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Sample records for demand side management

  1. System Demand-Side Management: Regional results

    SciTech Connect

    Englin, J.E.; Sands, R.D.; De Steese, J.G.; Marsh, S.J.

    1990-05-01

    To improve the Bonneville Power Administration's (Bonneville's) ability to analyze the value and impacts of demand-side programs, Pacific Northwest Laboratory (PNL) developed and implemented the System Demand-Side Management (SDSM) model, a microcomputer-based model of the Pacific Northwest Public Power system. This document outlines the development and application of the SDSM model, which is an hourly model. Hourly analysis makes it possible to examine the change in marginal revenues and marginal costs that accrue from the movement of energy consumption from daytime to nighttime. It also allows a more insightful analysis of programs such as water heater control in the context of hydroelectric-based generation system. 7 refs., 10 figs., 10 tabs.

  2. Industrial demand side management status report: Synopsis

    SciTech Connect

    Hopkins, M.E.F.; Conger, R.L.; Foley, T.J.; Parker, J.W.; Placet, M.; Sandahl, L.J.; Spanner, G.E.; Woodruff, M.G.; Norland, D.

    1995-08-01

    Industrial demand side management (DSM) programs, though not as developed or widely implemented as residential and commercial programs, hold the promise of significant energy savings-savings that will benefit industrial firms, utilities and the environment. This paper is a synopsis of a larger research report, Industrial Demand Side Management. A Status Report, prepared for the US Department of Energy. The report provides an overview of and rationale for DSM programs. Benefits and barriers are described, and data from the Manufacturing Energy Consumption Survey are used to estimate potential electricity savings from industrial energy efficiency measures. Overcoming difficulties to effective program implementation is worthwhile, since rough estimates indicate a substantial potential for electricity savings. The report categorizes types of DSM programs, presents several examples of each type, and explores elements of successful programs. Two in-depth case studies (of Boise Cascade and of Eli Lilly and Company) illustrate two types of effective DSM programs. Interviews with staff from state public utility commissions indicate the current thinking about the status and future of industrial DSM programs. Finally, the research report also includes a comprehensive bibliography, a description of technical assistance programs, and an example of a methodology for evaluating potential or actual savings from projects.

  3. Industrial demand side management: A status report

    SciTech Connect

    Hopkins, M.F.; Conger, R.L.; Foley, T.J.

    1995-05-01

    This report provides an overview of and rationale for industrial demand side management (DSM) programs. Benefits and barriers are described, and data from the Manufacturing Energy Consumption Survey are used to estimate potential energy savings in kilowatt hours. The report presents types and examples of programs and explores elements of successful programs. Two in-depth case studies (from Boise Cascade and Eli Lilly and Company) illustrate two types of effective DSM programs. Interviews with staff from state public utility commissions indicate the current thinking about the status and future of industrial DSM programs. A comprehensive bibliography is included, technical assistance programs are listed and described, and a methodology for evaluating potential or actual savings from projects is delineated.

  4. Incentives for demand-side management

    SciTech Connect

    Reid, M.W.; Brown, J.B.

    1992-01-01

    This report is the first product of an ongoing project to monitor the efforts of states to remove regulatory barriers to, and provide financial incentives for, utility investment in demand-side management (DSM) resources. The project was commissioned by the National Association of Regulatory Utility Commissioners (NARUC) in response to growing interest among regulators for a comprehensive survey of developments in this area. Each state report beings with an overview of the state`s progress toward removing regulatory barriers and providing incentives for DSM. Information is organized under five headings: status; IRP regulations and practice; current treatment of DSM, directions and trends; commission contact person. Where applicable, each overview is followed by one or more sections that report on specific incentive proposals or mechanisms within the state. Information on each proposal or mechanism is organized under eight headings. A notation on each page identifies the utility or other group associated with the proposal or mechanism. The eight headings are as follows: status; background; treatment of cost recovery; treatment of lost revenues/decoupling; treatment of profitability; other features; issues, and additional observations.

  5. Incentives for demand-side management

    SciTech Connect

    Reid, M.W.; Brown, J.B. )

    1992-01-01

    This report is the first product of an ongoing project to monitor the efforts of states to remove regulatory barriers to, and provide financial incentives for, utility investment in demand-side management (DSM) resources. The project was commissioned by the National Association of Regulatory Utility Commissioners (NARUC) in response to growing interest among regulators for a comprehensive survey of developments in this area. Each state report beings with an overview of the state's progress toward removing regulatory barriers and providing incentives for DSM. Information is organized under five headings: status; IRP regulations and practice; current treatment of DSM, directions and trends; commission contact person. Where applicable, each overview is followed by one or more sections that report on specific incentive proposals or mechanisms within the state. Information on each proposal or mechanism is organized under eight headings. A notation on each page identifies the utility or other group associated with the proposal or mechanism. The eight headings are as follows: status; background; treatment of cost recovery; treatment of lost revenues/decoupling; treatment of profitability; other features; issues, and additional observations.

  6. U.S. electric utility demand-side management 1993

    SciTech Connect

    1995-07-01

    This report presents comprehensive information on electric power industry demand-side management activities in the United States at the national, regional, and utility levels. Data is included for energy savings, peakload reductions, and costs.

  7. U.S. electric utility demand-side management 1996

    SciTech Connect

    1997-12-01

    The US Electric Utility Demand-Side Management report presents comprehensive information on electric power industry demand-side management (DSM) activities in the US at the national, regional, and utility levels. The objective of the publication is to provide industry decision makers, government policy makers, analysts, and the general public with historical data that may be used in understanding DSM as it related to the US electric power industry. The first chapter, ``Profile: U.S. Electric Utility Demand-Side Management,`` presents a general discussion of DSM, its history, current issues, and a review of key statistics for the year. Subsequent chapters present discussions and more detailed data on energy savings, peak load reductions and costs attributable to DSM. 9 figs., 24 tabs.

  8. U.S. electric utility demand-side management 1995

    SciTech Connect

    1997-01-01

    The US Electric Utility Demand-Side Management report is prepared by the Coal and Electric Data and Renewables Division; Office of Coal, Nuclear, Electric and Alternative Fuels; Energy Information Administration (EIA); US Department of Energy. The report presents comprehensive information on electric power industry demand-side management (DSM) activities in the US at the national, regional, and utility levels. The objective of the publication is to provide industry decision makers, government policy makers, analysts, and the general public with historical data that may be used in understanding DSM as it relates to the US electric power industry. The first chapter, ``Profile: US Electric Utility Demand-Side Management``, presents a general discussion of DSM, its history, current issues, and a review of key statistics for the year. Subsequent chapters present discussions and more detailed data on energy savings, peak load reductions and costs attributable to DSM. 9 figs., 24 tabs.

  9. US electric utility demand-side management, 1994

    SciTech Connect

    1995-12-26

    The report presents comprehensive information on electric power industry demand-side management (DSM) activities in US at the national, regional, and utility levels. Objective is provide industry decision makers, government policy makers, analysts, and the general public with historical data that may be used in understanding DSM as it relates to the US electric power industry. The first chapter, ``Profile: US Electric Utility Demand-Side Management,`` presents a general discussion of DSM, its history, current issues, and a review of key statistics for the year. Subsequent chapters present discussions and more detailed data on energy savings, peak load reductions, and costs attributable to DSM.

