interventions across implementing partners to spread initial start-up costs. © Mahler et al.

Covering the Last Kilometer: Using GIS to Scale-Up Voluntary Medical Male Circumcision Services in Iringa and Njombe Regions, Tanzania

PubMed Central

Mahler, Hally; Plotkin, Marya; Kulindwa, Yusuph; Greenberg, Seth; Mlanga, Erick; Njeuhmeli, Emmanuel; Lija, Gissenje

2015-01-01

Background: Based on the established protective effect of voluntary medical male circumcision (VMMC) in reducing female-to-male HIV transmission, Tanzania's Ministry of Health and Social Welfare (MOHSW) embarked on the scale-up of VMMC services in 2009. The Maternal and Child Health Integrated Project (MCHIP) supported the MOHSW to roll out VMMC services in Iringa and Njombe, 2 regions of Tanzania with among the highest HIV and lowest circumcision prevalence. With ambitious targets of reaching 264,990 males aged 10–34 years with VMMC in 5 years, efficient and innovative program approaches were necessary. Program Description: Outreach campaigns, in which mobile teams set up temporary services in facilities or non-facility settings, are used to reach lesser-served areas with VMMC. In 2012, MCHIP began using geographic information systems (GIS) to strategically plan the location of outreach campaigns. MCHIP gathered geocoded data on variables such as roads, road conditions, catchment population, staffing, and infrastructure for every health facility in Iringa and Njombe. These data were uploaded to a central database and overlaid with various demographic and service delivery data in order to identify the VMMC needs of the 2 regions. Findings: MCHIP used the interactive digital maps as decision-making tools to extend mobile VMMC outreach to “the last kilometer.” As of September 2014, the MOHSW with MCHIP support provided VMMC to 267,917 men, 259,144 of whom were men were aged 10–34 years, an achievement of 98% of the target of eligible males in Iringa and Njombe. The project reached substantially more men through rural dispensaries and non-health care facilities each successive year after GIS was introduced in 2012, jumping from 48% of VMMCs performed in rural areas in fiscal year 2011 to 88% in fiscal year 2012 and to 93% by the end of the project in 2014. Conclusion: GIS was an effective tool for making strategic decisions about where to prioritize VMMC service delivery, particularly for mobile and outreach services. Donors may want to consider funding mapping initiatives that support numerous interventions across implementing partners to spread initial start-up costs. PMID:26374807

Integration and use of Microgravity Research Facility: Lessons learned by the crystals by vapor transport experiment and Space Experiments Facility programs

NASA Technical Reports Server (NTRS)

Heizer, Barbara L.

1992-01-01

The Crystals by Vapor Transport Experiment (CVTE) and Space Experiments Facility (SEF) are materials processing facilities designed and built for use on the Space Shuttle mid deck. The CVTE was built as a commercial facility owned by the Boeing Company. The SEF was built under contract to the UAH Center for Commercial Development of Space (CCDS). Both facilities include up to three furnaces capable of reaching 850 C minimum, stand-alone electronics and software, and independent cooling control. In addition, the CVTE includes a dedicated stowage locker for cameras, a laptop computer, and other ancillary equipment. Both systems are designed to fly in a Middeck Accommodations Rack (MAR), though the SEF is currently being integrated into a Spacehab rack. The CVTE hardware includes two transparent furnaces capable of achieving temperatures in the 850 to 870 C range. The transparent feature allows scientists/astronauts to directly observe and affect crystal growth both on the ground and in space. Cameras mounted to the rack provide photodocumentation of the crystal growth. The basic design of the furnace allows for modification to accommodate techniques other than vapor crystal growth. Early in the CVTE program, the decision was made to assign a principal scientist to develop the experiment plan, affect the hardware/software design, run the ground and flight research effort, and interface with the scientific community. The principal scientist is responsible to the program manager and is a critical member of the engineering development team. As a result of this decision, the hardware/experiment requirements were established in such a way as to balance the engineering and science demands on the equipment. Program schedules for hardware development, experiment definition and material selection, flight operations development and crew training, both ground support and astronauts, were all planned and carried out with the understanding that the success of the program science was as important as the hardware functionality. How the CVTE payload was designed and what it is capable of, the philosophy of including the scientists in design and operations decisions, and the lessons learned during the integration process are descussed.

Are patients bypassing paediatric cardiology outreach clinics?

PubMed

Fletcher, Alexander; Samson, Ray; McLeod, Karen

2017-07-01

Previous studies have identified that receiving specialist care close to home can positively influence patients' experience. Despite this, a review of cardiology outpatient appointments at the Royal Hospital for Children in Glasgow demonstrated that a large number of families are bypassing their local children's cardiology centre to attend cardiac clinics at the specialist children's surgical centre. We used patient questionnaire, audit of local facilities, and examined the relationship between diagnosis and bypass numbers to better understand factors influencing this trend. Our results suggest that patient preference, short travelling distance to specialist children's cardiac centre, a more severe cardiac diagnosis, and inconsistent local facilities, expertise, and support are likely to influence a family's decision to bypass their local children's cardiology centre.

Factors associated with institutional delivery in Ghana: the role of decision-making autonomy and community norms.

PubMed

Speizer, Ilene S; Story, William T; Singh, Kavita

2014-11-27

In Ghana, the site of this study, the maternal mortality ratio and under-five mortality rate remain high indicating the need to focus on maternal and child health programming. Ghana has high use of antenatal care (95%) but sub-optimum levels of institutional delivery (about 57%). Numerous barriers to institutional delivery exist including financial, physical, cognitive, organizational, and psychological and social. This study examines the psychological and social barriers to institutional delivery, namely women's decision-making autonomy and their perceptions about social support for institutional delivery in their community. This study uses cross-sectional data collected for the evaluation of the Maternal and Newborn Referrals Project of Project Fives Alive in Northern and Central districts of Ghana. In 2012 and 2013, a total of 2,527 women aged 15 to 49 were surveyed at baseline and midterm (half in 2012 and half in 2013). The analysis sample of 1,606 includes all women who had a birth three years prior to the survey date and who had no missing data. To determine the relationship between institutional delivery and the two key social barriers-women's decision-making autonomy and community perceptions of institutional delivery-we used multi-level logistic regression models, including cross-level interactions between community-level attitudes and individual-level autonomy. All analyses control for the clustered survey design by including robust standard errors in Stata 13 statistical software. The findings show that women who are more autonomous and who perceive positive attitudes toward facility delivery (among women, men and mothers-in-law) were more likely to deliver in a facility. Moreover, the interactions between autonomy and community-level perceptions of institutional delivery among men and mothers-in-law were significant, such that the effect of decision-making autonomy is more important for women who live in communities that are less supportive of institutional delivery compared to communities that are more supportive. This study builds upon prior work by using indicators that provide a more direct assessment of perceived community norms and women's decision-making autonomy. The findings lead to programmatic recommendations that go beyond individuals and engaging the broader network of people (husbands and mothers-in-law) that influence delivery behaviors.

Transitioning from caregiver to visitor in a long-term care facility: the experience of caregivers of people with dementia.

PubMed

Crawford, K; Digby, R; Bloomer, M; Tan, H; Williams, A

2015-01-01

Transitioning from the primary caregiver to the visitor in a long-term care facility may be challenging for the caregiver; they are required to surrender their caring duties to the medical and nursing staff. The aim of this study was to explore the experiences of caregivers during their transition from day-to-day caregiver of a person with dementia to a visitor in a long-term care facility. This study utilised a qualitative descriptive design. Twenty caregivers of people with dementia were recruited from the one Aged Rehabilitation and Geriatric Evaluation and Management facility, located in Victoria, Australia. Semi-structured interviews were used to explore the caregiver's experiences. Interviews were analysed using thematic analysis. The interview data revealed that the participants were undergoing similar experiences. The findings revealed that it was difficult for the caregiver to transition to their new role of visitor; negative reactions of grief, loss of motivation and loneliness were also coupled with positive feelings of relief and the reassurance that their relative or friend would be well cared for and safe within the long-term care facility. The findings offer insight into the experiences felt by caregivers when their relative or friend with dementia is admitted to hospital. Implications of this study include the need to improve the transition process for the caregiver by allowing them to be involved in the decision-making process, keeping them informed of care decisions, and importantly, providing emotional support to help the caregiver positively adapt to this transition.

Ethics roundtable debate: Withdrawal of tube feeding in a patient with persistent vegetative state where the patients wishes are unclear and there is family dissension

PubMed Central

Buckley, Tom; Crippen, David; DeWitt, Anthony L; Fisher, Malcolm; Liolios, Antonios; Scheetz, Christine L; Whetstine, Leslie M

2004-01-01

The decision to withdraw or withhold life supporting treatment in moribund patients is difficult under any circumstances. When the patient becomes incompetent to clarify their wishes regarding continued maintenance in long-term facilities, surrogates sometimes cannot agree, further clouding the issue. We examine a case where the State's interests come into play, forcing a controversial resolution. PMID:15025760

Canadian Innovations in Siting Hazardous Waste Management Facilities

PubMed

Kuhn; Ballard

1998-07-01

/ Siting hazardous waste facilities is an extremely complex and difficult endeavor. Public aversion to the construction of these facilities in or near their community often results in concerted opposition, referred to as the NIMBY syndrome. For the most part, siting processes do not fail because of inadequate environmental or technical considerations, but because of the adversarial decision-making strategies employed by the proponents. Innovative siting processes used in the provinces of Alberta and Manitoba offer tangible evidence of the successful application of an innovative siting approach based on the principles of decentralization of decision-making authority and full and meaningful public involvement. The purpose of this paper is to evaluate four Canadian siting processes from the perspective of public participation and access to decision-making authority. Examples of siting processes related to hazardous waste management facilities are provided from the provinces of Alberta, Manitoba, British Columbia, and Ontario. Siting has evolved from approaches dominated by top-down decision making to increasing decentralized and pluralistic approaches. Focusing on social and political concerns of potentially affected communities and on the process of decision making itself are fundamental to achieving siting success. In Alberta initially, and later in Manitoba, this new "open approach" to siting has resulted in the construction of the first two comprehensive hazardous waste treatment facilities in Canada.KEY WORDS: Hazardous waste facilities; Siting methodologies; Public participation

Beyond Control Centers

NASA Technical Reports Server (NTRS)

Trimble, Jay

2017-01-01

For NASA's Resource Prospector (RP) Lunar Rover Mission, we are moving away from a control center concept, to a fully distributed operation utilizing control nodes, with decision support from anywhere via mobile devices. This operations concept will utilize distributed information systems, notifications, mobile data access, and optimized mobile data display for off-console decision support. We see this concept of operations as a step in the evolution of mission operations from a central control center concept to a mission operations anywhere concept. The RP example is part of a trend, in which mission expertise for design, development and operations is distributed across countries and across the globe. Future spacecraft operations will be most cost efficient and flexible by following this distributed expertise, enabling operations from anywhere. For the RP mission we arrived at the decision to utilize a fully distributed operations team, where everyone operates from their home institution, based on evaluating the following factors: the requirement for physical proximity for near-real time command and control decisions; the cost of distributed control nodes vs. a centralized control center; the impact on training and mission preparation of flying the team to a central location. Physical proximity for operational decisions is seldom required, though certain categories of decisions, such as launch abort, or close coordination for mission or safety-critical near-real-time command and control decisions may benefit from co-location. The cost of facilities and operational infrastructure has not been found to be a driving factor for location in our studies. Mission training and preparation benefit from having all operators train and operate from home institutions.

77 FR 35080 - Entergy Nuclear Operations, Inc., Pilgrim Nuclear Power Station; Record of Decision and Issuance...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-12

...., Pilgrim Nuclear Power Station; Record of Decision and Issuance of Renewed Facility Operating License No... as the record of decision for the renewal of facility operating license No. DPR-35, consistent with... referenced. NRC's PDR: You may examine and purchase copies of public documents at the NRC's PDR, Room O1-F21...

76 FR 45301 - PSEG Nuclear LLC, Hope Creek Generating Station; Notice of Issuance of Renewed Facility Operating...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-28

... alternative, and the no-action alternative. The factors considered in the record of decision can be found in...-Year Period; Record of Decision Notice is hereby given that the U.S. Nuclear Regulatory Commission (the.... The notice also serves as the record of decision for the Renewal of Facility Operating License No. NPF...

U-PLANT GEOGRAPHIC ZONE CLEANUP PROTOTYPE

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

ROMINE, L.D.

2006-02-01

The U Plant geographic zone (UPZ) occupies 0.83 square kilometers on the Hanford Site Central Plateau (200 Area). It encompasses the U Plant canyon (221-U Facility), ancillary facilities that supported the canyon, soil waste sites, and underground pipelines. The UPZ cleanup initiative coordinates the cleanup of the major facilities, ancillary facilities, waste sites, and contaminated pipelines (collectively identified as ''cleanup items'') within the geographic zone. The UPZ was selected as a geographic cleanup zone prototype for resolving regulatory, technical, and stakeholder issues and demonstrating cleanup methods for several reasons: most of the area is inactive, sufficient characterization information is availablemore » to support decisions, cleanup of the high-risk waste sites will help protect the groundwater, and the zone contains a representative cross-section of the types of cleanup actions that will be required in other geographic zones. The UPZ cleanup demonstrates the first of 22 integrated zone cleanup actions on the Hanford Site Central Plateau to address threats to groundwater, the environment, and human health. The UPZ contains more than 100 individual cleanup items. Cleanup actions in the zone will be undertaken using multiple regulatory processes and decision documents. Cleanup actions will include building demolition, waste site and pipeline excavation, and the construction of multiple, large engineered barriers. In some cases, different cleanup actions may be taken at item locations that are immediately adjacent to each other. The cleanup planning and field activities for each cleanup item must be undertaken in a coordinated and cohesive manner to ensure effective execution of the UPZ cleanup initiative. The UPZ zone cleanup implementation plan (ZCIP) was developed to address the need for a fundamental integration tool for UPZ cleanup. As UPZ cleanup planning and implementation moves forward, the ZCIP is intended to be a living document that will provide a focal point for integrating UPZ actions, including field cleanup activities, waste staging and handling, and post-cleanup monitoring and institutional controls.« less

Hazardous Materials Verification and Limited Characterization Report on Sodium and Caustic Residuals in Materials and Fuel Complex Facilities MFC-799/799A

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

Gary Mecham

2010-08-01

This report is a companion to the Facilities Condition and Hazard Assessment for Materials and Fuel Complex Sodium Processing Facilities MFC-799/799A and Nuclear Calibration Laboratory MFC-770C (referred to as the Facilities Condition and Hazards Assessment). This report specifically responds to the requirement of Section 9.2, Item 6, of the Facilities Condition and Hazards Assessment to provide an updated assessment and verification of the residual hazardous materials remaining in the Sodium Processing Facilities processing system. The hazardous materials of concern are sodium and sodium hydroxide (caustic). The information supplied in this report supports the end-point objectives identified in the Transition Planmore » for Multiple Facilities at the Materials and Fuels Complex, Advanced Test Reactor, Central Facilities Area, and Power Burst Facility, as well as the deactivation and decommissioning critical decision milestone 1, as specified in U.S. Department of Energy Guide 413.3-8, “Environmental Management Cleanup Projects.” Using a tailored approach and based on information obtained through a combination of process knowledge, emergency management hazardous assessment documentation, and visual inspection, this report provides sufficient detail regarding the quantity of hazardous materials for the purposes of facility transfer; it also provides that further characterization/verification of these materials is unnecessary.« less

Workflow management in large distributed systems

NASA Astrophysics Data System (ADS)

Legrand, I.; Newman, H.; Voicu, R.; Dobre, C.; Grigoras, C.

2011-12-01

The MonALISA (Monitoring Agents using a Large Integrated Services Architecture) framework provides a distributed service system capable of controlling and optimizing large-scale, data-intensive applications. An essential part of managing large-scale, distributed data-processing facilities is a monitoring system for computing facilities, storage, networks, and the very large number of applications running on these systems in near realtime. All this monitoring information gathered for all the subsystems is essential for developing the required higher-level services—the components that provide decision support and some degree of automated decisions—and for maintaining and optimizing workflow in large-scale distributed systems. These management and global optimization functions are performed by higher-level agent-based services. We present several applications of MonALISA's higher-level services including optimized dynamic routing, control, data-transfer scheduling, distributed job scheduling, dynamic allocation of storage resource to running jobs and automated management of remote services among a large set of grid facilities.

Development of a scalable mental healthcare plan for a rural district in Ethiopia

PubMed Central

Fekadu, Abebaw; Hanlon, Charlotte; Medhin, Girmay; Alem, Atalay; Selamu, Medhin; Giorgis, Tedla W.; Shibre, Teshome; Teferra, Solomon; Tegegn, Teketel; Breuer, Erica; Patel, Vikram; Tomlinson, Mark; Thornicroft, Graham; Prince, Martin; Lund, Crick

2016-01-01

Background Developing evidence for the implementation and scaling up of mental healthcare in low- and middle-income countries (LMIC) like Ethiopia is an urgent priority. Aims To outline a mental healthcare plan (MHCP), as a scalable template for the implementation of mental healthcare in rural Ethiopia. Method A mixed methods approach was used to develop the MHCP for the three levels of the district health system (community, health facility and healthcare organisation). Results The community packages were community case detection, community reintegration and community inclusion. The facility packages included capacity building, decision support and staff well-being. Organisational packages were programme management, supervision and sustainability. Conclusions The MHCP focused on improving demand and access at the community level, inclusive care at the facility level and sustainability at the organisation level. The MHCP represented an essential framework for the provision of integrated care and may be a useful template for similar LMIC. PMID:26447174

An Investigation into the Prioritization of Air Force Civil Engineering Structural Maintenance Decisions.

DTIC Science & Technology

1981-09-01

Systems and Logistics AREA &WORIUNITNUMUERS Air Force Institute of Technology WPAFB OH 11. CONTROLLING OFFICE NAME AND ADDRESS 12. REPORT DATE Department of...consists of a cursory glance at structural members located in easily accessable areas and many critical parts of the facility go unnoticed. A counterpart...too far, If inspection teams can be persuaded to take a little extra time to inspect obscure areas of a structural support system and educated with

Force Structure: Preliminary Observations on Army Plans to Implement and Fund Modular Forces

DTIC Science & Technology

2005-03-16

affect the size and composition of the modular force as well as its cost. First, the Army’s Campaign Plan calls for a potential decision by fiscal year...upgrading existing active brigades, or other support and command elements; and • accounted for construction of temporary , relocatable facilities...Kevin Handley, Joah Iannotta, Harry Jobes, Joseph Kirschbaum, Eric Theus, Jason Venner , and J. Andrew Walker.Page 11 GAO-05-443T (350683) GAO’s

Country Immunization Information System Assessments - Kenya, 2015 and Ghana, 2016.

PubMed

Scott, Colleen; Clarke, Kristie E N; Grevendonk, Jan; Dolan, Samantha B; Ahmed, Hussein Osman; Kamau, Peter; Ademba, Peter Aswani; Osadebe, Lynda; Bonsu, George; Opare, Joseph; Diamenu, Stanley; Amenuvegbe, Gregory; Quaye, Pamela; Osei-Sarpong, Fred; Abotsi, Francis; Ankrah, Joseph Dwomor; MacNeil, Adam

2017-11-10

The collection, analysis, and use of data to measure and improve immunization program performance are priorities for the World Health Organization (WHO), global partners, and national immunization programs (NIPs). High quality data are essential for evidence-based decision-making to support successful NIPs. Consistent recording and reporting practices, optimal access to and use of health information systems, and rigorous interpretation and use of data for decision-making are characteristics of high-quality immunization information systems. In 2015 and 2016, immunization information system assessments (IISAs) were conducted in Kenya and Ghana using a new WHO and CDC assessment methodology designed to identify root causes of immunization data quality problems and facilitate development of plans for improvement. Data quality challenges common to both countries included low confidence in facility-level target population data (Kenya = 50%, Ghana = 53%) and poor data concordance between child registers and facility tally sheets (Kenya = 0%, Ghana = 3%). In Kenya, systemic challenges included limited supportive supervision and lack of resources to access electronic reporting systems; in Ghana, challenges included a poorly defined subdistrict administrative level. Data quality improvement plans (DQIPs) based on assessment findings are being implemented in both countries. IISAs can help countries identify and address root causes of poor immunization data to provide a stronger evidence base for future investments in immunization programs.

Principles and application of LIMS in mouse clinics.

PubMed

Maier, Holger; Schütt, Christine; Steinkamp, Ralph; Hurt, Anja; Schneltzer, Elida; Gormanns, Philipp; Lengger, Christoph; Griffiths, Mark; Melvin, David; Agrawal, Neha; Alcantara, Rafael; Evans, Arthur; Gannon, David; Holroyd, Simon; Kipp, Christian; Raj, Navis Pretheeba; Richardson, David; LeBlanc, Sophie; Vasseur, Laurent; Masuya, Hiroshi; Kobayashi, Kimio; Suzuki, Tomohiro; Tanaka, Nobuhiko; Wakana, Shigeharu; Walling, Alison; Clary, David; Gallegos, Juan; Fuchs, Helmut; de Angelis, Martin Hrabě; Gailus-Durner, Valerie

2015-10-01

Large-scale systemic mouse phenotyping, as performed by mouse clinics for more than a decade, requires thousands of mice from a multitude of different mutant lines to be bred, individually tracked and subjected to phenotyping procedures according to a standardised schedule. All these efforts are typically organised in overlapping projects, running in parallel. In terms of logistics, data capture, data analysis, result visualisation and reporting, new challenges have emerged from such projects. These challenges could hardly be met with traditional methods such as pen & paper colony management, spreadsheet-based data management and manual data analysis. Hence, different Laboratory Information Management Systems (LIMS) have been developed in mouse clinics to facilitate or even enable mouse and data management in the described order of magnitude. This review shows that general principles of LIMS can be empirically deduced from LIMS used by different mouse clinics, although these have evolved differently. Supported by LIMS descriptions and lessons learned from seven mouse clinics, this review also shows that the unique LIMS environment in a particular facility strongly influences strategic LIMS decisions and LIMS development. As a major conclusion, this review states that there is no universal LIMS for the mouse research domain that fits all requirements. Still, empirically deduced general LIMS principles can serve as a master decision support template, which is provided as a hands-on tool for mouse research facilities looking for a LIMS.

Space Launch System, Core Stage, Structural Test Design and Implementation

NASA Technical Reports Server (NTRS)

Shaughnessy, Ray

2017-01-01

As part of the National Aeronautics and Space Administration's (NASA) Space Launch System (SLS) Program, engineers at NASA's Marshall Space Flight Center (MSFC) in Huntsville, Alabama are working to design, develop and implement the SLS Core Stage structural testing. The SLS will have the capability to return humans to the Moon and beyond and its first launch is scheduled for December of 2017. The SLS Core Stage consist of five major elements; Forward Skirt, Liquid Oxygen (LOX) tank, Intertank (IT), Liquid Hydrogen (LH2) tank and the Engine Section (ES). Structural Test Articles (STA) for each of these elements are being designed and produced by Boeing at Michoud Assembly Facility located in New Orleans, La. The structural test for the Core Stage STAs (LH2, LOX, IT and ES) are to be conducted by the MSFC Test Laboratory. Additionally, the MSFC Test Laboratory manages the Structural Test Equipment (STE) design and development to support the STAs. It was decided early (April 2012) in the project life that the LH2 and LOX tank STAs would require new test stands and the Engine Section and Intertank would be tested in existing facilities. This decision impacted schedules immediately because the new facilities would require Construction of Facilities (C of F) funds that require congressional approval and long lead times. The Engine Section and Intertank structural test are to be conducted in existing facilities which will limit lead times required to support the first launch of SLS. With a SLS launch date of December, 2017 Boeing had a need date for testing to be complete by September of 2017 to support flight certification requirements. The test facilities were required to be ready by October of 2016 to support test article delivery. The race was on to get the stands ready before Test Article delivery and meet the test complete date of September 2017. This paper documents the past and current design and development phases and the supporting processes, tools, and methodology for supporting the SLS Core Stage STA test stands and related STE. The paper will address key requirements, system development activities and project challenges. Additionally, the interrelationships as well as interdependencies within the SLS project will be discussed.

Probabilistic Radiological Performance Assessment Modeling and Uncertainty

NASA Astrophysics Data System (ADS)

Tauxe, J.

2004-12-01

A generic probabilistic radiological Performance Assessment (PA) model is presented. The model, built using the GoldSim systems simulation software platform, concerns contaminant transport and dose estimation in support of decision making with uncertainty. Both the U.S. Nuclear Regulatory Commission (NRC) and the U.S. Department of Energy (DOE) require assessments of potential future risk to human receptors of disposal of LLW. Commercially operated LLW disposal facilities are licensed by the NRC (or agreement states), and the DOE operates such facilities for disposal of DOE-generated LLW. The type of PA model presented is probabilistic in nature, and hence reflects the current state of knowledge about the site by using probability distributions to capture what is expected (central tendency or average) and the uncertainty (e.g., standard deviation) associated with input parameters, and propagating through the model to arrive at output distributions that reflect expected performance and the overall uncertainty in the system. Estimates of contaminant release rates, concentrations in environmental media, and resulting doses to human receptors well into the future are made by running the model in Monte Carlo fashion, with each realization representing a possible combination of input parameter values. Statistical summaries of the results can be compared to regulatory performance objectives, and decision makers are better informed of the inherently uncertain aspects of the model which supports their decision-making. While this information may make some regulators uncomfortable, they must realize that uncertainties which were hidden in a deterministic analysis are revealed in a probabilistic analysis, and the chance of making a correct decision is now known rather than hoped for. The model includes many typical features and processes that would be part of a PA, but is entirely fictitious. This does not represent any particular site and is meant to be a generic example. A practitioner could, however, start with this model as a GoldSim template and, by adding site specific features and parameter values (distributions), use this model as a starting point for a real model to be used in real decision making.

Propulsion Ground Testing: Planning for the Future

NASA Technical Reports Server (NTRS)

Bruce, Robert

2003-01-01

Advanced planners are constantly being asked to plan for the provision of future test capability. Historically, this capability is provided either by substantial investment in new test facility capabilities, or in the substantial investment in the modification of pre- existing test capabilities. The key words in the previous sentence are "substantial investment". In the evolving environment of increasingly constrained resources, how is an advanced planner to plan for the provisions of such capabilities? Additionally, the conundrum exists that program formulation decisions are being made based upon both life cycle cost decisions in an environment in which the more immediate challenge of "front-end" capital investment? Often times is the linch-pin upon which early decisions are made. In such an environment, how are plans and decisions made? This paper cites examples of decisions made in the past in the area of both major test facility upgrades, as well as major new test facility investment.

An investigation of the effect of anecdotal information on the choice of a healthcare facility.

PubMed

Chalil Madathil, Kapil; Greenstein, Joel S

2018-07-01

This article includes two studies investigating the impact of anecdotal healthcare information from the Internet on healthcare decisions. The availability of anecdotal information on the Internet through social media and peer support groups has increased the risk of the dissemination of misleading information. The first study investigated the effect of demographics, quality of life, health status and public reports usage on the use of anecdotal healthcare information from the Internet. The second employed a 2 (anecdotal information presented as videos supporting and contradicting public report information) * 2 (phase of introduction of anecdotal information: early, late) between-subjects experimental design to investigate the consumer's choice between two health facilities, the level of confidence in the decision, the knowledge acquired and the workload experienced. The results from the first study found that age, gender, educational level, health status and public report usage were significant predictors of consumer use of anecdotal information on the Internet. The results from the second suggest that the probability of making the optimal choice was reduced by more than half when contradicting rather than supporting anecdotal information was presented first. The data from anecdotal information became the anchor points for developing an understanding of the healthcare situation, meaning initial perceptions did not change after the presentation of the more reliable public reports. Because of comprehension issues related to public reports, consumers may give more weight to anecdotal information found online. Thus, new approaches are needed to ensure the former is engaging for a wide range of healthcare consumers. Copyright © 2018 Elsevier Ltd. All rights reserved.

High-speed civil transport issues and technology program

NASA Technical Reports Server (NTRS)

Hewett, Marle D.

1992-01-01

A strawman program plan is presented, consisting of technology developments and demonstrations required to support the construction of a high-speed civil transport. The plan includes a compilation of technology issues related to the development of a transport. The issues represent technical areas in which research and development are required to allow airframe manufacturers to pursue an HSCT development. The vast majority of technical issues presented require flight demonstrated and validated solutions before a transport development will be undertaken by the industry. The author believes that NASA is the agency best suited to address flight demonstration issues in a concentrated effort. The new Integrated Test Facility at NASA Dryden Flight Research Facility is considered ideally suited to the task of supporting ground validations of proof-of-concept and prototype system demonstrations before night demonstrations. An elaborate ground hardware-in-the-loop (iron bird) simulation supported in this facility provides a viable alternative to developing an expensive fill-scale prototype transport technology demonstrator. Drygen's SR-71 assets, modified appropriately, are a suitable test-bed for supporting flight demonstrations and validations of certain transport technology solutions. A subscale, manned or unmanned flight demonstrator is suitable for flight validation of transport technology solutions, if appropriate structural similarity relationships can be established. The author contends that developing a full-scale prototype transport technology demonstrator is the best alternative to ensuring that a positive decision to develop a transport is reached by the United States aerospace industry.

FEMA's Earthquake Incident Journal: A Web-Based Data Integration and Decision Support Tool for Emergency Management

NASA Astrophysics Data System (ADS)

Jones, M.; Pitts, R.

2017-12-01

For emergency managers, government officials, and others who must respond to rapidly changing natural disasters, timely access to detailed information related to affected terrain, population and infrastructure is critical for planning, response and recovery operations. Accessing, analyzing and disseminating such disparate information in near real-time are critical decision support components. However, finding a way to handle a variety of informative yet complex datasets poses a challenge when preparing for and responding to disasters. Here, we discuss the implementation of a web-based data integration and decision support tool for earthquakes developed by the Federal Emergency Management Agency (FEMA) as a solution to some of these challenges. While earthquakes are among the most well- monitored and measured of natural hazards, the spatially broad impacts of shaking, ground deformation, landslides, liquefaction, and even tsunamis, are extremely difficult to quantify without accelerated access to data, modeling, and analytics. This web-based application, deemed the "Earthquake Incident Journal", provides real-time access to authoritative and event-specific data from external (e.g. US Geological Survey, NASA, state and local governments, etc.) and internal (FEMA) data sources. The journal includes a GIS-based model for exposure analytics, allowing FEMA to assess the severity of an event, estimate impacts to structures and population in near real-time, and then apply planning factors to exposure estimates to answer questions such as: What geographic areas are impacted? Will federal support be needed? What resources are needed to support survivors? And which infrastructure elements or essential facilities are threatened? This presentation reviews the development of the Earthquake Incident Journal, detailing the data integration solutions, the methodology behind the GIS-based automated exposure model, and the planning factors as well as other analytical advances that provide near real-time decision support to the federal government.

A First Look at PCMH Implementation for Minority Veterans: Room for Improvement.

PubMed

Hernandez, Susan E; Taylor, Leslie; Grembowski, David; Reid, Robert J; Wong, Edwin; Nelson, Karin M; Liu, Chuan-Fen; Fihn, Stephan D; Hebert, Paul L

2016-03-01

Implementation of Patient Aligned Care Teams (PACT), a patient-centered medical home model, has been inconsistent among the >900 primary care facilities in the Veterans Health Administration. Estimate if the degree of PACT implementation at a facility varied with the percentage of minority veteran patients at the facility. Cross-sectional, facility-level analysis of PACT implementation measures in 2012. Veterans Health Administration hospital-based and community-based primary care facilities. We used a previously validated PACT Implementation Progress Index (Pi) and its 8 domains: access, continuity of care, care coordination, comprehensiveness, self-management support, and patient-centered care and communication, shared decision-making domains, and team functioning. Facilities were categorized as low (<5.2%, n=208), medium (5.2%-25.8%, n=413), and high (>25.8%, n=206) percent minority based on the percent of their own veteran population. Most minority veterans received care in high minority (69%) and medium minority facilities (29%). In adjusted analyses, medium and high minority facilities scored 0.773 (P=0.009) and 0.930 (P=0.008) points lower on the Pi score relative to low minority facilities. Relative to low minority facilities, both medium and high minority facilities were less likely of having high Pi scores (≥2) and more likely of having low Pi scores (≤-2). Both medium and high minority facilities had the same 3 domain scores lower than low minority facilities (care coordination, comprehensiveness, and self-management). Overall PACT implementation varied with respect to the racial/ethnic composition of a facility, with medium and high minority facilities having a lower implementation scores.

Impact of intermodal facilities to the design of supply chains for biorefineries.

DOT National Transportation Integrated Search

2009-08-15

This paper analyzes the impact that an intermodal facility has on location and transportation decisions for biofuel production plants. Location decisions impact the management of the in-bound and out-bound logistics of a plant. We model this supply c...

Load index model: An advanced tool to support decision making during mass-casualty incidents.

PubMed

Adini, Bruria; Aharonson-Daniel, Limor; Israeli, Avi

2015-03-01

In mass-casualty events, accessing information concerning hospital congestion levels is crucial to improving patient distribution and optimizing care. The study aimed to develop a decision support tool for distributing casualties to hospitals in an emergency scenario involving multiple casualties. A comprehensive literature review and structured interviews with 20 content experts produced a shortlist of relevant criteria for inclusion in the model. A "load index model" was prepared, incorporating results of a modified Delphi survey of 100 emergency response experts. The model was tested in three simulation exercises in which an emergency scenario was presented to six groups of senior emergency managers. Information was provided regarding capacities of 11 simulated admitting hospitals in the region, and evacuation destinations were requested for 600 simulated casualties. Of the three simulation rounds, two were performed without the model and one after its presentation. Following simulation experiments and implementation during a real-life security threat, the efficacy of the model was assessed. Variability between experts concerning casualties' evacuation destinations decreased significantly following the model's introduction. Most responders (92%) supported the need for standardized data, and 85% found that the model improved policy setting regarding casualty evacuation in an emergency situation. These findings were reaffirmed in a real-life emergency scenario. The proposed model improved capacity to ensure evacuation of patients to less congested medical facilities in emergency situations, thereby enhancing lifesaving medical services. The model supported decision-making processes in both simulation exercises and an actual emergency situation.

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

Integration of research infrastructures and ecosystem models toward development of predictive ecology

NASA Astrophysics Data System (ADS)

Luo, Y.; Huang, Y.; Jiang, J.; MA, S.; Saruta, V.; Liang, G.; Hanson, P. J.; Ricciuto, D. M.; Milcu, A.; Roy, J.

2017-12-01

The past two decades have witnessed rapid development in sensor technology. Built upon the sensor development, large research infrastructure facilities, such as National Ecological Observatory Network (NEON) and FLUXNET, have been established. Through networking different kinds of sensors and other data collections at many locations all over the world, those facilities generate large volumes of ecological data every day. The big data from those facilities offer an unprecedented opportunity for advancing our understanding of ecological processes, educating teachers and students, supporting decision-making, and testing ecological theory. The big data from the major research infrastructure facilities also provides foundation for developing predictive ecology. Indeed, the capability to predict future changes in our living environment and natural resources is critical to decision making in a world where the past is no longer a clear guide to the future. We are living in a period marked by rapid climate change, profound alteration of biogeochemical cycles, unsustainable depletion of natural resources, and deterioration of air and water quality. Projecting changes in future ecosystem services to the society becomes essential not only for science but also for policy making. We will use this panel format to outline major opportunities and challenges in integrating research infrastructure and ecosystem models toward developing predictive ecology. Meanwhile, we will also show results from an interactive model-experiment System - Ecological Platform for Assimilating Data into models (EcoPAD) - that have been implemented at the Spruce and Peatland Responses Under Climatic and Environmental change (SPRUCE) experiment in Northern Minnesota and Montpellier Ecotron, France. EcoPAD is developed by integrating web technology, eco-informatics, data assimilation techniques, and ecosystem modeling. EcoPAD is designed to streamline data transfer seamlessly from research infrastructure facilities to model simulation, data assimilation, and ecological forecasting.

Fuzzy Multicriteria Decision Analysis for Adaptive Watershed Management

NASA Astrophysics Data System (ADS)

Chang, N.

2006-12-01

The dramatic changes of societal complexity due to intensive interactions among agricultural, industrial, and municipal sectors have resulted in acute issues of water resources redistribution and water quality management in many river basins. Given the fact that integrated watershed management is more a political and societal than a technical challenge, there is a need for developing a compelling method leading to justify a water-based land use program in some critical regions. Adaptive watershed management is viewed as an indispensable tool nowadays for providing step-wise constructive decision support that is concerned with all related aspects of the water consumption cycle and those facilities affecting water quality and quantity temporally and spatially. Yet the greatest challenge that decision makers face today is to consider how to leverage ambiguity, paradox, and uncertainty to their competitive advantage of management policy quantitatively. This paper explores a fuzzy multicriteria evaluation method for water resources redistribution and subsequent water quality management with respect to a multipurpose channel-reservoir system--the Tseng- Wen River Basin, South Taiwan. Four fuzzy operators tailored for this fuzzy multicriteria decision analysis depict greater flexibility in representing the complexity of various possible trade-offs among management alternatives constrained by physical, economic, and technical factors essential for adaptive watershed management. The management strategies derived may enable decision makers to integrate a vast number of internal weirs, water intakes, reservoirs, drainage ditches, transfer pipelines, and wastewater treatment facilities within the basin and bring up the permitting issue for transboundary diversion from a neighboring river basin. Experience gained indicates that the use of different types of fuzzy operators is highly instructive, which also provide unique guidance collectively for achieving the overarching goals of sustainable development on a regional scale.

Public School Desegregation and Education Facilities

ERIC Educational Resources Information Center

Hunter, Richard C.

2011-01-01

Early federal court decisions in school desegregation placed little emphasis on public school facilities. Those early decisions focused primarily on requiring black and white students to attend the same schools and requiring the integration of teachers. What does the literature say about the relationship between student achievement and educational…

Analyzing the impact of intermodal facilities to the design and management of biofuels supply chain.

DOT National Transportation Integrated Search

2010-01-01

This paper analyzes the impact that an intermodal facility has on location and transportation : decisions for biofuel production plants. Location decisions impact the management of the in-bound and out-bound logistics of a plant. We model this supply...

A Clinical Decision Support Engine Based on a National Medication Repository for the Detection of Potential Duplicate Medications: Design and Evaluation

PubMed Central

Yang, Cheng-Yi; Lo, Yu-Sheng; Chen, Ray-Jade

2018-01-01

Background A computerized physician order entry (CPOE) system combined with a clinical decision support system can reduce duplication of medications and thus adverse drug reactions. However, without infrastructure that supports patients’ integrated medication history across health care facilities nationwide, duplication of medication can still occur. In Taiwan, the National Health Insurance Administration has implemented a national medication repository and Web-based query system known as the PharmaCloud, which allows physicians to access their patients’ medication records prescribed by different health care facilities across Taiwan. Objective This study aimed to develop a scalable, flexible, and thematic design-based clinical decision support (CDS) engine, which integrates a national medication repository to support CPOE systems in the detection of potential duplication of medication across health care facilities, as well as to analyze its impact on clinical encounters. Methods A CDS engine was developed that can download patients’ up-to-date medication history from the PharmaCloud and support a CPOE system in the detection of potential duplicate medications. When prescribing a medication order using the CPOE system, a physician receives an alert if there is a potential duplicate medication. To investigate the impact of the CDS engine on clinical encounters in outpatient services, a clinical encounter log was created to collect information about time, prescribed drugs, and physicians’ responses to handling the alerts for each encounter. Results The CDS engine was installed in a teaching affiliate hospital, and the clinical encounter log collected information for 3 months, during which a total of 178,300 prescriptions were prescribed in the outpatient departments. In all, 43,844/178,300 (24.59%) patients signed the PharmaCloud consent form allowing their physicians to access their medication history in the PharmaCloud. The rate of duplicate medication was 5.83% (1843/31,614) of prescriptions. When prescribing using the CDS engine, the median encounter time was 4.3 (IQR 2.3-7.3) min, longer than that without using the CDS engine (median 3.6, IQR 2.0-6.3 min). From the physicians’ responses, we found that 42.06% (1908/4536) of the potential duplicate medications were recognized by the physicians and the medication orders were canceled. Conclusions The CDS engine could easily extend functions for detection of adverse drug reactions when more and more electronic health record systems are adopted. Moreover, the CDS engine can retrieve more updated and completed medication histories in the PharmaCloud, so it can have better performance for detection of duplicate medications. Although our CDS engine approach could enhance medication safety, it would make for a longer encounter time. This problem can be mitigated by careful evaluation of adopted solutions for implementation of the CDS engine. The successful key component of a CDS engine is the completeness of the patient’s medication history, thus further research to assess the factors in increasing the PharmaCloud consent rate is required. PMID:29351893

Underground Test Area Activity Preemptive Review Guidance Nevada National Security Site, Nevada, Revision 0

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

Farnham, Irene; Rehfeldt, Kenneth

Preemptive reviews (PERs) of Underground Test Area (UGTA) Activity corrective action unit (CAU) studies are an important and long-maintained quality improvement process. The CAU-specific PER committees provide internal technical review of ongoing work throughout the CAU lifecycle. The reviews, identified in the UGTA Quality Assurance Plan (QAP) (Sections 1.3.5.1 and 3.2), assure work is comprehensive, accurate, in keeping with the state of the art, and consistent with CAU goals. PER committees review various products, including data, documents, software/codes, analyses, and models. PER committees may also review technical briefings including Federal Facility Agreement and Consent Order (FFACO)-required presentations to the Nevadamore » Division of Environmental Protection (NDEP) and presentations supporting key technical decisions (e.g., investigation plans and approaches). PER committees provide technical recommendations to support regulatory decisions that are the responsibility of the U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Field Office (NNSA/NFO) and NDEP.« less

Immediate financial impact of computerized clinical decision support for long-term care residents with renal insufficiency: a case study.

PubMed

Subramanian, Sujha; Hoover, Sonja; Wagner, Joann L; Donovan, Jennifer L; Kanaan, Abir O; Rochon, Paula A; Gurwitz, Jerry H; Field, Terry S

2012-01-01

In a randomized trial of a clinical decision support system for drug prescribing for residents with renal insufficiency in a large long-term care facility, analyses were conducted to estimate the system's immediate, direct financial impact. We determined the costs that would have been incurred if drug orders that triggered the alert system had actually been completed compared to the costs of the final submitted orders and then compared intervention units to control units. The costs incurred by additional laboratory testing that resulted from alerts were also estimated. Drug orders were conservatively assigned a duration of 30 days of use for a chronic drug and 10 days for antibiotics. It was determined that there were modest reductions in drug costs, partially offset by an increase in laboratory-related costs. Overall, there was a reduction in direct costs (US$1391.43, net 7.6% reduction). However, sensitivity analyses based on alternative estimates of duration of drug use suggested a reduction as high as US$7998.33 if orders for non-antibiotic drugs were assumed to be continued for 180 days. The authors conclude that the immediate and direct financial impact of a clinical decision support system for medication ordering for residents with renal insufficiency is modest and that the primary motivation for such efforts must be to improve the quality and safety of medication ordering.