  10. Demand Side Management: An approach to peak load smoothing

    NASA Astrophysics Data System (ADS)

    Gupta, Prachi

    A preliminary national-level analysis was conducted to determine whether Demand Side Management (DSM) programs introduced by electric utilities since 1992 have made any progress towards their stated goal of reducing peak load demand. Estimates implied that DSM has a very small effect on peak load reduction and there is substantial regional and end-user variability. A limited scholarly literature on DSM also provides evidence in support of a positive effect of demand response programs. Yet, none of these studies examine the question of how DSM affects peak load at the micro-level by influencing end-users' response to prices. After nearly three decades of experience with DSM, controversy remains over how effective these programs have been. This dissertation considers regional analyses that explore both demand-side solutions and supply-side interventions. On the demand side, models are estimated to provide in-depth evidence of end-user consumption patterns for each North American Electric Reliability Corporation (NERC) region, helping to identify sectors in regions that have made a substantial contribution to peak load reduction. The empirical evidence supports the initial hypothesis that there is substantial regional and end-user variability of reductions in peak demand. These results are quite robust in rapidly-urbanizing regions, where air conditioning and lighting load is substantially higher, and regions where the summer peak is more pronounced than the winter peak. It is also evident from the regional experiences that active government involvement, as shaped by state regulations in the last few years, has been successful in promoting DSM programs, and perhaps for the same reason we witness an uptick in peak load reductions in the years 2008 and 2009. On the supply side, we estimate the effectiveness of DSM programs by analyzing the growth of capacity margin with the introduction of DSM programs. The results indicate that DSM has been successful in offsetting the

  11. Demand Side Management in Pellet Production: Internal and External Factors

    NASA Astrophysics Data System (ADS)

    Vigants, Haralds; Blumberga, Dagnija; Veidenbergs, Ivars

    2014-12-01

    This paper demonstrates a demand side management case study: how to save energy and how research and data analysis help to create an energy management system in a pellet production facility; and shows ways to implement the EU energy efficiency directive in production facilities. The study carried out in this research serves as a far-reaching step that can be taken to improve energy efficiency during the operation mode of technological equipment. The benchmarking methodology is used for analysis of results. Internal and external factors and indicators, which affect energy management potential in pellet production are analysed. Analysis of external factors is based on the state legal framework regulating the development of the energy sector. Methodology on the analysis of energy demand includes the internal energy management of an enterprise. The experimental results discussed in this paper show that particular steps, which are oriented to specific use of technological equipment, could play significant role in energy efficiency improvement in industry which is illustrated by the pre-milling process in the pellet production system using power.

  12. Intelligent demand side management of residential building energy systems

    NASA Astrophysics Data System (ADS)

    Sinha, Maruti N.

    Advent of modern sensing technologies, data processing capabilities and rising cost of energy are driving the implementation of intelligent systems in buildings and houses which constitute 41% of total energy consumption. The primary motivation has been to provide a framework for demand-side management and to improve overall reliability. The entire formulation is to be implemented on NILM (Non-Intrusive Load Monitoring System), a smart meter. This is going to play a vital role in the future of demand side management. Utilities have started deploying smart meters throughout the world which will essentially help to establish communication between utility and consumers. This research is focused on investigation of a suitable thermal model of residential house, building up control system and developing diagnostic and energy usage forecast tool. The present work has considered measurement based approach to pursue. Identification of building thermal parameters is the very first step towards developing performance measurement and controls. The proposed identification technique is PEM (Prediction Error Method) based, discrete state-space model. The two different models have been devised. First model is focused toward energy usage forecast and diagnostics. Here one of the novel idea has been investigated which takes integral of thermal capacity to identify thermal model of house. The purpose of second identification is to build up a model for control strategy. The controller should be able to take into account the weather forecast information, deal with the operating point constraints and at the same time minimize the energy consumption. To design an optimal controller, MPC (Model Predictive Control) scheme has been implemented instead of present thermostatic/hysteretic control. This is a receding horizon approach. Capability of the proposed schemes has also been investigated.

  13. Guidebook for Farmstead Demand-Side Management (DSM) program design

    SciTech Connect

    Rose, M.; Camera, R.K.

    1992-02-21

    The acceptance and growth of Demand-Side Management (DSM) continues to increase in the US. According to latest estimates, total expenditures on electric utility DSM programs now exceed $1.2 billion annually, with these investments ranging from 1 to 5 percent of a utility's gross revenues. In addition, due to increasing environmental concerns and the high cost of new capacity, these expenditure levels are expected to increase. While the vast majority of these DSM programs are directed at the more traditional residential, commercial and industrial market sectors, significant opportunities still exist. One market segment that has not been the focus of attention but a critical sector from an economic development perspective for marry utilities -- is the agricultural and farmstead market. Although the total number of farms in the United States decreased by approximately 5 percent between 1985 and 1989, the land dedicated to farming still accounts for over 995 million acres. Furthermore, the total value of farm output in the United States has been steadily increasing since 1986. The limited penetration of energy efficiency measures in farmsteads provides an excellent opportunity for utilities to expand their DSM programming efforts to capture this non-traditional'' market segment, and at the same time assist farms in increasing their efficiency and competitiveness. In marry states, and, in particular New York State, agriculture plays a major economic role. The importance of farms not only from a utility perspective but also from a state and federal perspective cannot be overstated. As such, utilities are in a unique position to facilitate farmstead DSM technology investments in an effort to benefit the farmer (and his profitability), the utility, the state and the country. This guidebook is designed to provide the framework for agricultural demand planning, including market assessment, technology assessment, market penetration analysis and program design.

  14. Bounded decision making and analytical biases in demand side management

    SciTech Connect

    Janda, K.B.

    1994-08-01

    Demand side management (DSM) programs across the United States commonly approach barriers to energy efficiency through technical/economic means and evaluate their impact through technical/economic analysis. To the extent that non-technical barriers exist and influence decision making, they complicate the expected capture of savings. Two utility DSM projects -- Pacific Gas and Electric`s Advanced Customer Technology Test for Maximum Energy Efficiency (ACT{sup 2}) and Bonneville Power Administration`s Energy Edge -- serve as case studies to illustrate how non-technical barriers to specific energy-efficiency measures (EEMs) can limit technical conservation potential. An analysis of rejected EEMs suggest that lessons about non-technical barriers to specific energy-efficiency measures (EEMs) can limit technical conservation potential. An analysis of rejected EEMs suggests that lessons about non-technical barriers may be lost or obscured because of the predominant focus on technical/economic criteria over social, institutional, or cultural constraints. These findings support the need for different evaluation methodologies and further social science research devoted to understanding the non-technical barriers confronted by DSM project participants.

  15. Textile industry: Profile and DSM (demand-side management) options

    SciTech Connect

    Not Available

    1990-07-01

    The Textile Industry Guidebook provides electric utility planning, marketing, and customer service staff with a practical tool to better understand the textile industry and the challenges it faces; its manufacturing processes, technologies, and energy use; and its opportunities for demand-site management (DSM). The Guidebook concludes with guidance and summary data for developing and evaluating DSM plans to realize such opportunities. 5 refs., 37 figs., 52 tabs.

  16. Demand side management in recycling and electricity retail pricing

    NASA Astrophysics Data System (ADS)

    Kazan, Osman

    This dissertation addresses several problems from the recycling industry and electricity retail market. The first paper addresses a real-life scheduling problem faced by a national industrial recycling company. Based on their practices, a scheduling problem is defined, modeled, analyzed, and a solution is approximated efficiently. The recommended application is tested on the real-life data and randomly generated data. The scheduling improvements and the financial benefits are presented. The second problem is from electricity retail market. There are well-known patterns in daily usage in hours. These patterns change in shape and magnitude by seasons and days of the week. Generation costs are multiple times higher during the peak hours of the day. Yet most consumers purchase electricity at flat rates. This work explores analytic pricing tools to reduce peak load electricity demand for retailers. For that purpose, a nonlinear model that determines optimal hourly prices is established based on two major components: unit generation costs and consumers' utility. Both are analyzed and estimated empirically in the third paper. A pricing model is introduced to maximize the electric retailer's profit. As a result, a closed-form expression for the optimal price vector is obtained. Possible scenarios are evaluated for consumers' utility distribution. For the general case, we provide a numerical solution methodology to obtain the optimal pricing scheme. The models recommended are tested under various scenarios that consider consumer segmentation and multiple pricing policies. The recommended model reduces the peak load significantly in most cases. Several utility companies offer hourly pricing to their customers. They determine prices using historical data of unit electricity cost over time. In this dissertation we develop a nonlinear model that determines optimal hourly prices with parameter estimation. The last paper includes a regression analysis of the unit generation cost

  17. Energy Demand-Side Management: New Perspectives for a New Era

    ERIC Educational Resources Information Center

    Carley, Sanya

    2012-01-01

    Over the past decade and a half, state governments have assumed greater responsibility over demand-side management (DSM) operations. Whereas DSM programs formerly were initiated primarily by utilities or state public utility commissions, they are now becoming increasingly state-initiated and incentivized through funding mechanisms or…

  18. Energy Demand-Side Management: New Perspectives for a New Era

    ERIC Educational Resources Information Center

    Carley, Sanya

    2012-01-01

    Over the past decade and a half, state governments have assumed greater responsibility over demand-side management (DSM) operations. Whereas DSM programs formerly were initiated primarily by utilities or state public utility commissions, they are now becoming increasingly state-initiated and incentivized through funding mechanisms or…

  19. Summary of Characteristics and Energy Efficiency Demand-side Management Programs in the Southeastern United States

    SciTech Connect

    Glatt, Sandy

    2010-04-01

    This report is the first in a series that seeks to characterize energy supply and industrial sector energy consumption, and summarize successful industrial demand-side management (DSM) programs within each of the eight North American Electric Reliability Corporation (NERC) regions.

  20. Modeling and Analysis of Commercial Building Electrical Loads for Demand Side Management

    NASA Astrophysics Data System (ADS)

    Berardino, Jonathan

    In recent years there has been a push in the electric power industry for more customer involvement in the electricity markets. Traditionally the end user has played a passive role in the planning and operation of the power grid. However, many energy markets have begun opening up opportunities to consumers who wish to commit a certain amount of their electrical load under various demand side management programs. The potential benefits of more demand participation include reduced operating costs and new revenue opportunities for the consumer, as well as more reliable and secure operations for the utilities. The management of these load resources creates challenges and opportunities to the end user that were not present in previous market structures. This work examines the behavior of commercial-type building electrical loads and their capacity for supporting demand side management actions. This work is motivated by the need for accurate and dynamic tools to aid in the advancement of demand side operations. A dynamic load model is proposed for capturing the response of controllable building loads. Building-specific load forecasting techniques are developed, with particular focus paid to the integration of building management system (BMS) information. These approaches are tested using Drexel University building data. The application of building-specific load forecasts and dynamic load modeling to the optimal scheduling of multi-building systems in the energy market is proposed. Sources of potential load uncertainty are introduced in the proposed energy management problem formulation in order to investigate the impact on the resulting load schedule.

  1. Electricity pricing as a demand-side management strategy: Western lessons for developing countries

    SciTech Connect

    Hill, L.J.

    1990-12-01

    Electric utilities in the Western world have increasingly realized that load commitments can be met not only by constructing new generating plants but also by influencing electricity demand. This demand-side management (DSM) process requires that electric utilities promote measures on the customer's side of the meter to directly or indirectly influence electricity consumption to meet desired load objectives. An important demand-side option to achieve these load objectives is innovative electricity pricing, both by itself and as a financial incentive for other demand-site measures. This study explores electricity pricing as a DSM strategy, addressing four questions in the process: What is the Western experience with DSM in general and electricity pricing in particular Do innovative pricing strategies alter the amount and pattern of electricity consumption Do the benefits of these pricing strategies outweigh the costs of implementation What are future directions in electricity pricing Although DSM can be used to promote increases in electricity consumption for electric utilities with excess capacity as well as to slow demand growth for capacity-short utilities, emphasis here is placed on the latter. The discussion should be especially useful for electric utilities in developing countries that are exploring alternatives to capacity expansion to meet current and future electric power demand.

  2. Demand-Side Management and Integrated Resource Planning: Findings from a Survey of 24 Electric Utilities

    SciTech Connect

    Schweitzer, M.

    1991-01-01

    Integrated resource planning differs from traditional utility planning practices primarily in its increased attention to demand-side management (DSM) programs and its integration of supply- and demand-side resources into a combined resource portfolio. This report details the findings from an Oak Ridge National Laboratory (ORNL) survey of 24 electric utilities that have well-developed integrated planning processes. These utilities account for roughly one-third of total capacity, electricity generation, and DSM-program expenditures nationwide. The ORNL survey was designed to obtain descriptive data on a national sample of utilities and to test a number of hypothesized relationships between selected utility characteristics and the mix of resources selected for the integrated plan, with an emphasis on the use of DSM resources and the processes by which they are chosen. The survey solicited information on each utility's current and projected resource mix, operating environment, procedures used to screen potential DSM resources, techniques used to obtain public input and to integrate supply- and demand-side options into a unified plan, and procedures used in the final selection of resources for the plan.

  3. Demand Side Management in the Smart Grid: Information Processing for the Power Switch

    SciTech Connect

    Alizadeh, Mahnoosh; LI, Xiao; Wang, Zhifang; Scagilone, Anna; Melton, Ronald B.

    2012-09-01

    In this article we discuss the most recent developments in the area of load management, and consider possible interaction schemes of novel architectures with distributed energy resources (DER). In order to handle the challenges faced by tomorrow’s smart grid, which are caused by volatile load and generation profiles (from the large number of plug-in EVs and from renewable integration), the conventional grid operating principle of load-following needs to be changed into load-shaping or generation-following. Demand Side Management will be a most promising and powerful solution to the above challenges. However, many other issues such as load forecasting, pricing structure, market policy, renewable integration interface, and even the AC/DC implementation at the distribution side, need to be taken into the design in order to search for the most effective and applicable solution.

  4. A novel microgrid demand-side management system for manufacturing facilities

    NASA Astrophysics Data System (ADS)

    Harper, Terance J.

    Thirty-one percent of annual energy consumption in the United States occurs within the industrial sector, where manufacturing processes account for the largest amount of energy consumption and carbon emissions. For this reason, energy efficiency in manufacturing facilities is increasingly important for reducing operating costs and improving profits. Using microgrids to generate local sustainable power should reduce energy consumption from the main utility grid along with energy costs and carbon emissions. Also, microgrids have the potential to serve as reliable energy generators in international locations where the utility grid is often unstable. For this research, a manufacturing process that had approximately 20 kW of peak demand was matched with a solar photovoltaic array that had a peak output of approximately 3 KW. An innovative Demand-Side Management (DSM) strategy was developed to manage the process loads as part of this smart microgrid system. The DSM algorithm managed the intermittent nature of the microgrid and the instantaneous demand of the manufacturing process. The control algorithm required three input signals; one from the microgrid indicating the availability of renewable energy, another from the manufacturing process indicating energy use as a percent of peak production, and historical data for renewable sources and facility demand. Based on these inputs the algorithm had three modes of operation: normal (business as usual), curtailment (shutting off non-critical loads), and energy storage. The results show that a real-time management of a manufacturing process with a microgrid will reduce electrical consumption and peak demand. The renewable energy system for this research was rated to provide up to 13% of the total manufacturing capacity. With actively managing the process loads with the DSM program alone, electrical consumption from the utility grid was reduced by 17% on average. An additional 24% reduction was accomplished when the microgrid

  5. Load curve classification for the evaluation of demand side management programs

    NASA Astrophysics Data System (ADS)

    Yumak, K.; Tosun, G.; Varlik, B.; Bağriyanık, M.

    2016-11-01

    The demand side management of electrical power systems is an issue of growing concern. In this study, annual load curves those have been obtained by field measurements on MV (31.5kV) feeders in an electricity distribution company in Turkey have been studied. Feeders supplying different type of customers (Agricultural irrigation, Commercial & Industrial and Residential) are classified through Peak and Night Ratio for the assessment of convenient incentive or price based methods. Statistical parameters, such as peak-to-average ratio, load factor and standard deviation are calculated. Active power deviations on annual and daily load curves are discussed.

  6. Evaluating demand-side management alternatives through the use of a fuzzy expert system

    SciTech Connect

    Benson, S.J.; Asgarpoor, S.

    1997-09-01

    It is believed that the onset of true competition in the electric power industry may result in the demise of demand-side management (DSM) practices. DSM as it is known today, is primarily a means of optimizing a utility`s load curve, will no doubt lessen in importance as competition gives power producers a better strategic position. However, this does not mean that DSM can not evolve to meet the changing needs of electric utilities. One certainty is that utilities will need to evaluate the large number of possible options more efficiently and effectively than ever before. This is sometimes a drawn out process because DSM programs, at least initially, are commonly evaluated and ranked on a subjective basis by a utility`s various experts in that field. This paper proposes to formulate this subjective process into an automated methodology, yielding more efficient and consistent results. An expert system is implemented through the use of fuzzy logic, which helps to account for the in-exact nature of the projected input data. This paper outlines the development of a visual basic and spreadsheet based Fuzzy Expert system designed to evaluate Demand-Side Management alternatives, named FEDSM. FEDSM is a user-friendly, menu-driven evaluation tool. It allows the user to develop a flexible expert system--one that is both easy to create and update. Finally, FEDSM is tested and evaluated on actual DSM data collected by a public utility in Nebraska.