32 CFR 775.6 - Planning considerations.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., installation, and operation of utility (e.g., water, sewer, electrical) and communication systems (e.g., data... systems, and/or facilities; (37) Decisions to close facilities, decommission equipment, and/or temporarily... environment. The agency decision in the case of an EIS is reflected in a ROD. (b) Where a proposed major...

32 CFR 775.6 - Planning considerations.

Code of Federal Regulations, 2011 CFR

2011-07-01

..., installation, and operation of utility (e.g., water, sewer, electrical) and communication systems (e.g., data... systems, and/or facilities; (37) Decisions to close facilities, decommission equipment, and/or temporarily... environment. The agency decision in the case of an EIS is reflected in a ROD. (b) Where a proposed major...

41 CFR 102-74.245 - Who makes the decision to activate the Occupant Emergency Organization?

Code of Federal Regulations, 2010 CFR

2010-07-01

... Property Management Federal Property Management Regulations System (Continued) FEDERAL MANAGEMENT REGULATION REAL PROPERTY 74-FACILITY MANAGEMENT Facility Management Occupant Emergency Program § 102-74.245... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Who makes the decision...

38 CFR 17.70 - Written decision following a hearing.

Code of Federal Regulations, 2011 CFR

2011-07-01

... shall consider the safety and health of the residents of the community residential care facility and the... AFFAIRS MEDICAL Community Residential Care § 17.70 Written decision following a hearing. (a) The hearing... community residential care facility's noncompliance with VA standards shall be based on the preponderance of...

38 CFR 17.70 - Written decision following a hearing.

Code of Federal Regulations, 2010 CFR

2010-07-01

... shall consider the safety and health of the residents of the community residential care facility and the... AFFAIRS MEDICAL Community Residential Care § 17.70 Written decision following a hearing. (a) The hearing... community residential care facility's noncompliance with VA standards shall be based on the preponderance of...

Factors influencing the decision to use nurse practitioners in the emergency department.

PubMed

McGee, Laurie A; Kaplan, Louise

2007-10-01

Emergency department overcrowding is a serious problem nationwide. Of an estimated 14 million visits to hospital emergency departments, only 12.9% are considered emergent. Many emergency departments, however, employ only physicians despite the fact that nurse practitioners have a proven record of providing high quality, cost-effective care in the emergency department. The purpose of the study was to determine factors that influence the decision to use nurse practitioners in the emergency department. Interviews were conducted with ED managers in hospitals that both employ and do not employ nurse practitioners in the emergency department. In this study, the primary reason that nurse practitioners were not employed by emergency departments was that physician groups with whom the hospitals contract refuse to use nurse practitioners. Emergency department managers of facilities with nurse practitioners reported high levels of satisfaction with the nurse practitioners performance. The 2 ED managers without nurse practitioners in their facility were highly supportive of having nurse practitioners in the emergency department and have advocated for hiring nurse practitioners. Education needs to occur with emergency departments regarding the value of the nurse practitioner's role to the facility. Research is needed to investigate why emergency department physician groups resist hiring nurse practitioners. Increased staffing with nurse practitioners in the emergency department can serve to reduce overcrowding, reduce waiting times, and increase patient satisfaction.

The role of marketing research in securing a certificate of need for a new renal transplant facility.

PubMed

Tucker, L R; Laric, M V; McCann, D

1991-06-01

The authors describe how a negative Certificate of Need decision on the establishment of a new renal transplantation center was reversed by the reintroduction of arguments based on primary data. Specifically, a research project was undertaken to survey attitudes of past and potential patients toward using the new facility. In addition to overturning the negative decision, the data gathered were of significant value to hospital and transplantation facility administrators.

Gender equality and childbirth in a health facility: Nigeria and MDG5.

PubMed

Singh, Kavita; Bloom, Shelah; Haney, Erica; Olorunsaiye, Comfort; Brodish, Paul

2012-09-01

This paper examined how addressing gender equality can lead to reductions in maternal mortality in Nigeria through an increased use of facility delivery. Because the majority of maternal complications cannot be predicted and often arise suddenly during labor, delivery and the immediate postpartum period, childbirth in a health facility is key to reducing maternal mortality. This paper used data from the 2008 Nigeria Demographic and Health Survey (DHS) to examine associations of gender measures on the utilization of facility delivery after controlling for socio-demographic factors. Four gender equality measures were studied: household decision-making, financial decision-making, attitudes towards wife beating, and attitudes regarding a wife's ability to refuse sex. Results found older, more educated, wealthier, urban, and working women were more likely to have a facility delivery than their counterparts. In addition ethnicity was a significant variable indicating the importance of cultural and regional diversity. Notably, after controlling for the socioeconomic variables, two of the gender equality variables were significant: household decision-making and attitudes regarding a wife's ability to refuse sex. In resource-poor settings such as Nigeria, women with more decision-making autonomy are likely better able to advocate for and access a health facility for childbirth. Thus programs and policies that focus on gender in addition to focusing on education and poverty have the potential to reduce maternal mortality even further.

A decision support system for real-time hydropower scheduling in a competitive power market environment

NASA Astrophysics Data System (ADS)

Shawwash, Ziad Khaled Elias

2000-10-01

The electricity supply market is rapidly changing from a monopolistic to a competitive environment. Being able to operate their system of reservoirs and generating facilities to get maximum benefits out of existing assets and resources is important to the British Columbia Hydro Authority (B.C. Hydro). A decision support system has been developed to help B.C. Hydro operate their system in an optimal way. The system is operational and is one of the tools that are currently used by the B.C. Hydro system operations engineers to determine optimal schedules that meet the hourly domestic load and also maximize the value B.C. Hydro obtains from spot transactions in the Western U.S. and Alberta electricity markets. This dissertation describes the development and implementation of the decision support system in production mode. The decision support system consists of six components: the input data preparation routines, the graphical user interface (GUI), the communication protocols, the hydraulic simulation model, the optimization model, and the results display software. A major part of this work involved the development and implementation of a practical and detailed large-scale optimization model that determines the optimal tradeoff between the long-term value of water and the returns from spot trading transactions in real-time operations. The postmortem-testing phase showed that the gains in value from using the model accounted for 0.25% to 1.0% of the revenues obtained. The financial returns from using the decision support system greatly outweigh the costs of building it. Other benefits are the savings in the time needed to prepare the generation and trading schedules. The system operations engineers now can use the time saved to focus on other important aspects of their job. The operators are currently experimenting with the system in production mode, and are gradually gaining confidence that the advice it provides is accurate, reliable and sensible. The main lesson learned from developing and implementing the system was that there is no alternative to working very closely with the intended end-users of the system, and with the people who have deep knowledge, experience and understanding of how the system is and should be operated.

Can Research Findings Help School Systems Obtain the Most Bang from the Construction Bucks?

ERIC Educational Resources Information Center

Earthman, Glen I.; Lemasters, Linda K.

Research on educational facilities is important to help industry and school districts make decisions on funding and maintaining good educational environments for their students. This paper presents findings from three syntheses of 232 studies on educational facilities and funding decisions, followed by discussions of practical solutions designed…

The MOVE study: a study protocol for a randomised controlled trial assessing interventions to maximise attendance at physical activity facilities.

PubMed

Newton, Joshua D; Klein, Ruth; Bauman, Adrian; Newton, Fiona J; Mahal, Ajay; Gilbert, Kara; Piterman, Leon; Ewing, Michael T; Donovan, Robert J; Smith, Ben J

2015-04-18

Physical activity is associated with a host of health benefits, yet many individuals do not perform sufficient physical activity to realise these benefits. One approach to rectifying this situation is through modifying the built environment to make it more conducive to physical activity, such as by building walking tracks or recreational physical activity facilities. Often, however, modifications to the built environment are not connected to efforts aimed at encouraging their use. The purpose of the Monitoring and Observing the Value of Exercise (MOVE) study is to evaluate the effectiveness of two interventions designed to encourage the ongoing use of a new, multi-purpose, community-based physical activity facility. A two-year, randomised controlled trial with yearly survey points (baseline, 12 months follow-up, 24 months follow-up) will be conducted among 1,300 physically inactive adult participants aged 18-70 years. Participants will be randomly assigned to one of three groups: control, intervention 1 (attendance incentives), or intervention 2 (attendance incentives and tailored support following a model based on customer relationship management). Primary outcome measures will include facility usage, physical activity participation, mental and physical wellbeing, community connectedness, social capital, friendship, and social support. Secondary outcome measures will include stages of change for facility usage and social cognitive decision-making variables. This study will assess whether customer relationship management systems, a tool commonly used in commercial marketing settings, can encourage the ongoing use of a physical activity facility. Findings may also indicate the population segments among which the use of such systems are most effective, as well as their cost-effectiveness. Australian New Zealand Clinical Trials Registry: ACTRN12615000012572 (registered 9 January 2015).

Personnel reliability impact on petrochemical facilities monitoring system's failure skipping probability

NASA Astrophysics Data System (ADS)

Kostyukov, V. N.; Naumenko, A. P.

2017-08-01

The paper dwells upon urgent issues of evaluating impact of actions conducted by complex technological systems operators on their safe operation considering application of condition monitoring systems for elements and sub-systems of petrochemical production facilities. The main task for the research is to distinguish factors and criteria of monitoring system properties description, which would allow to evaluate impact of errors made by personnel on operation of real-time condition monitoring and diagnostic systems for machinery of petrochemical facilities, and find and objective criteria for monitoring system class, considering a human factor. On the basis of real-time condition monitoring concepts of sudden failure skipping risk, static and dynamic error, monitoring systems, one may solve a task of evaluation of impact that personnel's qualification has on monitoring system operation in terms of error in personnel or operators' actions while receiving information from monitoring systems and operating a technological system. Operator is considered as a part of the technological system. Although, personnel's behavior is usually a combination of the following parameters: input signal - information perceiving, reaction - decision making, response - decision implementing. Based on several researches on behavior of nuclear powers station operators in USA, Italy and other countries, as well as on researches conducted by Russian scientists, required data on operator's reliability were selected for analysis of operator's behavior at technological facilities diagnostics and monitoring systems. The calculations revealed that for the monitoring system selected as an example, the failure skipping risk for the set values of static (less than 0.01) and dynamic (less than 0.001) errors considering all related factors of data on reliability of information perception, decision-making, and reaction fulfilled is 0.037, in case when all the facilities and error probability are under control - not more than 0.027. In case when only pump and compressor units are under control, the failure skipping risk is not more than 0.022, when the probability of error in operator's action is not more than 0.011. The work output shows that on the basis of the researches results an assessment of operators' reliability can be made in terms of almost any kind of production, but considering only technological capabilities, since operators' psychological and general training considerable vary in different production industries. Using latest technologies of engineering psychology and design of data support systems, situation assessment systems, decision-making and responding system, as well as achievement in condition monitoring in various production industries one can evaluate hazardous condition skipping risk probability considering static, dynamic errors and human factor.

Design challenges for electronic medication administration record systems in residential aged care facilities: a formative evaluation.

PubMed

Tariq, A; Lehnbom, E; Oliver, K; Georgiou, A; Rowe, C; Osmond, T; Westbrook, J

2014-01-01

Electronic medication administration record (eMAR) systems are promoted as a potential intervention to enhance medication safety in residential aged care facilities (RACFs). The purpose of this study was to conduct an in-practice evaluation of an eMAR being piloted in one Australian RACF before its roll out, and to provide recommendations for system improvements. A multidisciplinary team conducted direct observations of workflow (n=34 hours) in the RACF site and the community pharmacy. Semi-structured interviews (n=5) with RACF staff and the community pharmacist were conducted to investigate their views of the eMAR system. Data were analysed using a grounded theory approach to identify challenges associated with the design of the eMAR system. The current eMAR system does not offer an end-to-end solution for medication management. Many steps, including prescribing by doctors and communication with the community pharmacist, are still performed manually using paper charts and fax machines. Five major challenges associated with the design of eMAR system were identified: limited interactivity; inadequate flexibility; problems related to information layout and semantics; the lack of relevant decision support; and system maintenance issues. We suggest recommendations to improve the design of the eMAR system and to optimize existing workflows. Immediate value can be achieved by improving the system interactivity, reducing inconsistencies in data entry design and offering dedicated organisational support to minimise connectivity issues. Longer-term benefits can be achieved by adding decision support features and establishing system interoperability requirements with stakeholder groups (e.g. community pharmacies) prior to system roll out. In-practice evaluations of technologies like eMAR system have great value in identifying design weaknesses which inhibit optimal system use.

Design Challenges for Electronic Medication Administration Record Systems in Residential Aged Care Facilities

PubMed Central

Lehnbom, E.; Oliver, K.; Georgiou, A.; Rowe, C.; Osmond, T.; Westbrook, J.

2014-01-01

Summary Introduction Electronic medication administration record (eMAR) systems are promoted as a potential intervention to enhance medication safety in residential aged care facilities (RACFs). The purpose of this study was to conduct an in-practice evaluation of an eMAR being piloted in one Australian RACF before its roll out, and to provide recommendations for system improvements. Methods A multidisciplinary team conducted direct observations of workflow (n=34 hours) in the RACF site and the community pharmacy. Semi-structured interviews (n=5) with RACF staff and the community pharmacist were conducted to investigate their views of the eMAR system. Data were analysed using a grounded theory approach to identify challenges associated with the design of the eMAR system. Results The current eMAR system does not offer an end-to-end solution for medication management. Many steps, including prescribing by doctors and communication with the community pharmacist, are still performed manually using paper charts and fax machines. Five major challenges associated with the design of eMAR system were identified: limited interactivity; inadequate flexibility; problems related to information layout and semantics; the lack of relevant decision support; and system maintenance issues. We suggest recommendations to improve the design of the eMAR system and to optimize existing workflows. Discussion Immediate value can be achieved by improving the system interactivity, reducing inconsistencies in data entry design and offering dedicated organisational support to minimise connectivity issues. Longer-term benefits can be achieved by adding decision support features and establishing system interoperability requirements with stakeholder groups (e.g. community pharmacies) prior to system roll out. In-practice evaluations of technologies like eMAR system have great value in identifying design weaknesses which inhibit optimal system use. PMID:25589911

Factors Influencing Neurosurgeons' Decision to Retain in a Work Location: A Qualitative Study.

PubMed

Rafiei, Sima; Arab, Mohammad; Rashidian, Arash; Mahmoudi, Mahmood; Rahimi-Movaghar, Vafa

2015-04-02

Physician retention is a serious concern to have an effective and efficient health system; the key challenge is how best to encourage and retain health providers in their work location. There have been considerable studies on factors influencing physicians' retention but little research has been conducted in Iran. This study aims to determine the affecting factors from neurosurgeons' viewpoint to support policy makers in proposing a sort of evidence based retention strategies. We conducted semi structured interviews with 17 neurosurgeons working in 9 provinces of Iran between September and November 2014. We included physicians remaining to work in a particular community for at least 3 years and asked them about the factors influenced their decision to retain in a work place. Data were thematically analyzed using "framework approach" for qualitative research. Satisfaction with monetary incentives, availability of adequate clinical infrastructure in a community and appropriate working condition were most commonly cited factors mentioned by all participants as key reasons for retention. Furthermore elements which contributed to the quality of living condition, personal background and incentives, family convenience were emphasized by majority of them. A small number of participants mentioned opportunity for continuing learning and updating knowledge as well as supportive organizational policies as important motivators in a workplace. Ministry of Health and Medical Education (MOHME) should consider a multifaceted and holistic approach to improve neurosurgeons' retention in their work location. Our findings suggests a combination of financial remuneration, establishment of adequate hospitals and clinical facilities, collaborative working environment with reasonable workload, proper living condition, family support and facilities for professional development to be employed as an effective strategy for promoting physicians' retention.

Factors Influencing Neurosurgeons’ Decision to Retain in a Work Location: A Qualitative Study

PubMed Central

Rafiei, Sima; Arab, Mohammad; Rashidian, Arash; Mahmoudi, Mahmood; Rahimi-Movaghar, Vafa

2015-01-01

Introduction: Physician retention is a serious concern to have an effective and efficient health system; the key challenge is how best to encourage and retain health providers in their work location. There have been considerable studies on factors influencing physicians’ retention but little research has been conducted in Iran. This study aims to determine the affecting factors from neurosurgeons’ viewpoint to support policy makers in proposing a sort of evidence based retention strategies. Methods: We conducted semi structured interviews with 17 neurosurgeons working in 9 provinces of Iran between September and November 2014. We included physicians remaining to work in a particular community for at least 3 years and asked them about the factors influenced their decision to retain in a work place. Data were thematically analyzed using “framework approach” for qualitative research. Results: Satisfaction with monetary incentives, availability of adequate clinical infrastructure in a community and appropriate working condition were most commonly cited factors mentioned by all participants as key reasons for retention. Furthermore elements which contributed to the quality of living condition, personal background and incentives, family convenience were emphasized by majority of them. A small number of participants mentioned opportunity for continuing learning and updating knowledge as well as supportive organizational policies as important motivators in a workplace. Conclusion: Ministry of Health and Medical Education (MOHME) should consider a multifaceted and holistic approach to improve neurosurgeons’ retention in their work location. Our findings suggests a combination of financial remuneration, establishment of adequate hospitals and clinical facilities, collaborative working environment with reasonable workload, proper living condition, family support and facilities for professional development to be employed as an effective strategy for promoting physicians’ retention. PMID:26156906

Event-based knowledge elicitation of operating room management decision-making using scenarios adapted from information systems data

PubMed Central

2011-01-01

Background No systematic process has previously been described for a needs assessment that identifies the operating room (OR) management decisions made by the anesthesiologists and nurse managers at a facility that do not maximize the efficiency of use of OR time. We evaluated whether event-based knowledge elicitation can be used practically for rapid assessment of OR management decision-making at facilities, whether scenarios can be adapted automatically from information systems data, and the usefulness of the approach. Methods A process of event-based knowledge elicitation was developed to assess OR management decision-making that may reduce the efficiency of use of OR time. Hypothetical scenarios addressing every OR management decision influencing OR efficiency were created from published examples. Scenarios are adapted, so that cues about conditions are accurate and appropriate for each facility (e.g., if OR 1 is used as an example in a scenario, the listed procedure is a type of procedure performed at the facility in OR 1). Adaptation is performed automatically using the facility's OR information system or anesthesia information management system (AIMS) data for most scenarios (43 of 45). Performing the needs assessment takes approximately 1 hour of local managers' time while they decide if their decisions are consistent with the described scenarios. A table of contents of the indexed scenarios is created automatically, providing a simple version of problem solving using case-based reasoning. For example, a new OR manager wanting to know the best way to decide whether to move a case can look in the chapter on "Moving Cases on the Day of Surgery" to find a scenario that describes the situation being encountered. Results Scenarios have been adapted and used at 22 hospitals. Few changes in decisions were needed to increase the efficiency of use of OR time. The few changes were heterogeneous among hospitals, showing the usefulness of individualized assessments. Conclusions Our technical advance is the development and use of automated event-based knowledge elicitation to identify suboptimal OR management decisions that decrease the efficiency of use of OR time. The adapted scenarios can be used in future decision-making. PMID:21214905

Event-based knowledge elicitation of operating room management decision-making using scenarios adapted from information systems data.

PubMed

Dexter, Franklin; Wachtel, Ruth E; Epstein, Richard H

2011-01-07

No systematic process has previously been described for a needs assessment that identifies the operating room (OR) management decisions made by the anesthesiologists and nurse managers at a facility that do not maximize the efficiency of use of OR time. We evaluated whether event-based knowledge elicitation can be used practically for rapid assessment of OR management decision-making at facilities, whether scenarios can be adapted automatically from information systems data, and the usefulness of the approach. A process of event-based knowledge elicitation was developed to assess OR management decision-making that may reduce the efficiency of use of OR time. Hypothetical scenarios addressing every OR management decision influencing OR efficiency were created from published examples. Scenarios are adapted, so that cues about conditions are accurate and appropriate for each facility (e.g., if OR 1 is used as an example in a scenario, the listed procedure is a type of procedure performed at the facility in OR 1). Adaptation is performed automatically using the facility's OR information system or anesthesia information management system (AIMS) data for most scenarios (43 of 45). Performing the needs assessment takes approximately 1 hour of local managers' time while they decide if their decisions are consistent with the described scenarios. A table of contents of the indexed scenarios is created automatically, providing a simple version of problem solving using case-based reasoning. For example, a new OR manager wanting to know the best way to decide whether to move a case can look in the chapter on "Moving Cases on the Day of Surgery" to find a scenario that describes the situation being encountered. Scenarios have been adapted and used at 22 hospitals. Few changes in decisions were needed to increase the efficiency of use of OR time. The few changes were heterogeneous among hospitals, showing the usefulness of individualized assessments. Our technical advance is the development and use of automated event-based knowledge elicitation to identify suboptimal OR management decisions that decrease the efficiency of use of OR time. The adapted scenarios can be used in future decision-making.

Updated Liquid Secondary Waste Grout Formulation and Preliminary Waste Form Qualification

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

Saslow, Sarah A.; Um, Wooyong; Russell, Renee L.

This report describes the results from liquid secondary waste grout (LSWG) formulation and cementitious waste form qualification tests performed by Pacific Northwest National Laboratory (PNNL) for Washington River Protection Solutions, LLC (WRPS). New formulations for preparing a cementitious waste form from a high-sulfate liquid secondary waste stream simulant, developed for Effluent Management Facility (EMF) process condensates merged with low activity waste (LAW) caustic scrubber, and the release of key constituents (e.g. 99Tc and 129I) from these monoliths were evaluated. This work supports a technology development program to address the technology needs for Hanford Site Effluent Treatment Facility (ETF) liquid secondarymore » waste (LSW) solidification and supports future Direct Feed Low-Activity Waste (DFLAW) operations. High-priority activities included simulant development, LSWG formulation, and waste form qualification. The work contained within this report relates to waste form development and testing and does not directly support the 2017 integrated disposal facility (IDF) performance assessment (PA). However, this work contains valuable information for use in PA maintenance past FY17, and for future waste form development efforts. The provided data should be used by (i) cementitious waste form scientists to further understanding of cementitious dissolution behavior, (ii) IDF PA modelers who use quantified constituent leachability, effective diffusivity, and partitioning coefficients to advance PA modeling efforts, and (iii) the U.S. Department of Energy (DOE) contractors and decision makers as they assess the IDF PA program. The results obtained help fill existing data gaps, support final selection of a LSWG waste form, and improve the technical defensibility of long-term waste form performance estimates.« less

A Global Survey and Interactive Map Suite of Deep Underground Facilities; Examples of Geotechnical and Engineering Capabilities, Achievements, Challenges: (Mines, Shafts, Tunnels, Boreholes, Sites and Underground Facilities for Nuclear Waste and Physics R&D)

NASA Astrophysics Data System (ADS)

Tynan, M. C.; Russell, G. P.; Perry, F.; Kelley, R.; Champenois, S. T.

2017-12-01

This global survey presents a synthesis of some notable geotechnical and engineering information reflected in four interactive layer maps for selected: 1) deep mines and shafts; 2) existing, considered or planned radioactive waste management deep underground studies, sites, or disposal facilities; 3) deep large diameter boreholes, and 4) physics underground laboratories and facilities from around the world. These data are intended to facilitate user access to basic information and references regarding deep underground "facilities", history, activities, and plans. In general, the interactive maps and database [http://gis.inl.gov/globalsites/] provide each facility's approximate site location, geology, and engineered features (e.g.: access, geometry, depth, diameter, year of operations, groundwater, lithology, host unit name and age, basin; operator, management organization, geographic data, nearby cultural features, other). Although the survey is not all encompassing, it is a comprehensive review of many of the significant existing and historical underground facilities discussed in the literature addressing radioactive waste management and deep mined geologic disposal safety systems. The global survey is intended to support and to inform: 1) interested parties and decision makers; 2) radioactive waste disposal and siting option evaluations, and 3) safety case development as a communication tool applicable to any mined geologic disposal facility as a demonstration of historical and current engineering and geotechnical capabilities available for use in deep underground facility siting, planning, construction, operations and monitoring.

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

Study on Network Error Analysis and Locating based on Integrated Information Decision System

NASA Astrophysics Data System (ADS)

Yang, F.; Dong, Z. H.

2017-10-01

Integrated information decision system (IIDS) integrates multiple sub-system developed by many facilities, including almost hundred kinds of software, which provides with various services, such as email, short messages, drawing and sharing. Because the under-layer protocols are different, user standards are not unified, many errors are occurred during the stages of setup, configuration, and operation, which seriously affect the usage. Because the errors are various, which may be happened in different operation phases, stages, TCP/IP communication protocol layers, sub-system software, it is necessary to design a network error analysis and locating tool for IIDS to solve the above problems. This paper studies on network error analysis and locating based on IIDS, which provides strong theory and technology supports for the running and communicating of IIDS.

PRagmatic trial Of Video Education in Nursing homes: The design and rationale for a pragmatic cluster randomized trial in the nursing home setting.

PubMed

Mor, Vincent; Volandes, Angelo E; Gutman, Roee; Gatsonis, Constantine; Mitchell, Susan L

2017-04-01

Background/Aims Nursing homes are complex healthcare systems serving an increasingly sick population. Nursing homes must engage patients in advance care planning, but do so inconsistently. Video decision support tools improved advance care planning in small randomized controlled trials. Pragmatic trials are increasingly employed in health services research, although not commonly in the nursing home setting to which they are well-suited. This report presents the design and rationale for a pragmatic cluster randomized controlled trial that evaluated the "real world" application of an Advance Care Planning Video Program in two large US nursing home healthcare systems. Methods PRagmatic trial Of Video Education in Nursing homes was conducted in 360 nursing homes (N = 119 intervention/N = 241 control) owned by two healthcare systems. Over an 18-month implementation period, intervention facilities were instructed to offer the Advance Care Planning Video Program to all patients. Control facilities employed usual advance care planning practices. Patient characteristics and outcomes were ascertained from Medicare Claims, Minimum Data Set assessments, and facility electronic medical record data. Intervention adherence was measured using a Video Status Report embedded into electronic medical record systems. The primary outcome was the number of hospitalizations/person-day alive among long-stay patients with advanced dementia or cardiopulmonary disease. The rationale for the approaches to facility randomization and recruitment, intervention implementation, population selection, data acquisition, regulatory issues, and statistical analyses are discussed. Results The large number of well-characterized candidate facilities enabled several unique design features including stratification on historical hospitalization rates, randomization prior to recruitment, and 2:1 control to intervention facilities ratio. Strong endorsement from corporate leadership made randomization prior to recruitment feasible with 100% participation of facilities randomized to the intervention arm. Critical regulatory issues included minimal risk determination, waiver of informed consent, and determination that nursing home providers were not engaged in human subjects research. Intervention training and implementation were initiated on 5 January 2016 using corporate infrastructures for new program roll-out guided by standardized training elements designed by the research team. Video Status Reports in facilities' electronic medical records permitted "real-time" adherence monitoring and corrective actions. The Centers for Medicare and Medicaid Services Virtual Research Data Center allowed for rapid outcomes ascertainment. Conclusion We must rigorously evaluate interventions to deliver more patient-focused care to an increasingly frail nursing home population. Video decision support is a practical approach to improve advance care planning. PRagmatic trial Of Video Education in Nursing homes has the potential to promote goal-directed care among millions of older Americans in nursing homes and establish a methodology for future pragmatic randomized controlled trials in this complex healthcare setting.

Locations and attributes of utility-scale solar power facilities in Colorado and New Mexico, 2011

USGS Publications Warehouse

Ignizio, Drew A.; Carr, Natasha B.

2012-01-01

The data series consists of polygonal boundaries for utility-scale solar power facilities (both photovoltaic and concentrating solar power) located within Colorado and New Mexico as of December 2011. Attributes captured for each facility include the following: facility name, size/production capacity (in MW), type of solar technology employed, location, state, operational status, year the facility came online, and source identification information. Facility locations and perimeters were derived from 1-meter true-color aerial photographs (2011) produced by the National Agriculture Imagery Program (NAIP); the photographs have a positional accuracy of about ±5 meters (accessed from the NAIP GIS service: http://gis.apfo.usda.gov/arcgis/services). Solar facility perimeters represent the full extent of each solar facility site, unless otherwise noted. When visible, linear features such as fences or road lines were used to delineate the full extent of the solar facility. All related equipment including buildings, power substations, and other associated infrastructure were included within the solar facility. If solar infrastructure was indistinguishable from adjacent infrastructure, or if solar panels were installed on existing building tops, only the solar collecting equipment was digitized. The "Polygon" field indicates whether the "equipment footprint" or the full "site outline" was digitized. The spatial accuracy of features that represent site perimeters or an equipment footprint is estimated at +/- 10 meters. Facilities under construction or not fully visible in the NAIP imagery at the time of digitization (December 2011) are represented by an approximate site outline based on the best available information and documenting materials. The spatial accuracy of these facilities cannot be estimated without more up-to-date imagery – users are advised to consult more recent imagery as it becomes available. The "Status" field provides information about the operational status of each facility as of December 2011. This data series contributes to an Online Interactive Energy Atlas currently in development by the U.S. Geological Survey. The Energy Atlas will synthesize data on existing and potential energy development in Colorado and New Mexico and will include additional natural resource data layers. This information may be used by decision makers to evaluate and compare the potential benefits and tradeoffs associated with different energy development strategies or scenarios. Interactive maps, downloadable data layers, metadata, and decision support tools will be included in the Energy Atlas. The format of the Energy Atlas will facilitate the integration of information about energy with key terrestrial and aquatic resources for evaluating resource values and minimizing risks from energy development activities.

Gatekeepers for Pragmatic Clinical Trials

PubMed Central

Whicher, Danielle M.; Miller, Jennifer E.; Dunham, Kelly M.; Joffe, Steven

2015-01-01

To successfully implement a pragmatic clinical trial, investigators need access to numerous resources, including financial support, institutional infrastructure (e.g., clinics, facilities, staff), eligible patients, and patient data. Gatekeepers are people or entities who have the ability to allow or deny access to the resources required to support the conduct of clinical research. Based on this definition, gatekeepers relevant to the United States clinical research enterprise include research sponsors, regulatory agencies, payers, health system and other organizational leadership, research team leadership, human research protections programs, advocacy and community groups, and clinicians. This manuscript provides a framework to help guide gatekeepers’ decision-making related to the use of resources for pragmatic clinical trials. These include (1) concern for the interests of individuals, groups, and communities affected by the gatekeepers’ decisions, including protection from harm and maximization of benefits, (2) advancement of organizational mission and values, and (3) stewardship of financial, human, and other organizational resources. Separate from these ethical considerations, gatekeepers’ actions will be guided by relevant federal, state, and local regulations. This framework also suggests that to further enhance the legitimacy of their decision-making, gatekeepers should adopt transparent processes that engage relevant stakeholders when feasible and appropriate. We apply this framework to the set of gatekeepers responsible for making decisions about resources necessary for pragmatic clinical trials in the United States, describing the relevance of the criteria in different situations and pointing out where conflicts among the criteria and relevant regulations may affect decision-making. Recognition of the complex set of considerations that should inform decision-making will guide gatekeepers in making justifiable choices regarding the use of limited and valuable resources. PMID:26374683

Building University Capacity to Visualize Solutions to Complex Problems in the Arctic

NASA Astrophysics Data System (ADS)

Broderson, D.; Veazey, P.; Raymond, V. L.; Kowalski, K.; Prakash, A.; Signor, B.

2016-12-01

Rapidly changing environments are creating complex problems across the globe, which are particular magnified in the Arctic. These worldwide challenges can best be addressed through diverse and interdisciplinary research teams. It is incumbent on such teams to promote co-production of knowledge and data-driven decision-making by identifying effective methods to communicate their findings and to engage with the public. Decision Theater North (DTN) is a new semi-immersive visualization system that provides a space for teams to collaborate and develop solutions to complex problems, relying on diverse sets of skills and knowledge. It provides a venue to synthesize the talents of scientists, who gather information (data); modelers, who create models of complex systems; artists, who develop visualizations; communicators, who connect and bridge populations; and policymakers, who can use the visualizations to develop sustainable solutions to pressing problems. The mission of Decision Theater North is to provide a cutting-edge visual environment to facilitate dialogue and decision-making by stakeholders including government, industry, communities and academia. We achieve this mission by adopting a multi-faceted approach reflected in the theater's design, technology, networking capabilities, user support, community relationship building, and strategic partnerships. DTN is a joint project of Alaska's National Science Foundation Experimental Program to Stimulate Competitive Research (NSF EPSCoR) and the University of Alaska Fairbanks (UAF), who have brought the facility up to full operational status and are now expanding its development space to support larger team science efforts. Based in Fairbanks, Alaska, DTN is uniquely poised to address changes taking place in the Arctic and subarctic, and is connected with a larger network of decision theaters that include the Arizona State University Decision Theater Network and the McCain Institute in Washington, DC.

TethysCluster: A comprehensive approach for harnessing cloud resources for hydrologic modeling

NASA Astrophysics Data System (ADS)

Nelson, J.; Jones, N.; Ames, D. P.

2015-12-01

Advances in water resources modeling are improving the information that can be supplied to support decisions affecting the safety and sustainability of society. However, as water resources models become more sophisticated and data-intensive they require more computational power to run. Purchasing and maintaining the computing facilities needed to support certain modeling tasks has been cost-prohibitive for many organizations. With the advent of the cloud, the computing resources needed to address this challenge are now available and cost-effective, yet there still remains a significant technical barrier to leverage these resources. This barrier inhibits many decision makers and even trained engineers from taking advantage of the best science and tools available. Here we present the Python tools TethysCluster and CondorPy, that have been developed to lower the barrier to model computation in the cloud by providing (1) programmatic access to dynamically scalable computing resources, (2) a batch scheduling system to queue and dispatch the jobs to the computing resources, (3) data management for job inputs and outputs, and (4) the ability to dynamically create, submit, and monitor computing jobs. These Python tools leverage the open source, computing-resource management, and job management software, HTCondor, to offer a flexible and scalable distributed-computing environment. While TethysCluster and CondorPy can be used independently to provision computing resources and perform large modeling tasks, they have also been integrated into Tethys Platform, a development platform for water resources web apps, to enable computing support for modeling workflows and decision-support systems deployed as web apps.

Factors affecting institutional delivery in rural Chitwan district of Nepal: a community-based cross-sectional study.

PubMed

Shah, Rajani; Rehfuess, Eva A; Maskey, Mahesh K; Fischer, Rainald; Bhandari, Prem B; Delius, Maria

2015-02-13

Health facility delivery is considered a critical strategy to improve maternal health. The Government of Nepal is promoting institutional delivery through different incentive programmes and the establishment of birthing centres. This study aimed to identify the socio-demographic, socio-cultural, and health service-related factors influencing institutional delivery uptake in rural areas of Chitwan district, where high rates of institutional deliveries co-exist with a significant proportion of home deliveries. This community-based cross-sectional study was conducted in six rural Village Development Committees of Chitwan district, which are characterised by relatively low institutional delivery rates and the availability of birthing centres. The study area represents both hilly and plain areas of Chitwan. A total of 673 mothers who had given birth during a one-year-period were interviewed using a structured questionnaire. Univariate and multivariable logistic regression analysis using stepwise backward elimination was performed to identify key factors affecting institutional delivery. Adjusting for all other factors in the final model, advantaged caste/ethnicity [aOR: 1.98; 95% CI: 1.15-3.42], support for institutional delivery by the husband [aOR: 19.85; 95% CI: 8.53-46.21], the decision on place of delivery taken jointly by women and family members [aOR: 5.43; 95% CI: 2.91-10.16] or by family members alone [aOR: 4.61; 95% CI: 2.56-8.28], birth preparations [aOR: 1.75; 95% CI: 1.04-2.92], complications during the most recent pregnancy/delivery [aOR: 2.88; 95% CI: 1.67-4.98], a perception that skilled health workers are always available [aOR: 2.70; 95% CI: 1.20-6.07] and a birthing facility located within one hour's travelling distance [aOR: 2.15; 95% CI: 1.26-3.69] significantly increased the likelihood of institutional delivery. On the other hand, not knowing about the adequacy of physical facilities significantly decreased the likelihood of institutional delivery [aOR: 0.14; 95% CI: 0.05-0.41]. With multiple incentives present, the decision to deliver in a health facility is affected by a complex interplay of socio-demographic, socio-cultural, and health service-related factors. Family decision-making roles and a husband's support for institutional delivery exert a particularly strong influence on the place of delivery, and this should be emphasized in the health policy as well as development and implementation of maternal health programmes in Nepal.

Development and application of a model for the analysis of trades between space launch system operations and acquisition costs

NASA Astrophysics Data System (ADS)

Nix, Michael B.

2005-12-01

Early design decisions in the development of space launch systems determine the costs to acquire and operate launch systems. Some sources indicate that as much as 90% of life cycle costs are fixed by the end of the critical design review phase. System characteristics determined by these early decisions are major factors in the acquisition cost of flight hardware elements and facilities and influence operations costs through the amount of maintenance and support labor required to sustain system function. Operations costs are also dependent on post-development management decisions regarding how much labor will be deployed to meet requirements of market demand and ownership profit. The ability to perform early trade-offs between these costs is vital to the development of systems that have the necessary capacity to provide service and are profitable to operate. An Excel-based prototype model was developed for making early analyses of trade-offs between the costs to operate a space launch system and to acquire the necessary assets to meet a given set of operational requirements. The model, integrating input from existing models and adding missing capability, allows the user to make such trade-offs across a range of operations concepts (required flight rates, staffing levels, shifts per workday, workdays per week and per year, unreliability, wearout and depot maintenance) and the number, type and capability of assets (flight hardware elements, processing and supporting facilities and infrastructure). The costs and capabilities of hypothetical launch systems can be modeled as a function of interrelated turnaround times and labor resource levels, and asset loss and retirement. The number of flight components and facilities required can be calculated and the operations and acquisition costs compared for a specified scenario. Findings, based on the analysis of a hypothetical two stage to orbit, reusable, unmanned launch system, indicate that the model is suitable for the trade-off analyses desired. The minimum turnaround time/maximum labor allocation for specific hardware configurations and characteristics and corresponding asset requirements can be estimated. Either turnaround time or resources can be varied and the resulting operations and acquisition costs can be compared. Asset reliability, wearout and depot maintenance intervals and durations can be varied as well to analyze the effects on costs. Likewise, the effects on operations and acquisitions costs of the introduction of alternative technologies that affect reliability, maintainability and supportability in various hardware configurations can be evaluated.

Advanced building energy management system demonstration for Department of Defense buildings.

PubMed

O'Neill, Zheng; Bailey, Trevor; Dong, Bing; Shashanka, Madhusudana; Luo, Dong

2013-08-01

This paper presents an advanced building energy management system (aBEMS) that employs advanced methods of whole-building performance monitoring combined with statistical methods of learning and data analysis to enable identification of both gradual and discrete performance erosion and faults. This system assimilated data collected from multiple sources, including blueprints, reduced-order models (ROM) and measurements, and employed advanced statistical learning algorithms to identify patterns of anomalies. The results were presented graphically in a manner understandable to facilities managers. A demonstration of aBEMS was conducted in buildings at Naval Station Great Lakes. The facility building management systems were extended to incorporate the energy diagnostics and analysis algorithms, producing systematic identification of more efficient operation strategies. At Naval Station Great Lakes, greater than 20% savings were demonstrated for building energy consumption by improving facility manager decision support to diagnose energy faults and prioritize alternative, energy-efficient operation strategies. The paper concludes with recommendations for widespread aBEMS success. © 2013 New York Academy of Sciences.

The Research on Application of Information Technology in sports Stadiums

NASA Astrophysics Data System (ADS)

Can, Han; Lu, Ma; Gan, Luying

With the Olympic glory in the national fitness program planning and the smooth development of China, the public's concern for the sport continues to grow, while their physical health is also increasingly fervent desired, the country launched a modern technological construction of sports facilities. Information technology applications in the sports venues in the increasingly wide range of modern venues and facilities, including not only the intelligent application of office automation systems, intelligent systems and sports facilities, communication systems for event management, ticket access control system, contest information systems, television systems, Command and Control System, but also in action including the use of computer technology, image analysis, computer-aided training athletes, sports training system and related data entry systems, decision support systems.Using documentary data method, this paper focuses on the research on application of information technology in Sports Stadiums, and try to explore its future trends.With a view to promote the growth of China's national economyand,so as to improve the students'quality and promote the cause of Chinese sports.

Nursing Homes and their Spatial Contexts - Findings from Austria

NASA Astrophysics Data System (ADS)

Fischer, Tatjana

2017-10-01

Against the background of aging and the increasing number of persons in need of care on one hand and the decreasing potential of family support on the other hand, in-patient facilities both in rural areas as well as urban areas of Austria receive importance as final residence. The decision on a facility is challenging. That is why the Austrian Federal Ministry of Labour, Social Affairs and Consumer Protection edits a brochure in three volumes that provides interested persons with information on each residential and nursing home for elderly people. Basing on data from the year 2014, this contribution aims at analysing relevant spatial related information on 885 residential and nursing homes in urban and rural contexts in order to demonstrate how spatial related aspects are considered in the facilities’ presentations and how they illustrate the level of community integration of these in-patient offers, to understand facility-specific future plans as well as to reveal important questions and define urgent research demand and to stimulate the interdisciplinary and cross-cutting dialogue.

Illness recognition, decision-making, and care-seeking for maternal and newborn complications: a qualitative study in Sarlahi District, Nepal.

PubMed

Lama, Tsering P; Khatry, Subarna K; Katz, Joanne; LeClerq, Steven C; Mullany, Luke C

2017-12-21

Identification of maternal and newborn illness and the decision-making and subsequent care-seeking patterns are poorly understood in Nepal. We aimed to characterize the process and factors influencing recognition of complications, the decision-making process, and care-seeking behavior among families and communities who experienced a maternal complication, death, neonatal illness, or death in a rural setting of Nepal. Thirty-two event narratives (six maternal/newborn deaths each and 10 maternal/newborn illnesses each) were collected using in-depth interviews and small group interviews. We purposively sampled across specific illness and complication definitions, using data collected prospectively from a cohort of women and newborns followed from pregnancy through the first 28 days postpartum. The event narratives were coded and analyzed for common themes corresponding to three main domains of illness recognition, decision-making, and care-seeking; detailed event timelines were created for each. While signs were typically recognized early, delays in perceiving the severity of illness compromised prompt care-seeking in both maternal and newborn cases. Further, care was often sought initially from informal health providers such as traditional birth attendants, traditional healers, and village doctors. Key decision-makers were usually female family members; husbands played limited roles in decisions related to care-seeking, with broader family involvement in decision-making for newborns. Barriers to seeking care at any type of health facility included transport problems, lack of money, night-time illness events, low perceived severity, and distance to facility. Facility care was often sought only after referral or following treatment failure from an informal provider and private facilities were sought for newborn care. Respondents characterized government facility-based care as low quality and reported staff rudeness and drug type and/or supply stock shortages. Delaying the decision to seek skilled care was common in both newborn and maternal cases. Among maternal cases, delays in receiving appropriate care when at a facility were also seen. Improved recognition of danger signs and increased demand for skilled care, motivated through community level interventions and health worker mobilization, needs to be encouraged. Engaging informal providers through training in improved danger sign identification and prompt referral, especially for newborn illnesses, is recommended.