  7. Optimal Multi-scale Demand-side Management for Continuous Power-Intensive Processes

    NASA Astrophysics Data System (ADS)

    Mitra, Sumit

    With the advent of deregulation in electricity markets and an increasing share of intermittent power generation sources, the profitability of industrial consumers that operate power-intensive processes has become directly linked to the variability in energy prices. Thus, for industrial consumers that are able to adjust to the fluctuations, time-sensitive electricity prices (as part of so-called Demand-Side Management (DSM) in the smart grid) offer potential economical incentives. In this thesis, we introduce optimization models and decomposition strategies for the multi-scale Demand-Side Management of continuous power-intensive processes. On an operational level, we derive a mode formulation for scheduling under time-sensitive electricity prices. The formulation is applied to air separation plants and cement plants to minimize the operating cost. We also describe how a mode formulation can be used for industrial combined heat and power plants that are co-located at integrated chemical sites to increase operating profit by adjusting their steam and electricity production according to their inherent flexibility. Furthermore, a robust optimization formulation is developed to address the uncertainty in electricity prices by accounting for correlations and multiple ranges in the realization of the random variables. On a strategic level, we introduce a multi-scale model that provides an understanding of the value of flexibility of the current plant configuration and the value of additional flexibility in terms of retrofits for Demand-Side Management under product demand uncertainty. The integration of multiple time scales leads to large-scale two-stage stochastic programming problems, for which we need to apply decomposition strategies in order to obtain a good solution within a reasonable amount of time. Hence, we describe two decomposition schemes that can be applied to solve two-stage stochastic programming problems: First, a hybrid bi-level decomposition scheme with

  8. Advanced monitoring technologies for the evaluation of demand-side management programs

    SciTech Connect

    Almeida, A.T. de . Dept. Engineering Electrotecnica); Vine, E.L. )

    1994-08-01

    The aim of this paper is to provide an assessment of the state-of-art of the technologies that can be used for monitoring demand-side management programs. This paper examines the following techniques that can be used for end-use monitoring: field test equipment, general purpose data loggers, run-time data loggers, utility-oriented data loggers, energy management systems, smart meters, direct and distributed load control, power line carrier techniques, non-intrusive load monitoring and building automation. Additionally, the paper points out research and development activities whose implementation can contribute to a more accurate and cost-effective evaluation of the performance of end-use technologies.

  9. Hawaii demand-side management resource assessment. Final report: DSM opportunity report

    SciTech Connect

    1995-08-01

    The Hawaii Demand-Side Management Resource Assessment was the fourth of seven projects in the Hawaii Energy Strategy (HES) program. HES was designed by the Department of Business, Economic Development, and Tourism (DBEDT) to produce an integrated energy strategy for the State of Hawaii. The purpose of Project 4 was to develop a comprehensive assessment of Hawaii`s demand-side management (DSM) resources. To meet this objective, the project was divided into two phases. The first phase included development of a DSM technology database and the identification of Hawaii commercial building characteristics through on-site audits. These Phase 1 products were then used in Phase 2 to identify expected energy impacts from DSM measures in typical residential and commercial buildings in Hawaii. The building energy simulation model DOE-2.1E was utilized to identify the DSM energy impacts. More detailed information on the typical buildings and the DOE-2.1E modeling effort is available in Reference Volume 1, ``Building Prototype Analysis``. In addition to the DOE-2.1E analysis, estimates of residential and commercial sector gas and electric DSM potential for the four counties of Honolulu, Hawaii, Maui, and Kauai through 2014 were forecasted by the new DBEDT DSM Assessment Model. Results from DBEDTs energy forecasting model, ENERGY 2020, were linked with results from DOE-2.1E building energy simulation runs and estimates of DSM measure impacts, costs, lifetime, and anticipated market penetration rates in the DBEDT DSM Model. Through its algorithms, estimates of DSM potential for each forecast year were developed. Using the load shape information from the DOE-2.1E simulation runs, estimates of electric peak demand impacts were developed. 10 figs., 55 tabs.

  10. Public perceptions of demand-side management and a smarter energy future

    NASA Astrophysics Data System (ADS)

    Spence, Alexa; Demski, Christina; Butler, Catherine; Parkhill, Karen; Pidgeon, Nick

    2015-06-01

    Demand-side management (DSM) is a key aspect of many future energy system scenarios. DSM refers to a range of technologies and interventions designed to create greater efficiency and flexibility on the demand-side of the energy system. Examples include the provision of more information to users to support efficient behaviour and new `smart’ technologies that can be automatically controlled. Key stated outcomes of implementing DSM are benefits for consumers, such as cost savings and greater control over energy use. Here, we use results from an online survey to examine public perceptions and acceptability of a range of current DSM possibilities in a representative sample of the British population (N = 2,441). We show that, although cost is likely to be a significant reason for many people to take up DSM measures, those concerned about energy costs are actually less likely to accept DSM. Notably, individuals concerned about climate change are more likely to be accepting. A significant proportion of people, particularly those concerned about affordability, indicated unwillingness or concerns about sharing energy data, a necessity for many forms of DSM. We conclude substantial public engagement and further policy development is required for widespread DSM implementation.

  11. Hawaii demand-side management resource assessment. Final report, Reference Volume 1: Building prototype analysis

    SciTech Connect

    1995-04-01

    This report provides a detailed description of, and the baseline assumptions and simulation results for, the building prototype simulations conducted for the building types designated in the Work Plan for Demand-side Management Assessment of Hawaii`s Demand-Side Resources (HES-4, Phase 2). This report represents the second revision to the initial building prototype description report provided to DBEDT early in the project. Modifications and revisions to the prototypes, based on further calibration efforts and on comments received from DBEDT Staff have been incorporated into this final version. These baseline prototypes form the basis upon which the DSM measure impact estimates and the DSM measure data base were developed for this project. This report presents detailed information for each of the 17 different building prototypes developed for use with the DOE-21E program (23 buildings in total, including resorts and hotels defined separately for each island) to estimate the impact of the building technologies and measures included in this project. The remainder of this section presents some nomenclature and terminology utilized in the reports, tables, and data bases developed from this project to denote building type and vintage. Section 2 contains a more detailed discussion of the data sources, the definition of the residential sector building prototypes, and results of the DOE-2 analysis. Section 3 provides a similar discussion for the commercial sector. The prototype and baseline simulation results are presented in a separate section for each building type. Where possible, comparison of the baseline simulation results with benchmark data from the ENERGY 2020 model or other demand forecasting models specific to Hawaii is included for each building. Appendix A contains a detailed listing of the commercial sector baseline indoor lighting technologies included in the existing and new prototypes by building type.

  12. Public involvement in integrated resource planning: A study of demand-side management collaboratives

    SciTech Connect

    Raab, J.; Schweitzer, M.

    1992-02-01

    Many utilities and nonutility parties (NUPs) across the country have tried a new approach to reaching agreement on Demand-Side Management (DSM) program design and policy issues. Through this, which is called the DSM collaborative process, parties who have often been adversaries in the past attempt to reach consensus rather than using traditional litigation to resolve differences. We examined nine cases of DSM collaboration involving 24 utilities and approximately 50 NUPs in 10 states. This is the first comprehensive, in-depth review and assessment of collaboratives and it allows conclusions to be drawn about the collaborative process and the factors that contribute to successful efforts of this type. Collaboratives are described in terms of four major contextual and organizational characteristics: regulatory and legal history, parties involved and parties excluded, collaborative scope, and the collaborative process itself.

  13. Public involvement in integrated resource planning: A study of demand-side management collaboratives

    SciTech Connect

    Raab, J. , Boston, MA ); Schweitzer, M. )

    1992-02-01

    Many utilities and nonutility parties (NUPs) across the country have tried a new approach to reaching agreement on Demand-Side Management (DSM) program design and policy issues. Through this, which is called the DSM collaborative process, parties who have often been adversaries in the past attempt to reach consensus rather than using traditional litigation to resolve differences. We examined nine cases of DSM collaboration involving 24 utilities and approximately 50 NUPs in 10 states. This is the first comprehensive, in-depth review and assessment of collaboratives and it allows conclusions to be drawn about the collaborative process and the factors that contribute to successful efforts of this type. Collaboratives are described in terms of four major contextual and organizational characteristics: regulatory and legal history, parties involved and parties excluded, collaborative scope, and the collaborative process itself.