From Hospital to Nursing Facility: Factors Influencing Decisions

ERIC Educational Resources Information Center

Mason, Susan E.; Auerbach, Charles; LaPorte, Heidi Heft

2009-01-01

This study addresses the factors influencing decisions to send medicine-surgical (med-surg) patients home or to nursing facilities (NFs). The sample (n = 7,852) was taken from a large, urban, teaching, med-surg unit where discharges were documented and data collected over a two-and-a-half-year period. Using logistical regression, the factors found…

76 FR 11823 - Dominion Energy Kewaunee, Inc.; Kewaunee Power Station; Notice of Issuance of Renewed Facility...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-03

... Additional 20-Year Period; Record of Decision Notice is hereby given that the U.S. Nuclear Regulatory... technical specifications. The notice also serves as the record of decision for the renewal of facility..., efficiency, wood-fired generation, and wind power; and non-renewal of the operating license. The factors...

Societal acceptance of controversial facilities: The role of two public participation strategies---negotiation and risk communication

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

Wolfe, A.K.

Public participation in decision making about the siting of controversial facilities is viewed in contradictory ways by different groups of people. Some see public participation as an impediment, while others think it is an important mechanism in gaining societal acceptance for eventual siting. This paper discusses two strategies for obtaining societal acceptance--- negotiation and risk communication---in light of the extent to which they (1) involve members of the public; (2) focus on risk-related issues; and (3) contribute to decisions to site controversial facilities. The paper presents an integrated conceptual model for public participation in siting decisions that incorporates risk asmore » well as social, political, and historical contexts. 20 refs., 1 fig.« less

The influence of financial officers on the decision-making process in health facilities: a study in Ankara.

PubMed

Kisa, Adnan; Kavuncubasi, Sahin; Ersoy, Korkut

2006-01-01

Financial officers in health facilities currently face 2 main duties. The first is to help the management team in the decision-making process and the second is to ensure the integrity of financial reports to outsiders and outside agencies. A roster of 191 private outpatient clinics in Ankara was drawn up. Fourteen private hospitals and 66 private clinics were included in the study via systematic sampling. Financial officers' perceptions of involvement in 46 decisions (grouped as strategic decisions, accounting and assessment, and nonfinancial decisions) were gauged using a responsive scale ranging from 1 (no involvement) to 5 (greatly involved). Involvement was defined as the extent of participation in specific decision-making issues. High involvement is assumed to be tantamount to influence and can be visualized in the extent to which financial officers could challenge plans, recommend or disapprove, or take a very significant role in reaching decisions. The results of the study show that in the dynamic environment in which health facilities operate, the financial officer's role is somewhat equivocal. The study suggests that the power and influence of financial officers should be defined in such a way so as to develop a clear role for these members of the management team.

78 FR 76317 - Llano Seco Riparian Sanctuary Unit Restoration and Pumping Plant/Fish Screen Facility Protection...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-17

...We, the U.S. Fish and Wildlife Service (Service) and the California Department of Fish and Wildlife (CDFW), announce that the record of decision (ROD) for the Llano Seco Riparian Sanctuary Unit Restoration and Princeton, Codora, Glenn & Provident Irrigation Districts (PCGID-PID) Pumping Plan/Fish Screen Facility Protection Project is now available. The ROD includes a statement of the decisions made, the basis for the decisions, a description of the alternative considered, a description of the environmentally preferable alternative, an overview of the measures to minimize environmental impacts, and a summary of public involvement in the decision-making process.

Need for power and the choice of technologies: State decisions on electric power facilities

NASA Astrophysics Data System (ADS)

1981-06-01

The decision-making processes at the state level regarding the licensing of electric generating facilities were assessed. The basic issues addressed are the need for power and choice of technology: state decisions which directly influence and affect the nation's energy supply, and the tradeoffs involved in meeting energy demand. The areas of special emphasis included the legal mechanisms and regulatory procedures used to determine and resolve these issues. The effectiveness of state decision-making was assessed, focusing on legal and administrative histories and accommodation of interests of concerned parties. Recent innovations to enhance the decision-making process were also assessed where applicable. No particular substantive results are advocated in the findings. The recommendations presented are broad in scope.

Maximizing Social Model Principles in Residential Recovery Settings

PubMed Central

Polcin, Douglas; Mericle, Amy; Howell, Jason; Sheridan, Dave; Christensen, Jeff

2014-01-01

Abstract Peer support is integral to a variety of approaches to alcohol and drug problems. However, there is limited information about the best ways to facilitate it. The “social model” approach developed in California offers useful suggestions for facilitating peer support in residential recovery settings. Key principles include using 12-step or other mutual-help group strategies to create and facilitate a recovery environment, involving program participants in decision making and facility governance, using personal recovery experience as a way to help others, and emphasizing recovery as an interaction between the individual and their environment. Although limited in number, studies have shown favorable outcomes for social model programs. Knowledge about social model recovery and how to use it to facilitate peer support in residential recovery homes varies among providers. This article presents specific, practical suggestions for enhancing social model principles in ways that facilitate peer support in a range of recovery residences. PMID:25364996

Maternal Perceptions and Views About Breastfeeding Practices Among Emirati Mothers.

PubMed

Radwan, Hadia; Sapsford, Roger

2016-03-01

Understanding women's breastfeeding perceptions and experiences is increasingly recognized as a vital tool to provide effective support that would encourage the extension of the breastfeeding period. To identify and explore the perceptions and views that influence the feeding and weaning decisions of Emirati mother. A qualitative study using indepth interviews was undertaken with a convenience sample of 45 Emirati mothers who had infants aged between 6 months and 2 years. Participants were interviewed in the health centers in 3 cities in United Arab Emirates. Data were recorded through field notes and analyzed thematically using grounded theory analysis. The following themes emerged: influences of others on the decisions to breastfeed, sources of information, infants' behavior and participants' views and decisions about when to introduce supplementary feeding, knowledge of and attitudes toward current World Health Organization recommendations, and mothers' perception of the benefits of breastfeeding. Grandmothers in this study played an important role in the breastfeeding practices of Emirati mothers. They supported breastfeeding, however, some encouraged giving the infants prelacteal feeds for a variety of reasons: colic, hunger, promoting growth, and hydration. Fathers, according to the mothers, either supported or ignored breastfeeding practices. Health promotions and health care facilities failed to deliver the message of exclusive breastfeeding. Mothers in our study were resorting to the expertise of the grandmothers and receiving information and advice about child feeding from them. The findings highlight the need for successful intervention programs to be implemented for mothers and grandmothers through health care providers. © The Author(s) 2016.

Preferences and concerns for care needs in advanced Parkinson's disease: a qualitative study of couples.

PubMed

Habermann, Barbara; Shin, Ju Young

2017-06-01

To explore how couples with Parkinson's disease discuss their needs, concerns and preferences at the advanced stages of illness. The majority of care for people with Parkinson's disease is provided at home by family members. Parkinson's disease is characterised by a slow progressive decline with care needs often exceeding a decade. A descriptive qualitative study with 14 couples. Data were collected on two occasions over a one-month period using semi-structured interviews, with both individual and couple interviews. Data were analysed thematically by the research team. All participants discussed the strong desire to remain in their homes for as long as possible. For the people with Parkinson's disease, placement to long-term facilities was not an option to be considered. For spouses, there was an acknowledgement there may come a time when they could no longer continue to provide care. Concerns regarding falls, choking, voice production, financial strain and need for prognostic information from providers were influences on what they believed the future would hold and the decisions they would need to make. The need for improved communication between providers and Parkinson's disease couples is evident. Interventions to support the couple in their discussions and decision-making regarding remaining in the home or not, and options to support advanced care needs are required. Nurses can help support decision-making by providing tangible information regarding the advanced stages of Parkinson's disease including adequate prognostic information. © 2016 John Wiley & Sons Ltd.

The Flash Environmental Assessment Tool: worldwide first aid for chemical accidents response, pro action, prevention and preparedness.

PubMed

Posthuma, Leo; Wahlstrom, Emilia; Nijenhuis, René; Dijkens, Chris; de Zwart, Dick; van de Meent, Dik; Hollander, Anne; Brand, Ellen; den Hollander, Henri A; van Middelaar, Johan; van Dijk, Sander; Hall, E F; Hoffer, Sally

2014-11-01

The United Nations response mechanism to environmental emergencies requested a tool to support disaster assessment and coordination actions by United Nations Disaster Assessment and Coordination (UNDAC) teams. The tool should support on-site decision making when substantial chemical emissions affect human health directly or via the environment and should be suitable for prioritizing impact reduction management options under challenging conditions worldwide. To answer this need, the Flash Environmental Assessment Tool (FEAT) was developed and the scientific and practical underpinning and application of this tool are described in this paper. FEAT consists of a printed decision framework and lookup tables, generated by combining the scientific data on chemicals, exposure pathways and vulnerabilities with the pragmatic needs of emergency field teams. Application of the tool yields information that can help prioritize impact reduction measures. The first years of use illustrated the usefulness of the tool as well as suggesting additional uses and improvements. An additional use is application of the back-office tool (Hazard Identification Tool, HIT), the results of which aid decision-making by the authorities of affected countries and the preparation of field teams for on-site deployment. Another extra use is in disaster pro action and prevention. In this case, the application of the tool supports safe land-use planning and improved technical design of chemical facilities. UNDAC teams are trained to use the tool after large-scale sudden onset natural disasters. Copyright © 2014 Elsevier Ltd. All rights reserved.

The used nuclear fuel problem - can reprocessing and consolidated storage be complementary?

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

Phillips, C.; Thomas, I.

2013-07-01

This paper describes our CISF (Consolidated Interim Storage Facilities) and Reprocessing Facility concepts and show how they can be combined with a geologic repository to provide a comprehensive system for dealing with spent fuels in the USA. The performance of the CISF was logistically analyzed under six operational scenarios. A 3-stage plan has been developed to establish the CISF. Stage 1: the construction at the CISF site of only a rail receipt interface and storage pad large enough for the number of casks that will be received. The construction of the CISF Canister Handling Facility, the Storage Cask Fabrication Facility,more » the Cask Maintenance Facility and supporting infrastructure are performed during stage 2. The construction and placement into operation of a water-filled pool repackaging facility is completed for Stage 3. By using this staged approach, the capital cost of the CISF is spread over a number of years. It also allows more time for a final decision on the geologic repository to be made. A recycling facility will be built, this facility will used the NUEX recycling process that is based on the aqueous-based PUREX solvent extraction process, using a solvent of tri-N-butyl phosphate in a kerosene diluent. It is capable of processing spent fuels at a rate of 5 MT per day, at burn-ups up to 50 GWD per ton of spent fuels and a minimum of 5 years out-of-reactor cooling.« less

Locations and attributes of wind turbines in Colorado, 2009

USGS Publications Warehouse

Carr, Natasha B.; Diffendorfer, Jay E.; Fancher, Tammy S.; Latysh, Natalie E.; Leib, Kenneth J.; Matherne, Anne-Marie; Turner, Christine

2011-01-01

The Colorado wind-turbine data series provides geospatial data for all wind turbines established within the State as of August 2009. Attributes specific to each turbine include: turbine location, manufacturer and model, rotor diameter, hub height, rotor height, potential megawatt output, land ownership, and county. Wind energy facility data for each turbine include: facility name, facility power capacity, number of turbines associated with each facility to date, facility developer, facility ownership, year the facility went online, and development status of wind facility. Turbine locations were derived from August 2009 1-meter true-color aerial photographs produced by the National Agriculture Imagery Program; the photographs have a positional accuracy of about + or - 5 meters. The location of turbines under construction during August 2009 likely will be less accurate than the location of existing turbines. This data series contributes to an Online Interactive Energy Atlas currently (2011) in development by the U.S. Geological Survey. The Energy Atlas will synthesize data on existing and potential energy development in Colorado and New Mexico and will include additional natural resource data layers. This information may be used by decisionmakers to evaluate and compare the potential benefits and tradeoffs associated with different energy development strategies or scenarios. Interactive maps, downloadable data layers, comprehensive metadata, and decision-support tools will be included in the Energy Atlas. The format of the Energy Atlas will facilitate the integration of information about energy with key terrestrial and aquatic resources for evaluating resource values and minimizing risks from energy development.

Locations and attributes of wind turbines in New Mexico, 2009

USGS Publications Warehouse

Carr, Natasha B.; Diffendorfer, Jay E.; Fancher, Tammy S.; Latysh, Natalie E.; Leib, Kenneth J.; Matherne, Anne-Marie; Turner, Christine

2011-01-01

The New Mexico wind-turbine data series provides geospatial data for all wind turbines established within the State as of August 2009. Attributes specific to each turbine include: turbine location, manufacturer and model, rotor diameter, hub height, rotor height, potential megawatt output, land ownership, and county. Wind energy facility data for each turbine include: facility name, facility power capacity, number of turbines associated with each facility to date, facility developer, facility ownership, year the facility went online, and development status of wind facility. Turbine locations were derived from 1-meter August 2009 true-color aerial photographs produced by the National Agriculture Imagery Program; the photographs have a positional accuracy of about + or - 5 meters. The location of turbines under construction during August 2009 likely will be less accurate than the location of existing turbines. This data series contributes to an Online Interactive Energy Atlas currently (2011) in development by the U.S. Geological Survey. The Energy Atlas will synthesize data on existing and potential energy development in Colorado and New Mexico and will include additional natural resource data layers. This information may be used by decisionmakers to evaluate and compare the potential benefits and tradeoffs associated with different energy development strategies or scenarios. Interactive maps, downloadable data layers, comprehensive metadata, and decision-support tools will be included in the Energy Atlas. The format of the Energy Atlas will facilitate the integration of information about energy with key terrestrial and aquatic resources for evaluating resource values and minimizing risks from energy development.

Computer-Aided Facilities Management Systems (CAFM).

ERIC Educational Resources Information Center

Cyros, Kreon L.

Computer-aided facilities management (CAFM) refers to a collection of software used with increasing frequency by facilities managers. The six major CAFM components are discussed with respect to their usefulness and popularity in facilities management applications: (1) computer-aided design; (2) computer-aided engineering; (3) decision support…

The effect of the electronic medical record on nurses' work.

PubMed

Robles, Jane

2009-01-01

The electronic medical record (EMR) is a workplace reality for most nurses. Its advantages include a single consolidated record for each person; capacity for data interfaces and alerts; improved interdisciplinary communication; and evidence-based decision support. EMRs can add to work complexity, by forcing better documentation of previously unrecorded data and/or because of poor design. Well-designed and well-implemented computerized provider order entry (CPOE) systems can streamline nurses' work. Generational differences in acceptance of and facility with EMRs can be addressed through open, healthy communication.

A Clinical Decision Support Engine Based on a National Medication Repository for the Detection of Potential Duplicate Medications: Design and Evaluation.

PubMed

Yang, Cheng-Yi; Lo, Yu-Sheng; Chen, Ray-Jade; Liu, Chien-Tsai

2018-01-19

A computerized physician order entry (CPOE) system combined with a clinical decision support system can reduce duplication of medications and thus adverse drug reactions. However, without infrastructure that supports patients' integrated medication history across health care facilities nationwide, duplication of medication can still occur. In Taiwan, the National Health Insurance Administration has implemented a national medication repository and Web-based query system known as the PharmaCloud, which allows physicians to access their patients' medication records prescribed by different health care facilities across Taiwan. This study aimed to develop a scalable, flexible, and thematic design-based clinical decision support (CDS) engine, which integrates a national medication repository to support CPOE systems in the detection of potential duplication of medication across health care facilities, as well as to analyze its impact on clinical encounters. A CDS engine was developed that can download patients' up-to-date medication history from the PharmaCloud and support a CPOE system in the detection of potential duplicate medications. When prescribing a medication order using the CPOE system, a physician receives an alert if there is a potential duplicate medication. To investigate the impact of the CDS engine on clinical encounters in outpatient services, a clinical encounter log was created to collect information about time, prescribed drugs, and physicians' responses to handling the alerts for each encounter. The CDS engine was installed in a teaching affiliate hospital, and the clinical encounter log collected information for 3 months, during which a total of 178,300 prescriptions were prescribed in the outpatient departments. In all, 43,844/178,300 (24.59%) patients signed the PharmaCloud consent form allowing their physicians to access their medication history in the PharmaCloud. The rate of duplicate medication was 5.83% (1843/31,614) of prescriptions. When prescribing using the CDS engine, the median encounter time was 4.3 (IQR 2.3-7.3) min, longer than that without using the CDS engine (median 3.6, IQR 2.0-6.3 min). From the physicians' responses, we found that 42.06% (1908/4536) of the potential duplicate medications were recognized by the physicians and the medication orders were canceled. The CDS engine could easily extend functions for detection of adverse drug reactions when more and more electronic health record systems are adopted. Moreover, the CDS engine can retrieve more updated and completed medication histories in the PharmaCloud, so it can have better performance for detection of duplicate medications. Although our CDS engine approach could enhance medication safety, it would make for a longer encounter time. This problem can be mitigated by careful evaluation of adopted solutions for implementation of the CDS engine. The successful key component of a CDS engine is the completeness of the patient's medication history, thus further research to assess the factors in increasing the PharmaCloud consent rate is required. ©Cheng-Yi Yang, Yu-Sheng Lo, Ray-Jade Chen, Chien-Tsai Liu. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 19.01.2018.

A Model of Consumer Decision Making in the Selection of a Long-Term Care Facility.

ERIC Educational Resources Information Center

Neugroschel, William J.; Notzon, Linda R.

Since nursing home placement is frequently the last choice for families of elderly people who need long-term care, little literature exists which delineates a model for consumer decision making in the selection of a specific long-term care facility. Critical issues include the following: (1) who actually makes the selection; (2) what other…

Measuring the quality of child health care at first-level facilities.

PubMed

Gouws, Eleanor; Bryce, Jennifer; Pariyo, George; Armstrong Schellenberg, Joanna; Amaral, João; Habicht, Jean-Pierre

2005-08-01

Sound policy and program decisions require timely information based on valid and relevant measures. Recent findings suggest that despite the availability of effective and affordable guidelines for the management of sick children in first-level health facilities in developing countries, the quality and coverage of these services remains low. We report on the development and evaluation of a set of summary indices reflecting the quality of care received by sick children in first-level facilities. The indices were first developed through a consultative process to achieve face validity by involving technical experts and policymakers. The definition of evaluation measures for many public health programs stops at this point. We added a second phase in which standard statistical techniques were used to evaluate the content and construct validity of the indices and their reliability, drawing on data sets from the multi-country evaluation of integrated management of childhood illness (MCE) in Brazil, Tanzania and Uganda. The statistical evaluation identified important conceptual errors in the indices arising from the theory-driven expert review. The experts had combined items into inappropriate indicators resulting in summary indices that were difficult to interpret and had limited validity for program decision making. We propose a revised set of summary indices for the measurement of child health care in developing countries that is supported by both expert and statistical reviews and that led to similar programmatic insights across the three countries. We advocate increased cross-disciplinary research within public health to improve measurement approaches. Child survival policymakers, program planners and implementers can use these tools to improve their monitoring and so increase the health impact of investments in health facility care.

45 CFR 1309.12 - Timely decisions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 4 2010-10-01 2010-10-01 false Timely decisions. 1309.12 Section 1309.12 Public... PROGRAM HEAD START FACILITIES PURCHASE, MAJOR RENOVATION AND CONSTRUCTION Application Procedures § 1309.12 Timely decisions. The responsible HHS official shall promptly review and make final decisions regarding...

The Daniel K. Inouye College of Pharmacy Scripts

PubMed Central

Goo, Roy Alan SH; Chu, Cherie HL; Yoneda, Melissa K; Ma, Carolyn SJ

2016-01-01

In recent years the misuse of antimicrobials has contributed to the growing problem of antimicrobial resistance. Antimicrobial Stewardship Programs (ASP) decrease the misuse of antimicrobials by supporting a rational, systematic approach. ASP strategies vary from broad-ranging policies and other decision support tools to prospective audit review of patients on antimicrobials. Many healthcare facilities, however, have been slow to adopt stewardship attributable to the fact that early ASP models required individuals with specialized training, and a significant amount of time and infrastructural investment from facilities. In response to the increasing need for ASPs in Hawai‘i, the Hawai‘i Department of Health (HDOH) partnered with the Daniel K. Inouye College of Pharmacy (DKICP) to develop the Hawai‘i Antimicrobial Stewardship Collaborative (HASC), a voluntary collaboration whose main objective is to assist hospital institutions in the implementation of a simplified model of the Centers for Disease Control and Prevention's Core Elements of Hospital Antimicrobial Stewardship Programs. The work of HASC places Hawai‘i's health care institutions in an advantageous position to be able to comply with impending accreditation standards relating to antibiotics and infections. PMID:27437167

Optimal condition sampling for a network of infrastructure facilities.

DOT National Transportation Integrated Search

2011-12-31

In response to the developments in inspection technologies, infrastructure decision-making methods evolved whereby the optimum combination of inspection decisions on the one hand and maintenance and rehabilitation decisions on the other are determine...

Defining "adverse environmental impact" and making paragraph 316(b) decisions: a fisheries management approach.

PubMed

Bailey, David E; Bulleit, Kristy A N

2002-05-17

The electric utility industry has developed an approach for decisionmaking that includes a definition of Adverse Environmental Impact (AEI) and an implementation process. The definition of AEI is based on lessons from fishery management science and analysis of the statutory term "adverse environmental impact" and is consistent with current natural resource management policy. The industry has proposed a definition focusing on "unacceptable risk to the population"s ability to sustain itself, to support reasonably anticipated commercial or recreational harvests, or to perform its normal ecological function." This definition focuses not on counting individual fish or eggs cropped by the various uses of a water body, but on preserving populations of aquatic organisms and their functions in the aquatic community. The definition recognizes that assessment of AEI should be site-specific and requires both a biological decision and a balancing of diverse societal values. The industry believes that the definition of AEI should be implemented in a process that will maximize the overall societal benefit of the paragraph 316(b) decision by considering the facility"s physical location, design, and operation, as well as the local biology. The approach considers effects on affected fish and shellfish populations and the benefits of any necessary best technology available (BTA) alternatives. This is accomplished through consideration of population impacts, which conversely allows consideration of the benefits of any necessary BTA modifications. This in turn allows selection of BTAs that will protect potentially affected populations in a cost-effective manner. The process also employs risk assessment with stakeholder participation, in accordance with EPA's Guidelines for Ecological Risk Assessment. The information and tools are now available to make informed decisions about site-specific impacts that will ensure protection of aquatic ecosystems and best serve the public interest.

The Economic Burden of Urinary Tract Infection and Pressure Ulceration in Acute Traumatic Spinal Cord Injury Admissions: Evidence for Comparative Economics and Decision Analytics from a Matched Case-Control Study.

PubMed

White, Barry A B; Dea, Nicolas; Street, John T; Cheng, Christiana L; Rivers, Carly S; Attabib, Najmedden; Kwon, Brian K; Fisher, Charles G; Dvorak, Marcel F

2017-10-15

Secondary complications of spinal cord injury (SCI) are a burden to affected individuals and the rest of society. There is limited evidence of the economic burden or cost of complications in SCI populations in Canada, however, which is necessary for comparative economic analyses and decision analytic modeling of possible solutions to these common health problems. Comparative economic analyses can inform resource allocation decisions, but the outputs are only as good as the inputs. In this article, new evidence of the excess or incremental costs of urinary tract infection (UTI) and pressure ulceration (PU) in acute traumatic SCI from an exploratory case series analysis of admissions to a Level I specialized Canadian spine facility (2008-2013) is presented. Participants in a national SCI registry were case-control matched (1:1) on the predicted probability of experiencing UTI or PU during initial acute SCI admission. The excess costs of UTI and PU are estimated as the mean of the differences in total direct acute SCI admission costs (length of stay, accommodation, nursing, pharmacy) from the perspective of the admitting facility between participants matched or paired on demographic and SCI characteristics. Even relatively minor UTI and PU, respectively, added an average of $7,790 (standard deviation [SD] $6,267) and $18,758 (SD $27,574) to the direct cost of acute SCI admission in 2013 Canadian dollars (CAD). This case series analysis established evidence of the excess costs of UTI and PU in acute SCI admissions, which will support decision-informing analyses in SCI.

Knowledge assisted diagnosis of mood disorders using DSM-3

NASA Technical Reports Server (NTRS)

Fritz, Robert H.

1990-01-01

As part of an Expert Systems class at the University of Houston Clear Lake, a system has been developed using CLIPS to allow a clinical psychologist or psychiatrist to diagnose mood disturbances by providing answers to questions corresponding to branches of a DSM-III criteria tree. Experienced clinicians may assert indications of the client's behavior in order to circumvent multiple levels of the tree, thus speeding diagnosis. An explanation facility was developed for validation of the diagnosis . It also allows for 'what if' scenarios by allowing the clinician to move backwards from the diagnosis to any decision branch and alter the answer previously provided. The system was implemented with a limited vocabulary of symptoms associated primarily with depressive disorders. However, the design supports the addition of vocabulary modules and knowledge bases for other types of disorders. The system currently has applicability in an instructional setting. With the addition of a more complete vocabulary, it could have applicability in a clinical setting. The overall design will support any application where determinations are made via a decision tree.

Development and validation of an algorithm for laser application in wound treatment 1

PubMed Central

da Cunha, Diequison Rite; Salomé, Geraldo Magela; Massahud, Marcelo Renato; Mendes, Bruno; Ferreira, Lydia Masako

2017-01-01

ABSTRACT Objective: To develop and validate an algorithm for laser wound therapy. Method: Methodological study and literature review. For the development of the algorithm, a review was performed in the Health Sciences databases of the past ten years. The algorithm evaluation was performed by 24 participants, nurses, physiotherapists, and physicians. For data analysis, the Cronbach’s alpha coefficient and the chi-square test for independence was used. The level of significance of the statistical test was established at 5% (p<0.05). Results: The professionals’ responses regarding the facility to read the algorithm indicated: 41.70%, great; 41.70%, good; 16.70%, regular. With regard the algorithm being sufficient for supporting decisions related to wound evaluation and wound cleaning, 87.5% said yes to both questions. Regarding the participants’ opinion that the algorithm contained enough information to support their decision regarding the choice of laser parameters, 91.7% said yes. The questionnaire presented reliability using the Cronbach’s alpha coefficient test (α = 0.962). Conclusion: The developed and validated algorithm showed reliability for evaluation, wound cleaning, and use of laser therapy in wounds. PMID:29211197

NewYork-Presbyterian Hospital: translating innovation into practice.

PubMed

Johnson, Trudy; Currie, Gail; Keill, Patricia; Corwin, Steven J; Pardes, Herbert; Cooper, Mary Reich

2005-10-01

NewYork-Presbyterian (NYP) Hospital, a 2,242-bed not-for-profit academic medical center, was formed by a merger of The New York Hospital and The Presbyterian Hospital in the City of New York. It is also the flagship for the NewYork-Presbyterian Healthcare System, with 37 acute care facilities and 18 others. The hospital embeds safety in the culture through strategic initiatives and enhances service and efficiency using Six Sigma and other techniques to drive adoption of improvements. Goals are selected in alignment with the annual strategic initiatives, which are chosen on the basis of satisfaction surveys, patient and family complaints, community advisory groups, and performance measures, among other sources. A new business intelligence system enables online, dynamic analysis of performance results, replacing static paper reports. Advanced features in the clinical information systems include computerized physician order entry; interactive clinical alerts for decision support; a real-time infection control tracking system; and a clinical data warehouse supporting data mining and analysis for quality improvement, decision making, and education. To achieve clinical, service, and operational excellence, NYP focuses on all Institute of Medicine quality aims.

A prototype knowledge-based decision support system for industrial waste management. Part 2: Application to a Trinidadian industrial estate case study

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

Boyle, C.A.; Baetz, B.W.

1998-09-01

A knowledge-based decision support system (KBDSS) has been developed to examine the potentials for reuse, co-treatment, recycling and disposal of wastes from different industrial facilities. Four plants on the Point Lisas Industrial Estate in Trinidad were selected to test this KBDSS; a gas processing plant, a methanol plant, a fertilizer/ammonia plant and a steel processing plant. A total of 77 wastes were produced by the plants (51,481,500 t year{sup {minus}1}) with the majority being released into the ocean or emitted into the air. Seventeen wastes were already being recycled off-site so were not included in the database. Using a knowledgemore » base of 25 possible treatment processes, the KBDSS generated over 4,600 treatment train options for managing the plant wastes. The developed system was able to determine treatment options for the wastes which would minimize the number of treatments and the amount of secondary wastes produced and maximize the potential for reuse, recycling and co-treatment of wastes.« less

Designing Decentralized Water and Electricity Supply System for Small Recreational Facilities in the South of Russia

NASA Astrophysics Data System (ADS)

Kasharin, D. V.

2017-11-01

The article tackles the issues of designing seasonal water and power supply systems for small recreational facilities in the south of Russia based on intelligent decision support systems. The paper proposes modular prefabricated shell water and power supply works (MPSW&PW) along with energy-efficient standalone water-treatment plants as the principal facilities compliant with the environmental and infrastructural requirements applied to specially protected areas and ensuring the least possible damage to the environment due to a maximum possible use of local construction materials characterized by impressive safety margins in highly seismic environments. The task of designing water and power supply systems requires the consideration of issues pertaining to the development of an intelligent GIS-based system for the selection of water intake sites that facilitate automation of data-processing systems using a priori scanning methods with a variable step and random directions. The paper duly addresses such issues and develops parameterized optimization algorithms for MPSW&PW shell facilities. It equally provides the substantiation of water-treatment plants intelligent design based on energy recovery reverse osmosis and nanofiltration plants that enhance the energy efficiency of such plants serving as the optimum solution for the decentralized water supply of small recreational facilities from renewable energy sources.

Understanding Functional Adequacy and Facility Condition for Strategic Decision Making

ERIC Educational Resources Information Center

Dufresne, Ray

2012-01-01

At colleges and universities today, the increasing number of students is putting new pressure on facilities--and on facility staff. Student needs are also increasingly different, and most campus facilities have not kept up with the changing times. Facilities are expensive to build, maintain, and renovate, and costs are on the rise. Funds for…

Lessons learned from the Siting Process of an Interim Storage Facility in Spain - 12024

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

Lamolla, Meritxell Martell

2012-07-01

On 29 December 2009, the Spanish government launched a site selection process to host a centralised interim storage facility for spent fuel and high-level radioactive waste. It was an unprecedented call for voluntarism among Spanish municipalities to site a controversial facility. Two nuclear municipalities, amongst a total of thirteen municipalities from five different regions, presented their candidatures to host the facility in their territories. For two years the government did not make a decision. Only in November 30, 2011, the new government elected on 20 November 2011 officially selected a non-nuclear municipality, Villar de Canas, for hosting this facility. Thismore » paper focuses on analysing the factors facilitating and hindering the siting of controversial facilities, in particular the interim storage facility in Spain. It demonstrates that involving all stakeholders in the decision-making process should not be underestimated. In the case of Spain, all regional governments where there were candidate municipalities willing to host the centralised interim storage facility, publicly opposed to the siting of the facility. (author)« less

A work-centered cognitively based architecture for decision support: the work-centered infomediary layer (WIL) model

NASA Astrophysics Data System (ADS)

Zachary, Wayne; Eggleston, Robert; Donmoyer, Jason; Schremmer, Serge

2003-09-01

Decision-making is strongly shaped and influenced by the work context in which decisions are embedded. This suggests that decision support needs to be anchored by a model (implicit or explicit) of the work process, in contrast to traditional approaches that anchor decision support to either context free decision models (e.g., utility theory) or to detailed models of the external (e.g., battlespace) environment. An architecture for cognitively-based, work centered decision support called the Work-centered Informediary Layer (WIL) is presented. WIL separates decision support into three overall processes that build and dynamically maintain an explicit context model, use the context model to identify opportunities for decision support and tailor generic decision-support strategies to the current context and offer them to the system-user/decision-maker. The generic decision support strategies include such things as activity/attention aiding, decision process structuring, work performance support (selective, contextual automation), explanation/ elaboration, infosphere data retrieval, and what if/action-projection and visualization. A WIL-based application is a work-centered decision support layer that provides active support without intent inferencing, and that is cognitively based without requiring classical cognitive task analyses. Example WIL applications are detailed and discussed.

The role of public relations activities in hospital choice.

PubMed

Tengilimoglu, Dilaver; Yesiltas, Mehmet; Kisa, Adnan; Dziegielewski, Sophia F

2007-01-01

Public relations activities for all organizations can have an important effect on consumer decision-making when buying goods or services. This study examines the effect that public relations activities can have regarding consumer decisions and choice. To explore exemplify this relationship a questionnaire was given to 971 patients within public, university and private hospitals in Ankara, Turkey. Study results show that public relations activities were a crucial factor in determining consumer hospital choice. The majority of respondents reported that the behaviors and attitude of personnel as public relations activities that support the hospital's reputation within the public were the primary variables in hospital choice. Health care managers can use these findings to further understand how patients make informed choices related to usage of a health care facility and to develop and/or improve public relations activities.

Promoting Physical Activity Through the Shared Use of School Recreational Spaces: A Policy Statement From the American Heart Association

PubMed Central

Young, Deborah R.; Spengler, John O.; Frost, Natasha; Evenson, Kelly R.; Vincent, Jeffrey M.; Whitsel, Laurie

2014-01-01

Most Americans are not sufficiently physically active, even though regular physical activity improves health and reduces the risk of many chronic diseases. Those living in rural, non-White, and lower-income communities often have insufficient access to places to be active, which can contribute to their lower level of physical activity. The shared use of school recreational facilities can provide safe and affordable places for communities. Studies suggest that challenges to shared use include additional cost, liability protection, communication among constituencies interested in sharing space, and decision-making about scheduling and space allocation. This American Heart Association policy statement has provided recommendations for federal, state, and local decision-makers to support and expand opportunities for physical activity in communities through the shared use of school spaces. PMID:24134355

Promoting physical activity through the shared use of school recreational spaces: a policy statement from the American Heart Association.

PubMed

Young, Deborah R; Spengler, John O; Frost, Natasha; Evenson, Kelly R; Vincent, Jeffrey M; Whitsel, Laurie

2014-09-01

Most Americans are not sufficiently physically active, even though regular physical activity improves health and reduces the risk of many chronic diseases. Those living in rural, non-White, and lower-income communities often have insufficient access to places to be active, which can contribute to their lower level of physical activity. The shared use of school recreational facilities can provide safe and affordable places for communities. Studies suggest that challenges to shared use include additional cost, liability protection, communication among constituencies interested in sharing space, and decision-making about scheduling and space allocation. This American Heart Association policy statement has provided recommendations for federal, state, and local decision-makers to support and expand opportunities for physical activity in communities through the shared use of school spaces.

Wageningen UR Unmanned Aerial Remote Sensing Facility - Overview of activities

NASA Astrophysics Data System (ADS)

Bartholomeus, Harm; Keesstra, Saskia; Kooistra, Lammert; Suomalainen, Juha; Mucher, Sander; Kramer, Henk; Franke, Jappe

2016-04-01

To support environmental management there is an increasing need for timely, accurate and detailed information on our land. Unmanned Aerial Systems (UAS) are increasingly used to monitor agricultural crop development, habitat quality or urban heat efficiency. An important reason is that UAS technology is maturing quickly while the flexible capabilities of UAS fill a gap between satellite based and ground based geo-sensing systems. In 2012, different groups within Wageningen University and Research Centre have established an Unmanned Airborne Remote Sensing Facility. The objective of this facility is threefold: a) To develop innovation in the field of remote sensing science by providing a platform for dedicated and high-quality experiments; b) To support high quality UAS services by providing calibration facilities and disseminating processing procedures to the UAS user community; and c) To promote and test the use of UAS in a broad range of application fields like habitat monitoring, precision agriculture and land degradation assessment. The facility is hosted by the Laboratory of Geo-Information Science and Remote Sensing (GRS) and the Department of Soil Physics and Land Management (SLM) of Wageningen University together with the team Earth Informatics (EI) of Alterra. The added value of the Unmanned Aerial Remote Sensing Facility is that compared to for example satellite based remote sensing more dedicated science experiments can be prepared. This includes for example higher frequent observations in time (e.g., diurnal observations), observations of an object under different observation angles for characterization of BRDF and flexibility in use of camera's and sensors types. In this way, laboratory type of set ups can be tested in a field situation and effects of up-scaling can be tested. In the last years we developed and implemented different camera systems (e.g. a hyperspectral pushbroom system, and multispectral frame cameras) which we operated in projects all around the world, while new camera systems are being planned such as LiDAR and a full frame hyperspectral camera. In the presentation we will give an overview of our activities, ranging from erosion studies, decision support for precision agriculture, determining leaf biochemistry and canopy structure in tropical forests to the mapping of coastal zones.

The ICCB Computer Based Facilities Inventory & Utilization Management Information Subsystem.

ERIC Educational Resources Information Center

Lach, Ivan J.

The Illinois Community College Board (ICCB) Facilities Inventory and Utilization subsystem, a part of the ICCB management information system, was designed to provide decision makers with needed information to better manage the facility resources of Illinois community colleges. This subsystem, dependent upon facilities inventory data and course…

Overcoming barriers to cancer-helpline professionals providing decision support for callers: an implementation study.

PubMed

Stacey, Dawn; Chambers, Suzanne K; Jacobsen, Mary Jane; Dunn, Jeff

2008-11-01

To evaluate the effect of an intervention on healthcare professionals' perceptions of barriers influencing their provision of decision support for callers facing cancer-related decisions. A pre- and post-test study guided by the Ottawa Model of Research Use. Australian statewide cancer call center that provides public access to information and supportive cancer services. 34 nurses, psychologists, and other allied healthcare professionals at the cancer call center. Participants completed baseline measures and, subsequently, were exposed to an intervention that included a decision support tutorial, coaching protocol, and skill-building workshop. Strategies were implemented to address organizational barriers. Perceived barriers and facilitators influencing provision of decision support, decision support knowledge, quality of decision support provided to standardized callers, and call length. Postintervention participants felt more prepared, confident in providing decision support, and aware of decision support resources. They had a stronger belief that providing decision support was within their role. Participants significantly improved their knowledge and provided higher-quality decision support to standardized callers without changing call length. The implementation intervention overcame several identified barriers that influenced call center professionals when providing decision support. Nurses and other helpline professionals have the potential to provide decision support designed to help callers understand cancer information, clarify their values associated with their options, and reduce decisional conflict. However, they require targeted education and organizational interventions to reduce their perceived barriers to providing decision support.

The impact of the asylum process on mental health: a longitudinal study of unaccompanied refugee minors in Norway.

PubMed

Jakobsen, Marianne; Meyer DeMott, Melinda Ashley; Wentzel-Larsen, Tore; Heir, Trond

2017-06-21

To examine the mental health of unaccompanied refugee minors prospectively during the asylum-seeking process, with a focus on specific stages in the asylum process, such as age assessment, placement in a supportive or non-supportive facility and final decision on the asylum applications. This was a2½ year follow-up study of unaccompanied minors (UM) seeking asylum in Norway. Data were collected within three weeks (n=138) and at 4 months (n=101), 15 months (n=84) and 26 months (n=69) after arrival. Initially in an observation and orientation centre for unaccompanied asylum-seeking adolescents, and subsequently wherever the UM were located in other refugee facilities in Norway. Male UM from Afghanistan, Somalia, Algeria and Iran. Mental health symptoms assessed by Hopkins Symptom Checklist-25 and Harvard Trauma Questionnaire. At the group level, the young asylum seekers reported high levels of psychological distress on arrival and symptom levels that stayed relatively unchanged over time. According to age-assessment procedures, 56% of the population were not recognised as minors. Subsequent placement in a low-support facility was associated with higher levels of psychological distress in the follow-up period. Those who were placed in a reception centre for adults had higher levels of psychological distress symptoms both after 15 months and 26 months compared with the remaining participants who were placed in reception centres for youth. Refusal of asylum was highly associated with higher levels of psychological distress. Mental health trajectory of young asylum seekers appears to be negatively affected by low support and refusal of asylum. © 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.

Collaboration support system for "Phobos-Soil" space mission.

NASA Astrophysics Data System (ADS)

Nazarov, V.; Nazirov, R.; Zakharov, A.

2009-04-01

Rapid development of communication facilities leads growth of interactions done via electronic means. However we can see some paradox in this segment in last times: Extending of communication facilities increases collaboration chaos. And it is very sensitive for space missions in general and scientific space mission particularly because effective decision of this task provides successful realization of the missions and promises increasing the ratio of functional characteristic and cost of mission at all. Resolving of this problem may be found by using respective modern technologies and methods which widely used in different branches and not in the space researches only. Such approaches as Social Networking, Web 2.0 and Enterprise 2.0 look most prospective in this context. The primary goal of the "Phobos-Soil" mission is an investigation of the Phobos which is the Martian moon and particularly its regolith, internal structure, peculiarities of the orbital and proper motion, as well as a number of different scientific measurements and experiments for investigation of the Martian environment. A lot of investigators involved in the mission. Effective collaboration system is key facility for information support of the mission therefore. Further to main goal: communication between users of the system, modern approaches allows using such capabilities as self-organizing community, user generated content, centralized and federative control of the system. Also it may have one unique possibility - knowledge management which is very important for space mission realization. Therefore collaboration support system for "Phobos-Soil" mission designed on the base of multilayer model which includes such levels as Communications, Announcement and Information, Data sharing and Knowledge management. The collaboration support system for "Phobos-Soil" mission will be used as prototype for prospective Russian scientific space missions and the presentation describes its architecture, methodological and technical aspects of its design.

The impact of the asylum process on mental health: a longitudinal study of unaccompanied refugee minors in Norway

PubMed Central

Jakobsen, Marianne; Meyer DeMott, Melinda Ashley; Wentzel-Larsen, Tore; Heir, Trond

2017-01-01

Objectives To examine the mental health of unaccompanied refugee minors prospectively during the asylum-seeking process, with a focus on specific stages in the asylum process, such as age assessment, placement in a supportive or non-supportive facility and final decision on the asylum applications. Design This was a2½ year follow-up study of unaccompanied minors (UM) seeking asylum in Norway. Data were collected within three weeks (n=138) and at 4 months (n=101), 15 months (n=84) and 26 months (n=69) after arrival. Setting Initially in an observation and orientation centre for unaccompanied asylum-seeking adolescents, and subsequently wherever the UM were located in other refugee facilities in Norway. Participants Male UM from Afghanistan, Somalia, Algeria and Iran. Main outcome measures Mental health symptoms assessed by Hopkins Symptom Checklist-25 and Harvard Trauma Questionnaire. Results At the group level, the young asylum seekers reported high levels of psychological distress on arrival and symptom levels that stayed relatively unchanged over time. According to age-assessment procedures, 56% of the population were not recognised as minors. Subsequent placement in a low-support facility was associated with higher levels of psychological distress in the follow-up period. Those who were placed in a reception centre for adults had higher levels of psychological distress symptoms both after 15 months and 26 months compared with the remaining participants who were placed in reception centres for youth. Refusal of asylum was highly associated with higher levels of psychological distress. Conclusion Mental health trajectory of young asylum seekers appears to be negatively affected by low support and refusal of asylum. PMID:28637731

The development of a Simplified, Effective, Labour Monitoring-to-Action (SELMA) tool for Better Outcomes in Labour Difficulty (BOLD): study protocol.

PubMed

Souza, João Paulo; Oladapo, Olufemi T; Bohren, Meghan A; Mugerwa, Kidza; Fawole, Bukola; Moscovici, Leonardo; Alves, Domingos; Perdona, Gleici; Oliveira-Ciabati, Livia; Vogel, Joshua P; Tunçalp, Özge; Zhang, Jim; Hofmeyr, Justus; Bahl, Rajiv; Gülmezoglu, A Metin

2015-05-26

The partograph is currently the main tool available to support decision-making of health professionals during labour. However, the rate of appropriate use of the partograph is disappointingly low. Apart from limitations that are associated with partograph use, evidence of positive impact on labour-related health outcomes is lacking. The main goal of this study is to develop a Simplified, Effective, Labour Monitoring-to-Action (SELMA) tool. The primary objectives are: to identify the essential elements of intrapartum monitoring that trigger the decision to use interventions aimed at preventing poor labour outcomes; to develop a simplified, monitoring-to-action algorithm for labour management; and to compare the diagnostic performance of SELMA and partograph algorithms as tools to identify women who are likely to develop poor labour-related outcomes. A prospective cohort study will be conducted in eight health facilities in Nigeria and Uganda (four facilities from each country). All women admitted for vaginal birth will comprise the study population (estimated sample size: 7,812 women). Data will be collected on maternal characteristics on admission, labour events and pregnancy outcomes by trained research assistants at the participating health facilities. Prediction models will be developed to identify women at risk of intrapartum-related perinatal death or morbidity (primary outcomes) throughout the course of labour. These predictions models will be used to assemble a decision-support tool that will be able to suggest the best course of action to avert adverse outcomes during the course of labour. To develop this set of prediction models, we will use up-to-date techniques of prognostic research, including identification of important predictors, assigning of relative weights to each predictor, estimation of the predictive performance of the model through calibration and discrimination, and determination of its potential for application using internal validation techniques. This research offers an opportunity to revisit the theoretical basis of the partograph. It is envisioned that the final product would help providers overcome the challenging tasks of promptly interpreting complex labour information and deriving appropriate clinical actions, and thus increase efficiency of the care process, enhance providers' competence and ultimately improve labour outcomes. Please see related articles ' http://dx.doi.org/10.1186/s12978-015-0027-6 ' and ' http://dx.doi.org/10.1186/s12978-015-0028-5 '.

{open_quotes}In close proximity{close_quotes} to E&P waste management facilities: Lessons of three communities in the Four Corners Area

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

Shuey, C.

1994-12-31

Contaminant releases from E&P waste management facilities located near residences in three communities in the Four Corners Area -- two in New Mexico and one in Utah -- spurred vocal concern among local residents in recent years. Noxious odors, including hydrogen sulfide, were present in all cases and releases of production wastes and oil spills were prevalent in two of the cases. In all three, residents said they felt powerless to change operator or agency decisions about siting of facilities close to places where people congregate. These cases illustrate the need for regulators to consider facility locations in permitting decisions.more » They also demonstrate the need for creation of statutorily recognized buffer zones around new oil and gas production and processing facilities where releases of pollutants to the air, land and water can reasonably be expected, regardless of the level of pollution control. Buffer zones may be especially important in states where local governments have not elected to adopt land use and zoning requirements that affect the siting of E&P facilities. Agency and corporate sensitivity to siting concerns will engender public confidence in permitting decisions and avoid the needless waste of public and private resources.« less

Economic evaluation of pharmacist-led medication reviews in residential aged care facilities.

PubMed

Hasan, Syed Shahzad; Thiruchelvam, Kaeshaelya; Kow, Chia Siang; Ghori, Muhammad Usman; Babar, Zaheer-Ud-Din

2017-10-01

Medication reviews is a widely accepted approach known to have a substantial impact on patients' pharmacotherapy and safety. Numerous options to optimise pharmacotherapy in older people have been reported in literature and they include medication reviews, computerised decision support systems, management teams, and educational approaches. Pharmacist-led medication reviews are increasingly being conducted, aimed at attaining patient safety and medication optimisation. Cost effectiveness is an essential aspect of a medication review evaluation. Areas covered: A systematic searching of articles that examined the cost-effectiveness of medication reviews conducted in aged care facilities was performed using the relevant databases. Pharmacist-led medication reviews confer many benefits such as attainment of biomarker targets for improved clinical outcomes, and other clinical parameters, as well as depict concrete financial advantages in terms of decrement in total medication costs and associated cost savings. Expert commentary: The cost-effectiveness of medication reviews are more consequential than ever before. A critical evaluation of pharmacist-led medication reviews in residential aged care facilities from an economical aspect is crucial in determining if the time, effort, and direct and indirect costs involved in the review rationalise the significance of conducting medication reviews for older people in aged care facilities.

The Development of the Multi-Center Traffic Management Advisor (MCTMA): Traffic Flow Management Research in a Multi-Facility Environment

NASA Technical Reports Server (NTRS)

Lee, Katharine K.; Davis, Thomas J.; Levin, Kerry M.; Rowe, Dennis W.

2001-01-01

The Traffic Management Advisor (TMA) is a decision-support tool for traffic managers and air traffic controllers that provides traffic flow visualization and other flow management tools. TMA creates an efficiently sequenced and safely spaced schedule for arrival traffic that meets but does not exceed specified airspace system constraints. TMA is being deployed at selected facilities throughout the National Airspace System in the US as part of the FAA's Free Flight Phase 1 program. TMA development and testing, and its current deployment, focuses on managing the arrival capacity for single major airports within single terminal areas and single en route centers. The next phase of development for this technology is the expansion of the TMA capability to complex facilities in which a terminal area or airport is fed by multiple en route centers, thus creating a multicenter TMA functionality. The focus of the multi-center TMA (McTMA) development is on the busy facilities in the Northeast comdor of the US. This paper describes the planning and development of McTMA and the challenges associated with adapting a successful traffic flow management tool for a very complex airspace.

Worksite nutrition supports and sugar-sweetened beverage consumption.

PubMed

Hipp, J A; Becker, H V; Marx, C M; Tabak, R G; Brownson, R C; Yang, L

2016-06-01

This study examined the link between worksite environmental supports for nutrition behaviours and sugar-sweetened beverage (SSB) consumption and offers insight into potential intervention points for reducing SSB consumption and combatting overweight and obesity. Perceived worksite supports for healthy nutrition and self-reported SSB consumption were analysed for 2,015 working adults in the state of Missouri using a subset of questions from the Supports at Home and Work for Maintaining Energy Balance (SHOW-ME) study. Employees' use of vending facilities and the availability of water coolers/water bottles was significantly associated with increased SSB consumption, while use of cafeterias was significantly associated with decreased SSB consumption. Symbols or signs to identify healthy alternatives were significantly associated with sports drink consumption. This study supports previous work indicating the worksite as a necessary environment for nutrition interventions. When choices (vending and cafeteria) are provided, employees report making healthier decisions. For worksites without cafeterias, alternatives should be explored including mobile food trucks and farmer's markets.

Worksite nutrition supports and sugar‐sweetened beverage consumption

PubMed Central

Becker, H. V.; Marx, C. M.; Tabak, R. G.; Brownson, R. C.; Yang, L.

2016-01-01

Summary Objective This study examined the link between worksite environmental supports for nutrition behaviours and sugar‐sweetened beverage (SSB) consumption and offers insight into potential intervention points for reducing SSB consumption and combatting overweight and obesity. Methods Perceived worksite supports for healthy nutrition and self‐reported SSB consumption were analysed for 2,015 working adults in the state of Missouri using a subset of questions from the Supports at Home and Work for Maintaining Energy Balance (SHOW‐ME) study. Results Employees' use of vending facilities and the availability of water coolers/water bottles was significantly associated with increased SSB consumption, while use of cafeterias was significantly associated with decreased SSB consumption. Symbols or signs to identify healthy alternatives were significantly associated with sports drink consumption. Conclusions This study supports previous work indicating the worksite as a necessary environment for nutrition interventions. When choices (vending and cafeteria) are provided, employees report making healthier decisions. For worksites without cafeterias, alternatives should be explored including mobile food trucks and farmer's markets. PMID:29071097

Why the Medical Research Council refused Robert Edwards and Patrick Steptoe support for research on human conception in 1971

PubMed Central

Johnson, Martin H.; Franklin, Sarah B.; Cottingham, Matthew; Hopwood, Nick

2010-01-01

BACKGROUND In 1971, Cambridge physiologist Robert Edwards and Oldham gynaecologist Patrick Steptoe applied to the UK Medical Research Council (MRC) for long-term support for a programme of scientific and clinical ‘Studies on Human Reproduction’. The MRC, then the major British funder of medical research, declined support on ethical grounds and maintained this policy throughout the 1970s. The work continued with private money, leading to the birth of Louise Brown in 1978 and transforming research in obstetrics, gynaecology and human embryology. METHODS The MRC decision has been criticized, but the processes by which it was reached have yet to be explored. Here, we present an archive-based analysis of the MRC decision. RESULTS We find evidence of initial support for Edwards and Steptoe, including from within the MRC, which invited the applicants to join its new directly funded Clinical Research Centre at Northwick Park Hospital. They declined the offer, preferring long-term grant support at the University of Cambridge, and so exposed the project to competitive funding mode. Referees and the Clinical Research Board saw the institutional set-up in Cambridge as problematic with respect to clinical facilities and patient management; gave infertility a low priority compared with population control; assessed interventions as purely experimental rather than potential treatments, and so set the bar for safety high; feared fatal abnormalities and so wanted primate experiments first; and were antagonized by the applicants’ high media profile. The rejection set MRC policy on IVF for 8 years, until, after the birth of just two healthy babies, the Council rapidly converted to enthusiastic support. CONCLUSIONS This analysis enriches our view of a crucial decision, highlights institutional opportunities and constraints and provides insight into the then dominant attitudes of reproductive scientists and clinicians towards human conception research. PMID:20657027

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

PubMed

Ko, Eunjeong; Lee, Jaehoon; Hong, Youngjoon

2016-11-01

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

Nepal's Health Facility Operation and Management Committees: exploring community participation and influence in the Dang district's primary care clinics.

PubMed

Gurung, Gagan; Derrett, Sarah; Hill, Philip C; Gauld, Robin

2018-01-28

Aim To describe community representation in Nepal's Health Facility Operation and Management Committees (HFMCs) and the degree of influence of community representatives in the HFMC decision-making processes. Community participation has been recognised as one of the key components for the successful implementation of primary health care (PHC) strategies, following the 1978 Declaration of Alma-Ata. In low- and middle-income countries (LMICs), HFMCs are now widely considered as a mechanism to increase community participation in health through community representation. There is some research examining the implementation process, impact and factors affecting the effectiveness of HFMCs. Despite the documented evidence of the importance of factors such as adequate representation, links with wider community, and decision-making power, there is limited evidence about the nature of community representation and degree of decision making within HFMCs in the PHC setting, particularly in LMICs. Qualitative interviews with 39 key informants were held to explore different aspects of community representation in HFMCs, and the influence of the HFMC on health facility decision-making processes. In addition, a facility audit at 22 facilities and review of HFMC meeting minutes at six health facilities were conducted. Findings There were Dalit (a marginalised caste) and Janajati (an ethnic group) representations in 77% and 100% of the committees, respectively. Likewise, there were at least two female members in each committee. However, the HFMC member selection process and decision making within the committees were influenced by powerful elites. The degree of participation through HFMCs appeared to be at the 'Manipulation' and 'Informing' stage of Arnstein's ladder of participation. In conclusion, despite representation of the community on HFMCs, the depth of participation seems low. There is a need to ensure a democratic selection process of committee members; and to expand the depth of participation.

Data mining of audiology patient records: factors influencing the choice of hearing aid type

PubMed Central

2012-01-01

Background This paper describes the analysis of a database of over 180,000 patient records, collected from over 23,000 patients, by the hearing aid clinic at James Cook University Hospital in Middlesbrough, UK. These records consist of audiograms (graphs of the faintest sounds audible to the patient at six different pitches), categorical data (such as age, gender, diagnosis and hearing aid type) and brief free text notes made by the technicians. This data is mined to determine which factors contribute to the decision to fit a BTE (worn behind the ear) hearing aid as opposed to an ITE (worn in the ear) hearing aid. Methods From PCA (principal component analysis) four main audiogram types are determined, and are related to the type of hearing aid chosen. The effects of age, gender, diagnosis, masker, mould and individual audiogram frequencies are combined into a single model by means of logistic regression. Some significant keywords are also discovered in the free text fields by using the chi-squared (χ2) test, which can also be used in the model. The final model can act a decision support tool to help decide whether an individual patient should be offered a BTE or an ITE hearing aid. Results The final model was tested using 5-fold cross validation, and was able to replicate the decisions of audiologists whether to fit an ITE or a BTE hearing aid with precision in the range 0.79 to 0.87. Conclusions A decision support system was produced to predict the type of hearing aid which should be prescribed, with an explanation facility explaining how that decision was arrived at. This system should prove useful in providing a "second opinion" for audiologists. PMID:22595091

Development, deployment and usability of a point-of-care decision support system for chronic disease management using the recently-approved HL7 decision support service standard.

PubMed

Lobach, David F; Kawamoto, Kensaku; Anstrom, Kevin J; Russell, Michael L; Woods, Peter; Smith, Dwight

2007-01-01

Clinical decision support is recognized as one potential remedy for the growing crisis in healthcare quality in the United States and other industrialized nations. While decision support systems have been shown to improve care quality and reduce errors, these systems are not widely available. This lack of availability arises in part because most decision support systems are not portable or scalable. The Health Level 7 international standard development organization recently adopted a draft standard known as the Decision Support Service standard to facilitate the implementation of clinical decision support systems using software services. In this paper, we report the first implementation of a clinical decision support system using this new standard. This system provides point-of-care chronic disease management for diabetes and other conditions and is deployed throughout a large regional health system. We also report process measures and usability data concerning the system. Use of the Decision Support Service standard provides a portable and scalable approach to clinical decision support that could facilitate the more extensive use of decision support systems.

Cross-Border Healthcare Requests to Publicly Funded Healthcare Insurance: Empirical Analysis.

PubMed

Stewart Ferreira, Lydia

2016-02-01

Despite the legal authority to confirm, override or modify healthcare insurance decisions made by physicians and government officials, health tribunal decisions have not been empirically analyzed. Using a novel quantitative methodology, all 387 Health Services Appeal and Review Board written and publicly available electronic decisions released over a five-year time period were statistically analyzed with respect to Ontario public health insurance requests for global cross-border healthcare. The statistical results found that patients knew their diagnosis prior to requesting cross-border healthcare, and 84% of patients requested specific northern US facilities for specific treatment. Two specific healthcare facilities in the US were requested for either surgery or assessments. A significant number of patients were seeking cross-border healthcare for pain treatment. This research challenges the assumption that cross-border treatment requests result only from domestic delay when instead patients are seeking specific treatments at specific facilities. This novel quantitative research methodology and data source of written and publicly available electronic Health Services Appeal and Review Board decisions should be used to inform policy decision regarding the utilization and evaluation of Canada's healthcare system and publicly funded healthcare insurance. Copyright © 2016 Longwoods Publishing.

Superfund record of decision (EPA Region 1): Peterson/Puritan Site, Operable Unit 1, Cumberland/Lincoln, RI, September 1993

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

Not Available

1993-09-01

This Decision Document presents the selected remedial action for the Peterson/Puritan, Inc. Superfund Site, Operable Unit 1, in Cumberland and Lincoln, Rhode Island. Operable Unit 1 contains two remediation areas. The CCL remediation area, a source of volatile organic contamination, includes the former Peterson/Puritan, Inc. facility, which is the Site's namesake (currently the CCL Custom Manufacturing facility, and referred to as CCL). The PAC remediation area includes the Pacific Anchor Chemical Corporation (PAC ) facility (formerly the Lonza and Universal Chemical Company facility), which is a source of arsenic and volatile organic contamination. Each remediation area is further split intomore » source and downgradient area components, respectively.« less

How Decision Support Systems Can Benefit from a Theory of Change Approach.

PubMed

Allen, Will; Cruz, Jennyffer; Warburton, Bruce

2017-06-01

Decision support systems are now mostly computer and internet-based information systems designed to support land managers with complex decision-making. However, there is concern that many environmental and agricultural decision support systems remain underutilized and ineffective. Recent efforts to improve decision support systems use have focused on enhancing stakeholder participation in their development, but a mismatch between stakeholders' expectations and the reality of decision support systems outputs continues to limit uptake. Additional challenges remain in problem-framing and evaluation. We propose using an outcomes-based approach called theory of change in conjunction with decision support systems development to support both wider problem-framing and outcomes-based monitoring and evaluation. The theory of change helps framing by placing the decision support systems within a wider context. It highlights how decision support systems use can "contribute" to long-term outcomes, and helps align decision support systems outputs with these larger goals. We illustrate the benefits of linking decision support systems development and application with a theory of change approach using an example of pest rabbit management in Australia. We develop a theory of change that outlines the activities required to achieve the outcomes desired from an effective rabbit management program, and two decision support systems that contribute to specific aspects of decision making in this wider problem context. Using a theory of change in this way should increase acceptance of the role of decision support systems by end-users, clarify their limitations and, importantly, increase effectiveness of rabbit management. The use of a theory of change should benefit those seeking to improve decision support systems design, use and, evaluation.

How Decision Support Systems Can Benefit from a Theory of Change Approach

NASA Astrophysics Data System (ADS)

Allen, Will; Cruz, Jennyffer; Warburton, Bruce

2017-06-01

Decision support systems are now mostly computer and internet-based information systems designed to support land managers with complex decision-making. However, there is concern that many environmental and agricultural decision support systems remain underutilized and ineffective. Recent efforts to improve decision support systems use have focused on enhancing stakeholder participation in their development, but a mismatch between stakeholders' expectations and the reality of decision support systems outputs continues to limit uptake. Additional challenges remain in problem-framing and evaluation. We propose using an outcomes-based approach called theory of change in conjunction with decision support systems development to support both wider problem-framing and outcomes-based monitoring and evaluation. The theory of change helps framing by placing the decision support systems within a wider context. It highlights how decision support systems use can "contribute" to long-term outcomes, and helps align decision support systems outputs with these larger goals. We illustrate the benefits of linking decision support systems development and application with a theory of change approach using an example of pest rabbit management in Australia. We develop a theory of change that outlines the activities required to achieve the outcomes desired from an effective rabbit management program, and two decision support systems that contribute to specific aspects of decision making in this wider problem context. Using a theory of change in this way should increase acceptance of the role of decision support systems by end-users, clarify their limitations and, importantly, increase effectiveness of rabbit management. The use of a theory of change should benefit those seeking to improve decision support systems design, use and, evaluation.

Effluent Management Facility Evaporator Bottom-Waste Streams Formulation and Waste Form Qualification Testing

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

Saslow, Sarah A.; Um, Wooyong; Russell, Renee L.

This report describes the results from grout formulation and cementitious waste form qualification testing performed by Pacific Northwest National Laboratory (PNNL) for Washington River Protection Solutions, LLC (WRPS). These results are part of a screening test that investigates three grout formulations proposed for wide-range treatment of different waste stream compositions expected for the Hanford Effluent Management Facility (EMF) evaporator bottom waste. This work supports the technical development need for alternative disposition paths for the EMF evaporator bottom wastes and future direct feed low-activity waste (DFLAW) operations at the Hanford Site. High-priority activities included simulant production, grout formulation, and cementitious wastemore » form qualification testing. The work contained within this report relates to waste form development and testing, and does not directly support the 2017 Integrated Disposal Facility (IDF) performance assessment (PA). However, this work contains valuable information for use in PA maintenance past FY 2017 and future waste form development efforts. The provided results and data should be used by (1) cementitious waste form scientists to further the understanding of cementitious leach behavior of contaminants of concern (COCs), (2) decision makers interested in off-site waste form disposal, and (3) the U.S. Department of Energy, their Hanford Site contractors and stakeholders as they assess the IDF PA program at the Hanford Site. The results reported help fill existing data gaps, support final selection of a cementitious waste form for the EMF evaporator bottom waste, and improve the technical defensibility of long-term waste form risk estimates.« less

Correctional nursing: a study protocol to develop an educational intervention to optimize nursing practice in a unique context.

PubMed

Almost, Joan; Gifford, Wendy A; Doran, Diane; Ogilvie, Linda; Miller, Crystal; Rose, Don N; Squires, Mae

2013-06-21

Nurses are the primary healthcare providers in correctional facilities. A solid knowledge and expertise that includes the use of research evidence in clinical decision making is needed to optimize nursing practice and promote positive health outcomes within these settings. The institutional emphasis on custodial care within a heavily secured, regulated, and punitive environment presents unique contextual challenges for nursing practice. Subsequently, correctional nurses are not always able to obtain training or ongoing education that is required for broad scopes of practice. The purpose of the proposed study is to develop an educational intervention for correctional nurses to support the provision of evidence-informed care. A two-phase mixed methods research design will be used. The setting will be three provincial correctional facilities. Phase one will focus on identifying nurses' scope of practice and practice needs, describing work environment characteristics that support evidence-informed practice and developing the intervention. Semi-structured interviews will be completed with nurses and nurse managers. To facilitate priorities for the intervention, a Delphi process will be used to rank the learning needs identified by participants. Based on findings, an online intervention will be developed. Phase two will involve evaluating the acceptability and feasibility of the intervention to inform a future experimental design. The context of provincial correctional facilities presents unique challenges for nurses' provision of care. This study will generate information to address practice and learning needs specific to correctional nurses. Interventions tailored to barriers and supports within specific contexts are important to enable nurses to provide evidence-informed care.

Alternatives to seclusion and restraint in psychiatry and in long-term care facilities for the elderly: perspectives of service users and family members.

PubMed

Gagnon, Marie-Pierre; Desmartis, Marie; Dipankui, Mylène Tantchou; Gagnon, Johanne; St-Pierre, Michèle

2013-01-01

There is growing interest in involving patients in decisions regarding healthcare technologies. This research project was conducted in collaboration with decision makers and health technology assessment agents in order to involve healthcare service users (and their loved ones) in the assessment of alternatives to seclusion and restraint in short-term psychiatric wards and long-term care facilities for the elderly. This paper explores the viewpoints and suggestions of service users and service users' families about alternatives to restraint and seclusion, as well as conditions under which they could be used among adults in short-term psychiatric care and residents in long-term care facilities. Using a semi-structured guide, we held eight focus groups: five with mental health service users and three with family members of elderly people in long-term care facilities. Focus group discussions were digitally recorded and transcribed verbatim, and we performed content analysis using NVivo 8 software. In both care environments, participants emphasized the importance of communicating with service users, as well as assessing their needs and their particular situation, for reducing the use of restraint and seclusion. A better welcome and accompaniment of people admitted for short-term psychiatric care emerged also as key approaches to reduce the use of restraint and seclusion. Long-term care facilities could also reduce the need for restraint and seclusion by creating a stimulating home environment and individualized occupational therapy programs. Participants in both groups suggested that caregivers other than healthcare staff could be more involved, especially peer-support workers in the case of psychiatric care and volunteers in the case of long-term care facilities. Participants suggested that changes were needed at a broader and more systemic level than simply replacing current measures of restraint and seclusion with alternative techniques. They favored an approach focused more on the person than on the techniques: they suggested that listening to and communicating with the service user could reduce the use of restraint and seclusion in both healthcare environments.

Feasibility and Effectiveness of a Peer Referral Incentive Intervention to Promote Male Circumcision Uptake in Zambia

PubMed Central

Bolton, Carolyn; Lyabola, Lane-Lee; Phiri, Gabriel; Samona, Alick; Kaonga, Albert; Thirumurthy, Harsha

2016-01-01

Background: Medical male circumcision is a promising HIV prevention tool in countries with generalized HIV epidemics, but demand creation interventions are needed to support scale-up. We piloted a peer referral intervention in which circumcision clients were offered incentives for referring their peers for circumcision. Methods: The intervention was implemented between June 2014 and February 2015 in 6 randomly selected health facilities in Southern Province, Zambia. For the first 5 months, circumcision clients ≥18 years of age were given referral vouchers that allowed them to refer up to 5 peers for circumcision within a 3-month period. An incentive of US$2 was offered for each referral. The primary outcome was the number of circumcisions performed per month in each facility. To assess the effect of the intervention, a difference-in-difference analysis was performed using longitudinal data from the intervention facilities and 22 nonintervention facilities. A questionnaire was also implemented to understand men's perceptions of the intervention. Results: During the 8-month intervention period, 1222 men over 18 years of age were circumcised in intervention facilities. In the first 5 months, 699 circumcision clients were enrolled and 385 clients brought a referral voucher given to them by an enrolled client. Difference-in-difference analyses did not show a significant increase in circumcisions performed in intervention facilities. However, circumcision clients reported that the referral incentive motivated them to encourage their friends to seek male circumcision. Peer referrals were also reported to be an important factor in men's decisions because 78% of clients who were referred reported that talking with a circumcised friend was important for their decision to get circumcised. Conclusions: The peer referral incentive intervention for male circumcision was feasible and acceptable. However, the intervention did not have a significant effect on demand for male circumcision. Barriers to circumcision and features of the intervention may have limited the effect of the intervention. Further efforts regarding encouraging male-to-male communication and evaluations with larger sample sizes are needed. PMID:27404006

A Global Survey of Deep Underground Facilities; Examples of Geotechnical and Engineering Capabilities, Achievements, Challenges (Mines, Shafts, Tunnels, Boreholes, Sites and Underground Facilities for Nuclear Waste and Physics R&D): A Guide to Interactive Global Map Layers, Table Database, References and Notes

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

Tynan, Mark C.; Russell, Glenn P.; Perry, Frank V.

These associated tables, references, notes, and report present a synthesis of some notable geotechnical and engineering information used to create four interactive layer maps for selected: 1) deep mines and shafts; 2) existing, considered or planned radioactive waste management deep underground studies or disposal facilities 3) deep large diameter boreholes, and 4) physics underground laboratories and facilities from around the world. These data are intended to facilitate user access to basic information and references regarding “deep underground” facilities, history, activities, and plans. In general, the interactive maps and database provide each facility’s approximate site location, geology, and engineered features (e.g.:more » access, geometry, depth, diameter, year of operations, groundwater, lithology, host unit name and age, basin; operator, management organization, geographic data, nearby cultural features, other). Although the survey is not comprehensive, it is representative of many of the significant existing and historical underground facilities discussed in the literature addressing radioactive waste management and deep mined geologic disposal safety systems. The global survey is intended to support and to inform: 1) interested parties and decision makers; 2) radioactive waste disposal and siting option evaluations, and 3) safety case development applicable to any mined geologic disposal facility as a demonstration of historical and current engineering and geotechnical capabilities available for use in deep underground facility siting, planning, construction, operations and monitoring.« less

Decision Support | Solar Research | NREL

Science.gov Websites

informed solar decision making with credible, objective, accessible, and timely resources. Solar Energy Decision Support Decision Support NREL provides technical and analytical support to support provide unbiased information on solar policies and issues for state and local government decision makers

Barriers to and facilitators of implementing shared decision making and decision support in a paediatric hospital: A descriptive study.

PubMed

Boland, Laura; McIsaac, Daniel I; Lawson, Margaret L

2016-04-01

To explore multiple stakeholders' perceived barriers to and facilitators of implementing shared decision making and decision support in a tertiary paediatric hospital. An interpretive descriptive qualitative study was conducted using focus groups and interviews to examine senior hospital administrators', clinicians', parents' and youths' perceived barriers to and facilitators of shared decision making and decision support implementation. Data were analyzed using inductive thematic analysis. Fifty-seven stakeholders participated. Six barrier and facilitator themes emerged. The main barrier was gaps in stakeholders' knowledge of shared decision making and decision support. Facilitators included compatibility between shared decision making and the hospital's culture and ideal practices, perceptions of positive patient and family outcomes associated with shared decision making, and positive attitudes regarding shared decision making and decision support. However, youth attitudes regarding the necessity and usefulness of a decision support program were a barrier. Two themes were both a barrier and a facilitator. First, stakeholder groups were uncertain which clinical situations are suitable for shared decision making (eg, new diagnoses, chronic illnesses, complex decisions or urgent decisions). Second, the clinical process may be hindered if shared decision making and decision support decrease efficiency and workflow; however, shared decision making may reduce repeat visits and save time over the long term. Specific knowledge translation strategies that improve shared decision making knowledge and match specific barriers identified by each stakeholder group may be required to promote successful shared decision making and decision support implementation in the authors' paediatric hospital.

Performance evaluation of the machine learning algorithms used in inference mechanism of a medical decision support system.

PubMed

Bal, Mert; Amasyali, M Fatih; Sever, Hayri; Kose, Guven; Demirhan, Ayse

2014-01-01

The importance of the decision support systems is increasingly supporting the decision making process in cases of uncertainty and the lack of information and they are widely used in various fields like engineering, finance, medicine, and so forth, Medical decision support systems help the healthcare personnel to select optimal method during the treatment of the patients. Decision support systems are intelligent software systems that support decision makers on their decisions. The design of decision support systems consists of four main subjects called inference mechanism, knowledge-base, explanation module, and active memory. Inference mechanism constitutes the basis of decision support systems. There are various methods that can be used in these mechanisms approaches. Some of these methods are decision trees, artificial neural networks, statistical methods, rule-based methods, and so forth. In decision support systems, those methods can be used separately or a hybrid system, and also combination of those methods. In this study, synthetic data with 10, 100, 1000, and 2000 records have been produced to reflect the probabilities on the ALARM network. The accuracy of 11 machine learning methods for the inference mechanism of medical decision support system is compared on various data sets.

Fostering good governance at peripheral public health facilities: an experience from Nepal.

PubMed

Gurung, G; Tuladhar, S

2013-01-01

The Nepalese primary healthcare system at sub-district level consists of three different levels of health facility to serve the mostly rural population. The Ministry of Health and Population decentralised health services by handing over 1433 health facilities in 28 districts to Health Facility Operation and Management Committees (HFOMCs), which were formed following a public meeting, and consist of 9 to 13 members, representing the health facility in-charge, elected members of the village development committee, dalit (disadvantaged caste) and women members. The purpose was to make this local committee responsible for managing all affairs of the health facility. However, the handing over of the health facilities to HFOMCs was not matched by an equivalent increase in the managerial capacity of the members, which potentially makes this initiative ineffective. The Health Facility Management Strengthening Program was implemented in 13 districts to foster good governance in the health facilities by increasing the capacity of HFOMCs. This effort focuses on capacity building of HFOMCs as a continuous process rather than a one-off event. Training, follow-up and promotional activities were conducted. This article focuses on how good governance at the peripheral public health facilities in Nepal can be fostered through the active engagement and capacity building of HFOMCs. This article used baseline and monitoring data collected during technical support visits to HFOMCs and their members between July 2008 and October 2011. The results show that the Health Facility Management Strengthening Program was quite successful in strengthening local health governance in the health facilities. The level of community engagement in governance improved, that is, the number of effective HFOMC meetings increased, the inclusion of dalit/women members in the decision-making process expanded, resource mobilization was facilitated, and community accountability, as measured by health facility opening days, increased. Furthermore, availability of technical staff, supervision and monitoring, and display of the citizen charter increased, and health services became more inclusive. Several lessons emerged. Functioning of HFOMCs is largely dependent on the process of selecting members, the staff and community's support of the HFOMC, and a sense of volunteerism and team spirit among the members. Similarly, to ensure the effective participation of dalit/woman members, the educational and livelihood empowerment of the members is deemed necessary. Furthermore, capacity building of and giving authority to HFOMCs should go hand-in-hand. Local governance of health facilities was fostered through the local people's active engagement in HFOMCs and capacity building of the HFOMC members.

Review of Potential Candidate Stabilization Technologies for Liquid and Solid Secondary Waste Streams

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

Pierce, Eric M.; Mattigod, Shas V.; Westsik, Joseph H.

2010-01-30

Pacific Northwest National Laboratory has initiated a waste form testing program to support the long-term durability evaluation of a waste form for secondary wastes generated from the treatment and immobilization of Hanford radioactive tank wastes. The purpose of the work discussed in this report is to identify candidate stabilization technologies and getters that have the potential to successfully treat the secondary waste stream liquid effluent, mainly from off-gas scrubbers and spent solids, produced by the Hanford Tank Waste Treatment and Immobilization Plant (WTP). Down-selection to the most promising stabilization processes/waste forms is needed to support the design of a solidificationmore » treatment unit (STU) to be added to the Effluent Treatment Facility (ETF). To support key decision processes, an initial screening of the secondary liquid waste forms must be completed by February 2010.« less

Aquatics Systems Branch: transdisciplinary research to address water-related environmental problems

USGS Publications Warehouse

Dong, Quan; Walters, Katie D.

2015-01-01

The Aquatic Systems Branch at the Fort Collins Science Center is a group of scientists dedicated to advancing interdisciplinary science and providing science support to solve water-related environmental issues. Natural resource managers have an increasing need for scientific information and stakeholders face enormous challenges of increasing and competing demands for water. Our scientists are leaders in ecological flows, riparian ecology, hydroscape ecology, ecosystem management, and contaminant biology. The Aquatic Systems Branch employs and develops state-of-the-science approaches in field investigations, laboratory experiments, remote sensing, simulation and predictive modeling, and decision support tools. We use the aquatic experimental laboratory, the greenhouse, the botanical garden and other advanced facilities to conduct unique research. Our scientists pursue research on the ground, in the rivers, and in the skies, generating and testing hypotheses and collecting quantitative information to support planning and design in natural resource management and aquatic restoration.

Physics through the 1990s: An overview

NASA Technical Reports Server (NTRS)

1986-01-01

The volume details the interaction of physics and society, and presents a short summary of the progress in the major fields of physics and a summary of the other seven volumes of the Physics through the 1990s series, issues and recommended policy changes are described regarding funding, education, industry participation, small-group university research and large facility programs, government agency programs, and computer database needs. Three supplements report in detail on international issues in physics (the US position in the field, international cooperation and competition-especially on large projects, freedom for scientists, free flow of information, and education of foreign students), the education and supply of physicists (the changes in US physics education, employment and manpower, and demographics of the field), and the organization and support of physics (government, university, and industry research; facilities; national laboratories; and decision making). An executive summary contains recommendations for maintaining excellence in physics. A glossary of scientific terms is appended.

Integrated forward and reverse supply chain: A tire case study.

PubMed

Pedram, Ali; Yusoff, Nukman Bin; Udoncy, Olugu Ezutah; Mahat, Abu Bakar; Pedram, Payam; Babalola, Ayo

2017-02-01

This paper attempts to integrate both a forward and reverse supply chain to design a closed-loop supply chain network (CLSC). The problem in the design of a CLSC network is uncertainty in demand, return products and the quality of return products. Scenario analyses are generated to overcome this uncertainty. In contrast to the existing supply chain network design models, a new application of a CLSC network was studied in this paper to reduce waste. A multi-product, multi-tier mixed integer linear model is developed for a CLSC network design. The main objective is to maximize profit and provide waste management decision support in order to minimize pollution. The result shows applicability of the model in the tire industry. The model determines the number and the locations of facilities and the material flows between these facilities. Copyright © 2016 Elsevier Ltd. All rights reserved.

Linear accelerator radiosurgery for arteriovenous malformations: Updated literature review.

PubMed

Yahya, S; Heyes, G; Nightingale, P; Lamin, S; Chavda, S; Geh, I; Spooner, D; Cruickshank, G; Sanghera, P

2017-04-01

Arteriovenous malformations (AVMs) are the leading causing of intra-cerebral haemorrhage. Stereotactic radiosurgery (SRS) is an established treatment for arteriovenous malformations (AVM) and commonly delivered using Gamma Knife within dedicated radiosurgery units. Linear accelerator (LINAC) SRS is increasingly available however debate remains over whether it offers an equivalent outcome. The aim of this project is to evaluate the outcomes using LINAC SRS for AVMs used within a UK neurosciences unit and review the literature to aid decision making across various SRS platforms. Results have shown comparability across platforms and strongly supports that an adapted LINAC based SRS facility within a dynamic regional neuro-oncology department delivers similar outcomes (in terms of obliteration and toxicity) to any other dedicated radio-surgical platform. Locally available facilities can facilitate discussion between options however throughput will inevitably be lower than centrally based dedicated national radiosurgery units. Copyright © 2016. Published by Elsevier Ltd.

SECONDARY WASTE/ETF (EFFLUENT TREATMENT FACILITY) PRELIMINARY PRE-CONCEPTUAL ENGINEERING STUDY

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

MAY TH; GEHNER PD; STEGEN GARY

2009-12-28

This pre-conceptual engineering study is intended to assist in supporting the critical decision (CD) 0 milestone by providing a basis for the justification of mission need (JMN) for the handling and disposal of liquid effluents. The ETF baseline strategy, to accommodate (WTP) requirements, calls for a solidification treatment unit (STU) to be added to the ETF to provide the needed additional processing capability. This STU is to process the ETF evaporator concentrate into a cement-based waste form. The cementitious waste will be cast into blocks for curing, storage, and disposal. Tis pre-conceptual engineering study explores this baseline strategy, in additionmore » to other potential alternatives, for meeting the ETF future mission needs. Within each reviewed case study, a technical and facility description is outlined, along with a preliminary cost analysis and the associated risks and benefits.« less

Pilot-based assessment of the economics of recycling construction demolition waste.

PubMed

Srour, Issam M; Chehab, Ghassan R; El-Fadel, Mutasem; Tamraz, Sandy

2013-11-01

The significant amount of waste generated from construction demolition has become a chronic problem in many developing countries. Using data obtained from demolition contractors and various other sources, this paper proposes a framework for proper handling of construction demolition waste (CDW) to serve as a decision support tool in countries suffering from the lack of national CDW management guidelines. The framework is then demonstrated through a case study in the city of Beirut, Lebanon, and a sensitivity analysis is carried out to examine the economic feasibility of developing a recycling facility. The analysis showed that in order for a facility to be feasible, a gate fee should be charged in the presence of a market for recycled aggregates. The results confirm the significance of instigating and implementing legislation to control illegal dumping, constructing, and managing engineered landfills, and establishing markets for recycled CDW.

Numbers, systems, people: how interactions influence integration. Insights from case studies of HIV and reproductive health services delivery in Kenya

PubMed Central

Mayhew, Susannah H; Warren, Charlotte E; Collumbien, Martine; Ndwiga, Charity; Mutemwa, Richard; Lut, Irina; Colombini, Manuela; Vassall, Anna

2017-01-01

Abstract Drawing on rich data from the Integra evaluation of integrated HIV and reproductive-health services, we explored the interaction of systems hardware and software factors to explain why some facilities were able to implement and sustain integrated service delivery while others were not. This article draws on detailed mixed-methods data for four case-study facilities offering reproductive-health and HIV services between 2009 and 2013 in Kenya: (i) time-series client flow, tracking service uptake for 8841 clients; (ii) structured questionnaires with 24 providers; (iii) in-depth interviews with 17 providers; (iv) workload and facility data using a periodic activity review and cost-instruments; and (v) contextual data on external activities related to integration in study sites. Overall, our findings suggested that although structural factors like stock-outs, distribution of staffing and workload, rotation of staff can affect how integrated care is provided, all these factors can be influenced by staff themselves: both frontline and management. Facilities where staff displayed agency of decision making, worked as a team to share workload and had management that supported this, showed better integration delivery and staff were able to overcome some structural deficiencies to enable integrated care. Poor-performing facilities had good structural integration, but staff were unable to utilize this because they were poorly organized, unsupported or teams were dysfunctional. Conscientious objection and moralistic attitudes were also barriers. Integra has demonstrated that structural integration is not sufficient for integrated service delivery. Rather, our case studies show that in some cases excellent leadership and peer-teamwork enabled facilities to perform well despite resource shortages. The ability to provide support for staff to work flexibly to deliver integrated services and build resilient health systems to meet changing needs is particularly relevant as health systems face challenges of changing burdens of disease, climate change, epidemic outbreaks and more. PMID:29194544

Targeted proteomics coming of age - SRM, PRM and DIA performance evaluated from a core facility perspective.

PubMed

Kockmann, Tobias; Trachsel, Christian; Panse, Christian; Wahlander, Asa; Selevsek, Nathalie; Grossmann, Jonas; Wolski, Witold E; Schlapbach, Ralph

2016-08-01

Quantitative mass spectrometry is a rapidly evolving methodology applied in a large number of omics-type research projects. During the past years, new designs of mass spectrometers have been developed and launched as commercial systems while in parallel new data acquisition schemes and data analysis paradigms have been introduced. Core facilities provide access to such technologies, but also actively support the researchers in finding and applying the best-suited analytical approach. In order to implement a solid fundament for this decision making process, core facilities need to constantly compare and benchmark the various approaches. In this article we compare the quantitative accuracy and precision of current state of the art targeted proteomics approaches single reaction monitoring (SRM), parallel reaction monitoring (PRM) and data independent acquisition (DIA) across multiple liquid chromatography mass spectrometry (LC-MS) platforms, using a readily available commercial standard sample. All workflows are able to reproducibly generate accurate quantitative data. However, SRM and PRM workflows show higher accuracy and precision compared to DIA approaches, especially when analyzing low concentrated analytes. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Selection, training and retention of an armed private security department.

PubMed

Hollar, David B

2009-01-01

To arm or not to arm security officers? One hospital which has opted for arming its officers is Cook Children's Healthcare System, Fort Worth, TX, an integrated pediatric healthcare facility with over 4000 employees. Because of its location in a major metropolitan area and based on several factors including demographics, exterior risk assessments and crime statistics, the hospital's Administration and its Risk Manager supported the decision to operate as an armed security force, according to the author. In this article he shares its current program and presents some thoughts and ideas that may benefit others who are considering this important step.