  14. Incentive-compatible demand-side management for smart grids based on review strategies

    NASA Astrophysics Data System (ADS)

    Xu, Jie; van der Schaar, Mihaela

    2015-12-01

    Demand-side load management is able to significantly improve the energy efficiency of smart grids. Since the electricity production cost depends on the aggregate energy usage of multiple consumers, an important incentive problem emerges: self-interested consumers want to increase their own utilities by consuming more than the socially optimal amount of energy during peak hours since the increased cost is shared among the entire set of consumers. To incentivize self-interested consumers to take the socially optimal scheduling actions, we design a new class of protocols based on review strategies. These strategies work as follows: first, a review stage takes place in which a statistical test is performed based on the daily prices of the previous billing cycle to determine whether or not the other consumers schedule their electricity loads in a socially optimal way. If the test fails, the consumers trigger a punishment phase in which, for a certain time, they adjust their energy scheduling in such a way that everybody in the consumer set is punished due to an increased price. Using a carefully designed protocol based on such review strategies, consumers then have incentives to take the socially optimal load scheduling to avoid entering this punishment phase. We rigorously characterize the impact of deploying protocols based on review strategies on the system's as well as the users' performance and determine the optimal design (optimal billing cycle, punishment length, etc.) for various smart grid deployment scenarios. Even though this paper considers a simplified smart grid model, our analysis provides important and useful insights for designing incentive-compatible demand-side management schemes based on aggregate energy usage information in a variety of practical scenarios.

  15. Cost-effectiveness of trees for demand-side management Washington, DC

    SciTech Connect

    1992-12-01

    Trees can reduce demand for air conditioning to cool buildings by shading residences and lowering summertime air temperatures. During winter, trees can reduce heating needs by lowering wind speeds and thereby reducing infiltration of cold air. On the otherhand, winter shade from improperly located trees can increase heating requirements. Projections from computer simulations indicate that 100 million mature trees in U.S. cities (3 trees for every other single family home) could reduce energy use for heating and cooling by 30 billion kWh and reduce carbon dioxide emissions by as much as 9 million tons per year. This energy analysis is part of a larger study that quantifies costs and benefits of proposed tree plantings in 12 U.S. cities. While energy savings is an important benefit from community forests, other benefits (e.g., air quality improvement, reduced stormwater runoff, increased property values) can have equal or greater value. Tree planting, care, and other costs (e.g., water-sewer line repair, green waste disposal, litigation/liability, program administration) from the cost-benefit study can be used to help estimate costs associated with a tree planting program for demand-side management. Data from this energy analysis should be of direct value to local utilities, urban foresters, planners, landscape designers, and non-profit tree planting groups.

  16. Managing Sustainable Demand-side Infrastructure for Power System Ancillary Services

    NASA Astrophysics Data System (ADS)

    Parkinson, Simon Christopher

    Widespread access to renewable electricity is seen as a viable method to mitigate carbon emissions, although problematic are the issues associated with the integration of the generation systems within current power system configurations. Wind power plants are the primary large-scale renewable generation technology applied globally, but display considerable short-term supply variability that is difficult to predict. Power systems are currently not designed to operate under these conditions, and results in the need to increase operating reserve in order to guarantee stability. Often, operating conventional generation as reserve is both technically and economically inefficient, which can overshadow positive benefits associated with renewable energy exploitation. The purpose of this thesis is to introduce and assess an alternative method of enhancing power system operations through the control of electric loads. In particular, this thesis focuses on managing highly-distributed sustainable demand-side infrastructure, in the form of heat pumps, electric vehicles, and electrolyzers, as dispatchable short-term energy balancing resources. The main contribution of the thesis is an optimal control strategy capable of simultaneously balancing grid- and demand-side objectives. The viability of the load control strategy is assessed through model-based simulations that explicitly track end-use functionality of responsive devices within a power systems analysis typically implemented to observe the effects of integrated wind energy systems. Results indicate that there is great potential for the proposed method to displace the need for increased reserve capacity in systems considering a high penetration of wind energy, thereby allowing conventional generation to operate more efficiently and avoid the need for possible capacity expansions.

  17. Lessons learned in implementing a demand side management contract at the Presidio of San Francisco

    SciTech Connect

    Sartor, D.; Munn, M.

    1998-07-01

    The National Park Service (NPS) recently completed the implementation phase of its PowerSaving Partners (PSP) Demand Side Management (DSM) contract with the local utility, Pacific Gas and Electric (PG and E). Through the DSM contract, NPS will receive approximately $4.1 million over eight years in payment for saving 61 kW of electrical demand, 179,000 kWh of electricity per year, and 1.1 million therms of natural gas per year. These payments are for two projects: the installation of high-efficiency lighting systems at the Thoreau Center for Sustainability and the replacement of an old central boiler plant with new, distributed boilers. Although these savings and payments are substantial, the electrical savings and contract payments fall well short of the projected 1,700 kW of electrical demand, 8 million kWh of annual electricity savings, and $11 million in payments, anticipated at the project's onset. Natural gas savings exceeded the initial forecast of 800,000 therms per year. The DSM contract payments did not meet expectations for a variety of reasons which fall into two broad categories: first, many anticipated projects were not constructed, and second, some of the projects that were constructed were not included in the program because the cost of implementing the DSM program's measurement and verification (M and V) requirements outweighed anticipated payments. This paper discusses the projects implemented and examines the decisions made to withdraw some of them from the DSM contract. It also presents the savings that were realized and documented through M and V efforts. Finally, it makes suggestions relative to M and V protocols to encourage all efficiency measures, not just those that are easy to measure.

  18. Lessons learned in implementing a demand side management contract at the Presidio of San Francisco

    SciTech Connect

    Sartor, D.; Munn, M.

    1998-06-01

    The National Park Service (NSP) recently completed the implementation phase of its Power Saving Partners (PSP) Demand Side Management (DSM) contract with the local utility, Pacific Gas and Electric (PG&E). Through the DSM contract, NPS will receive approximately $4.1 million over eight years in payment for saving 61 kW of electrical demand, 179,000 km of electricity per year, and 1.1 million therms of natural gas per year. These payments are for two projects: the installation of high-efficiency lighting systems at the Thoreau Center for Sustainability and the replacement of an old central boiler plant with new, distributed boilers. Although these savings and payments are substantial, the electrical savings and contract payments fall well short of the projected 1,700 kW of electrical demand, 8 million kwh of annual electricity savings, and $11 million in payments, anticipated at the project's onset. Natural gas savings exceeded the initial forecast of 800,000 therms per year. The DSM contract payments did not meet expectations for a variety of reasons which fall into two broad categories: first, many anticipated projects were not constructed, and second, some of the projects that were constructed were not included in the program because the cost of implementing the DSM program's measurement and verification (M&V) requirements outweighed anticipated payments. This paper discusses the projects implemented, and examines the decisions made to withdraw some of them from the DSM contract. It also presents the savings that were realized and documented through M&V efforts. Finally, it makes suggestions relative to M&V protocols to encourage all efficiency measures, not just those that are easy to measure.

  19. Industrial demand-side management programs: What`s happened, what works, what`s needed

    SciTech Connect

    Jordan, J.A.; Nadel, S.M.

    1993-03-01

    In order to analyze experience to date with industrial demand-side management (DSM), a survey of utilities was conducted and a database of industrial DSM programs was prepared. More than eighty utilities and third-party organizations were interviewed. Data were collected via phone, fax, and/or mail from the utilities and entered into a database. In order to limit the scope of this study, the database contains incentive-based, energy-saving programs and not load management or information-only programs (including technical assistance programs). Programs in the database were divided into four categories: two ``prescriptive rebate`` categories and two ``custom rebate`` categories. The database contains 31 incentive-based, energy-saving industrial DSM programs offered by 17 utilities. The appendix to this report summarizes the results approximately 60 industrial DSM programs. Most of the programs included in the appendix, but not in the database, are either C&I programs for which commercial and industrial data were not disaggregated or new industrial DSM programs for which data are not yet available.