The approaches for the decision support in case natural hazards

NASA Astrophysics Data System (ADS)

Vyazilov, Evgeny; Chunyaev, Nikita

2013-04-01

In spite of using highly automated systems of measurement, collecting, storing, handling, prediction and delivery of information on the marine environment, including natural hazards, the amount of damage from natural phenomena increases. Because information on the marine environment delivered to the industrial facilities not effectively used. To such information pays little attention by individual decision-makers and not always perform preventive measures necessary for reduce and prevent damage. Automation of information support will improve the efficiency management of the marine activities. In Russia develops "The Unified system of the information about World ocean" (ESIMO, http://esimo.ru/), that integrates observation, analysis, prognostic and climate data. Necessary to create tools to automatic selection natural disasters through all integrated data; notification decision-makers about arising natural hazards - software agent; provision of information in a compact form for the decision-makers; assessment of possible damage and costs to the preventive measures; providing information on the impacts of environment on economic facilities and recommendations for decision-making; the use of maps, diagrams, tables for reporting. Tools for automatic selection designed for identification of natural phenomena based on the resources ESIMO and corresponding critical values of the indicators environment. The result of this module will be constantly updated database of critical situations of environment for each object or technological process. To operational notify and provide current information about natural hazards proposes using a software agent that is installed on the computer decision-makers, which is activated in case critical situations and provides a minimum of information. In the event of natural disaster software agent should be able to inform decision-makers about this, providing information on the current situation, and the possibility for more and detailed information about natural hazard. Software agent must be able to be configured by the user to a specific object: a specific station or a drilling rigs that region or area, regardless of the size of the object. And depending on the selected settings and parameters it needs to apply the values of critical indexes. There is a need for real-time display hydrometeorological information with compact scheme that reflects the environment indicators that affect industrial facility in the form of devices (thermometer, aneroid, footstock, speedometer, hygrometer, thermograph, barograph, rain gauge, wind vane, etc.) with the ability to display indicators exceed a critical value. This scheme is designed to provide maximum information in the shortest possible time reference that provides an intuitive interface (display by generally accepted standardized instruments). Analytical services ESIMO combined with geographic information service provides information about area or point to decision-makers of showing the dynamics of changes of parameters in the form of graphics, diagrams, maps, tables. If the data sources are updated, analytical services automatically provides the relevance of the data in the analytical views of the complex. Analytical services works with database of integrated data and used for the preparation and presentation of the consumers of the federal and regional level for the analysis of information on the World Oceans. The analytic services show a set of indicators about the situation in the World Ocean. The complex provides the processing, analysis of qualitative and quantitative characteristics (indexes) of the marine environment and maritime activities of the Russian Federation. To assess the need for preventive measures, decision-makers require information in the form of potential economic consequences of natural hazard, cost of preventive measures to prevent damage. We can use for that the economic and mathematical models. When making the decision decision-makers must understand the possible consequences of natural phenomena and rely on the advice that they receive from a decision support system. Such information about the impacts and recommendations are based on the knowledge base (rules of "if, then"), formed on the basis of experience gained in the past. This should take into account not only the critical values for each object and technological process, but also the type of information (observations, forecasting, climate, and after the phenomenon), the level of decision-making, the season of the year, the climate zone where the object is located. Within ESIMO created integrated database that containing the results of the monitoring of the marine environment. The database includes the observation, analysis, and forecasting and climate data. Operational data is updated automatically at specified intervals of a few minutes to a week, depending on the frequency of observations. Climatic data is updated as needed, for example, once a year or once every five years. Integrated database contains a set of indicators related to a specific object, and to a certain geographic area, according to the observations made and the data entered data. In addition to hydrometeorological parameters database contains socio-economic information. At present, was created the database of critical values and information about the impacts of and recommendations for the 30 natural hazards, developed the data structure and software is under development. The interaction of all components of an information support will reduce the economic damage from natural disaster on individual objects economy (ships, ports, etc.) and improve public safety through more prompt delivery of information to decision-makers and the public, besides receive more informative data (district with symptoms natural phenomena , assessment of possible damage, the impact of and recommendations).

School Facilities in Arizona: An Examination of the Relationships between and among School Facilities Characteristics and Educational Outcomes.

ERIC Educational Resources Information Center

2000

This report examines the relations between school design and student productivity and informs policy decisions. It contains three analytic sections: an analysis of school facilities characteristics and student productivity, a review of other research examining school facilities and student productivity, and an analysis of the need for school…

Facility Targeting, Protection and Mission Decision Making Using the VISAC Code

NASA Technical Reports Server (NTRS)

Morris, Robert H.; Sulfredge, C. David

2011-01-01

The Visual Interactive Site Analysis Code (VISAC) has been used by DTRA and several other agencies to aid in targeting facilities and to predict the associated collateral effects for the go, no go mission decision making process. VISAC integrates the three concepts of target geometric modeling, damage assessment capabilities, and an event/fault tree methodology for evaluating accident/incident consequences. It can analyze a variety of accidents/incidents at nuclear or industrial facilities, ranging from simple component sabotage to an attack with military or terrorist weapons. For nuclear facilities, VISAC predicts the facility damage, estimated downtime, amount and timing of any radionuclides released. Used in conjunction with DTRA's HPAC code, VISAC also can analyze transport and dispersion of the radionuclides, levels of contamination of the surrounding area, and the population at risk. VISAC has also been used by the NRC to aid in the development of protective measures for nuclear facilities that may be subjected to attacks by car/truck bombs.

Creating and sharing clinical decision support content with Web 2.0: Issues and examples.

PubMed

Wright, Adam; Bates, David W; Middleton, Blackford; Hongsermeier, Tonya; Kashyap, Vipul; Thomas, Sean M; Sittig, Dean F

2009-04-01

Clinical decision support is a powerful tool for improving healthcare quality and patient safety. However, developing a comprehensive package of decision support interventions is costly and difficult. If used well, Web 2.0 methods may make it easier and less costly to develop decision support. Web 2.0 is characterized by online communities, open sharing, interactivity and collaboration. Although most previous attempts at sharing clinical decision support content have worked outside of the Web 2.0 framework, several initiatives are beginning to use Web 2.0 to share and collaborate on decision support content. We present case studies of three efforts: the Clinfowiki, a world-accessible wiki for developing decision support content; Partners Healthcare eRooms, web-based tools for developing decision support within a single organization; and Epic Systems Corporation's Community Library, a repository for sharing decision support content for customers of a single clinical system vendor. We evaluate the potential of Web 2.0 technologies to enable collaborative development and sharing of clinical decision support systems through the lens of three case studies; analyzing technical, legal and organizational issues for developers, consumers and organizers of clinical decision support content in Web 2.0. We believe the case for Web 2.0 as a tool for collaborating on clinical decision support content appears strong, particularly for collaborative content development within an organization.

Communities ready for takeoffIntegrating social assets for biofuel site-selection modeling.

PubMed

Rijkhoff, Sanne A M; Hoard, Season A; Gaffney, Michael J; Smith, Paul M

2017-01-01

Although much of the social science literature supports the importance of community assets for success in many policy areas, these assets are often overlooked when selecting communities for new infrastructure facilities. Extensive collaboration is crucial for the success of environmental and economic projects, yet it often is not adequately addressed when making siting decisions for new projects. This article develops a social asset framework that includes social, creative, and human capital to inform site-selection decisions. This framework is applied to the Northwest Advanced Renewables Alliance project to assess community suitability for biofuel-related developments. This framework is the first to take all necessary community assets into account, providing insight into successful site selection beyond current models. The framework not only serves as a model for future biorefinery projects but also guides tasks that depend on informed location selection for success.

Stratospheric Observatory for Infrared Astronomy (SOPHIA) Mirror Coating Facility

NASA Astrophysics Data System (ADS)

Austin, Ed

The joint US and German project, Stratospheric Observatory for Infrared Astronomy (SOFIA), to develop and operate a 2.5 meter infrared airborne telescope in a Boeing 747-SP began late last year. Universities Space Research Association (USRA), teamed with Raytheon E-Systems and United Airlines, was selected by NASA to develop and operate SOPHIA. The 2.5 meter telescope will be designed and built by a consortium of German companies. The observatory is expected to operate for over 29 years with the first science flights beginning in 2001. The SOPHIA Observatory will fly at and above 12.5 km, where the telescope will collect radiation in the wavelength range from 0.3 micrometers to a 1.6 millimeters. Universities Space Research Association (USRA) with support from NASA is currently evaluating methods of recoating the primary mirror in preparation for procurement of mirror coating equipment. The decision analysis technique, decision criteria and telescope specifications will be discussed.

Dynamic analysis for solid waste management systems: an inexact multistage integer programming approach.

PubMed

Li, Yongping; Huang, Guohe

2009-03-01

In this study, a dynamic analysis approach based on an inexact multistage integer programming (IMIP) model is developed for supporting municipal solid waste (MSW) management under uncertainty. Techniques of interval-parameter programming and multistage stochastic programming are incorporated within an integer-programming framework. The developed IMIP can deal with uncertainties expressed as probability distributions and interval numbers, and can reflect the dynamics in terms of decisions for waste-flow allocation and facility-capacity expansion over a multistage context. Moreover, the IMIP can be used for analyzing various policy scenarios that are associated with different levels of economic consequences. The developed method is applied to a case study of long-term waste-management planning. The results indicate that reasonable solutions have been generated for binary and continuous variables. They can help generate desired decisions of system-capacity expansion and waste-flow allocation with a minimized system cost and maximized system reliability.

Modeling Tool for Decision Support during Early Days of an Anthrax Event.

PubMed

Rainisch, Gabriel; Meltzer, Martin I; Shadomy, Sean; Bower, William A; Hupert, Nathaniel

2017-01-01

Health officials lack field-implementable tools for forecasting the effects that a large-scale release of Bacillus anthracis spores would have on public health and hospitals. We created a modeling tool (combining inhalational anthrax caseload projections based on initial case reports, effects of variable postexposure prophylaxis campaigns, and healthcare facility surge capacity requirements) to project hospitalizations and casualties from a newly detected inhalation anthrax event, and we examined the consequences of intervention choices. With only 3 days of case counts, the model can predict final attack sizes for simulated Sverdlovsk-like events (1979 USSR) with sufficient accuracy for decision making and confirms the value of early postexposure prophylaxis initiation. According to a baseline scenario, hospital treatment volume peaks 15 days after exposure, deaths peak earlier (day 5), and recovery peaks later (day 23). This tool gives public health, hospital, and emergency planners scenario-specific information for developing quantitative response plans for this threat.

Integrating multi-criteria techniques with geographical information systems in waste facility location to enhance public participation.

PubMed

Higgs, Gary

2006-04-01

Despite recent U.K. Government commitments' to encourage public participation in environmental decision making, those exercises conducted to date have been largely confined to 'traditional' modes of participation such as the dissemination of information and in encouraging feedback on proposals through, for example, questionnaires or surveys. It is the premise of this paper that participative approaches that use IT-based methods, based on combined geographical information systems (GIS) and multi-criteria evaluation techniques that could involve the public in the decision-making process, have the potential to build consensus and reduce disputes and conflicts such as those arising from the siting of different types of waste facilities. The potential of these techniques are documented through a review of the existing literature in order to highlight the opportunities and challenges facing decision makers in increasing the involvement of the public at different stages of the waste facility management process. It is concluded that there are important lessons to be learned by researchers, consultants, managers and decision makers if barriers hindering the wider use of such techniques are to be overcome.

Barriers to and facilitators of implementing shared decision making and decision support in a paediatric hospital: A descriptive study

PubMed Central

Boland, Laura; McIsaac, Daniel I; Lawson, Margaret L

2016-01-01

OBJECTIVE: To explore multiple stakeholders’ perceived barriers to and facilitators of implementing shared decision making and decision support in a tertiary paediatric hospital. METHODS: An interpretive descriptive qualitative study was conducted using focus groups and interviews to examine senior hospital administrators’, clinicians’, parents’ and youths’ perceived barriers to and facilitators of shared decision making and decision support implementation. Data were analyzed using inductive thematic analysis. RESULTS: Fifty-seven stakeholders participated. Six barrier and facilitator themes emerged. The main barrier was gaps in stakeholders’ knowledge of shared decision making and decision support. Facilitators included compatibility between shared decision making and the hospital’s culture and ideal practices, perceptions of positive patient and family outcomes associated with shared decision making, and positive attitudes regarding shared decision making and decision support. However, youth attitudes regarding the necessity and usefulness of a decision support program were a barrier. Two themes were both a barrier and a facilitator. First, stakeholder groups were uncertain which clinical situations are suitable for shared decision making (eg, new diagnoses, chronic illnesses, complex decisions or urgent decisions). Second, the clinical process may be hindered if shared decision making and decision support decrease efficiency and workflow; however, shared decision making may reduce repeat visits and save time over the long term. CONCLUSIONS: Specific knowledge translation strategies that improve shared decision making knowledge and match specific barriers identified by each stakeholder group may be required to promote successful shared decision making and decision support implementation in the authors’ paediatric hospital. PMID:27398058

Quality of antenatal and childbirth care in rural health facilities in Burkina Faso, Ghana and Tanzania: an intervention study.

PubMed

Duysburgh, Els; Temmerman, Marleen; Yé, Maurice; Williams, Afua; Massawe, Siriel; Williams, John; Mpembeni, Rose; Loukanova, Svetla; Haefeli, Walter E; Blank, Antje

2016-01-01

To assess the impact of an intervention consisting of a computer-assisted clinical decision support system and performance-based incentives, aiming at improving quality of antenatal and childbirth care. Intervention study in rural primary healthcare (PHC) facilities in Burkina Faso, Ghana and Tanzania. In each country, six intervention and six non-intervention PHC facilities, located in one intervention and one non-intervention rural districts, were selected. Quality was assessed in each facility by health facility surveys, direct observation of antenatal and childbirth care, exit interviews, and reviews of patient records and maternal and child health registers. Findings of pre- and post-intervention and of intervention and non-intervention health facility quality assessments were analysed and assessed for significant (P < 0.05) quality of care differences. Post-intervention quality scores do not show a clear difference to pre-intervention scores and scores at non-intervention facilities. Only a few variables had a statistically significant better post-intervention quality score and when this is the case this is mostly observed in only one study-arm, being pre-/post-intervention or intervention/non-intervention. Post-intervention care shows similar deficiencies in quality of antenatal and childbirth care and in detection, prevention, and management of obstetric complications as at baseline and non-intervention study facilities. Our intervention study did not show a significant improvement in quality of care during the study period. However, the use of new technology seems acceptable and feasible in rural PHC facilities in resource-constrained settings, creating the opportunity to use this technology to improve quality of care. © 2015 John Wiley & Sons Ltd.

Multi-country analysis of treatment costs for HIV/AIDS (MATCH): facility-level ART unit cost analysis in Ethiopia, Malawi, Rwanda, South Africa and Zambia.

PubMed

Tagar, Elya; Sundaram, Maaya; Condliffe, Kate; Matatiyo, Blackson; Chimbwandira, Frank; Chilima, Ben; Mwanamanga, Robert; Moyo, Crispin; Chitah, Bona Mukosha; Nyemazi, Jean Pierre; Assefa, Yibeltal; Pillay, Yogan; Mayer, Sam; Shear, Lauren; Dain, Mary; Hurley, Raphael; Kumar, Ritu; McCarthy, Thomas; Batra, Parul; Gwinnell, Dan; Diamond, Samantha; Over, Mead

2014-01-01

Today's uncertain HIV funding landscape threatens to slow progress towards treatment goals. Understanding the costs of antiretroviral therapy (ART) will be essential for governments to make informed policy decisions about the pace of scale-up under the 2013 WHO HIV Treatment Guidelines, which increase the number of people eligible for treatment from 17.6 million to 28.6 million. The study presented here is one of the largest of its kind and the first to describe the facility-level cost of ART in a random sample of facilities in Ethiopia, Malawi, Rwanda, South Africa and Zambia. In 2010-2011, comprehensive data on one year of facility-level ART costs and patient outcomes were collected from 161 facilities, selected using stratified random sampling. Overall, facility-level ART costs were significantly lower than expected in four of the five countries, with a simple average of $208 per patient-year (ppy) across Ethiopia, Malawi, Rwanda and Zambia. Costs were higher in South Africa, at $682 ppy. This included medications, laboratory services, direct and indirect personnel, patient support, equipment and administrative services. Facilities demonstrated the ability to retain patients alive and on treatment at these costs, although outcomes for established patients (2-8% annual loss to follow-up or death) were better than outcomes for new patients in their first year of ART (77-95% alive and on treatment). This study illustrated that the facility-level costs of ART are lower than previously understood in these five countries. While limitations must be considered, and costs will vary across countries, this suggests that expanded treatment coverage may be affordable. Further research is needed to understand investment costs of treatment scale-up, non-facility costs and opportunities for more efficient resource allocation.

On the preparation of environmental impact statements in the United States of America

NASA Astrophysics Data System (ADS)

Carson, James E.

The National Environmental Policy Act of 1969 (NEPA) requires that an Environmental Impact Statement (FIS) be prepared whenever a federal action is considered that could result in a significant impact on the environment. Such actions include the issuance of construction or operating licenses for nuclear facilities and power plants, hydroelectric dams, or the diversion of water from rivers and lakes. An EIS is usually required if federal funds are involved. The U.S. Environmental Protection Agency and U.S. Council for Environmental Quality have developed guidelines and regulations for the preparation of an EIS. An EIS is not a scientific report. It is a legal document whose primary function is its use by decision-making agencies in approving or not approving the proposed federal action. The EIS is also used to inform the public and other government agencies of the environmental impacts of the proposed facility. The NEPA process allows public input into the decision-making process. An EIS should be short and concise, analytical, conclusory, be written for a non-technical audience, discuss the pros and cons of the proposed facility, and examine the impacts of all alternatives to the proposed action. The EIS should identify all adverse environmental impacts that cannot be avoided. The conclusions reached in the EIS should be clearly stated and supported by discussions and data in the text and by references to show that the agency has made the necessary analyses. The paper discusses the purpose and contents of these documents and the environmental procedures used in the U.S.A., especially as they relate to nuclear power plants.

Public health system and psychiatry in the treatment of 'dangerous' young offenders in Brazil.

PubMed

Ribeiro, Rafael Bernardon; Cordeiro, Quirino; Taborda, José G V

2015-01-01

We describe the Experimental Health Unit, a special forensic mental health facility in Brazil, created by court order and administered by the São Paulo Department of Health. It was designed for young offenders receiving compulsory inpatient treatment for severe personality disorders. All nine patients admitted to date came from Foundation CASA (a socio-educational centre of assistance for adolescents, the juvenile correctional centres managed by the São Paulo state Department of Justice). The court decision is questionable, relying on a new interpretation of the Child and Adolescent Statute and the law that regulates psychiatric treatment in Brazil. The public health system and psychiatry have been supporting the isolation of some individuals from society, based on the seriousness of their crimes and possession of particular personality characteristics. The decision to commit and send a small group of personality disordered individuals to this unit as inpatients is an unfair decision, since jails and correctional centres hold a high number of psychopathic who have also committed barbaric crimes. The central mental health issue is the role that the public health system should play in the custody of dangerous people; the cost-effectiveness of this model, the accuracy of risk assessment and tractability of people with severe personality disorders are also debatable. From a legal perspective, the operation of this facility raises questions about age of legal majority, the maximum period of incarceration of young offenders and use of whole-life sentences for certain types of crimes and criminals in Brazil. Copyright © 2015 Elsevier Ltd. All rights reserved.

Corrective Action Investigation Plan for Corrective Action Unit 204: Storage Bunkers, Nevada Test Site, Nevada (December 2002, Revision No.: 0), Including Record of Technical Change No. 1

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

NNSA /NSO

The Corrective Action Investigation Plan contains the U.S. Department of Energy, National Nuclear Security Administration Nevada Operations Office's approach to collect the data necessary to evaluate corrective action alternatives appropriate for the closure of Corrective Action Unit (CAU) 204 under the Federal Facility Agreement and Consent Order. Corrective Action Unit 204 is located on the Nevada Test Site approximately 65 miles northwest of Las Vegas, Nevada. This CAU is comprised of six Corrective Action Sites (CASs) which include: 01-34-01, Underground Instrument House Bunker; 02-34-01, Instrument Bunker; 03-34-01, Underground Bunker; 05-18-02, Chemical Explosives Storage; 05-33-01, Kay Blockhouse; 05-99-02, Explosive Storage Bunker.more » Based on site history, process knowledge, and previous field efforts, contaminants of potential concern for Corrective Action Unit 204 collectively include radionuclides, beryllium, high explosives, lead, polychlorinated biphenyls, total petroleum hydrocarbons, silver, warfarin, and zinc phosphide. The primary question for the investigation is: ''Are existing data sufficient to evaluate appropriate corrective actions?'' To address this question, resolution of two decision statements is required. Decision I is to ''Define the nature of contamination'' by identifying any contamination above preliminary action levels (PALs); Decision II is to ''Determine the extent of contamination identified above PALs. If PALs are not exceeded, the investigation is completed. If PALs are exceeded, then Decision II must be resolved. In addition, data will be obtained to support waste management decisions. Field activities will include radiological land area surveys, geophysical surveys to identify any subsurface metallic and nonmetallic debris, field screening for applicable contaminants of potential concern, collection and analysis of surface and subsurface soil samples from biased locations, and step-out sampling to define the extent of contamination, as necessary. The results of this field investigation will support a defensible evaluation of corrective action alternatives in the corrective action decision document.« less

Back-support large laser mirror unit: mounting modeling and analysis

NASA Astrophysics Data System (ADS)

Wang, Hui; Zhang, Zheng; Long, Kai; Liu, Tianye; Li, Jun; Liu, Changchun; Xiong, Zhao; Yuan, Xiaodong

2018-01-01

In high-power laser system, the surface wavefront of large optics has a close link with its structure design and mounting method. The back-support transport mirror design is presently being investigated as a means in China's high-power laser system to hold the optical component firmly while minimizing the distortion of its reflecting surface. We have proposed a comprehensive analytical framework integrated numerical modeling and precise metrology for the mirror's mounting performance evaluation while treating the surface distortion as a key decision variable. The combination of numerical simulation and field tests demonstrates that the comprehensive analytical framework provides a detailed and accurate approach to evaluate the performance of the transport mirror. It is also verified that the back-support transport mirror is effectively compatible with state-of-the-art optical quality specifications. This study will pave the way for future research to solidify the design of back-support large laser optics in China's next generation inertial confinement fusion facility.

Priority setting and the ethics of resource allocation within VA healthcare facilities: results of a survey.

PubMed

Foglia, Mary Beth; Pearlman, Robert A; Bottrell, Melissa M; Altemose, Jane A; Fox, Ellen

2008-01-01

Setting priorities and the subsequent allocation of resources is a major ethical issue facing healthcare facilities, including the Veterans Health Administration (VHA), the largest integrated healthcare delivery network in the United States. Yet despite the importance of priority setting and its impact on those who receive and those who provide care, we know relatively little about how clinicians and managers view allocation processes within their facilities. The purpose of this secondary analysis of survey data was to characterize staff members' perceptions regarding the fairness of healthcare ethics practices related to resource allocation in Veterans Administration (VA) facilities. The specific aim of the study was to compare the responses of clinicians, clinician managers, and non-clinician managers with respect to these survey items. We utilized a paper and web-based survey and a cross-sectional design of VHA clinicians and managers. Our sample consisted of a purposive stratified sample of 109 managers and a stratified random sample of 269 clinicians employed 20 or more hours per week in one of four VA medical centers. The four medical centers were participating as field sites selected to test the logistics of administering and reporting results of the Integrated Ethics Staff Survey, an assessment tool aimed at characterizing a broad range of ethical practices within a healthcare organization. In general, clinicians were more critical than clinician managers or non-clinician managers of the institutions' allocation processes and of the impact of resource decisions on patient care. Clinicians commonly reported that they did not (a) understand their facility's decision-making processes, (b) receive explanations from management regarding the reasons behind important allocation decisions, or (b) perceive that they were influential in allocation decisions. In addition, clinicians and managers both perceived that education related to the ethics of resource allocation was insufficient and that their facilities could increase their effectiveness in identifying and resolving ethical problems related to resource allocation. How well a healthcare facility ensures fairness in the way it allocates its resources across programs and services depends on multiple factors, including awareness by decision makers that setting priorities and allocating resources is a moral enterprise (moral awareness), the availability of a consistent process that includes important stakeholder groups (procedural justice), and concurrence by stakeholders that decisions represent outcomes that fairly balance competing interests and have a positive net effect on the quality of care (distributive justice). In this study, clinicians and managers alike identified the need for improvement in healthcare ethics practices related to resource allocation.

The Benefits of Guided Facility Self-Assessments

ERIC Educational Resources Information Center

O'Leary, Keith

2012-01-01

A growing number of educational institutions have discovered that a guided self-assessment solution helps them to consistently and cost-effectively obtain facility condition information and make better-informed capital planning decisions. Facility self-assessment employs a consistent, repeatable process for internal staff to quickly assess assets…

Electronic decision support for diagnostic imaging in a primary care setting

PubMed Central

Reed, Martin H

2011-01-01

Methods Clinical guideline adherence for diagnostic imaging (DI) and acceptance of electronic decision support in a rural community family practice clinic was assessed over 36 weeks. Physicians wrote 904 DI orders, 58% of which were addressed by the Canadian Association of Radiologists guidelines. Results Of those orders with guidelines, 76% were ordered correctly; 24% were inappropriate or unnecessary resulting in a prompt from clinical decision support. Physicians followed suggestions from decision support to improve their DI order on 25% of the initially inappropriate orders. The use of decision support was not mandatory, and there were significant variations in use rate. Initially, 40% reported decision support disruptive in their work flow, which dropped to 16% as physicians gained experience with the software. Conclusions Physicians supported the concept of clinical decision support but were reluctant to change clinical habits to incorporate decision support into routine work flow. PMID:21486884

Supporting end of life decision making: Case studies of relational closeness in supported decision making for people with severe or profound intellectual disability.

PubMed

Watson, Joanne; Wilson, Erin; Hagiliassis, Nick

2017-11-01

The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) promotes the use of supported decision making in lieu of substitute decision making. To date, there has been a lack of focus on supported decision making for people with severe or profound intellectual disability, including for end of life decisions. Five people with severe or profound intellectual disability's experiences of supported decision making were examined. This article is particularly focused on one participant's experiences at the end of his life. All five case studies identified that supporters were most effective in providing decision-making support for participants when they were relationally close to the person and had knowledge of the person's life story, particularly in relation to events that demonstrated preference. Findings from this study provide new understandings of supported decision making for people with severe or profound intellectual disability and have particular relevance for supporting decision making at the end of life. © 2017 John Wiley & Sons Ltd.

Risk assessment as standard work in design.

PubMed

Morrill, Patricia W

2013-01-01

This case study article examines a formal risk assessment as part of the decision making process for design solutions in high risk areas. The overview of the Failure Modes and Effects Analysis (FMEA) tool with examples of its application in hospital building projects will demonstrate the benefit of those structured conversations. This article illustrates how two hospitals used FMEA when integrating operational processes with building projects: (1) adjacency decision for Intensive Care Unit (ICU); and (2) distance concern for handling of specimens from Surgery to Lab. Both case studies involved interviews that exposed facility solution concerns. Just-in-time studies using the FMEA followed the same risk assessment process with the same workshop facilitator involving structured conversations in analyzing risks. In both cases, participants uncovered key areas of risk enabling them to take the necessary next steps. While the focus of this article is not the actual design solution, it is apparent that the risk assessment brought clarity to the situations resulting in prompt decision making about facility solutions. Hospitals are inherently risky environments; therefore, use of the formal risk assessment process, FMEA, is an opportunity for design professionals to apply more rigor to design decision making when facility solutions impact operations in high risk areas. Case study, decision making, hospital, infection control, strategy, work environment.

6 CFR 27.330 - Summary decision procedures.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 6 Domestic Security 1 2012-01-01 2012-01-01 false Summary decision procedures. 27.330 Section 27.330 Domestic Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY CHEMICAL FACILITY ANTI-TERRORISM STANDARDS Orders and Adjudications § 27.330 Summary decision procedures. (a) The Presiding Officer...

6 CFR 27.330 - Summary decision procedures.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 6 Domestic Security 1 2010-01-01 2010-01-01 false Summary decision procedures. 27.330 Section 27.330 Domestic Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY CHEMICAL FACILITY ANTI-TERRORISM STANDARDS Orders and Adjudications § 27.330 Summary decision procedures. (a) The Presiding Officer...

6 CFR 27.330 - Summary decision procedures.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 6 Domestic Security 1 2014-01-01 2014-01-01 false Summary decision procedures. 27.330 Section 27.330 Domestic Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY CHEMICAL FACILITY ANTI-TERRORISM STANDARDS Orders and Adjudications § 27.330 Summary decision procedures. (a) The Presiding Officer...

6 CFR 27.330 - Summary decision procedures.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 6 Domestic Security 1 2013-01-01 2013-01-01 false Summary decision procedures. 27.330 Section 27.330 Domestic Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY CHEMICAL FACILITY ANTI-TERRORISM STANDARDS Orders and Adjudications § 27.330 Summary decision procedures. (a) The Presiding Officer...

6 CFR 27.330 - Summary decision procedures.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 6 Domestic Security 1 2011-01-01 2011-01-01 false Summary decision procedures. 27.330 Section 27.330 Domestic Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY CHEMICAL FACILITY ANTI-TERRORISM STANDARDS Orders and Adjudications § 27.330 Summary decision procedures. (a) The Presiding Officer...

THE NGA-DOE GRANT TO EXAMINE CRITICAL ISSUES RELATED TO RADIOACTIVE WASTE AND MATERIALS DISPOSITION INVOLVING DOE FACILITIES

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

Ethan W. Brown

2001-09-01

Through the National Governors' Association (NGA) project ''Critical Issues Related to Radioactive Waste and Materials Disposition Involving DOE Facilities'' NGA brings together Governors' policy advisors, state regulators, and DOE officials to examine critical issues related to the cleanup and operation of DOE nuclear weapons and research facilities. Topics explored through this project include: Decisions involving disposal of mixed, low-level, and transuranic (TRU) waste and disposition of nuclear materials. Decisions involving DOE budget requests and their effect on environmental cleanup and compliance at DOE facilities. Strategies to treat mixed, low-level, and transuranic (TRU) waste and their effect on individual sites inmore » the complex. Changes to the FFCA site treatment plans as a result of proposals in the Department's Accelerating Cleanup: Paths to Closure plan and contractor integration analysis. Interstate waste and materials shipments. Reforms to existing RCRA and CERCLA regulations/guidance to address regulatory overlap and risks posed by DOE wastes. The overarching theme of this project is to help the Department improve coordination of its major program decisions with Governors' offices and state regulators and to ensure such decisions reflect input from these key state officials and stakeholders. This report summarizes activities conducted during the period from April 1, 2001 through June 30, 2001, under the NGA grant.« less

Systemwide board assessment.

PubMed

Hafertepe, E C

1987-01-01

The Sisters of Charity Health Care System (SCHCS), Inc., Cincinnati, undertook a systemwide board evaluation project to support and enhance effective aspects of governance and to deal with obstacles that often arise due to differing beliefs and role confusion. A task force of chief executive officers developed the questionnaire, which was then administered to members of individual facilities' boards and the system's board. The documented highlighted value issues important to SCHCS's ministry and business activities: overall board responsibilities, financial responsibilities, strategic planning, the board's role, committee structures, the board's operating process, board education, and overall board effectiveness. The responses from each member were returned to the local boards, who analyzed them and developed an action plan. A summary of each facility's responses and action plans were forwarded to the system's corporate office. The CEO committee critiqued the process and reported on significant issues and action plans. In general, survey results revealed a strong influence of mission and philosophy in decision making, support for current processes, and effective interaction among board members. The system's corporate office will use the responses to respond to a dynamic environment and strengthen their role in the delivery of Catholic health care services.

Advancing technician practice: Deliberations of a regulatory board.

PubMed

Adams, Alex J

2018-01-01

In 2016, the Idaho State Board of Pharmacy (U.S.) undertook a major rulemaking initiative to advance pharmacy practice by broadening the ability of pharmacists to delegate tasks to pharmacy technicians. The new rules of the Board thus moved the locus of control in technician scope of practice from law to pharmacist delegation. Pharmacist delegation is individualistic and takes into account the individual technician's capabilities, the pharmacist's comfort level, facility policies, and the risk mitigation strategies present at the facility, among other factors. State law limits, by contrast, are rigid and can mean that pharmacists are unable to delegate tasks that are or could otherwise be within the abilities of their technicians. The expanded technician duties are in two domains: 1) medication dispensing support (e.g., tech-check-tech, accepting verbal prescriptions, transferring prescriptions, and performing remote data entry); and 2) technical support for pharmacist clinical services (e.g., administering immunizations). This commentary reviews the evidence behind these expanded duties, as well as the key regulatory decision points for each task. The Board's rules and approach may prove useful to other states and even other governing bodies outside the U.S. as they consider similar issues. Copyright © 2017 Elsevier Inc. All rights reserved.

SME Acceptability Determination For DWPF Process Control (U)

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

Edwards, T.

2017-06-12

The statistical system described in this document is called the Product Composition Control System (PCCS). K. G. Brown and R. L. Postles were the originators and developers of this system as well as the authors of the first three versions of this technical basis document for PCCS. PCCS has guided acceptability decisions for the processing at the Defense Waste Processing Facility (DWPF) at the Savannah River Site (SRS) since the start of radioactive operations in 1996. The author of this revision to the document gratefully acknowledges the firm technical foundation that Brown and Postles established to support the ongoing successfulmore » operation at the DWPF. Their integration of the glass propertycomposition models, developed under the direction of C. M. Jantzen, into a coherent and robust control system, has served the DWPF well over the last 20+ years, even as new challenges, such as the introduction into the DWPF flowsheet of auxiliary streams from the Actinide Removal Process (ARP) and other processes, were met. The purpose of this revision is to provide a technical basis for modifications to PCCS required to support the introduction of waste streams from the Salt Waste Processing Facility (SWPF) into the DWPF flowsheet. An expanded glass composition region is anticipated by the introduction of waste streams from SWPF, and property-composition studies of that glass region have been conducted. Jantzen, once again, directed the development of glass property-composition models applicable for this expanded composition region. The author gratefully acknowledges the technical contributions of C.M. Jantzen leading to the development of these glass property-composition models. The integration of these models into the PCCS constraints necessary to administer future acceptability decisions for the processing at DWPF is provided by this sixth revision of this document.« less

Automation of orbit determination functions for National Aeronautics and Space Administration (NASA)-supported satellite missions

NASA Technical Reports Server (NTRS)

Mardirossian, H.; Beri, A. C.; Doll, C. E.

1990-01-01

The Flight Dynamics Facility (FDF) at Goddard Space Flight Center (GSFC) provides spacecraft trajectory determination for a wide variety of National Aeronautics and Space Administration (NASA)-supported satellite missions, using the Tracking Data Relay Satellite System (TDRSS) and Ground Spaceflight and Tracking Data Network (GSTDN). To take advantage of computerized decision making processes that can be used in spacecraft navigation, the Orbit Determination Automation System (ODAS) was designed, developed, and implemented as a prototype system to automate orbit determination (OD) and orbit quality assurance (QA) functions performed by orbit operations. Based on a machine-resident generic schedule and predetermined mission-dependent QA criteria, ODAS autonomously activates an interface with the existing trajectory determination system using a batch least-squares differential correction algorithm to perform the basic OD functions. The computational parameters determined during the OD are processed to make computerized decisions regarding QA, and a controlled recovery process is activated when the criteria are not satisfied. The complete cycle is autonomous and continuous. ODAS was extensively tested for performance under conditions resembling actual operational conditions and found to be effective and reliable for extended autonomous OD. Details of the system structure and function are discussed, and test results are presented.

Automation of orbit determination functions for National Aeronautics and Space Administration (NASA)-supported satellite missions

NASA Technical Reports Server (NTRS)

Mardirossian, H.; Heuerman, K.; Beri, A.; Samii, M. V.; Doll, C. E.

1989-01-01

The Flight Dynamics Facility (FDF) at Goddard Space Flight Center (GSFC) provides spacecraft trajectory determination for a wide variety of National Aeronautics and Space Administration (NASA)-supported satellite missions, using the Tracking Data Relay Satellite System (TDRSS) and Ground Spaceflight and Tracking Data Network (GSTDN). To take advantage of computerized decision making processes that can be used in spacecraft navigation, the Orbit Determination Automation System (ODAS) was designed, developed, and implemented as a prototype system to automate orbit determination (OD) and orbit quality assurance (QA) functions performed by orbit operations. Based on a machine-resident generic schedule and predetermined mission-dependent QA criteria, ODAS autonomously activates an interface with the existing trajectory determination system using a batch least-squares differential correction algorithm to perform the basic OD functions. The computational parameters determined during the OD are processed to make computerized decisions regarding QA, and a controlled recovery process isactivated when the criteria are not satisfied. The complete cycle is autonomous and continuous. ODAS was extensively tested for performance under conditions resembling actual operational conditions and found to be effective and reliable for extended autonomous OD. Details of the system structure and function are discussed, and test results are presented.

The role of pharmacoeconomics in current Indian healthcare system.

PubMed

Ahmad, Akram; Patel, Isha; Parimilakrishnan, Sundararajan; Mohanta, Guru Prasad; Chung, HaeChung; Chang, Jongwha

2013-01-01

Phamacoeconomics can aid the policy makers and the healthcare providers in decision making in evaluating the affordability of and access to rational drug use. Efficiency is a key concept of pharmacoeconomics, and various strategies are suggested for buying the greatest amount of benefits for a given resource use. Phamacoeconomic evaluation techniques such as cost minimization analysis, cost effectiveness analysis, cost benefit analysis, and cost utilization analysis, which support identification and quantification of cost of drugs, are conducted in a similar way, but vary in measurement of value of health benefits and outcomes. This article provides a brief overview about pharmacoeconomics, its utility with respect to the Indian pharmaceutical industry, and the expanding insurance system in India. Pharmacoeconomic evidences can be utilized to support decisions on licensing, pricing, reimbursement, and maintenance of formulary procedure of pharmaceuticals. For the insurance companies to give better facility at minimum cost, India must develop the platform for pharmacoeconomics with a validating methodology and appropriate training. The role of clinical pharmacists including PharmD graduates are expected to be more beneficial than the conventional pharmacists, as they will be able to apply the principles of economics in daily basis practice in community and hospital pharmacy.

The role of pharmacoeconomics in current Indian healthcare system

PubMed Central

Ahmad, Akram; Patel, Isha; Parimilakrishnan, Sundararajan; Mohanta, Guru Prasad; Chung, HaeChung; Chang, Jongwha

2013-01-01

Phamacoeconomics can aid the policy makers and the healthcare providers in decision making in evaluating the affordability of and access to rational drug use. Efficiency is a key concept of pharmacoeconomics, and various strategies are suggested for buying the greatest amount of benefits for a given resource use. Phamacoeconomic evaluation techniques such as cost minimization analysis, cost effectiveness analysis, cost benefit analysis, and cost utilization analysis, which support identification and quantification of cost of drugs, are conducted in a similar way, but vary in measurement of value of health benefits and outcomes. This article provides a brief overview about pharmacoeconomics, its utility with respect to the Indian pharmaceutical industry, and the expanding insurance system in India. Pharmacoeconomic evidences can be utilized to support decisions on licensing, pricing, reimbursement, and maintenance of formulary procedure of pharmaceuticals. For the insurance companies to give better facility at minimum cost, India must develop the platform for pharmacoeconomics with a validating methodology and appropriate training. The role of clinical pharmacists including PharmD graduates are expected to be more beneficial than the conventional pharmacists, as they will be able to apply the principles of economics in daily basis practice in community and hospital pharmacy. PMID:24991597

Surveillance system for air pollutants by combination of the decision support system COMPAS and optical remote sensing systems

NASA Astrophysics Data System (ADS)

Flassak, Thomas; de Witt, Helmut; Hahnfeld, Peter; Knaup, Andreas; Kramer, Lothar

1995-09-01

COMPAS is a decision support system designed to assist in the assessment of the consequences of accidental releases of toxic and flammable substances. One of the key elements of COMPAS is a feedback algorithm which allows us to calculate the source term with the aid of concentration measurements. Up to now the feedback technique is applied to concentration measurements done with test tubes or conventional point sensors. In this paper the extension of the actual method is presented which is the combination of COMPAS and an optical remote sensing system like the KAYSER-THREDE K300 FTIR system. Active remote sensing methods based on FTIR are, among other applications, ideal for the so-called fence line monitoring of the diffuse emissions and accidental releases from industrial facilities, since from the FTIR spectra averaged concentration levels along the measurement path can be achieved. The line-averaged concentrations are ideally suited as on-line input for COMPAS' feedback technique. Uncertainties in the assessment of the source term related with both shortcomings of the dispersion model itself and also problems of a feedback strategy based on point measurements are reduced.

DIII-D Upgrade to Prepare the Basis for Steady-State Burning Plasmas

NASA Astrophysics Data System (ADS)

Buttery, R. J.; Guo, H. Y.; Taylor, T. S.; Wade, M. R.; Hill, D. N.

2014-10-01

Future steady-state burning plasma facilities will access new physics regimes and modes of plasma behavior. It is vital to prepare for this both experimentally using existing facilities, and theoretically in order to develop the tools to project to and optimize these devices. An upgrade to DIII-D is proposed to address the three critical aspects where research must go beyond what we can do now: (i) torque free electron heating to address the energy, particle and momentum transport mechanisms of burning plasmas using electron cyclotron (EC) heating and full power balanced neutral beams; (ii) off-axis heating and current drive to develop the path to true fusion steady state by reorienting neutral beams and deploying EC and helicon current drive; (iii) a new divertor with hot walls and reactor relevant materials to develop the basis for benign detached divertor operation compatible with wall materials and a high performance fusion core. These elements with modest incremental cost and enacted as a user facility for the whole US program will enable the US to lead on ITER and take a decision to proceed with a Fusion Nuclear Science Facility. Work supported by the US Department of Energy under DE-FC02-04ER54698 and DE-AC52-07NA27344.

42 CFR 90.7 - Decision to conduct health effects study.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false Decision to conduct health effects study. 90.7... ASSESSMENTS AND HEALTH EFFECTS STUDIES OF HAZARDOUS SUBSTANCES RELEASES AND FACILITIES ADMINISTRATIVE FUNCTIONS, PRACTICES, AND PROCEDURES § 90.7 Decision to conduct health effects study. (a) ATSDR may decide...

42 CFR 90.7 - Decision to conduct health effects study.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Decision to conduct health effects study. 90.7... ASSESSMENTS AND HEALTH EFFECTS STUDIES OF HAZARDOUS SUBSTANCES RELEASES AND FACILITIES ADMINISTRATIVE FUNCTIONS, PRACTICES, AND PROCEDURES § 90.7 Decision to conduct health effects study. (a) ATSDR may decide...

40 CFR 304.40 - Effect and enforcement of final decision.

Code of Federal Regulations, 2011 CFR

2011-07-01

... established by this part shall not be liable for claims for contributions regarding matters addressed by the... against an action seeking contribution for matters addressed by the final decision, no final decision..., regulation or legal theory; or (2) Take further response action at the facility concerned pursuant to CERCLA...

40 CFR 304.40 - Effect and enforcement of final decision.

Code of Federal Regulations, 2013 CFR

2013-07-01

... established by this part shall not be liable for claims for contributions regarding matters addressed by the... against an action seeking contribution for matters addressed by the final decision, no final decision..., regulation or legal theory; or (2) Take further response action at the facility concerned pursuant to CERCLA...

40 CFR 304.40 - Effect and enforcement of final decision.

Code of Federal Regulations, 2012 CFR

2012-07-01

... established by this part shall not be liable for claims for contributions regarding matters addressed by the... against an action seeking contribution for matters addressed by the final decision, no final decision..., regulation or legal theory; or (2) Take further response action at the facility concerned pursuant to CERCLA...

40 CFR 304.40 - Effect and enforcement of final decision.

Code of Federal Regulations, 2014 CFR

2014-07-01

... established by this part shall not be liable for claims for contributions regarding matters addressed by the... against an action seeking contribution for matters addressed by the final decision, no final decision..., regulation or legal theory; or (2) Take further response action at the facility concerned pursuant to CERCLA...

Integrating Hydrologic and Water Quality Models as a Decision Support Tool for Implementation of Low Impact Development in a Coastal Urban Watershed under Climate Variability and Sea Level Rise

NASA Astrophysics Data System (ADS)

Chang, N. B.

2016-12-01

Many countries concern about development and redevelopment efforts in urban regions to reduce the flood risk by considering hazards such as high-tide events, storm surge, flash floods, stormwater runoff, and impacts of sea level rise. Combining these present and future hazards with vulnerable characteristics found throughout coastal communities such as majority low-lying areas and increasing urban development, create scenarios for increasing exposure of flood hazard. As such, the most vulnerable areas require adaptation strategies and mitigation actions for flood hazard management. In addition, in the U.S., Numeric Nutrient Criteria (NNC) are a critical tool for protecting and restoring the designated uses of a waterbody with regard to nitrogen and phosphorus pollution. Strategies such as low impact development (LID) have been promoted in recent years as an alternative to traditional stormwater management and drainage to control both flooding and water quality impact. LID utilizes decentralized multifunctional site designs and incorporates on-site storm water management practices rather than conventional storm water management approaches that divert flow toward centralized facilities. How to integrate hydrologic and water quality models to achieve the decision support becomes a challenge. The Cross Bayou Watershed of Pinellas County in Tampa Bay, a highly urbanized coastal watershed, is utilized as a case study due to its sensitivity to flood hazards and water quality management within the watershed. This study will aid the County, as a decision maker, to implement its stormwater management policy and honor recent NNC state policy via demonstration of an integrated hydrologic and water quality model, including the Interconnected Channel and Pond Routing Model v.4 (ICPR4) and the BMPTRAIN model as a decision support tool. The ICPR4 can be further coupled with the ADCIRC/SWAN model to reflect the storm surge and seal level rise in coastal regions.

Development of the Supported Decision Making Inventory System.

PubMed

Shogren, Karrie A; Wehmeyer, Michael L; Uyanik, Hatice; Heidrich, Megan

2017-12-01

Supported decision making has received increased attention as an alternative to guardianship and a means to enable people with intellectual and developmental disabilities to exercise their right to legal capacity. Assessments are needed that can used by people with disabilities and their systems of supports to identify and plan for needed supports to enable decision making. This article describes the steps taken to develop such an assessment tool, the Supported Decision Making Inventory System (SDMIS), and initial feedback received from self-advocates with intellectual disability. The three sections of the SDMIS (Supported Decision Making Personal Factors Inventory, Supported Decision Making Environmental Demands Inventory, and Decision Making Autonomy Inventory) are described and implications for future research, policy, and practice are discussed.

Work plan for the Isotopes Facilities Deactivation Project at Oak Ridge National Laboratory, Oak Ridge, Tennessee

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

NONE

1995-08-01

The purpose of the Isotopes Facilities Deactivation Project (IFDP) is to place former isotopes production facilities at the Oak Ridge National Laboratory in a safe, stable, and environmentally sound condition; suitable for an extended period of minimum surveillance and maintenance (S and M) and as quickly and economical as possible. Implementation and completion of the deactivation project will further reduce the risks to the environment and to public safety and health. Furthermore, completion of the project will result in significant S and M cost savings in future years. The IFDP work plan defines the project schedule, the cost estimate, andmore » the technical approach for the project. A companion document, the EFDP management plan, has been prepared to document the project objectives, define organizational relationships and responsibilities, and outline the management control systems to be employed in the management of the project. The project has adopted the strategy of deactivating the simple facilities first, to reduce the scope of the project and to gain experience before addressing more difficult facilities. A decision support system is being developed to identify the activities that best promote the project mission and result in the largest cost savings. This work plan will be reviewed and revised annually. Deactivation of EFDP Facilities was initiated in FY 1994 and will be completed in FY 2000. The schedule for deactivation of facilities is shown. The total cost of the project is estimated to be $51M. The costs are summarized. Upon completion of deactivation, annual S and M costs of these facilities will be reduced from the current level of $5M per year to less than $1M per year.« less

Apollo experience report: Real-time auxiliary computing facility development

NASA Technical Reports Server (NTRS)

Allday, C. E.

1972-01-01

The Apollo real time auxiliary computing function and facility were an extension of the facility used during the Gemini Program. The facility was expanded to include support of all areas of flight control, and computer programs were developed for mission and mission-simulation support. The scope of the function was expanded to include prime mission support functions in addition to engineering evaluations, and the facility became a mandatory mission support facility. The facility functioned as a full scale mission support activity until after the first manned lunar landing mission. After the Apollo 11 mission, the function and facility gradually reverted to a nonmandatory, offline, on-call operation because the real time program flexibility was increased and verified sufficiently to eliminate the need for redundant computations. The evaluation of the facility and function and recommendations for future programs are discussed in this report.

Integrating Lean Exploration Loops Into Healthcare Facility Design.

PubMed

Johnson, Kendra; M Mazur, Lukasz; Chadwick, Janet; Pooya, Pegah; Amos, Alison; McCreery, John

2017-04-01

To explore how Lean can add value during the schematic phase of design through providing additional resources and support to project leadership and the architectural design team. This case study-based research took place at one large academic hospital during design efforts of surgical tower to house 19 operating rooms (ORs) and support spaces including pre- and post-op, central processing and distribution, and materials management. Surgical services project leadership asked for Lean practitioners' support during the design process. Lean Exploration Loops (LELs) were conducted to generate evidence to support stakeholders, as they made important decisions about the new building design. The analyses conducted during LELs during the schematic phase were primarily conducted using express workouts (EWOs) and were focused on the flow of patients, staff, and family throughout the pavilion. LELs resulted in recommendations for key design features (e.g., number of pre- and post-op bays per OR floor, location of doors, scrub sinks, stretcher alcoves, equipment storage, and sterile core areas). Two-sided pre- and post-op bays with an inner clinical workspace and an outer patient transport corridor were recommended. Communicating elevator and a centrally located stairwell for staff to alleviate stress on the main bank of elevators at peak usage times were also suggested. We found Lean tools and methods to be of most value during schematic phase when focused on detailed process and layout analysis, while acknowledging the usefulness of focused EWOs to generate the evidence needed for the decision-making.

The emergent relevance of care staff decision-making and situation awareness to mobility care in nursing homes: an ethnographic study.

PubMed

Taylor, Janice; Sims, Jane; Haines, Terry P

2014-12-01

To explore mobility care as provided by care staff in nursing homes. Care staff regularly assist residents with their mobility. Nurses are increasingly reliant on such staff to provide safe and quality mobility care. However, the nature of care staff decision-making when providing assistance has not been fully addressed in the literature. A focused ethnography. The study was conducted in four nursing homes in Melbourne, Australia. Non-participant observations of residents and staff in 2011. Focus groups with 18 nurses, care and lifestyle staff were conducted at three facilities in 2012. Thematic analysis was employed for focus groups and content analysis for observation data. Cognitive Continuum Theory and the notion of 'situation awareness' assisted data interpretation. Decision-making during mobility care emerged as a major theme. Using Cognitive Continuum Theory as a guide, nursing home staff's decision-making was described as ranging from system-aided, through resident- and peer-aided, to reflective and intuitive. Staff seemed aware of the need for resident-aided decision-making consistent with person-centred care. Habitual mobility care based on shared mental models occurred. It was noted that levels of situation awareness may vary among staff. Care staff may benefit from support via collaborative and reflective practice to develop decision-making skills, situation awareness and person-centred mobility care. Further research is required to explore the connection between staff's skills in mobility care and their decision-making competence as well as how these factors link to quality mobility care. © 2014 John Wiley & Sons Ltd.

Supporting End of Life Decision Making: Case Studies of Relational Closeness in Supported Decision Making for People with Severe or Profound Intellectual Disability

ERIC Educational Resources Information Center

Watson, Joanne; Wilson, Erin; Hagiliassis, Nick

2017-01-01

Background: The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) promotes the use of supported decision making in lieu of substitute decision making. To date, there has been a lack of focus on supported decision making for people with severe or profound intellectual disability, including for end of life decisions.…

Applying the Wildland Fire Decision Support System (WFDSS) to support risk-informed decision making: The Gold Pan Fire, Bitterroot National Forest, Montana, USA

Treesearch

Erin K. Noonan-Wright; Tonja S. Opperman

2015-01-01

In response to federal wildfire policy changes, risk-informed decision-making by way of improved decision support, is increasingly becoming a component of managing wildfires. As fire incidents escalate in size and complexity, the Wildland Fire Decision Support System (WFDSS) provides support with different analytical tools as fire conditions change. We demonstrate the...

Decision support for clinical laboratory capacity planning.

PubMed

van Merode, G G; Hasman, A; Derks, J; Goldschmidt, H M; Schoenmaker, B; Oosten, M

1995-01-01

The design of a decision support system for capacity planning in clinical laboratories is discussed. The DSS supports decisions concerning the following questions: how should the laboratory be divided into job shops (departments/sections), how should staff be assigned to workstations and how should samples be assigned to workstations for testing. The decision support system contains modules for supporting decisions at the overall laboratory level (concerning the division of the laboratory into job shops) and for supporting decisions at the job shop level (assignment of staff to workstations and sample scheduling). Experiments with these modules are described showing both the functionality and the validity.

Features of computerized clinical decision support systems supportive of nursing practice: a literature review.

PubMed

Lee, Seonah

2013-10-01

This study aimed to organize the system features of decision support technologies targeted at nursing practice into assessment, problem identification, care plans, implementation, and outcome evaluation. It also aimed to identify the range of the five stage-related sequential decision supports that computerized clinical decision support systems provided. MEDLINE, CINAHL, and EMBASE were searched. A total of 27 studies were reviewed. The system features collected represented the characteristics of each category from patient assessment to outcome evaluation. Several features were common across the reviewed systems. For the sequential decision support, all of the reviewed systems provided decision support in sequence for patient assessment and care plans. Fewer than half of the systems included problem identification. There were only three systems operating in an implementation stage and four systems in outcome evaluation. Consequently, the key steps for sequential decision support functions were initial patient assessment, problem identification, care plan, and outcome evaluation. Providing decision support in such a full scope will effectively help nurses' clinical decision making. By organizing the system features, a comprehensive picture of nursing practice-oriented computerized decision support systems was obtained; however, the development of a guideline for better systems should go beyond the scope of a literature review.

10 CFR 2.649 - Partial decisions on limited work authorization.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Certain Utilization Facilities; and Advance Issuance of Limited Work Authorizations Phased Applications... same time as in the case of a full decision relating to the issuance of a construction permit or...

Use of a Data-Linked Weather Information Display and Effects on Pilot Navigation Decision Making in a Piloted Simulation Study

NASA Technical Reports Server (NTRS)

Yuchnovicz, Daniel E.; Novacek, Paul F.; Burgess, Malcolm A.; Heck, Michael L.; Stokes, Alan F.

2001-01-01

This study provides recommendations to the FAA and to prospective manufacturers based on an exploration of the effects of data link weather displays upon pilot decision performance. An experiment was conducted with twenty-four current instrument rated pilots who were divided into two equal groups and presented with a challenging but realistic flight scenario involving weather containing significant embedded convective activity. All flights were flown in a full-mission simulation facility within instrument meteorological conditions. The inflight weather display depicted NexRad images, graphical METARs and textual METARs. The objective was to investigate the potential for misuse of a weather display, and incorporate recommendations for the design and use of these displays. The primary conclusion of the study found that the inflight weather display did not improve weather avoidance decision making. Some of the reasons to support this finding include: the pilot's inability to easily perceive their proximity to the storms, increased workload and difficulty in deciphering METAR textual data. The compelling nature of a graphical weather display caused many pilots to reduce their reliance on corroborating weather information from other sources. Minor changes to the weather display could improve the ability of a pilot to make better decisions on hazard avoidance.

Everyday ethics and help-seeking in early rheumatoid arthritis

PubMed Central

Townsend, A.; Adam, P.; Cox, S.M.; Li, L.C.

2018-01-01

Background Sociological understandings of chronic illness have revealed tensions and complexities around help-seeking. Although ethics underpins healthcare, its application in the area of chronic illness is limited. Here we apply an ethical framework to interview accounts and identify ethical challenges in the early rheumatoid arthritis (RA) experience. Methods In-depth interviews were conducted with eight participants who had been diagnosed with RA in the 12 months prior to recruitment. Applying the concepts of autonomous decision-making and procedural justice highlighted ethical concerns which arose throughout the help-seeking process. Analysis was based on the constant-comparison approach. Results Individuals described decision-making, illness actions and the medical encounter. The process was complicated by inadequate knowledge about symptoms, common-sense understandings about the GP appointment, difficulties concerning access to specialists, and patient–practitioner interactions. Autonomous decision-making and procedural justice were compromised. The accounts revealed contradictions between the policy ideals of active self-management, patient-centred care and shared decision-making, and the everyday experiences of individuals. Conclusions For ethical healthcare there is a need for: public knowledge about early RA symptoms; more effective patient–practitioner communication; and increased support during the wait between primary and secondary care. Healthcare facilities and the government may consider different models to deliver services to people requiring rheumatology consults. PMID:20610465

An extreme events laboratory to provide network centric collaborative situation assessment and decision making

NASA Astrophysics Data System (ADS)

Panulla, Brian J.; More, Loretta D.; Shumaker, Wade R.; Jones, Michael D.; Hooper, Robert; Vernon, Jeffrey M.; Aungst, Stanley G.

2009-05-01

Rapid improvements in communications infrastructure and sophistication of commercial hand-held devices provide a major new source of information for assessing extreme situations such as environmental crises. In particular, ad hoc collections of humans can act as "soft sensors" to augment data collected by traditional sensors in a net-centric environment (in effect, "crowd-sourcing" observational data). A need exists to understand how to task such soft sensors, characterize their performance and fuse the data with traditional data sources. In order to quantitatively study such situations, as well as study distributed decision-making, we have developed an Extreme Events Laboratory (EEL) at The Pennsylvania State University. This facility provides a network-centric, collaborative situation assessment and decision-making capability by supporting experiments involving human observers, distributed decision making and cognition, and crisis management. The EEL spans the information chain from energy detection via sensors, human observations, signal and image processing, pattern recognition, statistical estimation, multi-sensor data fusion, visualization and analytics, and modeling and simulation. The EEL command center combines COTS and custom collaboration tools in innovative ways, providing capabilities such as geo-spatial visualization and dynamic mash-ups of multiple data sources. This paper describes the EEL and several on-going human-in-the-loop experiments aimed at understanding the new collective observation and analysis landscape.

Facility Energy Decision System (FEDS) Assessment Report for US Army Garrison, Japan - Honshu Installations

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

Kora, Angela R.; Brown, Daryl R.; Dixon, Douglas R.

2010-03-09

This report documents an assessment was performed by a team of engineers from Pacific Northwest National Laboratory (PNNL) under contract to the Installation Management Command (IMCOM) Pacific Region Office (PARO). The effort used the Facility Energy Decision System (FEDS) model to determine how energy is consumed at five U.S. Army Garrison-Japan (USAG-J) installations in the Honshu area, identify the most cost-effective energy retrofit measures, and calculate the potential energy and cost savings.

Tracking implementation and (un)intended consequences: a process evaluation of an innovative peripheral health facility financing mechanism in Kenya.

PubMed

Waweru, Evelyn; Goodman, Catherine; Kedenge, Sarah; Tsofa, Benjamin; Molyneux, Sassy

2016-03-01

In many African countries, user fees have failed to achieve intended access and quality of care improvements. Subsequent user fee reduction or elimination policies have often been poorly planned, without alternative sources of income for facilities. We describe early implementation of an innovative national health financing intervention in Kenya; the health sector services fund (HSSF). In HSSF, central funds are credited directly into a facility's bank account quarterly, and facility funds are managed by health facility management committees (HFMCs) including community representatives. HSSF is therefore a finance mechanism with potential to increase access to funds for peripheral facilities, support user fee reduction and improve equity in access. We conducted a process evaluation of HSSF implementation based on a theory of change underpinning the intervention. Methods included interviews at national, district and facility levels, facility record reviews, a structured exit survey and a document review. We found impressive achievements: HSSF funds were reaching facilities; funds were being overseen and used in a way that strengthened transparency and community involvement; and health workers' motivation and patient satisfaction improved. Challenges or unintended outcomes included: complex and centralized accounting requirements undermining efficiency; interactions between HSSF and user fees leading to difficulties in accessing crucial user fee funds; and some relationship problems between key players. Although user fees charged had not increased, national reduction policies were still not being adhered to. Finance mechanisms can have a strong positive impact on peripheral facilities, and HFMCs can play a valuable role in managing facilities. Although fiduciary oversight is essential, mechanisms should allow for local decision-making and ensure that unmanageable paperwork is avoided. There are also limits to what can be achieved with relatively small funds in contexts of enormous need. Process evaluations tracking (un)intended consequences of interventions can contribute to regional financing and decentralization debates. © The Author 2015. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

When Funding Is Scarce: Making the Best Use of Existing Facilities

ERIC Educational Resources Information Center

Yurko, Amy

2010-01-01

In this environment of economic uncertainty, school districts can be faced with tough decisions in their attempts to provide students and teachers with safe and functional facilities for teaching and learning. To accommodate program changes and enrollment fluctuations as well as aging facilities and limited capital budgets, it is increasingly…

Empowering Facilities Teams through Technology

ERIC Educational Resources Information Center

Cormier, Scott

2013-01-01

Facilities departments at colleges and universities are facing the same challenge: how not to do just the most projects, but also the right projects with the limited funds they are given. In order to make the best decisions, they need more control over the capital planning process, which requires accurate, current facility condition data. Each…

HUMAN HEALTH METRICS FOR ENVIRONMENTAL DECISION SUPPORT TOOLS: LESSONS FROM HEALTH ECONOMICS AND DECISION ANALYSIS: PUBLISHED REPORT

EPA Science Inventory

NRMRL-CIN-1351A Hofstetter**, P., and Hammitt, J. K. Human Health Metrics for Environmental Decision Support Tools: Lessons from Health Economics and Decision Analysis. EPA/600/R-01/104 (NTIS PB2002-102119). Decision makers using environmental decision support tools are often ...

Electricity generation and transmission planning in deregulated power markets

NASA Astrophysics Data System (ADS)

He, Yang

This dissertation addresses the long-term planning of power generation and transmission facilities in a deregulated power market. Three models with increasing complexities are developed, primarily for investment decisions in generation and transmission capacity. The models are presented in a two-stage decision context where generation and transmission capacity expansion decisions are made in the first stage, while power generation and transmission service fees are decided in the second stage. Uncertainties that exist in the second stage affect the capacity expansion decisions in the first stage. The first model assumes that the electric power market is not constrained by transmission capacity limit. The second model, which includes transmission constraints, considers the interactions between generation firms and the transmission network operator. The third model assumes that the generation and transmission sectors make capacity investment decisions separately. These models result in Nash-Cournot equilibrium among the unregulated generation firms, while the regulated transmission network operator supports the competition among generation firms. Several issues in the deregulated electric power market can be studied with these models such as market powers of generation firms and transmission network operator, uncertainties of the future market, and interactions between the generation and transmission sectors. Results deduced from the developed models include (a) regulated transmission network operator will not reserve transmission capacity to gain extra profits; instead, it will make capacity expansion decisions to support the competition in the generation sector; (b) generation firms will provide more power supplies when there is more demand; (c) in the presence of future uncertainties, the generation firms will add more generation capacity if the demand in the future power market is expected to be higher; and (d) the transmission capacity invested by the transmission network operator depends on the characteristic of the power market and the topology of the transmission network. Also, the second model, which considers interactions between generation and transmission sectors, yields higher social welfare in the electric power market, than the third model where generation firms and transmission network operator make investment decisions separately.

76 FR 68170 - Instructions for Implementing Sustainable Locations for Federal Facilities in Accordance With...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-03

... for integrating sustainable facility location decision-making principles into agency policies and..., Energy, and Economic Performance,'' signed by President Obama on October 5, 2009. 74 FR 52117, Oct. 8...

77 FR 17068 - Medicare and Medicaid Programs; Approval of the Application by the American Association for...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-23

... of Ambulatory Surgery Facilities for Deeming Authority for Rural Health Clinics AGENCY: Centers for... decision to approve the American Association for Accreditation of Ambulatory Surgery Facilities [[Page...

THE NGA-DOE GRANT TO EXAMINE CRITICAL ISSUES RELATED TO RADIOACTIVE WASTE AND MATERIALS DISPOSITION INVOLVING DOE FACILITIES

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

NONE

1998-01-01

Through the National Governors' Association (NGA) project ''Critical Issues Related to Radioactive Waste and Materials Disposition Involving DOE Facilities'' NGA brings together Governors' policy advisors, state regulators, and DOE officials to examine critical issues related to the cleanup and operation of DOE nuclear weapons and research facilities. Topics explored through this project include: Decisions involving disposal of mixed, low-level, and transuranic (TRU) waste and disposition of nuclear materials. Decisions involving DOE budget requests and their effect on environmental cleanup and compliance at DOE facilities. Strategies to treat mixed, low-level, and transuranic (TRU) waste and their effect on individual sites inmore » the complex. Changes to the FFCA site treatment plans as a result of proposals in the EM 2006 cleanup plans and contractor integration analysis. Interstate waste and materials shipments. Reforms to existing RCRA and CERCLA regulations/guidance to address regulatory overlap and risks posed by DOE wastes. The overarching theme of this project is to help the Department improve coordination of its major program decisions with Governors' offices and state regulators and to ensure such decisions reflect input from these key state officials and stakeholders. This report summarizes activities conducted during the quarter from October 1, 1997 through December 31, 1997, under the NGA project. The work accomplished by the NGA project team during the past four months can be categorized as follows: maintained open communication with DOE on a variety of activities and issues within the DOE environmental management complex; and maintained communication with NGA Federal Facilities Compliance Task Force members regarding DOE efforts to formulate a configuration for mixed low-level waste and low-level treatment and disposal, DOE activities in the area of the Hazardous Waste Identification Rule, and DOE's proposed National Dialogue.« less

Evolution of the Lunar Receiving Laboratory to the Astromaterial Sample Curation Facility: Technical Tensions Between Containment and Cleanliness, Between Particulate and Organic Cleanliness

NASA Technical Reports Server (NTRS)

Allton, J. H.; Zeigler, R. A.; Calaway, M. J.

2016-01-01

The Lunar Receiving Laboratory (LRL) was planned and constructed in the 1960s to support the Apollo program in the context of landing on the Moon and safely returning humans. The enduring science return from that effort is a result of careful curation of planetary materials. Technical decisions for the first facility included sample handling environment (vacuum vs inert gas), and instruments for making basic sample assessment, but the most difficult decision, and most visible, was stringent biosafety vs ultra-clean sample handling. Biosafety required handling of samples in negative pressure gloveboxes and rooms for containment and use of sterilizing protocols and animal/plant models for hazard assessment. Ultra-clean sample handling worked best in positive pressure nitrogen environment gloveboxes in positive pressure rooms, using cleanable tools of tightly controlled composition. The requirements for these two objectives were so different, that the solution was to design and build a new facility for specific purpose of preserving the scientific integrity of the samples. The resulting Lunar Curatorial Facility was designed and constructed, from 1972-1979, with advice and oversight by a very active committee comprised of lunar sample scientists. The high precision analyses required for planetary science are enabled by stringent contamination control of trace elements in the materials and protocols of construction (e.g., trace element screening for paint and flooring materials) and the equipment used in sample handling and storage. As other astromaterials, especially small particles and atoms, were added to the collections curated, the technical tension between particulate cleanliness and organic cleanliness was addressed in more detail. Techniques for minimizing particulate contamination in sample handling environments use high efficiency air filtering techniques typically requiring organic sealants which offgas. Protocols for reducing adventitious carbon on sample handling surfaces often generate particles. Further work is needed to achieve both minimal particulate and adventitious carbon contamination. This paper will discuss these facility topics and others in the historical context of nearly 50 years' curation experience for lunar rocks and regolith, meteorites, cosmic dust, comet particles, solar wind atoms, and asteroid particles at Johnson Space Center.

77 FR 52702 - Notice of Availability of Record of Decision for the Silver Strand Training Complex, California

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-30

... of Decision is available for public viewing on the project Web site at http://www... Decision are available by contacting: Ms. Amy P. Kelley, Naval Facilities Engineering Command Southwest... project Web site is found at http://www.silverstrandtrainingcomplexeis.com . Dated: August 24, 2012. C. K...

Planning Protective Action Decision-Making: Evacuate or Shelter-in-Place

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

Sorensen, J.H.

Appropriate protective action recommendations or decisions (PARs/PADs) are needed to achieve maximum protection of a population at risk. The factors that affect protective action decisions are complex but fairly well documented. Protective action decisions take into account population distributions, projected or actual exposure to a chemical substance, availability of adequate shelters, evacuation time estimates, and other relevant factors. To choose in-place sheltering, there should be a reasonable assurance that the movement of people beyond their residence, workplace, or school will endanger the health and safety of the public more so than allowing them to remain in place. The decision tomore » evacuate the public should be based on the reasonable assurance that the movement of people to an area outside of an affected area is in the best interest of their health and safety, and is of minimal risk to them. In reality, an evacuation decision is also a resource-dependent decision. The availability of transportation and other resources, including shelters, may factor heavily in the protective action decision-making process. All strategies to protect the health and safety of the public from a release of hazardous chemicals are explicitly considered during emergency decision making. Each institutional facility (such as hospitals, schools, day care centers, correctional facilities, assisted living facilities or nursing homes) in the community should be considered separately to determine what special protective actions may be necessary. Deciding whether to evacuate or to shelter-in-place is one of the most important questions facing local emergency planners responding to a toxic chemical release. That such a complex decision with such important potential consequences must be made with such urgency places tremendous responsibility on the planners and officials involved. Researchers have devoted considerable attention to the evacuation/shelter-in-place protection decision. While several decision aids have been developed, no single approach has achieved widespread acceptance based on validity, utility, and effectiveness (Ujihara 1989, Mannan and Kilpatrick 2000). In the absence of an agreed-upon methodology for making this decision, the best strategy for local emergency planners and officials is a thorough understanding of all the components affecting the decision. This paper summarizes what is currently known about the evacuation/shelter-in-place protection decision and points to available literature that more thoroughly explores the individual components of the decision. The next section summarizes the major issues in protective action decision process. This is followed by a discussion of all the factors that may bear on the protective action decision process. The final section address how to make a protective action decision.« less

How decision for seeking maternal care is made--a qualitative study in two rural medical districts of Burkina Faso.

PubMed

Somé, Donmozoun Télesphore; Sombié, Issiaka; Meda, Nicolas

2013-02-07

Delay in decision-making to use skilled care during pregnancy and childbirth is an important factor for maternal death in many developing countries. This paper examines how decisions for maternal care are made in two rural communities in Burkina Faso. Focus group discussions (FGDs) and individual interviews (IDIs)) were used to collect information with 30 women in Ouargaye and Diapaga medical districts. All interviews were tape recorded and analyzed using QSR Nvivo 2.0. Decision-making for use of obstetric care in the family follows the logic of the family's management. Husbands, brothers-in-law and parents-in-law make the decision about whether to use a health facility for antenatal care or for delivery. In general, decision-makers are those who can pay, including the woman herself. Payment of care is the responsibility of men, according to women interviewed, because of their social role and status. To increase use of health facilities in Ouargaye and Diapaga, the empowerment of women could be helpful as well as exemption of fees or cost sharing for care.

Lessons Learned through the Development and Publication of AstroImageJ

NASA Astrophysics Data System (ADS)

Collins, Karen

2018-01-01

As lead author of the scientific image processing software package AstroImageJ (AIJ), I will discuss the reasoning behind why we decided to release AIJ to the public, and the lessons we learned related to the development, publication, distribution, and support of AIJ. I will also summarize the AIJ code language selection, code documentation and testing approaches, code distribution, update, and support facilities used, and the code citation and licensing decisions. Since AIJ was initially developed as part of my graduate research and was my first scientific open source software publication, many of my experiences and difficulties encountered may parallel those of others new to scientific software publication. Finally, I will discuss the benefits and disadvantages of releasing scientific software that I now recognize after having AIJ in the public domain for more than five years.

Making the connection: the VA-Regenstrief project.

PubMed

Martin, D K

1992-01-01

The Regenstrief Automated Medical Record System is a well-established clinical information system with powerful facilities for querying and decision support. My colleagues and I introduced this system into the Indianapolis Veterans Affairs (VA) Medical Center by interfacing it to the institution's automated data-processing system, the Decentralized Hospital Computer Program (DHCP), using a recently standardized method for clinical data interchange. This article discusses some of the challenges encountered in that process, including the translation of vocabulary terms and maintenance of the software interface. Efforts such as these demonstrate the importance of standardization in medical informatics and the need for data standards at all levels of information exchange.

Developing academic surgery in a socialized health care system: a 35-year experience.

PubMed

Duranceau, Andre; Martin, Jocelyne; Liberman, Moishe; Ferraro, Pasquale

2012-07-01

The most important benefit of a socialized health care system is the elimination of the threat of personal financial ruin to pay for medical care. Serious disadvantages of a socialized health care system, particularly in a university hospital setting, include restricted financial resources for education and patient care, limited working facilities, and loss of physician-directed decision making in planning and prioritizing. This article describes how a group practice model has supported clinical and academic activities within the faculty of medicine of our university and offers this model as a possible template for other surgical and medical disciplines working in an academic socialized environment.

SANDS: an architecture for clinical decision support in a National Health Information Network.

PubMed

Wright, Adam; Sittig, Dean F

2007-10-11

A new architecture for clinical decision support called SANDS (Service-oriented Architecture for NHIN Decision Support) is introduced and its performance evaluated. The architecture provides a method for performing clinical decision support across a network, as in a health information exchange. Using the prototype we demonstrated that, first, a number of useful types of decision support can be carried out using our architecture; and, second, that the architecture exhibits desirable reliability and performance characteristics.

Nanotechnology on a dime: building affordable research facilities

NASA Astrophysics Data System (ADS)

DiBattista, Jeff; Clare, Donna; Lynch, David

2005-08-01

Designing buildings to house nanotechnology research presents a multitude of well-recognized challenges to architectural and engineering design teams, from environmental control to spatial arrangements to operational functionality. These technical challenges can be solved with relative ease on projects with large budgets: designers have the option of selecting leading-edge systems without undue regard for their expense. This is reflected in the construction cost of many nanotechnology research facilities that run well into the hundreds of millions of dollars. Smaller universities and other institutions need not be shut out of the nanotechnology research field simply because their construction budgets are tens of millions of dollars or less. The key to success for these less expensive projects lies with making good strategic decisions: identifying priorities for the facility in terms of what it will is--and will not--provide to the researchers. Making these strategic decisions puts bounds on the tactical, technical problems that the design team at large must address, allowing them to focus their efforts on the key areas for success. The process and challenges of this strategic decision-making process are examined, with emphasis placed on the types of decisions that must be made and the factors that must be considered when making them. Case study examples of projects undertaken at the University of Alberta are used to illustrate how strategic-level decision-making sets the stage for cutting-edge success on a modest budget.

The search and selection of assisted living facilities by elders and family.

PubMed

Castle, Nicholas G; Sonon, Kristen E

2007-08-01

In this study, we examine factors associated with the search, selection, and satisfaction of residents and family members in assisted living. Data were collected from 375 residents of 25 assisted living facilities matched with 375 family members. We conducted face-to-face interviews with the residents to determine: (1) the principal decision maker; (2) the process of searching for a facility; (3) the factors crucial to facility selection; (4) the time frame from the relocation decision to relocation; and (5) satisfaction with selection. Similar questions were asked of family members, using a mail survey. Residents described themselves as extremely influential in 39% of cases when searching for a facility, and in 27% of cases when selecting a facility. Quality, cost, and location were the most influential factors for both residents and family members in selecting a facility. Almost all residents and family would use different search and selection processes if they had to select a facility again, and almost all were dissatisfied with the sources of information available. Consumers and policy makers both favor the use of assisted living settings; but, the information available to choose a setting is far from ideal, and may represent a barrier to both consumer and policy makers' agendas.

Future of electronic health records: implications for decision support.

PubMed

Rothman, Brian; Leonard, Joan C; Vigoda, Michael M

2012-01-01

The potential benefits of the electronic health record over traditional paper are many, including cost containment, reductions in errors, and improved compliance by utilizing real-time data. The highest functional level of the electronic health record (EHR) is clinical decision support (CDS) and process automation, which are expected to enhance patient health and healthcare. The authors provide an overview of the progress in using patient data more efficiently and effectively through clinical decision support to improve health care delivery, how decision support impacts anesthesia practice, and how some are leading the way using these systems to solve need-specific issues. Clinical decision support uses passive or active decision support to modify clinician behavior through recommendations of specific actions. Recommendations may reduce medication errors, which would result in considerable savings by avoiding adverse drug events. In selected studies, clinical decision support has been shown to decrease the time to follow-up actions, and prediction has proved useful in forecasting patient outcomes, avoiding costs, and correctly prompting treatment plan modifications by clinicians before engaging in decision-making. Clinical documentation accuracy and completeness is improved by an electronic health record and greater relevance of care data is delivered. Clinical decision support may increase clinician adherence to clinical guidelines, but educational workshops may be equally effective. Unintentional consequences of clinical decision support, such as alert desensitization, can decrease the effectiveness of a system. Current anesthesia clinical decision support use includes antibiotic administration timing, improved documentation, more timely billing, and postoperative nausea and vomiting prophylaxis. Electronic health record implementation offers data-mining opportunities to improve operational, financial, and clinical processes. Using electronic health record data in real-time for decision support and process automation has the potential to both reduce costs and improve the quality of patient care. © 2012 Mount Sinai School of Medicine.

Assessing welfare of individual sirenians in the wild and in captivity

USGS Publications Warehouse

Flint, Mark; Bonde, Robert K.

2017-01-01

Assessing the welfare of wild populations of sirenians has required a “generalist” approach. The outcome has been a subjective decision as to whether what the observers are witnessing in an individual or group of animals is normal and whether that has positive or negative consequences. The understanding of sirenian welfare requirements, and a decision process for whether to support and maintain their natural habitats or to try to replicate it in a meaningful way in an artificial captive setting, is still in its early developmental stages and has dynamic qualities that are in need of urgent attention. In this chapter we use the knowledge and observations presented throughout the chapters on sirenians to outline a proposed standard approach for assessing welfare in individuals in wild populations, as well as guidelines for assessing captive groups of dugongs and manatees. In the wild, the suitability of the habitat and human impact on it, the limitations of carrying capacity, the dynamics of ecosystems, and the effects that the immediate environment will have on the known resident populations are examined. In captivity, we use the foundation of the Five Freedoms, based on experience derived from other captive species, and we combine this with experience from rehabilitating manatees in Europe and the United States and, more recently, dugongs in the Indo-Pacific, to identify requirements and to help us to assess the unique needs of these species when held in facilities. We present considerations and approaches to (1) holistically assess captive facilities and to assess the well-being of the individuals held in the facility, (2) derive a guideline for standard captive assessment, (3) determine if adequate welfare needs for the animals are being met, and (4) help to provide guidance on whether an animal is suitable for release after rehabilitation.

Toward a Multilingual, Experiential Environment for Learning Decision Technology.

ERIC Educational Resources Information Center

Yeo, Gee Kin; Tan, Seng Teen

1999-01-01

Describes work at the National University of Singapore on the Internet in expanding a simulation game used in supporting a course in decision technology. Topics include decision support systems, multilingual support for cross-cultural decision studies, process support in a World Wide Web-enhanced multiuser domain (MUD) learning environment, and…

Maintenance and operations decision support tool : Clarus regional demonstrations.

DOT National Transportation Integrated Search

2011-01-01

Weather affects almost all maintenance activity decisions. The Federal Highway Administration (FHWA) tested a new decision support system for maintenance in Iowa, Indiana, and Illinois called the Maintenance and Operations Decision Support System (MO...

Evaluation of the use of oseltamivir prophylaxis in the control of influenza outbreaks in long-term care facilities in Alberta, Canada: a retrospective provincial database analysis

PubMed Central

Ye, Ming; Jacobs, Angela; Khan, Muhammad Naeem; Jaipaul, Joy; Oda, Joanna; Johnson, Marcia; Doroshenko, Alexander

2016-01-01

Objectives To evaluate the impact of oseltamivir prophylaxis in the management and control of influenza outbreaks in long-term care facilities in Alberta, Canada. Setting and participants Long-term care facilities where 127 influenza outbreaks were reported to public health authorities in Alberta, Canada, during two influenza seasons from 2013 to 2015. Design and outcome measures Using routinely collected surveillance and administrative data, we examined the association between decision-making time for oseltamivir recommendation as prophylaxis strategy for influenza outbreaks in long-term care facilities (explanatory variable) and the duration of an influenza outbreak, the postprophylaxis risk of influenza-like illness and hospitalisation among residents of long-term care facilities in Alberta (outcome variables) using multivariable linear and Poisson regression models. Results Oseltamivir prophylaxis decision-making time was positively associated with the postintervention duration of an outbreak, with a 1-day delay in making decision on oseltamivir prophylaxis associated with 2.22 (95% CI 1.37 to 3.06) more days of the duration of an outbreak after controlling for potential confounding effect of the number of residents at risk at intervention, outbreak progression time, prevalence of influenza-like illness during outbreak progression, facility location, presence of mixed strain and based on optimal timing of oseltamivir prophylaxis. Although not statistically significant, a 1-day delay in making decision on oseltamivir prophylaxis was associated with a 5% (95% CI −1% to 11%) increase in the postintervention risk of influenza-like illness, and a 6% (95% CI −8% to 22%) increase in the postintervention risk of hospitalisation after controlling for the same potential confounders. Conclusions Our study demonstrated benefits of using oseltamivir prophylaxis to shorten the duration of influenza outbreaks; however, there were no significant differences in the influenza-like illness and hospitalisation risk occurring after the intervention. Surveillance data may offer means of rapid evaluation of oseltamivir prophylaxis in long-term care facilities as a public health measure. PMID:27381211

Evaluation of the use of oseltamivir prophylaxis in the control of influenza outbreaks in long-term care facilities in Alberta, Canada: a retrospective provincial database analysis.

PubMed

Ye, Ming; Jacobs, Angela; Khan, Muhammad Naeem; Jaipaul, Joy; Oda, Joanna; Johnson, Marcia; Doroshenko, Alexander

2016-07-05

To evaluate the impact of oseltamivir prophylaxis in the management and control of influenza outbreaks in long-term care facilities in Alberta, Canada. Long-term care facilities where 127 influenza outbreaks were reported to public health authorities in Alberta, Canada, during two influenza seasons from 2013 to 2015. Using routinely collected surveillance and administrative data, we examined the association between decision-making time for oseltamivir recommendation as prophylaxis strategy for influenza outbreaks in long-term care facilities (explanatory variable) and the duration of an influenza outbreak, the postprophylaxis risk of influenza-like illness and hospitalisation among residents of long-term care facilities in Alberta (outcome variables) using multivariable linear and Poisson regression models. Oseltamivir prophylaxis decision-making time was positively associated with the postintervention duration of an outbreak, with a 1-day delay in making decision on oseltamivir prophylaxis associated with 2.22 (95% CI 1.37 to 3.06) more days of the duration of an outbreak after controlling for potential confounding effect of the number of residents at risk at intervention, outbreak progression time, prevalence of influenza-like illness during outbreak progression, facility location, presence of mixed strain and based on optimal timing of oseltamivir prophylaxis. Although not statistically significant, a 1-day delay in making decision on oseltamivir prophylaxis was associated with a 5% (95% CI -1% to 11%) increase in the postintervention risk of influenza-like illness, and a 6% (95% CI -8% to 22%) increase in the postintervention risk of hospitalisation after controlling for the same potential confounders. Our study demonstrated benefits of using oseltamivir prophylaxis to shorten the duration of influenza outbreaks; however, there were no significant differences in the influenza-like illness and hospitalisation risk occurring after the intervention. Surveillance data may offer means of rapid evaluation of oseltamivir prophylaxis in long-term care facilities as a public health measure. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

The Role of Health Care Provider and Partner Decisional Support in Patients' Cancer Treatment Decision-Making Satisfaction.

PubMed

Palmer-Wackerly, Angela L; Krieger, Janice L; Rhodes, Nancy D

2017-01-01

Cancer patients rely on multiple sources of support when making treatment decisions; however, most research studies examine the influence of health care provider support while the influence of family member support is understudied. The current study fills this gap by examining the influence of health care providers and partners on decision-making satisfaction. In a cross-sectional study via an online Qualtrics panel, we surveyed cancer patients who reported that they had a spouse or romantic partner when making cancer treatment decisions (n = 479). Decisional support was measured using 5-point, single-item scales for emotional support, informational support, informational-advice support, and appraisal support. Decision-making satisfaction was measured using Holmes-Rovner and colleagues' (1996) Satisfaction With Decision Scale. We conducted a mediated regression analysis to examine treatment decision-making satisfaction for all participants and a moderated mediation analysis to examine treatment satisfaction among those patients offered a clinical trial. Results indicated that partner support significantly and partially mediated the relationship between health care provider support and patients' decision-making satisfaction but that results did not vary by enrollment in a clinical trial. This study shows how and why decisional support from partners affects communication between health care providers and cancer patients.