  20. Reliability assessment of non-utility generation and demand-side management in composite power systems

    NASA Astrophysics Data System (ADS)

    Adzanu, Steve Kwaku

    The last two decades have brought about significant changes in the resource planning environment of electric power utilities throughout the world. The conventional generation technologies that have been the backbone of every electric utility i.e., coal, hydro, nuclear, oil and natural gas, are being re-examined to address environmental concerns and resource utilization. The research described in this thesis focuses on the adequacy and economic assessment of non-utility generation (NUG) and demand-side management (DSM) initiatives within a typical power system. The main objective was to examine and extend the ability of the contingency enumeration approach to evaluate the economic reliability benefits of incorporating NUG and DSM options separately or jointly in composite system adequacy assessment. Two test systems were employed in the evaluations. The studies undertaken in this thesis demonstrate the need for accurate load model representations which clearly reflect the mix of customer sectors at each bus. Chronological hourly load curves were developed for each load bus in the test systems recognizing the individual load profiles of the customers. The adequacy and economic implications of demand-side management initiatives in the test systems were examined at each load point in the composite generation and transmission configuration. This thesis illustrates the development of techniques by which system planners and operators can incorporate reliability cost/worth assessment power system applications. Focus is placed in the thesis on the utilization of reliability cost/worth concepts in integrated resource planning in the form of NUG additions and DSM initiatives. Methods for the joint implementation of NUG and DSM options in a composite power system are presented and examples from the studies conducted are used to illustrate the procedures. Studies are presented which illustrate the impacts of NUG additions and DSM initiatives on the test system planning reserve

  1. Exploring Tradeoffs in Demand-side and Supply-side Management of Urban Water Resources using Agent-based Modeling and Evolutionary Computation

    NASA Astrophysics Data System (ADS)

    Kanta, L.; Berglund, E. Z.

    2015-12-01

    Urban water supply systems may be managed through supply-side and demand-side strategies, which focus on water source expansion and demand reductions, respectively. Supply-side strategies bear infrastructure and energy costs, while demand-side strategies bear costs of implementation and inconvenience to consumers. To evaluate the performance of demand-side strategies, the participation and water use adaptations of consumers should be simulated. In this study, a Complex Adaptive Systems (CAS) framework is developed to simulate consumer agents that change their consumption to affect the withdrawal from the water supply system, which, in turn influences operational policies and long-term resource planning. Agent-based models are encoded to represent consumers and a policy maker agent and are coupled with water resources system simulation models. The CAS framework is coupled with an evolutionary computation-based multi-objective methodology to explore tradeoffs in cost, inconvenience to consumers, and environmental impacts for both supply-side and demand-side strategies. Decisions are identified to specify storage levels in a reservoir that trigger (1) increases in the volume of water pumped through inter-basin transfers from an external reservoir and (2) drought stages, which restrict the volume of water that is allowed for residential outdoor uses. The proposed methodology is demonstrated for Arlington, Texas, water supply system to identify non-dominated strategies for an historic drought decade. Results demonstrate that pumping costs associated with maximizing environmental reliability exceed pumping costs associated with minimizing restrictions on consumer water use.

  2. Guidebook for Farmstead Demand-Side Management (DSM) program design. [Final report

    SciTech Connect

    Rose, M.; Camera, R.K.

    1992-02-21

    The acceptance and growth of Demand-Side Management (DSM) continues to increase in the US. According to latest estimates, total expenditures on electric utility DSM programs now exceed $1.2 billion annually, with these investments ranging from 1 to 5 percent of a utility`s gross revenues. In addition, due to increasing environmental concerns and the high cost of new capacity, these expenditure levels are expected to increase. While the vast majority of these DSM programs are directed at the more traditional residential, commercial and industrial market sectors, significant opportunities still exist. One market segment that has not been the focus of attention but a critical sector from an economic development perspective for marry utilities -- is the agricultural and farmstead market. Although the total number of farms in the United States decreased by approximately 5 percent between 1985 and 1989, the land dedicated to farming still accounts for over 995 million acres. Furthermore, the total value of farm output in the United States has been steadily increasing since 1986. The limited penetration of energy efficiency measures in farmsteads provides an excellent opportunity for utilities to expand their DSM programming efforts to capture this ``non-traditional`` market segment, and at the same time assist farms in increasing their efficiency and competitiveness. In marry states, and, in particular New York State, agriculture plays a major economic role. The importance of farms not only from a utility perspective but also from a state and federal perspective cannot be overstated. As such, utilities are in a unique position to facilitate farmstead DSM technology investments in an effort to benefit the farmer (and his profitability), the utility, the state and the country. This guidebook is designed to provide the framework for agricultural demand planning, including market assessment, technology assessment, market penetration analysis and program design.

  3. Employee retention and integrated disability management practices as demand side factors.

    PubMed

    Habeck, Rochelle; Hunt, Allan; Rachel, Colleen Head; Kregel, John; Chan, Fong

    2010-12-01

    Demand-side employment research on company policies and practices related to retention and absence and disability management (ADM) can contribute to our understanding of employment issues related to people with disabilities from the employers' perspective. To examine company ADM and retention practices and their effectiveness, as well as how these company policies and practices might influence hiring of people with disabilities. Disability Management Employer Coalition employer members (N = 650) were surveyed by internet and the survey data were analyzed using descriptive statistics, correlation, and multiple regression. Ninety-five participants responded to the survey resulting in a response rate of 14%. Retention practice was found to be associated with retention effectiveness (r = .39, P < .01). Items most highly correlated with retention effectiveness address the provision of development opportunities to employees at every level, seeking the ideas and involvement of employees, and assuring they know how their work and performance support the mission. ADM practice was related to improving health and managing health conditions (r = .26, P < .05) and resolving disability and bringing back to work (r = .37, P < .01). Consistent RTW procedures (r = .21), employee-oriented culture (r = .23), safety/risk prevention (r = .21), and very early intervention (r = .21) correlated with delaying/preventing employment exits related to health impairment. Retention practice, ADM practice, retention effectiveness, ADM effectiveness and disability attitudes comprised a model to predict the hiring of people with disabilities. The six-predictor model was significant, F(6, 86) = 13.54, P < .001 and accounted for 49% of the variance in hiring. However, only the disability attitudes factor (β = .628, P < .001) was found to be significantly associated with hiring. Findings substantiate a positive relationship among retention practices, ADM practices and outcomes. Both are associated

  4. Performance evaluation of selected U.S. utility commercial lighting demand-side management programs

    SciTech Connect

    Chen, T.; Yu, O.S.

    1997-10-01

    This article selects 18 commercial lighting demand-side management programs of electric utilities in the United States and evaluates their performance. It first uses four conventional measures, i.e., rate impact measurement, total resource cost, total utility cost, and total customer cost, to analyze the costs and benefits of each program. Although all programs achieve good benefit to cost ratios under each measure, the rankings are not always consistent, i.e., a program`s ranking in one measure is not always the same as in another measure. To provide a unified basis for comparison, the authors use a mathematical programming model--the data envelopment analysis (DEA) model--to integrate the results of these four conventional measures for each program. Based on the DEA results, programs of Southern California Edison, New York State Electric and Gas, and Potomac Electric Power produce the best overall performance, followed by Central Maine Power, Pacific Gas and Electric, and Central Vermont Public Service. Finally, this article discusses the implications of the DEA results, which can serve as an effective means for performance benchmarking.

  5. The past, present, and future of U.S. utility demand-side management programs

    SciTech Connect

    Eto, J.

    1996-12-01

    Demand-side management or DSM refers to active efforts by electric and gas utilities to modify customers` energy use patterns. The experience in the US shows that utilities, when provided with appropriate incentives, can provide a powerful stimulus to energy efficiency in the private sector. This paper describes the range and history of DSM programs offered by US electric utilities, with a focus on the political, economic, and regulatory events that have shaped their evolution. It also describes the changes these programs are undergoing as a result of US electricity industry restructuring. DSM programs began modestly in the 1970s in response to growing concerns about dependence on foreign sources of oil and environmental consequences of electricity generation, especially nuclear power. The foundation for the unique US partnership between government and utility interests can be traced first to the private-ownership structure of the vertically integrated electricity industry and second to the monopoly franchise granted by state regulators. Electricity industry restructuring calls into question both of these basic conditions, and thus the future of utility DSM programs for the public interest. Future policies guiding ratepayer-funded energy-efficiency DSM programs will need to pay close attention to the specific market objectives of the programs and to the balance between public and private interests.

  6. Secret weapon. [The Energy Act's assault against in-house utility demand side management (DSM)

    SciTech Connect

    Howard, J.H.