Tracking implementation and (un)intended consequences: a process evaluation of an innovative peripheral health facility financing mechanism in Kenya

PubMed Central

Waweru, Evelyn; Goodman, Catherine; Kedenge, Sarah; Tsofa, Benjamin; Molyneux, Sassy

2016-01-01

In many African countries, user fees have failed to achieve intended access and quality of care improvements. Subsequent user fee reduction or elimination policies have often been poorly planned, without alternative sources of income for facilities. We describe early implementation of an innovative national health financing intervention in Kenya; the health sector services fund (HSSF). In HSSF, central funds are credited directly into a facility’s bank account quarterly, and facility funds are managed by health facility management committees (HFMCs) including community representatives. HSSF is therefore a finance mechanism with potential to increase access to funds for peripheral facilities, support user fee reduction and improve equity in access. We conducted a process evaluation of HSSF implementation based on a theory of change underpinning the intervention. Methods included interviews at national, district and facility levels, facility record reviews, a structured exit survey and a document review. We found impressive achievements: HSSF funds were reaching facilities; funds were being overseen and used in a way that strengthened transparency and community involvement; and health workers’ motivation and patient satisfaction improved. Challenges or unintended outcomes included: complex and centralized accounting requirements undermining efficiency; interactions between HSSF and user fees leading to difficulties in accessing crucial user fee funds; and some relationship problems between key players. Although user fees charged had not increased, national reduction policies were still not being adhered to. Finance mechanisms can have a strong positive impact on peripheral facilities, and HFMCs can play a valuable role in managing facilities. Although fiduciary oversight is essential, mechanisms should allow for local decision-making and ensure that unmanageable paperwork is avoided. There are also limits to what can be achieved with relatively small funds in contexts of enormous need. Process evaluations tracking (un)intended consequences of interventions can contribute to regional financing and decentralization debates. PMID:25920355

Uncertainty and probability in wildfire management decision support: An example from the United States [Chapter 4

Treesearch

Matthew Thompson; David Calkin; Joe H. Scott; Michael Hand

2017-01-01

Wildfire risk assessment is increasingly being adopted to support federal wildfire management decisions in the United States. Existing decision support systems, specifically the Wildland Fire Decision Support System (WFDSS), provide a rich set of probabilistic and risk‐based information to support the management of active wildfire incidents. WFDSS offers a wide range...

Interprofessional practice and decision support: an organizational framework applied to a mental health setting.

PubMed

Campbell, Susan; Stowe, Karen; Ozanne, Elissa M

2011-11-01

Decision support as a means to assist people in making healthcare decisions has been discussed extensively in the medical literature. However, the potential for use of decision support and decision aids with people with psychiatric disabilities in order to promote recovery has only begun to be researched and discussed in the mental health literature. Organizational factors that foster interprofessional practice within a decision support environment focused on mental health issues are examined in this paper.

Fairness and legitimacy of decisions during delivery of malaria services and ITN interventions in Zambia.

PubMed

Tuba, Mary; Sandoy, Ingvild F; Bloch, Paul; Byskov, Jens

2010-11-01

Malaria is the leading cause of morbidity and the second leading cause of mortality in Zambia. Perceptions of fairness and legitimacy of decisions relating to treatment of malaria cases within public health facilities and distribution of ITNs were assessed in a district in Zambia. The study was conducted within the framework of REsponse to ACcountable priority setting for Trust in health systems (REACT), a north-south collaborative action research study, which evaluates the Accountability for Reasonableness (AFR) approach to priority setting in Zambia, Tanzania and Kenya. This paper is based on baseline in-depth interviews (IDIs) conducted with 38 decision-makers, who were involved in prioritization of malaria services and ITN distribution at district, facility and community levels in Zambia, one Focus Group Discussion (FGD) with District Health Management Team managers and eight FGDs with outpatients' attendees. Perceptions and attitudes of providers and users and practices of providers were systematized according to the four AFR conditions relevance, publicity, appeals and leadership. Conflicting criteria for judging fairness were used by decision-makers and patients. Decision-makers argued that there was fairness in delivery of malaria treatment and distribution of ITNs based on alleged excessive supply of free malaria medicines, subsidized ITNs, and presence of a qualified health-provider in every facility. Patients argued that there was unfairness due to differences in waiting time, distances to health facilities, erratic supply of ITNs, no responsive appeal mechanisms, inadequate access to malaria medicines, ITNs and health providers, and uncaring providers. Decision-makers only perceived government bodies and donors/NGOs to be legitimate stakeholders to involve during delivery. Patients found government bodies, patients, indigenous healers, chiefs and politicians to be legitimate stakeholders during both planning and delivery. Poor status of the AFR conditions of relevance, publicity, appeals and leadership corresponds well to the differing perceptions of fairness and unfairness among outpatient attendees and decision-makers. This may have been re-enforced by existing disagreements between the two groups regarding who the legitimate stakeholders to involve during service delivery were. Conflicts identified in this study could be resolved by promoting application of approaches such as AFR during priority setting in the district.

Effects of State Policies on Facilities Planning and Construction in Rural Districts. ERIC Digest.

ERIC Educational Resources Information Center

Lawrence, Barbara Kent

State policies greatly affect the decisions rural districts make about building or renovating school facilities. State, federal, and local mechanisms for funding school facilities are briefly described. Some states require a specific percentage of growth or decline in student population or a minimum number of students as a prerequisite for…

76 FR 37799 - DOE Final Decision in Response to Recommendation 2010-1 of the Defense Nuclear Facilities Safety...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-28

... the public, workers, and the environment. For example, the Board clarified that use of the term.... Department of Energy Nonreactor Nuclear Facility Documented Safety Analyses, as a safe harbor methodology..., our workers, and the environment at all of our facilities. We share your conviction that a clear set...

Implementation of workflow engine technology to deliver basic clinical decision support functionality.

PubMed

Huser, Vojtech; Rasmussen, Luke V; Oberg, Ryan; Starren, Justin B

2011-04-10

Workflow engine technology represents a new class of software with the ability to graphically model step-based knowledge. We present application of this novel technology to the domain of clinical decision support. Successful implementation of decision support within an electronic health record (EHR) remains an unsolved research challenge. Previous research efforts were mostly based on healthcare-specific representation standards and execution engines and did not reach wide adoption. We focus on two challenges in decision support systems: the ability to test decision logic on retrospective data prior prospective deployment and the challenge of user-friendly representation of clinical logic. We present our implementation of a workflow engine technology that addresses the two above-described challenges in delivering clinical decision support. Our system is based on a cross-industry standard of XML (extensible markup language) process definition language (XPDL). The core components of the system are a workflow editor for modeling clinical scenarios and a workflow engine for execution of those scenarios. We demonstrate, with an open-source and publicly available workflow suite, that clinical decision support logic can be executed on retrospective data. The same flowchart-based representation can also function in a prospective mode where the system can be integrated with an EHR system and respond to real-time clinical events. We limit the scope of our implementation to decision support content generation (which can be EHR system vendor independent). We do not focus on supporting complex decision support content delivery mechanisms due to lack of standardization of EHR systems in this area. We present results of our evaluation of the flowchart-based graphical notation as well as architectural evaluation of our implementation using an established evaluation framework for clinical decision support architecture. We describe an implementation of a free workflow technology software suite (available at http://code.google.com/p/healthflow) and its application in the domain of clinical decision support. Our implementation seamlessly supports clinical logic testing on retrospective data and offers a user-friendly knowledge representation paradigm. With the presented software implementation, we demonstrate that workflow engine technology can provide a decision support platform which evaluates well against an established clinical decision support architecture evaluation framework. Due to cross-industry usage of workflow engine technology, we can expect significant future functionality enhancements that will further improve the technology's capacity to serve as a clinical decision support platform.

An integrated decision support system for diagnosing and managing patients with community-acquired pneumonia.

PubMed Central

Aronsky, D.; Haug, P. J.

1999-01-01

Decision support systems that integrate guidelines have become popular applications to reduce variation and deliver cost-effective care. However, adverse characteristics of decision support systems, such as additional and time-consuming data entry or manually identifying eligible patients, result in a "behavioral bottleneck" that prevents decision support systems to become part of the clinical routine. This paper describes the design and the implementation of an integrated decision support system that explores a novel approach for bypassing the behavioral bottleneck. The real-time decision support system does not require health care providers to enter additional data and consists of a diagnostic and a management component. Images Fig. 1 Fig. 2 Fig. 3 PMID:10566348

Stakeholder views of management and decision support tools to integrate climate change into Great Lakes Lake Whitefish management

USGS Publications Warehouse

Lynch, Abigail J.; Taylor, William W.; McCright, Aaron M.

2016-01-01

Decision support tools can aid decision making by systematically incorporating information, accounting for uncertainties, and facilitating evaluation between alternatives. Without user buy-in, however, decision support tools can fail to influence decision-making processes. We surveyed fishery researchers, managers, and fishers affiliated with the Lake Whitefish Coregonus clupeaformis fishery in the 1836 Treaty Waters of Lakes Huron, Michigan, and Superior to assess opinions of current and future management needs to identify barriers to, and opportunities for, developing a decision support tool based on Lake Whitefish recruitment projections with climate change. Approximately 64% of 39 respondents were satisfied with current management, and nearly 85% agreed that science was well integrated into management programs. Though decision support tools can facilitate science integration into management, respondents suggest that they face significant implementation barriers, including lack of political will to change management and perceived uncertainty in decision support outputs. Recommendations from this survey can inform development of decision support tools for fishery management in the Great Lakes and other regions.

Cyborg practices: call-handlers and computerised decision support systems in urgent and emergency care.

PubMed

Pope, Catherine; Halford, Susan; Turnbull, Joanne; Prichard, Jane

2014-06-01

This article draws on data collected during a 2-year project examining the deployment of a computerised decision support system. This computerised decision support system was designed to be used by non-clinical staff for dealing with calls to emergency (999) and urgent care (out-of-hours) services. One of the promises of computerised decisions support technologies is that they can 'hold' vast amounts of sophisticated clinical knowledge and combine it with decision algorithms to enable standardised decision-making by non-clinical (clerical) staff. This article draws on our ethnographic study of this computerised decision support system in use, and we use our analysis to question the 'automated' vision of decision-making in healthcare call-handling. We show that embodied and experiential (human) expertise remains central and highly salient in this work, and we propose that the deployment of the computerised decision support system creates something new, that this conjunction of computer and human creates a cyborg practice.

The conversion of a room temperature NaK loop to a high temperature MHD facility for Li/V blanket testing

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

Reed, C.B.; Haglund, R.C.; Miller, M.E.

1996-12-31

The Vanadium/Lithium system has been the recent focus of ANL`s Blanket Technology Pro-ram, and for the last several years, ANL`s Liquid Metal Blanket activities have been carried out in direct support of the ITER (International Thermonuclear Experimental Reactor) breeding blanket task area. A key feasibility issue for the ITER Vanadium/Lithium breeding blanket is the Near the development of insulator coatings. Design calculations, Hua and Gohar, show that an electrically insulating layer is necessary to maintain an acceptably low magneto-hydrodynamic (MHD) pressure drop in the current ITER design. Consequently, the decision was made to convert Argonne`s Liquid Metal EXperiment (ALEX) frommore » a 200{degrees}C NaK facility to a 350{degrees}C lithium facility. The upgraded facility was designed to produce MHD pressure drop data, test section voltage distributions, and heat transfer data for mid-scale test sections and blanket mockups at Hartmann numbers (M) and interaction parameters (N) in the range of 10{sup 3} to 10{sup 5} in lithium at 350{degrees}C. Following completion of the upgrade work, a short performance test was conducted, followed by two longer multiple-hour, MHD tests, all at 230{degrees}C. The modified ALEX facility performed up to expectations in the testing. MHD pressure drop and test section voltage distributions were collected at Hartmann numbers of 1000.« less

Conversion of a room temperature NaK loop to a high temperature MHD facility for Li/V blanket testing

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

Reed, C.B.; Haglund, R.C.; Miller, M.E.

1996-12-31

The Vanadium/Lithium system has been the recent focus of ANL`s Blanket Technology Program, and for the last several years, ANL`s Liquid Metal Blanket activities have been carried out in direct support of the ITER (International Thermonuclear Experimental Reactor) breeding blanket task area. A key feasibility issue for the ITER Vanadium/Lithium breeding blanket is the development of insulator coatings. Design calculations, Hua and Gohar, show that an electrically insulating layer is necessary to maintain an acceptably low magnetohydrodynamic (MHD) pressure drop in the current ITER design. Consequently, the decision was made to convert Argonne`s Liquid Metal EXperiment (ALEX) from a 200{degree}Cmore » NaK facility to a 350{degree}C lithium facility. The upgraded facility was designed to produce MHD pressure drop data, test section voltage distributions, and heat transfer data for mid-scale test sections and blanket mockups at Hartmann numbers (M) and interaction parameters (N) in the range of 10{sup 3} to 10{sup 5} in lithium at 350{degree}C. Following completion of the upgrade work, a short performance test was conducted, followed by two longer, multiple-hour, MHD tests, all at 230{degree}C. The modified ALEX facility performed up to expectations in the testing. MHD pressure drop and test section voltage distributions were collected at Hartmann numbers of 1000. 4 refs., 2 figs.« less

Development of a decision support system for analysis and solutions of prolonged standing in the workplace.

PubMed

Halim, Isa; Arep, Hambali; Kamat, Seri Rahayu; Abdullah, Rohana; Omar, Abdul Rahman; Ismail, Ahmad Rasdan

2014-06-01

Prolonged standing has been hypothesized as a vital contributor to discomfort and muscle fatigue in the workplace. The objective of this study was to develop a decision support system that could provide systematic analysis and solutions to minimize the discomfort and muscle fatigue associated with prolonged standing. The integration of object-oriented programming and a Model Oriented Simultaneous Engineering System were used to design the architecture of the decision support system. Validation of the decision support system was carried out in two manufacturing companies. The validation process showed that the decision support system produced reliable results. The decision support system is a reliable advisory tool for providing analysis and solutions to problems related to the discomfort and muscle fatigue associated with prolonged standing. Further testing of the decision support system is suggested before it is used commercially.

Development of a Decision Support System for Analysis and Solutions of Prolonged Standing in the Workplace

PubMed Central

Halim, Isa; Arep, Hambali; Kamat, Seri Rahayu; Abdullah, Rohana; Omar, Abdul Rahman; Ismail, Ahmad Rasdan

2014-01-01

Background Prolonged standing has been hypothesized as a vital contributor to discomfort and muscle fatigue in the workplace. The objective of this study was to develop a decision support system that could provide systematic analysis and solutions to minimize the discomfort and muscle fatigue associated with prolonged standing. Methods The integration of object-oriented programming and a Model Oriented Simultaneous Engineering System were used to design the architecture of the decision support system. Results Validation of the decision support system was carried out in two manufacturing companies. The validation process showed that the decision support system produced reliable results. Conclusion The decision support system is a reliable advisory tool for providing analysis and solutions to problems related to the discomfort and muscle fatigue associated with prolonged standing. Further testing of the decision support system is suggested before it is used commercially. PMID:25180141

Evacuate or Shelter-in-place? The Role of Corporate Memory and Political Environment in Hospital-evacuation Decision Making.

PubMed

Ricci, Karen A; Griffin, Anne R; Heslin, Kevin C; Kranke, Derrick; Dobalian, Aram

2015-06-01

Hospital-evacuation decisions are rarely straightforward in protracted advance-warning events. Previous work provides little insight into the decision-making process around evacuation. This study was conducted to identify factors that most heavily influenced the decisions to evacuate the US Department of Veterans Affairs (VA) New York Harbor Healthcare System's (NYHHS; New York USA) Manhattan Campus before Hurricane Irene in 2011 and before Superstorm Sandy in 2012. Semi-structured interviews with 11 senior leaders were conducted on the processes and factors that influenced the evacuation decisions prior to each event. The most influential factor in the decision to evacuate the Manhattan Campus before Hurricane Irene was New York City's (NYC's) hospital-evacuation mandate. As a federal facility, the Manhattan VA medical center (VAMC) was exempt from the city's order, but decision makers felt compelled to comply. In the case of Superstorm Sandy, corporate memory of a similar 1992 storm that crippled the Manhattan facility drove the decision to evacuate before the storm hit. Results suggest that hospital-evacuation decisions are confounded by political considerations and are influenced by past disaster experience. Greater shared situational awareness among at-risk hospitals, along with a more coordinated approach to evacuation decision making, could reduce pressure on hospitals to make these high-stakes decisions. Systematic mechanisms for collecting, documenting, and sharing lessons learned from past disasters are sorely needed at the institutional, local, and national levels.

Developing the U.S. Wildland Fire Decision Support System

Treesearch

Erin Noonan-Wright; Tonja S. Opperman; Mark A. Finney; Tom Zimmerman; Robert C. Seli; Lisa M. Elenz; David E. Calkin; John R. Fiedler

2011-01-01

A new decision support tool, the Wildland Fire Decision Support System (WFDSS) has been developed to support risk-informed decision-making for individual fires in the United States. WFDSS accesses national weather data and forecasts, fire behavior prediction, economic assessment, smoke management assessment, and landscape databases to efficiently formulate and apply...

Decision Support for Ecosystem Management (Chapter 28)

Treesearch

Keith Reynolds; Jennifer Bjork; Rachel Riemann Hershey; Dan Schmoldt; John Payne; Susan King; Lee DeCola; Mark J. Twery; Pat Cunningham

1999-01-01

This chapter presents a management perspective on decision support for ecosystem management.The Introduction provides a brief historical overview of decision support technology as it has been used in natural resource management, discusses the role of decision support in ecosystem management as we see it, and summarizes the current state of the technology.

Education Leaders' Decision-Making Processes about Educational Facilities in a University Multiple Stakeholder Environment

ERIC Educational Resources Information Center

Kelting, Scott

2011-01-01

This research is a retrospective case study designed to document and analyze the process of decision-making by educational leaders and stakeholders at a four-year university. For this study, educational leaders and key stakeholders agreed to extensive interviews about the decisions made during the design, construction, and post-occupancy phases of…

76 FR 24064 - Arizona Public Service Company, Palo Verde Nuclear Generating Station, Units 1, 2, and 3, Notice...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-29

... Decision Notice is hereby given that the U.S. Nuclear Regulatory Commission (NRC, the Commission) has... notice also serves as the record of decision for Renewed Facility Operating License Nos. NPF-41, NPF-51... Decision--General.'' NUREG-1437, ``Generic Environmental Impact Statement for License Renewal of Nuclear...

Sample Federal Facility Land Use Control ROD Checklist and Suggested Language (LUC Checklist)

EPA Pesticide Factsheets

The LUC Checklist provides direction on describing and documenting land use controls (LUCs) in federal facility actrions under CERCLA in Records of Decision (RODs), remedial designs (RDs), and remedial action work plans (RAWPs).

SANDS: a service-oriented architecture for clinical decision support in a National Health Information Network.

PubMed

Wright, Adam; Sittig, Dean F

2008-12-01

In this paper, we describe and evaluate a new distributed architecture for clinical decision support called SANDS (Service-oriented Architecture for NHIN Decision Support), which leverages current health information exchange efforts and is based on the principles of a service-oriented architecture. The architecture allows disparate clinical information systems and clinical decision support systems to be seamlessly integrated over a network according to a set of interfaces and protocols described in this paper. The architecture described is fully defined and developed, and six use cases have been developed and tested using a prototype electronic health record which links to one of the existing prototype National Health Information Networks (NHIN): drug interaction checking, syndromic surveillance, diagnostic decision support, inappropriate prescribing in older adults, information at the point of care and a simple personal health record. Some of these use cases utilize existing decision support systems, which are either commercially or freely available at present, and developed outside of the SANDS project, while other use cases are based on decision support systems developed specifically for the project. Open source code for many of these components is available, and an open source reference parser is also available for comparison and testing of other clinical information systems and clinical decision support systems that wish to implement the SANDS architecture. The SANDS architecture for decision support has several significant advantages over other architectures for clinical decision support. The most salient of these are:

Whose decision is it anyway? How clinicians support decision-making participation after acquired brain injury.

PubMed

Knox, Lucy; Douglas, Jacinta M; Bigby, Christine

2013-01-01

To raise professional awareness of factors that may influence the support offered by clinicians to people with acquired brain injury (ABI), and to consider the potential implications of these factors in terms of post-injury rehabilitation and living. A review of the literature was conducted to identify factors that determine how clinicians provide support and influence opportunities for individuals with ABI to participate in decision making across the rehabilitation continuum. Clinical case studies are used to highlight two specific issues: (1) hidden assumptions on the part of the practitioner, and (2) perceptions of risk operating in clinical practice. There are a range of factors which may influence the decision-making support provided by clinicians and, ultimately, shape lifetime outcomes for individuals with ABI. A multidimensional framework may assist clinicians to identify relevant factors and consider their potential implications including those that influence how clinicians involved in supporting decision making approach this task. Participation in decision making is an undisputed human right and central to the provision of person-centred care. Further research is required to understand how clinical practice can maximise both opportunities and support for increased decision-making participation by individuals with ABI. There is an increasing focus on the rights of all individuals to be supported to participate in decision making about their life. A number of changes associated with ABI mean that individuals with ABI will require support with decision making. Clinicians have a critical role in providing this support over the course of the rehabilitation continuum. Clinicians need to be aware of the range of factors that may influence the decision-making support they provide. A multidimensional framework may be used by clinicians to identify influences on the decision-making support they provide.

Texas State Support for School Facilities, 1971 to 2001.

ERIC Educational Resources Information Center

Clark, Catherine

2001-01-01

Reviews 30 years of state efforts to support school-facilities construction and renovation in Texas. Describes recent state programs to provide direct funding for school facilities: Instructional Facilities Allotment, Existing Debt Allotment, and New Instructional Facilities Allotment. Although state funding of school facilities has increased,…

Withholding and withdrawing of life support from patients with severe head injury.

PubMed

O'Callahan, J G; Fink, C; Pitts, L H; Luce, J M

1995-09-01

To characterize the withholding or withdrawing of life support from patients with severe head injury. San Francisco General Hospital, a city and county hospital with a Level I trauma center. A standardized questionnaire was used to collect data on demographics and functional outcome of severely head-injured (Glasgow Coma Score of < or = 7) patients admitted to the medical-surgical intensive care unit, and to interview the patients' physician and family members. Forty-seven patients who were admitted to a medical-surgical intensive care unit over a 1-yr period. Twenty-four patients had life support withheld or withdrawn, and 23 patients did not. Physician and family separately assessed patient's probable functional outcome, degree of communication between them, reasons important in recommending or deciding on discontinuation of life support, and the result of action taken. Six months later, the families reviewed the process of their decision, how well physician(s) had communicated, and what might have improved communication. Of 24 patients with life support discontinued, 22 died; two were discharged from the hospital. Twenty-three of the 24 patients had a poor prognosis on admission. Of the 23 patients who were continued on life support for the duration of their hospitalization, ten had a poor (p < .001) prognosis on admission. Prognosis improved for two patients from the first group and five from the latter. Family's assessment of prognosis agreed with physician's assessment in 22 of the 24 patients from whom life support was discontinued (p < .001). Physicians' ability to convey the prognosis appeared to influence families' assessments. Physicians' considerations in recommending limitation of care and families' considerations in making decisions were the same, primarily an inevitably poor prognosis. Neither physician nor families cited cost or availability of care as a deciding factor. Two families disagreed with the recommendation to limit care after initial agreement because the patients' prognosis improved from "likely death" to "vegetative." Care was therefore continued, and both patients remained vegetative 6 months after admission to the hospital and discharge to chronic care facilities. Life support is commonly withheld or withdrawn from patients with severe head injury at San Francisco General Hospital, and usually it is accompanied by death. A reciprocal consideration exists in most cases between the physician and family making the difficult decision to limit care. Care is provided for patients whose families request it despite physician recommendations.

Future Challenges in Managing Human Health and Performance Risks for Space Flight

NASA Technical Reports Server (NTRS)

Corbin, Barbara J.; Barratt, Michael

2013-01-01

The global economy forces many nations to consider their national investments and make difficult decisions regarding their investment in future exploration. To enable safe, reliable, and productive human space exploration, we must pool global resources to understand and mitigate human health & performance risks prior to embarking on human exploration of deep space destinations. Consensus on the largest risks to humans during exploration is required to develop an integrated approach to mitigating risks. International collaboration in human space flight research will focus research on characterizing the effects of spaceflight on humans and the development of countermeasures or systems. Sharing existing data internationally will facilitate high quality research and sufficient power to make sound recommendations. Efficient utilization of ISS and unique ground-based analog facilities allows greater progress. Finally, a means to share results of human research in time to influence decisions for follow-on research, system design, new countermeasures and medical practices should be developed. Although formidable barriers to overcome, International working groups are working to define the risks, establish international research opportunities, share data among partners, share flight hardware and unique analog facilities, and establish forums for timely exchange of results. Representatives from the ISS partnership research and medical communities developed a list of the top ten human health & performance risks and their impact on exploration missions. They also drafted a multilateral data sharing plan to establish guidelines and principles for sharing human spaceflight data. Other working groups are also developing methods to promote international research solicitations. Collaborative use of analog facilities and shared development of space flight research and medical hardware continues. Establishing a forum for exchange of results between researchers, aerospace physicians and program managers takes careful consideration of researcher concerns and decision maker needs. Active participation by researchers in the development of this forum is essential, and the benefit can be tremendous. The ability to rapidly respond to research results without compromising publication rights and intellectual property will facilitate timely reduction in human health and performance risks in support of international exploration missions.

Toward the Modularization of Decision Support Systems

NASA Astrophysics Data System (ADS)

Raskin, R. G.

2009-12-01

Decision support systems are typically developed entirely from scratch without the use of modular components. This “stovepiped” approach is inefficient and costly because it prevents a developer from leveraging the data, models, tools, and services of other developers. Even when a decision support component is made available, it is difficult to know what problem it solves, how it relates to other components, or even that the component exists, The Spatial Decision Support (SDS) Consortium was formed in 2008 to organize the body of knowledge in SDS within a common portal. The portal identifies the canonical steps in the decision process and enables decision support components to be registered, categorized, and searched. This presentation describes how a decision support system can be assembled from modular models, data, tools and services, based on the needs of the Earth science application.

University lobbying

NASA Astrophysics Data System (ADS)

Richman, Barbara T.

In the past year, an increasing number of individual academic institutions have lobbied in Congress for new science facilities funds thus circumventing the traditional peer review process of evaluating the merits of such facilities. As an attempt to stem this rising tide, the National Academy of Sciences (NAS) governing council and the Association of American Universities (AAU) recently and independently issued strong statements condemning lobbying by individual universities and enthusiastically supporting the peer review system.“Informed peer judgments on the scientific merits of specific proposals, in open competition, should be a central element in the awarding of all federal funds for science,” the NAS resolution stated. AAU, meanwhile, implored “scientists, leaders of America's universities, and members of Congress” to “refrain from actions that would make scientific decisions a test of political influence rather than a judgment on the quality of the work to be done.” Roughly 50 research institutions constitute AAU; the two AAU Canadian members did not vote on the consortium's statement.

Improving Access to Institutional Delivery through Janani Shishu Suraksha Karyakram: Evidence from Rural Haryana, North India

PubMed Central

Salve, Harshal R.; Charlette, Lena; Kankaria, Ankita; Rai, Sanjay K.; Krishnan, Anand; Kant, Shashi

2017-01-01

Background: In India, Janani Shishu Suraksha Karyakaram (JSSK) was launched in the year 2011 to assure cashless institutional delivery to pregnant women, including free transport and diet. Objective: To assess the impact of JSSK on institutional delivery. Materials and Methods: A record review was done at the primary health care facility in Faridabad district of Haryana from August 2010 to March 2013. Focus group discussion/ informal interviews were carried out to get an insight about various factors determining use / non-use of health facilities for delivery. Results: Institutional delivery increased by almost 2.7 times (197 Vs 537) after launch of JSSK (p < 0.001). For institutional deliveries, the most important facilitator as well as barrier was identified as ambulance service under JSSK and pressure by elders in the family respectively. Conclusions: JSSK scheme had a positive impact on institutional deliveries. It should be supported with targeted intervention designed to facilitate appropriate decision-making at family level in order to address barriers to institutional delivery. PMID:28553021

Improving Access to Institutional Delivery through Janani Shishu Suraksha Karyakram: Evidence from Rural Haryana, North India.

PubMed

Salve, Harshal R; Charlette, Lena; Kankaria, Ankita; Rai, Sanjay K; Krishnan, Anand; Kant, Shashi

2017-01-01

In India, Janani Shishu Suraksha Karyakaram (JSSK) was launched in the year 2011 to assure cashless institutional delivery to pregnant women, including free transport and diet. To assess the impact of JSSK on institutional delivery. A record review was done at the primary health care facility in Faridabad district of Haryana from August 2010 to March 2013. Focus group discussion/ informal interviews were carried out to get an insight about various factors determining use / non-use of health facilities for delivery. Institutional delivery increased by almost 2.7 times (197 Vs 537) after launch of JSSK ( p < 0.001). For institutional deliveries, the most important facilitator as well as barrier was identified as ambulance service under JSSK and pressure by elders in the family respectively. JSSK scheme had a positive impact on institutional deliveries. It should be supported with targeted intervention designed to facilitate appropriate decision-making at family level in order to address barriers to institutional delivery.

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

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

Kruger, A. A.; Peeler, D. K.; Kim, D. S.

2015-11-23

The U.S. Department of Energy Office of River Protection (ORP) has initiated and leads an integrated Advanced Waste Glass (AWG) program to increase the loading of Hanford tank wastes in glass while meeting melter lifetime expectancies and process, regulatory, and product performance requirements. The integrated ORP program is focused on providing a technical, science-based foundation for making key decisions regarding the successful operation of the Hanford Tank Waste Treatment and Immobilization Plant (WTP) facilities in the context of an optimized River Protection Project (RPP) flowsheet. The fundamental data stemming from this program will support development of advanced glass formulations, keymore » product performance and process control models, and tactical processing strategies to ensure safe and successful operations for both the low-activity waste (LAW) and high-level waste vitrification facilities. These activities will be conducted with the objective of improving the overall RPP mission by enhancing flexibility and reducing cost and schedule.« less

Proposed Facility Modifications to Support Propulsion Systems Testing Under Simulated Space Conditions at Plum Brook Station's Spacecraft Propulsion Research Facility (B-2)

NASA Technical Reports Server (NTRS)

Edwards, Daryl A.

2008-01-01

Preparing NASA's Plum Brook Station's Spacecraft Propulsion Research Facility (B-2) to support NASA's new generation of launch vehicles has raised many challenges for B-2's support staff. The facility provides a unique capability to test chemical propulsion systems/vehicles while simulating space thermal and vacuum environments. Designed and constructed in the early 1960s to support upper stage cryogenic engine/vehicle system development, the Plum Brook Station B-2 facility will require modifications to support the larger, more powerful, and more advanced engine systems for the next generation of vehicles leaving earth's orbit. Engine design improvements over the years have included large area expansion ratio nozzles, greater combustion chamber pressures, and advanced materials. Consequently, it has become necessary to determine what facility changes are required and how the facility can be adapted to support varying customers and their specific test needs. Exhaust system performance, including understanding the present facility capabilities, is the primary focus of this work. A variety of approaches and analytical tools are being employed to gain this understanding. This presentation discusses some of the challenges in applying these tools to this project and expected facility configuration to support the varying customer needs.

Proposed Facility Modifications to Support Propulsion Systems Testing Under Simulated Space Conditions at Plum Brook Station's Spacecraft Propulsion Research Facility (B-2)

NASA Technical Reports Server (NTRS)

Edwards, Daryl A.

2007-01-01

Preparing NASA's Plum Brook Station's Spacecraft Propulsion Research Facility (B-2) to support NASA's new generation of launch vehicles has raised many challenges for B-2 s support staff. The facility provides a unique capability to test chemical propulsion systems/vehicles while simulating space thermal and vacuum environments. Designed and constructed 4 decades ago to support upper stage cryogenic engine/vehicle system development, the Plum Brook Station B-2 facility will require modifications to support the larger, more powerful, and more advanced engine systems for the next generation of vehicles leaving earth's orbit. Engine design improvements over the years have included large area expansion ratio nozzles, greater combustion chamber pressures, and advanced materials. Consequently, it has become necessary to determine what facility changes are required and how the facility can be adapted to support varying customers and their specific test needs. Instrumental in this task is understanding the present facility capabilities and identifying what reasonable changes can be implemented. A variety of approaches and analytical tools are being employed to gain this understanding. This paper discusses some of the challenges in applying these tools to this project and expected facility configuration to support the varying customer needs.

Numbers, systems, people: how interactions influence integration. Insights from case studies of HIV and reproductive health services delivery in Kenya.

PubMed

Mayhew, Susannah H; Sweeney, Sedona; Warren, Charlotte E; Collumbien, Martine; Ndwiga, Charity; Mutemwa, Richard; Lut, Irina; Colombini, Manuela; Vassall, Anna

2017-11-01

Drawing on rich data from the Integra evaluation of integrated HIV and reproductive-health services, we explored the interaction of systems hardware and software factors to explain why some facilities were able to implement and sustain integrated service delivery while others were not. This article draws on detailed mixed-methods data for four case-study facilities offering reproductive-health and HIV services between 2009 and 2013 in Kenya: (i) time-series client flow, tracking service uptake for 8841 clients; (ii) structured questionnaires with 24 providers; (iii) in-depth interviews with 17 providers; (iv) workload and facility data using a periodic activity review and cost-instruments; and (v) contextual data on external activities related to integration in study sites. Overall, our findings suggested that although structural factors like stock-outs, distribution of staffing and workload, rotation of staff can affect how integrated care is provided, all these factors can be influenced by staff themselves: both frontline and management. Facilities where staff displayed agency of decision making, worked as a team to share workload and had management that supported this, showed better integration delivery and staff were able to overcome some structural deficiencies to enable integrated care. Poor-performing facilities had good structural integration, but staff were unable to utilize this because they were poorly organized, unsupported or teams were dysfunctional. Conscientious objection and moralistic attitudes were also barriers.Integra has demonstrated that structural integration is not sufficient for integrated service delivery. Rather, our case studies show that in some cases excellent leadership and peer-teamwork enabled facilities to perform well despite resource shortages. The ability to provide support for staff to work flexibly to deliver integrated services and build resilient health systems to meet changing needs is particularly relevant as health systems face challenges of changing burdens of disease, climate change, epidemic outbreaks and more. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Systematic Review of Medical Informatics-Supported Medication Decision Making.

PubMed

Melton, Brittany L

2017-01-01

This systematic review sought to assess the applications and implications of current medical informatics-based decision support systems related to medication prescribing and use. Studies published between January 2006 and July 2016 which were indexed in PubMed and written in English were reviewed, and 39 studies were ultimately included. Most of the studies looked at computerized provider order entry or clinical decision support systems. Most studies examined decision support systems as a means of reducing errors or risk, particularly associated with medication prescribing, whereas a few studies evaluated the impact medical informatics-based decision support systems have on workflow or operations efficiency. Most studies identified benefits associated with decision support systems, but some indicate there is room for improvement.

UNAVCO facility support of NASA Dynamics of the Solid Earth (DOSE) GPS investigation for years 1995-1996

NASA Technical Reports Server (NTRS)

Ware, Randolph (Principal Investigator)

1996-01-01

This report consists of the following sections: a list of the NASA DOSE (Dynamics of the Solid Earth) Program Global Positioning System (GPS)-based campaigns supported by the UNAVCO (University Navstar Consortium) Boulder Facility; a list of NASA DOSE GPS permanent site installations supported by the UNAVCO Boulder Facility; and example science snapshots indicating the research projects supported with equipment and technical support available to DOSE Principal Investigators via the UNAVCO Boulder Facility.

The value of spatial analysis for tracking supply for family planning: the case of Kinshasa, DRC.

PubMed

Hernandez, Julie H; Akilimali, Pierre; Kayembe, Patrick; Dikamba, Nelly; Bertrand, Jane

2016-10-01

While geographic information systems (GIS) are frequently used to research accessibility issues for healthcare services around the world, sophisticated spatial analysis protocols and outputs often prove inappropriate and unsustainable to support evidence-based programme strategies in resource-constrained environments. This article examines how simple, open-source and interactive GIS tools have been used to locate family planning (FP) services delivery points in Kinshasa (Democratic Republic of Congo) and to identify underserved areas, determining the potential location of new service points, and to support advocacy for FP programmes. Using smartphone-based data collection applications (OpenDataKit), we conducted two surveys of FP facilities supported by partner organizations in 2012 and 2013 and used the results to assess gaps in FP services coverage, using both ratio of facilities per population and distance-based accessibility criteria. The cartographic outputs included both static analysis maps and interactive Google Earth displays, and sought to support advocacy and evidence-based planning for the placement of new service points. These maps, at the scale of Kinshasa or for each of the 35 health zones that cover the city, garnered a wide interest from the operational level of the health zones' Chief Medical Officers, who were consulted to contribute field knowledge on potential new service delivery points, to the FP programmes officers at the Ministry of Health, who could use the map to inform resources allocation decisions throughout the city. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Assessment of Ports for Offshore Wind Development in the United States

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

Elkinton, Chris; Blatiak, Alicia; Ameen, Hafsa

As offshore wind energy develops in the United States, port facilities will become strategic hubs in the offshore wind farm supply chain because all plant and transport logistics must transit through these facilities. Therefore, these facilities must provide suitable infrastructure to meet the specific requirements of the offshore wind industry. As a result, it is crucial that federal and state policy-makers and port authorities take effective action to position ports in the offshore wind value chain to take best advantage of their economic potential. The U.S. Department of Energy tasked the independent consultancy GL Garrad Hassan (GL GH) with carryingmore » out a review of the current capability of U.S. ports to support offshore wind project development and an assessment of the challenges and opportunities related to upgrading this capability to support the growth of as many as 54 gigawatts of offshore wind installed in U.S. waters by 2030. The GL GH report and the open-access web-based Ports Assessment Tool resulting from this study will aid decision-makers in making informed decisions regarding the choice of ports for specific offshore projects, and the types of investments that would be required to make individual port facilities suitable to serve offshore wind manufacturing, installation and/or operations. The offshore wind industry in the United States is still in its infancy and this study finds that additional port facilities capable of supporting offshore wind projects are needed to meet the anticipated project build-out by 2030; however, no significant barriers exist to prevent the development of such facilities. Furthermore, significant port capabilities are in place today with purpose-build port infrastructure currently being built. While there are currently no offshore wind farms operating in the United States, much of the infrastructure critical to the success of such projects does exist, albeit in the service of other industries. This conclusion is based on GL GH’s review of U.S. ports infrastructure and its readiness to support the development of proposed offshore wind projects in U.S. waters. Specific examples of facility costs and benefits are provided for five coastal regions (North Atlantic, South Atlantic, Gulf of Mexico, Great Lakes, and Pacific) around the country. GL GH began this study by identifying the logistical requirements of offshore wind ports to service offshore wind. This review was based on lessons learned through industry practice in Northern Europe. A web-based port readiness assessment tool was developed to allow a capability gap analysis to be conducted on existing port facilities based on the identified requirements. Cost models were added to the assessment tool, which allowed GL GH to estimate the total upgrade cost to a port over the period 2014-2030 based on a set of regional project build-out scenarios. Port fee information was gathered from each port allowing an estimate of the potential revenue to the port under this same set of scenarios. The comparison of these revenue and improvement cost figures provides an initial indication of the level of offshore wind port readiness. To facilitate a more in-depth infrastructure analysis, six ports from different geographic regions, with varied levels of interest and preparedness towards offshore wind, were evaluated by modeling a range of installation strategies and port use types to identify gaps in capability and potential opportunities for economic development. Commonalities, trends, and specific examples from these case studies are presented and provide a summary of the current state of offshore wind port readiness in the U.S. and also illustrate the direction some ports have chosen to take to prepare for offshore wind projects. For example, the land area required for wind turbine and foundation manufacturing is substantial, particularly due to the large size of offshore wind components. Also, the necessary bearing capacities of the quayside and storage area are typically greater for offshore wind components than for more conventional cargo handling. As a result, most U.S. ports will likely require soil strength improvements before they can fully support offshore wind project construction. As U.S. ports and offshore wind developers look to work together on specific projects, they will encounter synergies and challenges. The challenges they face will include identifying sources of funding for the facility improvements required, and addressing ports’ typical desire to engage in long-term partnerships on the order of 10-20 years. Early projects will especially feel these challenges as they set the precedent for these partnerships in the United States. This study seeks to provide information about gaps, costs, and opportunities to aid these discussions.« less

How to guide - transit operations decision support systems (TODSS).

DOT National Transportation Integrated Search

2014-12-01

Transit Operations Decision Support Systems (TODSS) are decision support systems designed to support dispatchers in real-time bus operations management in response to incidents, special events, and other changing conditions in order to restore servic...

Coupling sensing to crop models for closed-loop plant production in advanced life support systems

NASA Astrophysics Data System (ADS)

Cavazzoni, James; Ling, Peter P.

1999-01-01

We present a conceptual framework for coupling sensing to crop models for closed-loop analysis of plant production for NASA's program in advanced life support. Crop status may be monitored through non-destructive observations, while models may be independently applied to crop production planning and decision support. To achieve coupling, environmental variables and observations are linked to mode inputs and outputs, and monitoring results compared with model predictions of plant growth and development. The information thus provided may be useful in diagnosing problems with the plant growth system, or as a feedback to the model for evaluation of plant scheduling and potential yield. In this paper, we demonstrate this coupling using machine vision sensing of canopy height and top projected canopy area, and the CROPGRO crop growth model. Model simulations and scenarios are used for illustration. We also compare model predictions of the machine vision variables with data from soybean experiments conducted at New Jersey Agriculture Experiment Station Horticulture Greenhouse Facility, Rutgers University. Model simulations produce reasonable agreement with the available data, supporting our illustration.

Development of risk-based decision methodology for facility design.

DOT National Transportation Integrated Search

2014-06-01

This report develops a methodology for CDOT to use in the risk analysis of various types of facilities and provides : illustrative examples for the use of the proposed framework. An overview of the current practices and applications to : illustrate t...

Remedy Selection and Land Use at Federal Facilities

EPA Pesticide Factsheets

Analysis of approximately 98 percent of the interim and final source control Records of Decision signed at Federal Facilities on the NPL from the beginning of Superfund through August 1995. PB96-963309. EPA/540/R-96/020. August 1996

Facilities Information Management: A Guide for State and Local Education Agencies. NCES 2003-400

ERIC Educational Resources Information Center

National Center for Education Statistics (ED), Washington, DC.

This Guide has been developed to provide a framework for decision makers, school facility managers, and the public to identify a basic set of school facilities data elements, including definitions that will meet their information needs. Chapter 1 describes the purpose, scope, and intended audience for this guide. Chapter 2 describes how to use the…

Reducing Operating Costs by Optimizing Space in Facilities

DTIC Science & Technology

2012-03-01

Base level 5 engineering units will provide facility floor plans, furniture layouts, and staffing documentation as necessary. One obstacle...due to the quantity and diverse locations. Base level engineering units provided facility floor plans, furniture layouts, and staffing documentation... furniture purchases and placement 5. Follow a quality systematic process in all decisions The per person costs can be better understood with a real

A Decision Tool to Evaluate Budgeting Methodologies for Estimating Facility Recapitalization Requirements

DTIC Science & Technology

2008-03-01

1 . Maintenance Practices Influence Service Life .......................................................... 11 2 . Expectations or Standards May...BRB, 1991, p. 1 - 2 ) Additionally, public sector organizations typically have a larger inventory of facilities to maintain, making asset management...questions were answered. 1 . What are the long term causes and effects of under-funding the maintenance of facilities? 2 . What methods currently

CorRECTreatment: A Web-based Decision Support Tool for Rectal Cancer Treatment that Uses the Analytic Hierarchy Process and Decision Tree

PubMed Central

Karakülah, G.; Dicle, O.; Sökmen, S.; Çelikoğlu, C.C.

2015-01-01

Summary Background The selection of appropriate rectal cancer treatment is a complex multi-criteria decision making process, in which clinical decision support systems might be used to assist and enrich physicians’ decision making. Objective The objective of the study was to develop a web-based clinical decision support tool for physicians in the selection of potentially beneficial treatment options for patients with rectal cancer. Methods The updated decision model contained 8 and 10 criteria in the first and second steps respectively. The decision support model, developed in our previous study by combining the Analytic Hierarchy Process (AHP) method which determines the priority of criteria and decision tree that formed using these priorities, was updated and applied to 388 patients data collected retrospectively. Later, a web-based decision support tool named corRECTreatment was developed. The compatibility of the treatment recommendations by the expert opinion and the decision support tool was examined for its consistency. Two surgeons were requested to recommend a treatment and an overall survival value for the treatment among 20 different cases that we selected and turned into a scenario among the most common and rare treatment options in the patient data set. Results In the AHP analyses of the criteria, it was found that the matrices, generated for both decision steps, were consistent (consistency ratio<0.1). Depending on the decisions of experts, the consistency value for the most frequent cases was found to be 80% for the first decision step and 100% for the second decision step. Similarly, for rare cases consistency was 50% for the first decision step and 80% for the second decision step. Conclusions The decision model and corRECTreatment, developed by applying these on real patient data, are expected to provide potential users with decision support in rectal cancer treatment processes and facilitate them in making projections about treatment options. PMID:25848413

CorRECTreatment: a web-based decision support tool for rectal cancer treatment that uses the analytic hierarchy process and decision tree.

PubMed

Suner, A; Karakülah, G; Dicle, O; Sökmen, S; Çelikoğlu, C C

2015-01-01

The selection of appropriate rectal cancer treatment is a complex multi-criteria decision making process, in which clinical decision support systems might be used to assist and enrich physicians' decision making. The objective of the study was to develop a web-based clinical decision support tool for physicians in the selection of potentially beneficial treatment options for patients with rectal cancer. The updated decision model contained 8 and 10 criteria in the first and second steps respectively. The decision support model, developed in our previous study by combining the Analytic Hierarchy Process (AHP) method which determines the priority of criteria and decision tree that formed using these priorities, was updated and applied to 388 patients data collected retrospectively. Later, a web-based decision support tool named corRECTreatment was developed. The compatibility of the treatment recommendations by the expert opinion and the decision support tool was examined for its consistency. Two surgeons were requested to recommend a treatment and an overall survival value for the treatment among 20 different cases that we selected and turned into a scenario among the most common and rare treatment options in the patient data set. In the AHP analyses of the criteria, it was found that the matrices, generated for both decision steps, were consistent (consistency ratio<0.1). Depending on the decisions of experts, the consistency value for the most frequent cases was found to be 80% for the first decision step and 100% for the second decision step. Similarly, for rare cases consistency was 50% for the first decision step and 80% for the second decision step. The decision model and corRECTreatment, developed by applying these on real patient data, are expected to provide potential users with decision support in rectal cancer treatment processes and facilitate them in making projections about treatment options.

Energy Decision Science and Informatics | Integrated Energy Solutions |

Science.gov Websites

Science Advanced decision science methods include multi-objective and multi-criteria decision support. Our decision science methods, including multi-objective and multi-criteria decision support. For example, we

Multi-Country Analysis of Treatment Costs for HIV/AIDS (MATCH): Facility-Level ART Unit Cost Analysis in Ethiopia, Malawi, Rwanda, South Africa and Zambia

PubMed Central

Tagar, Elya; Sundaram, Maaya; Condliffe, Kate; Matatiyo, Blackson; Chimbwandira, Frank; Chilima, Ben; Mwanamanga, Robert; Moyo, Crispin; Chitah, Bona Mukosha; Nyemazi, Jean Pierre; Assefa, Yibeltal; Pillay, Yogan; Mayer, Sam; Shear, Lauren; Dain, Mary; Hurley, Raphael; Kumar, Ritu; McCarthy, Thomas; Batra, Parul; Gwinnell, Dan; Diamond, Samantha; Over, Mead

2014-01-01

Background Today's uncertain HIV funding landscape threatens to slow progress towards treatment goals. Understanding the costs of antiretroviral therapy (ART) will be essential for governments to make informed policy decisions about the pace of scale-up under the 2013 WHO HIV Treatment Guidelines, which increase the number of people eligible for treatment from 17.6 million to 28.6 million. The study presented here is one of the largest of its kind and the first to describe the facility-level cost of ART in a random sample of facilities in Ethiopia, Malawi, Rwanda, South Africa and Zambia. Methods & Findings In 2010–2011, comprehensive data on one year of facility-level ART costs and patient outcomes were collected from 161 facilities, selected using stratified random sampling. Overall, facility-level ART costs were significantly lower than expected in four of the five countries, with a simple average of $208 per patient-year (ppy) across Ethiopia, Malawi, Rwanda and Zambia. Costs were higher in South Africa, at $682 ppy. This included medications, laboratory services, direct and indirect personnel, patient support, equipment and administrative services. Facilities demonstrated the ability to retain patients alive and on treatment at these costs, although outcomes for established patients (2–8% annual loss to follow-up or death) were better than outcomes for new patients in their first year of ART (77–95% alive and on treatment). Conclusions This study illustrated that the facility-level costs of ART are lower than previously understood in these five countries. While limitations must be considered, and costs will vary across countries, this suggests that expanded treatment coverage may be affordable. Further research is needed to understand investment costs of treatment scale-up, non-facility costs and opportunities for more efficient resource allocation. PMID:25389777

Does physician communication style impact patient report of decision quality for breast cancer treatment?

PubMed

Martinez, Kathryn A; Resnicow, Ken; Williams, Geoffrey C; Silva, Marlene; Abrahamse, Paul; Shumway, Dean A; Wallner, Lauren P; Katz, Steven J; Hawley, Sarah T

2016-12-01

Provider communication that supports patient autonomy has been associated with numerous positive patient outcomes. However, to date, no research has examined the relationship between perceived provider communication style and patient-assessed decision quality in breast cancer. Using a population-based sample of women with localized breast cancer, we assessed patient perceptions of autonomy-supportive communication from their surgeons and medical oncologists, as well as patient-reported decision quality. We used multivariable linear regression to examine the association between autonomy-supportive communication and subjective decision quality for surgery and chemotherapy decisions, controlling for sociodemographic and clinical factors, as well as patient-reported communication preference (non-directive or directive). Among the 1690 women included in the overall sample, patient-reported decision quality scores were positively associated with higher levels of perceived autonomy-supportive communication from surgeons (β=0.30; p<0.001) and medical oncologists (β=0.26; p<0.001). Patient communication style preference moderated the association between physician communication style received and perceived decision quality. Autonomy-supportive communication by physicians was associated with higher subjective decision quality among women with localized breast cancer. These results support future efforts to design interventions that enhance autonomy-supportive communication. Autonomy-supportive communication by cancer doctors can improve patients' perceived decision quality. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Does physician communication style impact patient report of decision quality for breast cancer treatment?

PubMed Central

Resnicow, Ken; Williams, Geoffrey C.; Silva, Marlene; Abrahamse, Paul; Shumway, Dean; Wallner, Lauren; Katz, Steven; Hawley, Sarah

2016-01-01

Objective Provider communication that supports patient autonomy has been associated with numerous positive patient outcomes. However, to date, no research has examined the relationship between perceived provider communication style and patient-assessed decision quality in breast cancer. Methods Using a population-based sample of women with localized breast cancer, we assessed patient perceptions of autonomy-supportive communication from their surgeons and medical oncologists, as well as patient-reported decision quality. We used multivariable linear regression to examine the association between autonomy-supportive communication and subjective decision quality for surgery and chemotherapy decisions, controlling for sociodemographic and clinical factors, as well as patient-reported communication preference (non-directive or directive). Results Among the 1,690 women included in the overall sample, patient-reported decision quality scores were positively associated with higher levels of perceived autonomy-supportive communication from surgeons (β=0.30; p<0.001) and medical oncologists (β=0.26; p<0.001). Patient communication style preference moderated the association between physician communication style received and perceived decision quality. Conclusion Autonomy-supportive communication by physicians was associated with higher subjective decision quality among women with localized breast cancer. These results support future efforts to design interventions that enhance autonomy-supportive communication. Practice Implications Autonomy-supportive communication by cancer doctors can improve patients’ perceived decision quality. PMID:27395750

78 FR 79413 - Notice of Availability of Record of Decision for Hawaii-Southern California Training and Testing

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-30

... Decision (ROD) is available on the project Web site at http://www.hstteis.com , along with the Final... of the ROD are available upon request by contacting: Naval Facilities Engineering Command Pacific...

78 FR 72070 - Notice of Availability of Record of Decision for Atlantic Fleet Training and Testing

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-02

.... SUPPLEMENTARY INFORMATION: The complete text of the Record of Decision (ROD) is available on the project Web.... Single copies of the ROD are available upon request by contacting: Naval Facilities Engineering Command...

77 FR 75969 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-26

... rural areas by financing business facilities and community development. This purpose is achieved through... program decisions, and effectively monitor the intermediaries' activities to protect the Government's... instruments, loan agreements, and security, and other material necessary for prudent credit decisions and...

U.S. Offshore Wind Port Readiness

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

C. Elkinton, A. Blatiak, H. Ameen

2013-10-13

This study will aid decision-makers in making informed decisions regarding the choice of ports for specific offshore projects, and the types of investments that would be required to make individual port facilities suitable to serve offshore wind manufacturing, installation and/or operations.

Using Smartphones to Collect Bicycle Travel Data in Texas

DOT National Transportation Integrated Search

2012-08-08

Researchers believed that if smartphones could prove to be an effective tool for collecting bicycle travel data, the information could be used for aiding decision making as to what types of facilities users prefer and guiding decisions about future f...

Towards ethical decision support and knowledge management in neonatal intensive care.

PubMed

Yang, L; Frize, M; Eng, P; Walker, R; Catley, C

2004-01-01

Recent studies in neonatal medicine, clinical nursing, and cognitive psychology have indicated the need to augment current decision-making practice in neonatal intensive care units with computerized, intelligent decision support systems. Rapid progress in artificial intelligence and knowledge management facilitates the design of collaborative ethical decision-support tools that allow clinicians to provide better support for parents facing inherently difficult choices, such as when to withdraw aggressive treatment. The appropriateness of using computers to support ethical decision-making is critically analyzed through research and literature review. In ethical dilemmas, multiple diverse participants need to communicate and function as a team to select the best treatment plan. In order to do this, physicians require reliable estimations of prognosis, while parents need a highly useable tool to help them assimilate complex medical issues and address their own value system. Our goal is to improve and structuralize the ethical decision-making that has become an inevitable part of modern neonatal care units. The paper contributes to clinical decision support by outlining the needs and basis for ethical decision support and justifying the proposed development efforts.

Proof of concept for a banding scheme to support risk assessments related to multi-product biologics manufacturing.

PubMed

Card, Jeffrey W; Fikree, Hana; Haighton, Lois A; Blackwell, James; Felice, Brian; Wright, Teresa L

2015-11-01

A banding scheme theory has been proposed to assess the potency/toxicity of biologics and assist with decisions regarding the introduction of new biologic products into existing manufacturing facilities. The current work was conducted to provide a practical example of how this scheme could be applied. Information was identified for representatives from the following four proposed bands: Band A (lethal toxins); Band B (toxins and apoptosis signals); Band C (cytokines and growth factors); and Band D (antibodies, antibody fragments, scaffold molecules, and insulins). The potency/toxicity of the representative substances was confirmed as follows: Band A, low nanogram quantities exert lethal effects; Band B, repeated administration of microgram quantities is tolerated in humans; Band C, endogenous substances and recombinant versions administered to patients in low (interferons), intermediate (growth factors), and high (interleukins) microgram doses, often on a chronic basis; and Band D, endogenous substances present or produced in the body in milligram quantities per day (insulin, collagen) or protein therapeutics administered in milligram quantities per dose (mAbs). This work confirms that substances in Bands A, B, C, and D represent very high, high, medium, and low concern with regard to risk of cross-contamination in manufacturing facilities, thus supporting the proposed banding scheme. Copyright © 2015 Elsevier Inc. All rights reserved.

"Who'll do all these if I'm not around?": Bonding social capital and health and well-being of inpatients.

PubMed

Amoah, Padmore Adusei; Koduah, Adwoa Owusuaa; Gyasi, Razak Mohammed

2018-12-01

Although social capital influences health-related decisions and behavioural patterns in many developing countries, minimal attention has been paid to the nuances of its effect on healthcare. This paper examines how bonding social capital affects healthcare delivery for inpatients in Ghana. Semi-structured in-depth interviews were used and thematic analysis method employed to analyse the data. Interviews were conducted with health professionals and relatives and close friends of inpatients in three public health facilities in Ashanti region. Relatives and close friends of inpatients were a critical source of instrumental support such as provision of meals, laundry services, running errands and financial assistance as well as emotional support. These functions-that were both 'expected' and 'encouraged'- reduced the burden on the health facilities, which apparently had limited resources to offer adequate care. However, the relatives of inpatients sometimes inadvertently obstructed efficient healthcare delivery through actions such as extending 'unapproved' alternative care to patients. Moreover, the process of contributing towards health and well-being of the sick exposed the relatives to health risks due to poor living conditions. A well-defined and befitting role must be devised for at least an immediate social relation of inpatients to improve the positive effects of bonding social capital on healthcare delivery.

Implementation of workflow engine technology to deliver basic clinical decision support functionality

PubMed Central

2011-01-01

Background Workflow engine technology represents a new class of software with the ability to graphically model step-based knowledge. We present application of this novel technology to the domain of clinical decision support. Successful implementation of decision support within an electronic health record (EHR) remains an unsolved research challenge. Previous research efforts were mostly based on healthcare-specific representation standards and execution engines and did not reach wide adoption. We focus on two challenges in decision support systems: the ability to test decision logic on retrospective data prior prospective deployment and the challenge of user-friendly representation of clinical logic. Results We present our implementation of a workflow engine technology that addresses the two above-described challenges in delivering clinical decision support. Our system is based on a cross-industry standard of XML (extensible markup language) process definition language (XPDL). The core components of the system are a workflow editor for modeling clinical scenarios and a workflow engine for execution of those scenarios. We demonstrate, with an open-source and publicly available workflow suite, that clinical decision support logic can be executed on retrospective data. The same flowchart-based representation can also function in a prospective mode where the system can be integrated with an EHR system and respond to real-time clinical events. We limit the scope of our implementation to decision support content generation (which can be EHR system vendor independent). We do not focus on supporting complex decision support content delivery mechanisms due to lack of standardization of EHR systems in this area. We present results of our evaluation of the flowchart-based graphical notation as well as architectural evaluation of our implementation using an established evaluation framework for clinical decision support architecture. Conclusions We describe an implementation of a free workflow technology software suite (available at http://code.google.com/p/healthflow) and its application in the domain of clinical decision support. Our implementation seamlessly supports clinical logic testing on retrospective data and offers a user-friendly knowledge representation paradigm. With the presented software implementation, we demonstrate that workflow engine technology can provide a decision support platform which evaluates well against an established clinical decision support architecture evaluation framework. Due to cross-industry usage of workflow engine technology, we can expect significant future functionality enhancements that will further improve the technology's capacity to serve as a clinical decision support platform. PMID:21477364

Project Execution Plan for the Remote Handled Low-Level Waste Disposal Project

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

Danny Anderson

2014-07-01

As part of ongoing cleanup activities at the Idaho National Laboratory (INL), closure of the Radioactive Waste Management Complex (RWMC) is proceeding under the Comprehensive Environmental Response, Compensation, and Liability Act (42 USC 9601 et seq. 1980). INL-generated radioactive waste has been disposed of at RWMC since 1952. The Subsurface Disposal Area (SDA) at RWMC accepted the bulk of INL’s contact and remote-handled low-level waste (LLW) for disposal. Disposal of contact-handled LLW and remote-handled LLW ion-exchange resins from the Advanced Test Reactor in the open pit of the SDA ceased September 30, 2008. Disposal of remote-handled LLW in concrete disposalmore » vaults at RWMC will continue until the facility is full or until it must be closed in preparation for final remediation of the SDA (approximately at the end of fiscal year FY 2017). The continuing nuclear mission of INL, associated ongoing and planned operations, and Naval spent fuel activities at the Naval Reactors Facility (NRF) require continued capability to appropriately dispose of contact and remote handled LLW. A programmatic analysis of disposal alternatives for contact and remote-handled LLW generated at INL was conducted by the INL contractor in Fiscal Year 2006; subsequent evaluations were completed in Fiscal Year 2007. The result of these analyses was a recommendation to the Department of Energy (DOE) that all contact-handled LLW generated after September 30, 2008, be disposed offsite, and that DOE proceed with a capital project to establish replacement remote-handled LLW disposal capability. An analysis of the alternatives for providing replacement remote-handled LLW disposal capability has been performed to support Critical Decision-1. The highest ranked alternative to provide this required capability has been determined to be the development of a new onsite remote-handled LLW disposal facility to replace the existing remote-handled LLW disposal vaults at the SDA. Several offsite DOE and commercial disposal options exist for contact-handled LLW; however, offsite disposal options are either not currently available (i.e., commercial disposal facilities), practical, or cost-effective for all remote-handled LLW streams generated at INL. Offsite disposal of all INL and tenant-generated remote-handled waste is further complicated by issues associated with transporting highly radioactive waste in commerce; and infrastructure and processing changes at the generating facilities, specifically NRF, that would be required to support offsite disposal. The INL Remote-Handled LLW Disposal Project will develop a new remote handled LLW disposal facility to meet mission-critical, remote-handled LLW disposal needs. A formal DOE decision to proceed with the project has been made in accordance with the requirements of National Environmental Policy Act (42 USC§ 4321 et seq.). Remote-handled LLW is generated from nuclear programs conducted at INL, including spent nuclear fuel handling and operations at NRF and operations at the Advanced Test Reactor. Remote-handled LLW also will be generated by new INL programs and from segregation and treatment (as necessary) of remote handled scrap and waste currently stored in the Radioactive Scrap and Waste Facility at the Materials and Fuels Complex.« less

An Internationally Consented Standard for Nursing Process-Clinical Decision Support Systems in Electronic Health Records.

PubMed

Müller-Staub, Maria; de Graaf-Waar, Helen; Paans, Wolter

2016-11-01

Nurses are accountable to apply the nursing process, which is key for patient care: It is a problem-solving process providing the structure for care plans and documentation. The state-of-the art nursing process is based on classifications that contain standardized concepts, and therefore, it is named Advanced Nursing Process. It contains valid assessments, nursing diagnoses, interventions, and nursing-sensitive patient outcomes. Electronic decision support systems can assist nurses to apply the Advanced Nursing Process. However, nursing decision support systems are missing, and no "gold standard" is available. The study aim is to develop a valid Nursing Process-Clinical Decision Support System Standard to guide future developments of clinical decision support systems. In a multistep approach, a Nursing Process-Clinical Decision Support System Standard with 28 criteria was developed. After pilot testing (N = 29 nurses), the criteria were reduced to 25. The Nursing Process-Clinical Decision Support System Standard was then presented to eight internationally known experts, who performed qualitative interviews according to Mayring. Fourteen categories demonstrate expert consensus on the Nursing Process-Clinical Decision Support System Standard and its content validity. All experts agreed the Advanced Nursing Process should be the centerpiece for the Nursing Process-Clinical Decision Support System and should suggest research-based, predefined nursing diagnoses and correct linkages between diagnoses, evidence-based interventions, and patient outcomes.

A stochastic discrete optimization model for designing container terminal facilities

NASA Astrophysics Data System (ADS)

Zukhruf, Febri; Frazila, Russ Bona; Burhani, Jzolanda Tsavalista

2017-11-01

As uncertainty essentially affect the total transportation cost, it remains important in the container terminal that incorporates several modes and transshipments process. This paper then presents a stochastic discrete optimization model for designing the container terminal, which involves the decision of facilities improvement action. The container terminal operation model is constructed by accounting the variation of demand and facilities performance. In addition, for illustrating the conflicting issue that practically raises in the terminal operation, the model also takes into account the possible increment delay of facilities due to the increasing number of equipment, especially the container truck. Those variations expectantly reflect the uncertainty issue in the container terminal operation. A Monte Carlo simulation is invoked to propagate the variations by following the observed distribution. The problem is constructed within the framework of the combinatorial optimization problem for investigating the optimal decision of facilities improvement. A new variant of glow-worm swarm optimization (GSO) is thus proposed for solving the optimization, which is rarely explored in the transportation field. The model applicability is tested by considering the actual characteristics of the container terminal.

Use of the Physician Orders for Life-Sustaining Treatment program for patients being discharged from the hospital to the nursing facility.

PubMed

Hickman, Susan E; Nelson, Christine A; Smith-Howell, Esther; Hammes, Bernard J

2014-01-01

The Physician Orders for Life-Sustaining Treatment (POLST) documents patient preferences as medical orders that transfer across settings with patients. The objectives were to pilot test methods and gather preliminary data about POLST including (1) use at time of hospital discharge, (2) transfers across settings, and (3) consistency with prior decisions. Descriptive with chart abstraction and interviews. Participants were hospitalized patients discharged to a nursing facility and/or their surrogates in La Crosse County, Wisconsin. POLST forms were abstracted from hospital records for 151 patients. Hospital and nursing facility chart data were abstracted and interviews were conducted with an additional 39 patients/surrogates. Overall, 176 patients had valid POLST forms at the time of discharge from the hospital, and many (38.6%; 68/176) only documented code status. When the whole POLST was completed, orders were more often marked as based on a discussion with the patient and/or surrogate than when the form was used just for code status (95.1% versus 13.8%, p<.001). In the follow-up and interview sample, a majority (90.6%; 29/32) of POLST forms written in the hospital were unchanged up to three weeks after nursing facility admission. Most (71.9%; 23/32) appeared consistent with patient or surrogate recall of prior treatment decisions. POLST forms generated in the hospital do transfer with patients across settings, but are often used only to document code status. POLST orders appeared largely consistent with prior treatment decisions. Further research is needed to assess the quality of POLST decisions.

Chemotherapy and treatment scheduling: the Johns Hopkins Oncology Center Outpatient Department.

PubMed Central

Majidi, F.; Enterline, J. P.; Ashley, B.; Fowler, M. E.; Ogorzalek, L. L.; Gaudette, R.; Stuart, G. J.; Fulton, M.; Ettinger, D. S.

1993-01-01

The Chemotherapy and Treatment Scheduling System provides integrated appointment and facility scheduling for very complex procedures. It is fully integrated with other scheduling systems at The Johns Hopkins Oncology Center and is supported by the Oncology Clinical Information System (OCIS). It provides a combined visual and textual environment for the scheduling of events that have multiple dimensions and dependencies on other scheduled events. It is also fully integrated with other clinical decision support and ancillary systems within OCIS. The system has resulted in better patient flow through the ambulatory care areas of the Center. Implementing the system required changes in behavior among physicians, staff, and patients. This system provides a working example of building a sophisticated rule-based scheduling system using a relatively simple paradigm. It also is an example of what can be achieved when there is total integration between the operational and clinical components of patient care automation. PMID:8130453

STUDY ON SUPPORTING FOR DRAWING UP THE BCP FOR URBAN EXPRESSWAY NETWORK USING BY TRAFFIC SIMULATION SYSTEM

NASA Astrophysics Data System (ADS)

Yamawaki, Masashi; Shiraki, Wataru; Inomo, Hitoshi; Yasuda, Keiichi

The urban expressway network is an important infrastructure to execute a disaster restoration. Therefore, it is necessary to draw up the BCP (Business Continuity Plan) to enable securing of road user's safety and restoration of facilities, etc. It is important that each urban expressway manager execute decision and improvement of effective BCP countermeasures when disaster occurs by assuming various disaster situations. Then, in this study, we develop the traffic simulation system that can reproduce various disaster situations and traffic actions, and examine some methods supporting for drawing up the BCP for an urban expressway network. For disaster outside assumption such as tsunami generated by a huge earthquake, we examine some approaches securing safety of users and cars on the Hanshin Expressway Network as well as on general roads. And, we aim to propose a tsunami countermeasure not considered in the current urban expressway BCP.

Optimising reverse logistics network to support policy-making in the case of Electrical and Electronic Equipment.

PubMed

Achillas, Ch; Vlachokostas, Ch; Aidonis, D; Moussiopoulos, N; Iakovou, E; Banias, G

2010-12-01

Due to the rapid growth of Waste Electrical and Electronic Equipment (WEEE) volumes, as well as the hazardousness of obsolete electr(on)ic goods, this type of waste is now recognised as a priority stream in the developed countries. Policy-making related to the development of the necessary infrastructure and the coordination of all relevant stakeholders is crucial for the efficient management and viability of individually collected waste. This paper presents a decision support tool for policy-makers and regulators to optimise electr(on)ic products' reverse logistics network. To that effect, a Mixed Integer Linear Programming mathematical model is formulated taking into account existing infrastructure of collection points and recycling facilities. The applicability of the developed model is demonstrated employing a real-world case study for the Region of Central Macedonia, Greece. The paper concludes with presenting relevant obtained managerial insights. Copyright © 2010 Elsevier Ltd. All rights reserved.

Utility assessment of a map-based online geo-collaboration tool.

PubMed

Sidlar, Christopher L; Rinner, Claus

2009-05-01

Spatial group decision-making processes often include both informal and analytical components. Discussions among stakeholders or planning experts are an example of an informal component. When participants discuss spatial planning projects they typically express concerns and comments by pointing to places on a map. The Argumentation Map model provides a conceptual basis for collaborative tools that enable explicit linkages of arguments to the places to which they refer. These tools allow for the input of explicitly geo-referenced arguments as well as the visual access to arguments through a map interface. In this paper, we will review previous utility studies in geo-collaboration and evaluate a case study of a Web-based Argumentation Map application. The case study was conducted in the summer of 2005 when student participants discussed planning issues on the University of Toronto St. George campus. During a one-week unmoderated discussion phase, 11 participants wrote 60 comments on issues such as safety, facilities, parking, and building aesthetics. By measuring the participants' use of geographic references, we draw conclusions on how well the software tool supported the potential of the underlying concept. This research aims to contribute to a scientific approach to geo-collaboration in which the engineering of novel spatial decision support methods is complemented by a critical assessment of their utility in controlled, realistic experiments.

Military Medical Decision Support for Homeland Defense During Emergency

DTIC Science & Technology

2004-12-01

abstraction hierarchy, three levels of information requirement for designing emergency training interface are recognized. These are epistemological ...support human decision making process is considered to be decision-centric. A typical decision-centric interface is supported by at least four design ... Designing Emergency Training Interface ......................................................................................... 5 Epistemological

Geospatial Thinking of Information Professionals

ERIC Educational Resources Information Center

Bishop, Bradley Wade; Johnston, Melissa P.

2013-01-01

Geospatial thinking skills inform a host of library decisions including planning and managing facilities, analyzing service area populations, facility site location, library outlet and service point closures, as well as assisting users with their own geospatial needs. Geospatial thinking includes spatial cognition, spatial reasoning, and knowledge…

Bonds Boom.

ERIC Educational Resources Information Center

Reynolds, Cathryn

1989-01-01

The combined effect of the "Serrano" decision and Proposition 13 left California school districts with aging, overcrowded facilities. Chico schools won a $18.5 million general obligation bond election for facilities construction. With $11 billion needed for new school construction, California will need to tap local sources. A sidebar…

40 CFR 35.917-5 - Public participation.

Code of Federal Regulations, 2011 CFR

2011-07-01

... identification and evaluation of locations for waste water treatment facilities and of alternative treatment... treatment, reduce waste water volume, and encourage multiple use of facilities; (3) The evaluation of social... planning issues and decisions. (b) Basic Public Participation Program. Since waste water treatment...

Community Alternatives.

ERIC Educational Resources Information Center

Little (Arthur D.), Inc., Washington, DC.

This resource booklet offers communities alternatives to juvenile detention and correctional facilities. The range of possibilities to be considered in lieu of incarceration is made available to planners, advocates, and decision-makers. The use of detention, correctional facilities and alternatives is a function of the social, political and…

Expanding the Operational Use of Total Lightning Ahead of GOES-R

NASA Technical Reports Server (NTRS)

Stano, Geoffrey T.; Wood, Lance; Garner, Tim; Nunez, Roland; Kann, Deirdre; Reynolds, James; Rydell, Nezette; Cox, Rob; Bobb, William R.

2015-01-01

NASA's Short-term Prediction Research and Transition Center (SPoRT) has been transitioning real-time total lightning observations from ground-based lightning mapping arrays since 2003. This initial effort was with the local Weather Forecast Offices (WFO) that could use the North Alabama Lightning Mapping Array (NALMA). These early collaborations established a strong interest in the use of total lightning for WFO operations. In particular the focus started with warning decision support, but has since expanded to include impact-based decision support and lightning safety. SPoRT has used its experience to establish connections with new lightning mapping arrays as they become available. The GOES-R / JPSS Visiting Scientist Program has enabled SPoRT to conduct visits to new partners and expand the number of operational users with access to total lightning observations. In early 2014, SPoRT conducted the most recent visiting scientist trips to meet with forecast offices that will used the Colorado, Houston, and Langmuir Lab (New Mexico) lightning mapping arrays. In addition, SPoRT met with the corresponding Center Weather Service Units (CWSUs) to expand collaborations with the aviation community. These visits were an opportunity to learn about the forecast needs of each office visited as well as to provide on-site training for the use of total lightning, setting the stage for a real-time assessment during May-July 2014. With five lightning mapping arrays covering multiple geographic locations, the 2014 assessment has demonstrated numerous uses of total lightning in varying situations. Several highlights include a much broader use of total lightning for impact-based decision support ranging from airport weather warnings, supporting fire crews, and protecting large outdoor events. The inclusion of the CWSUs has broadened the operational scope of total lightning, demonstrating how these data can support air traffic management, particularly in the Terminal Radar Approach Control Facilities (TRACON) region around an airport. These collaborations continue to demonstrate, from the operational perspective, the utility of total lightning and the importance of continued training and preparation in advance of the Geostationary Lightning Mapper.

Legionella and risk management in hospitals-A bibliographic research methodology for people responsible for built environment and facility management.

PubMed

Leiblein, Thomas W; Tucker, Matthew; Ashall, Mal; Lee, Susanne B; Gollnisch, Carsten; Hofer, Susanne

2016-11-01

An ongoing research project investigates the roles and duties of persons responsible for the built environment with respect to risk management of water systems and Legionella prevention from a facility management's perspective. Our literature review provides an approach for selecting and analysing abstracts of initially 177 journal articles, subjected to certain topic-specific inclusion and exclusion criteria. Different decision strategies of either logic 'yes/no', Boolean operators 'OR' or 'AND' and decisions for single counts or cumulative counts of the identified three principal keywords 'Legionella', 'hospital' and 'water', were completed. A final list of ten principal reference articles from 29 journals was compiled. It suggests that the interconnected perspective of water systems, Legionella and hospitals seems to be underrepresented in the field of the built environment and facility management. The term 'stakeholder', which would refer to decision-makers, was not found more than once. Our result is a useful summary of established sources of information on environmental Legionella research. The results can be helpful for those new to the topic. Copyright © 2016 Elsevier GmbH. All rights reserved.

Semantic Clinical Guideline Documents

PubMed Central

Eriksson, Henrik; Tu, Samson W.; Musen, Mark

2005-01-01

Decision-support systems based on clinical practice guidelines can support physicians and other health-care personnel in the process of following best practice consistently. A knowledge-based approach to represent guidelines makes it possible to encode computer-interpretable guidelines in a formal manner, perform consistency checks, and use the guidelines directly in decision-support systems. Decision-support authors and guideline users require guidelines in human-readable formats in addition to computer-interpretable ones (e.g., for guideline review and quality assurance). We propose a new document-oriented information architecture that combines knowledge-representation models with electronic and paper documents. The approach integrates decision-support modes with standard document formats to create a combined clinical-guideline model that supports on-line viewing, printing, and decision support. PMID:16779037

Overcoming the Challenges Inherent in Conducting Design Research in Mental Health Settings: Lessons from St. Joseph's Healthcare, Hamilton's Pre and Post-Occupancy Evaluation.

PubMed

Ahern, Catherine; McKinnon, Margaret C; Bieling, Peter J; McNeely, Heather; Langstaff, Karen

2016-01-01

Conducting high-quality design research in a mental health setting presents significant challenges, limiting the availability of high-quality evidence to support design decisions for built environments. Here, we outline key approaches to overcoming these challenges. In conducting a rigorous post-occupancy evaluation of a newly built mental health and addictions facility, St. Joseph's Healthcare, Hamilton, we identified a number of systematic barriers associated with conducting design research in mental health settings. Our approach to overcoming these barriers relied heavily upon (i) selecting established measures and methods with demonstrated efficacy in a mental health context, (ii) navigating institutional protocols designed to protect vulnerable members of this population, and (iii) designing innovative data collection strategies to increase participation in research by individuals with mental illness. Each of these approaches drew heavily on the expert knowledge of mental health settings and the experiences with mental health, facilities management, and research of a research team that was well integrated within the parent institution. Engaging multiple stakeholders (e.g., care providers, patients, ethics board, and hospital administrators) contributed their trust and support of the research. Traditionally, post-occupancy evaluation researchers are independent of the facilities they research, yet this is not an effective approach in mental health settings. We found that, in working toward solutions to the three obstacles we described, having team members who were well "networked" within the parent institution was necessary. This approach can turn "gatekeepers" into champions for patients' engagement in the research, which is essential in generating high-quality evidence. © The Author(s) 2015.

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

Dowell, Jonathan; Franco, Joe

The discussion of Hanford's River Corridor will cover work that has already been completed plus the work remaining to be done. This includes the buildings, waste sites, and groundwater plumes in the 300 Area; large-scale burial ground remediation in the 600 Area; plutonium production reactor dismantling and 'cocooning' along the river; preservation of the world's first full-scale plutonium production reactor; removal of more than 14 million tons of contaminated soil and debris along the Columbia River shoreline and throughout the River Corridor; and the excavation of buried waste sites in the river shore area. It also includes operating an EPA-permittedmore » low-level waste disposal facility in the central portion of the site. At the completions of cleanup in 2015, Hanford's River Corridor will be the largest closure project ever completed by the Department of Energy. Cleanup of the River Corridor has been one of Hanford's top priorities since the early 1990's. This urgency has been due to the proximity of hundreds of waste sites to the Columbia River. In addition, removal of the sludge from K West Basin, near the river, remains a high priority. This 220-square-mile area of the Hanford Site sits on the edge of the last free-flowing stretch of the Columbia River. The River Corridor portion of the Hanford Site includes the 100 and 300 Areas along the south shore of the Columbia River. The 100 Areas contain nine retired plutonium production reactors. These areas are also the location of numerous support facilities and solid and liquid waste disposal sites that have contaminated groundwater and soil. The 300 Area, located just north of the city of Richland, contains fuel fabrication facilities, nuclear research and development facilities, and their associated solid and liquid waste disposal sites that have contaminated groundwater and soil. In order to ensure that cleanup actions address all threats to human health and the environment, the River Corridor includes the adjacent areas that extend from the 100 Area and 300 Area to the Central Plateau. For sites in the River Corridor, remedial actions are expected to restore groundwater to drinking water standards and ensure that aquatic life in the Columbia River is protected by achieving ambient water quality standards. It is intended that these objectives be achieved, unless technically impracticable, within a reasonable timeframe. In those instances where remedial action objectives are not achievable in a reasonable time frame, or are determined to be technically impracticable, programs are being implemented to contain the plume, prevent exposure to contaminated groundwater, and evaluate further risk reduction opportunities as new technologies become available. River Corridor cleanup work also removes potential sources of contamination, which are close to the Columbia River, and places them on the Central Plateau for final disposal. The intent is to shrink the footprint of active cleanup to within the 75-square- mile area of the Central Plateau by removing excess facilities and remediating waste sites. Cleanup actions are supporting anticipated future land uses consistent with the Hanford Reach National Monument, where applicable, and the Hanford Comprehensive Land- Use Plan (DOE 1999). The River Corridor has been divided into six geographic decision areas to achieve source and groundwater remedy decisions. These decisions will provide comprehensive coverage for all areas within the River Corridor and will incorporate ongoing interim action cleanup activities. Cleanup levels will be achieved in order to support anticipated future land uses of conservation and preservation for most of this area and industrial use for the 300 Area. At the conclusion of cleanup actions, the federal government will implement long-term stewardship activities to ensure protection of human health and the environment. (authors)« less

Revealed access to haemodialysis facilities in northeastern Iran: Factors that matter in rural and urban areas.

PubMed

Kiani, Behzad; Bagheri, Nasser; Tara, Ahmad; Hoseini, Benyamin; Tabesh, Hamed; Tara, Mahmood

2017-11-07

Poor access to haemodialysis facilities is associated with high mortality and morbidity rates. This study investigated factors affecting revealed access to the haemodialysis facilities considering patients living in rural and urban areas without any haemodialysis facility (Group A) and those living urban areas with haemodialysis facilities (Group B). This study is based on selfreported Actual Access Time (AAT) to referred haemodialysis facilities and other information regarding travel to haemodialysis facilities from patients. All significant variables on univariate analysis were entered into a univariate general linear model in order to identify factors associated with AAT. Both spatial (driving time and distance) and non-spatial factors (sex, income level, caregivers, transportation mode, education level, ethnicity and personal vehicle ownership) influenced the revealed access identified in Group A. The non-spatial factors for Group B patients were the same as for Group A, but no spatial factor was identified in Group B. It was found that accessibility is strongly underestimated when driving time is chosen as accessibility measure to haemodialysis facilities. Analysis of revealed access determinants provides policymakers with an appropriate decision base for making appropriate decisions and finding solutions to decrease the access time for patients under haemodialysis therapy. Driving time alone is not a good proxy for measuring access to haemodialysis facilities as there are many other potential obstacles, such as women's special travel problems, poor other transportation possibilities, ethnicity disparities, low education levels, low caregiver status and low-income.

A Methodology to Support Decision Making in Flood Plan Mitigation

NASA Astrophysics Data System (ADS)

Biscarini, C.; di Francesco, S.; Manciola, P.

2009-04-01

The focus of the present document is on specific decision-making aspects of flood risk analysis. A flood is the result of runoff from rainfall in quantities too great to be confined in the low-water channels of streams. Little can be done to prevent a major flood, but we may be able to minimize damage within the flood plain of the river. This broad definition encompasses many possible mitigation measures. Floodplain management considers the integrated view of all engineering, nonstructural, and administrative measures for managing (minimizing) losses due to flooding on a comprehensive scale. The structural measures are the flood-control facilities designed according to flood characteristics and they include reservoirs, diversions, levees or dikes, and channel modifications. Flood-control measures that modify the damage susceptibility of floodplains are usually referred to as nonstructural measures and may require minor engineering works. On the other hand, those measures designed to modify the damage potential of permanent facilities are called non-structural and allow reducing potential damage during a flood event. Technical information is required to support the tasks of problem definition, plan formulation, and plan evaluation. The specific information needed and the related level of detail are dependent on the nature of the problem, the potential solutions, and the sensitivity of the findings to the basic information. Actions performed to set up and lay out the study are preliminary to the detailed analysis. They include: defining the study scope and detail, the field data collection, a review of previous studies and reports, and the assembly of needed maps and surveys. Risk analysis can be viewed as having many components: risk assessment, risk communication and risk management. Risk assessment comprises an analysis of the technical aspects of the problem, risk communication deals with conveying the information and risk management involves the decision process. In the present paper we propose a novel methodology for supporting the priority setting in the assessment of such issues, beyond the typical "expected value" approach. Scientific contribution and management aspects are merged to create a simplified method for plan basin implementation, based on risk and economic analyses. However, the economic evaluation is not the sole criterion for flood-damage reduction plan selection. Among the different criteria that are relevant to the decision process, safety and quality of human life, economic damage, expenses related with the chosen measures and environmental issues should play a fundamental role on the decisions made by the authorities. Some numerical indices, taking in account administrative, technical, economical and risk aspects, are defined and are combined together in a mathematical formula that defines a Priority Index (PI). In particular, the priority index defines a ranking of priority interventions, thus allowing the formulation of the investment plan. The research is mainly focused on the technical factors of risk assessment, providing quantitative and qualitative estimates of possible alternatives, containing measures of the risk associated with those alternatives. Moreover, the issues of risk management are analyzed, in particular with respect to the role of decision making in the presence of risk information. However, a great effort is devoted to make this index easy to be formulated and effective to allow a clear and transparent comparison between the alternatives. Summarizing this document describes a major- steps for incorporation of risk analysis into the decision making process: framing of the problem in terms of risk analysis, application of appropriate tools and techniques to obtain quantified results, use of the quantified results in the choice of structural and non-structural measures. In order to prove the reliability of the proposed methodology and to show how risk-based information can be incorporated into a flood analysis process, its application to some middle italy river basins is presented. The methodology assessment is performed by comparing different scenarios and showing that the optimal decision stems from a feasibility evaluation.

Using Best Practices to Extract, Organize, and Reuse Embedded Decision Support Content Knowledge Rules from Mature Clinical Systems.

PubMed

DesAutels, Spencer J; Fox, Zachary E; Giuse, Dario A; Williams, Annette M; Kou, Qing-Hua; Weitkamp, Asli; Neal R, Patel; Bettinsoli Giuse, Nunzia

2016-01-01

Clinical decision support (CDS) knowledge, embedded over time in mature medical systems, presents an interesting and complex opportunity for information organization, maintenance, and reuse. To have a holistic view of all decision support requires an in-depth understanding of each clinical system as well as expert knowledge of the latest evidence. This approach to clinical decision support presents an opportunity to unify and externalize the knowledge within rules-based decision support. Driven by an institutional need to prioritize decision support content for migration to new clinical systems, the Center for Knowledge Management and Health Information Technology teams applied their unique expertise to extract content from individual systems, organize it through a single extensible schema, and present it for discovery and reuse through a newly created Clinical Support Knowledge Acquisition and Archival Tool (CS-KAAT). CS-KAAT can build and maintain the underlying knowledge infrastructure needed by clinical systems.