    1993-01-15

    With all the attention focused on electric transmission and reform of the Public Utility Holding Company Act, few people noticed new provisions in the Energy Policy Act protecting small business from unfair utility competition in demand-side management. Congressional staffers reportedly received more mail supporting a ban on unfair utility competition than for all of the rest of the energy bill. As a result, the Act directs state utility commissions to consider the effect of DSM programs on small business and to assure that utility actions would not provide such utilities with unfair competitive advantages over such small businesses. It also requires a report by the Federal Trade Commission on the competitive effects of DSM programs and whether any unfair, deceptive, or predatory acts or practices exist, or are likely to exist, from implementation of such programs. Where did this anti-utility weapon come from What does it do And, now that it has been adopted into law, how can electric utilities deal with it

  7. Industrial operations and maintenance demand-side management resource development: Literature and data review

    SciTech Connect

    Parker, S.A.; Gaustad, K.L.; Szydlowski, R.F.; Winiarski, D.W.

    1994-01-01

    Industry in the Pacific Northwest consumes a significant percentage of the total regional electric load; however, industrial demand-side management resource development activities in this sector are underdeveloped. One such opportunity for electricity resource development is through maintenance (O&M) activities. Despite the importance of industry in the Pacific Northwest, little information has been available on the DSM resource potential, particularly through O&M activities. To obtain this information, the Bonneville Power Administration commissioned Pacific Northwest Laboratory to study the DSM resource potential that may be achieved through O&M practices in Pacific Northwest industries. The information from this report will be used to identify one or more specific O&M activities or industries having significant opportunity for reducing electricity consumption for further evaluation in future tasks to this project. The overall goal of this project is to determine, confirm, and develop the conservation resources that can be achieved from O&M practices in Pacific Northwest industries. This project is developmental in nature because its scope involves a sizable task whose path and direction is difficult to define in advance. The primary focus of this report is to summarize the major findings of the literature and datareview. Detailed analysis and use of all data gathered in the review are beyond the scope this study. However, the reported findings in this analysis provide an extensive framework for identifying and estimating the electric resource potential available in the industrial manufacturing sector.

  8. An analysis of the factors influencing demand-side management activity in the electric utility industry

    NASA Astrophysics Data System (ADS)

    Bock, Mark Joseph

    Demand-side management (DSM), defined as the "planning, implementation, and monitoring of utility activities designed to encourage consumers to modify their pattern of electricity usage, including the timing and level of electricity demand," is a relatively new concept in the U.S. electric power industry. Nevertheless, in twenty years since it was first introduced, utility expenditures on DSM programs, as well as the number of such programs, have grown rapidly. At first glance, it may seem peculiar that a firm would actively attempt to reduce demand for its primary product. There are two primary explanations as to why a utility might pursue DSM: regulatory mandate, and self-interest. The purpose of this dissertation is to determine the impact these influences have on the amount of DSM undertaken by utilities. This research is important for two reasons. First, it provides insight into whether DSM will continue to exist as competition becomes more prevalent in the industry. Secondly, it is important because no one has taken a comprehensive look at firm-level DSM activity on an industry-wide basis. The primary data set used in this dissertation is the U.S. Department of Energy's Annual Electric Utility Report, Form EIA-861, which represents the most comprehensive data set available for analyzing DSM activity in the U.S. There are four measures of DSM activity in this data set: (1) utility expenditures on DSM programs; (2) energy savings by DSM program participants; and (3) the actual and (4) the potential reductions in peak load resulting from utility DSM measures. Each is used as the dependent variable in an econometric analysis where independent variables include various utility characteristics, regulatory characteristics, and service territory and customer characteristics. In general, the results from the econometric analysis suggest that in 1993, DSM activity was primarily the result of regulatory pressure. All of the evidence suggests that if DSM continues to

  9. Advanced monitoring technologies for the evaluation of demand-side management programs

    SciTech Connect

    De Almeida, A.T.; Vine, E.L.

    1993-06-01

    This report was commissioned by the California Institute for Energy Efficiency as part of its research mission to advance the energy efficiency and productivity of all end-use sectors in California. The aim of this study is to provide an assessment of the state-of-the-art technologies that can be used for monitoring and evaluating demand-side management (DSM) programs. Additionally, the study points out research, development, and demonstration projects whose implementation can contribute to a more accurate and cost-effective evaluation of the performance of end-use technologies. During the past two decades, technology developments in the fields of microelectronics, computers and communications had a large impact on monitoring equipment. The improvements achieved led to the appearance of increasingly powerful, convenient to use, and flexible equipment, enabling a wider application of end-use metering at a lower cost. Equipment specifications are getting closer and closer to an ``ideal`` monitoring system: Good accuracy, high reliability, moderate cost, large number of monitored end uses, large data storage capacity, flexible communications, non-intrusiveness, powerful preprocessing of data. This report briefly examines the following techniques that can be used for end-use monitoring: field test equipment, general purpose data loggers, run-time data loggers, utility-oriented data loggers, energy management systems, two-way communication, power line carrier techniques, direct and distributed load control, and non-intrusive load monitoring. The report concludes with recommendations for developing new measurement technologies, as well as additional research and development activities to support these efforts.

  10. DEMONSTRATION OF THE ENVIRONMENTAL AND DEMAND-SIDE MANAGEMENT BENEFITS OF GRID-CONNECTED PHOTOVOLTAIC POWER SYSTEMS

    EPA Science Inventory

    This study investigated the pollutant emission reduction and demand-side management potential of 16 photovoltaic (PV) systems installed across the U.S. in 1993 and 1994. The project was sponsored by the U.S. Environmental Protection Agency (EPA) and 11 electric utilities. This ar...

  11. DEMONSTRATION OF THE ENVIRONMENTAL AND DEMAND-SIDE MANAGEMENT BENEFITS OF GRID-CONNECTED PHOTOVOLTAIC POWER SYSTEMS

    EPA Science Inventory

    The report gives results of an investigation of the pollutant emission reduction and demand-side management potential of 16 photovoltaic (PV) systems installed across the U.S. in 1993 and 1994. The investigation was sponsored by the U.S. EPA and 11 electric utilities. The report ...

  12. DEMONSTRATION OF THE ENVIRONMENTAL AND DEMAND-SIDE MANAGEMENT BENEFITS OF GRID-CONNECTED PHOTOVOLTAIC POWER SYSTEMS

    EPA Science Inventory

    The report gives results of an investigation of the pollutant emission reduction and demand-side management potential of 16 photovoltaic (PV) systems installed across the U.S. in 1993 and 1994. The investigation was sponsored by the U.S. EPA and 11 electric utilities. The report ...

  13. DEMONSTRATION OF THE ENVIRONMENTAL AND DEMAND-SIDE MANAGEMENT BENEFITS OF GRID-CONNECTED PHOTOVOLTAIC POWER SYSTEMS

    EPA Science Inventory

    This study investigated the pollutant emission reduction and demand-side management potential of 16 photovoltaic (PV) systems installed across the U.S. in 1993 and 1994. The project was sponsored by the U.S. Environmental Protection Agency (EPA) and 11 electric utilities. This ar...

  14. A future Demand Side Management (DSM) opportunity for utility as variable renewable penetrate scale up using agriculture.

    NASA Astrophysics Data System (ADS)

    Ines, A.; Bhattacharjee, A.; Modi, V.; Robertson, A. W.; Lall, U.; Kocaman Ayse, S.; Chaudhary, S.; Kumar, A.; Ganapathy, A.; Kumar, A.; Mishra, V.

    2015-12-01

    Energy demand management, also known as demand side management (DSM), is the modification of consumer demand for energy through various methods such as smart metering, incentive based schemes, payments for turning off loads or rescheduling loads. Usually, the goal of demand side management is to encourage the consumer to use less power during periods of peak demand, or to move the time of energy use to off-peak times. Peak demand management does not necessarily decrease total energy consumption, but could be expected to reduce the need for investments in networks and/or power plants for meeting peak demands. Electricity use can vary dramatically on short and medium time frames, and the pricing system may not reflect the instantaneous cost as additional higher-cost that are brought on-line. In addition, the capacity or willingness of electricity consumers to adjust to prices by altering elasticity of demand may be low, particularly over short time frames. In the scenario of Indian grid setup, the retail customers do not follow real-time pricing and it is difficult to incentivize the utility companies for continuing the peak demand supply. A question for the future is how deeper penetration of renewable will be handled? This is a challenging problem since one has to deal with high variability, while managing loss of load probabilities. In the case of managing the peak demand using agriculture, in the future as smart metering matures with automatic turn on/off for a pump, it will become possible to provide an ensured amount of water or energy to the farmer while keeping the grid energized for 24 hours. Supply scenarios will include the possibility of much larger penetration of solar and wind into the grid. While, in absolute terms these sources are small contributors, their role will inevitably grow but DSM using agriculture could help reduce the capital cost. The other option is of advancing or delaying pump operating cycle even by several hours, will still ensure

  15. Local government involvement in long term resource planning for community energy systems. Demand side management

    SciTech Connect

    Not Available

    1992-03-01

    A program was developed to coordinate governmental, research, utility, and business energy savings efforts, and to evaluate future potential actions, based on actual field data obtained during the implementation of Phase I of the State Resource Plan. This has lead to the establishment of a state conservation and energy efficiency fund for the purpose of establishing a DSM Program. By taking a state wide perspective on resource planning, additional savings, including environmental benefits, can be achieved through further conservation and demand management. This effort has already blossomed into a state directive for DSM programs for the natural gas industry.

  16. Impact of the Demand-Side Management (DSM) Program structure on the cost-effectiveness of energy efficiency projects

    SciTech Connect

    Stucky, D.J.; Shankle, S.A.; Dixon, D.R.; Elliott, D.B.

    1994-12-01

    Pacific Northwest Laboratory (PNL) analyzed the cost-effective energy efficiency potential of Fort Drum, a customer of the Niagara Mohawk Power Corporation (NMPC) in Watertown, New York. Significant cost-effective investments were identified, even without any demand-side management (DSM) incentives from NMPC. Three NMPC DSM programs were then examined to determine the impact of participation on the cost-effective efficiency potential at the Fort. The following three utility programs were analyzed: (1) utility rebates to be paid back through surcharges, (2) a demand reduction program offered in conjunction with an energy services company, and (3) utility financing. Ultimately, utility rebates and financing were found to be the best programs for the Fort. This paper examines the influence that specific characteristics of the DSM programs had on the decision-making process of one customer. Fort Drum represents a significant demand-side resource, whose decisions regarding energy efficiency investments are based on life-cycle cost analysis subject to stringent capital constraints. The structures of the DSM programs offered by NMPC affect the cost-effectiveness of potential efficiency investments and the ability of the Fort to obtain sufficient capital to implement the projects. This paper compares the magnitude of the cost-effective resource available under each program, and the resulting level of energy and demand savings. The results of this analysis can be used to examine how DSM program structures impact the decision-making process of federal and large commercial customers.

  17. Low-flow appliances and household water demand: an evaluation of demand-side management policy in Albuquerque, New Mexico.

    PubMed

    Price, James I; Chermak, Janie M; Felardo, Jeff

    2014-01-15

    Residential rebate programs for low-flow water devices have become increasingly popular as a means of reducing urban water demand. Although program specifics vary, low-flow rebates are available in most U.S. metropolitan areas, as well as in many smaller municipalities. Despite their popularity, few statistical analyses have been conducted regarding the effects of low-flow rebates on household water use. In this paper, we consider the effects of rebates from the Albuquerque Bernalillo County Water Utility Authority (ABCWUA). Using panel regression techniques with a database of rebate recipients, we estimate the marginal effects of various low-flow devices on household water demand. Results indicate a negative correlation between household water use and the presence of most low-flow devices, after controlling for water price and weather conditions. Low-flow toilets have the greatest impact on water use, while low-flow washing machines, dishwashers, showerheads, and xeriscape have smaller but significant effects. In contrast, air conditioning systems, hot water recirculators, and rain barrels have no significant impact on water use. We also test for possible rebound effects (i.e. whether low-flow appliances become less-effective over time due to poor rates of retention or behavioral changes) and compare the cost effectiveness of each rebate using levelised-costs. We find no evidence of rebound effects and substantial variation in levelised-costs, with low-flow showerheads being the most cost-effective device under the current ABCWUA rebate program. The latter result suggests that water providers can improve the efficiency of rebate programs by targeting the most cost-effective devices.

  18. Demand Side Bidding. Final Report

    SciTech Connect

    Spahn, Andrew

    2003-12-31

    This document sets forth the final report for a financial assistance award for the National Association of Regulatory Utility Commissioners (NARUC) to enhance coordination between the building operators and power system operators in terms of demand-side responses to Location Based Marginal Pricing (LBMP). Potential benefits of this project include improved power system reliability, enhanced environmental quality, mitigation of high locational prices within congested areas, and the reduction of market barriers for demand-side market participants. NARUC, led by its Committee on Energy Resources and the Environment (ERE), actively works to promote the development and use of energy efficiency and clean distributive energy policies within the framework of a dynamic regulatory environment. Electric industry restructuring, energy shortages in California, and energy market transformation intensifies the need for reliable information and strategies regarding electric reliability policy and practice. NARUC promotes clean distributive generation and increased energy efficiency in the context of the energy sector restructuring process. NARUC, through ERE's Subcommittee on Energy Efficiency, strives to improve energy efficiency by creating working markets. Market transformation seeks opportunities where small amounts of investment can create sustainable markets for more efficient products, services, and design practices.

  19. Changing expectations and the role of demand side management in Canada

    SciTech Connect

    Read, W.S. )

    1992-01-01

    The circumstances in which Canadian electric power utilities find themselves today are vastly different form those that existed even a short 10 years ago. The public mood is different, and we have witnessed a dramatic shift in their expectations form our industry. A decade ago, most of our customers were content with utility performance that provided them with an adequate, reliable, safe, and reasonably priced supply of electricity.. The principal challenges were technical and financial as we struggled to keep up with the burgeoning demand for our product. This paper identifies some of the issues challenging the Canadian electric utilities and they describes a major initiative being aggressively pursued in Canada in order to gain some breathing space in our planning process.

  20. Distribution Automation and Demand-Side Management Demonstration for Northern States Power. Final report

    SciTech Connect

    Reder, W.; Zehlke, B.

    1995-09-01

    With increasing customer demands for reliable, competitively priced electric service, it has become essential for utilities to implement communications standards when deploying distribution automation systems. Northern States Power Company (NSP) in Minneapolis, Minnesota, hosted a project based on EPRI`s Utility Communications Architecture (UCA{trademark}), a set of open international standards for data communications. This project focused on building a model communication system from the corporate computer network to field devices following the UCA protocol. In the process, the project showed how the UCA could fit within an existing communications operating environment concurrently with proprietary protocols and specialized vendor equipment. Included in this report are industry recommendations, technical profiles of automation components, UCA object and 3-layer implementation details, screen prints of the graphical user interfaces, and a discussion of successful aspects of the project. The document provides a useful reference, benchmark, and source of automation concepts for future distribution automation projects, especially those involving UCA research.

  1. Lessons learned from new construction utility demand side management programs and their implications for implementing building energy codes

    SciTech Connect

    Wise, B.K.; Hughes, K.R.; Danko, S.L.; Gilbride, T.L.

    1994-07-01

    This report was prepared for the US Department of Energy (DOE) Office of Codes and Standards by the Pacific Northwest Laboratory (PNL) through its Building Energy Standards Program (BESP). The purpose of this task was to identify demand-side management (DSM) strategies for new construction that utilities have adopted or developed to promote energy-efficient design and construction. PNL conducted a survey of utilities and used the information gathered to extrapolate lessons learned and to identify evolving trends in utility new-construction DSM programs. The ultimate goal of the task is to identify opportunities where states might work collaboratively with utilities to promote the adoption, implementation, and enforcement of energy-efficient building energy codes.

  2. Review of Strategies and Technologies for Demand-Side Management on Isolated Mini-Grids

    SciTech Connect

    Harper, Meg

    2013-03-01

    This review provides an overview of strategies and currently available technologies used for demandside management (DSM) on mini-grids throughout the world. For the purposes of this review, mini-grids are defined as village-scale electricity distribution systems powered by small local generation sources and not connected to a main grid.1 Mini-grids range in size from less than 1 kW to several hundred kW of installed generation capacity and may utilize different generation technologies, such as micro-hydro, biomass gasification, solar, wind, diesel generators, or a hybrid combination of any of these. This review will primarily refer to AC mini-grids, though much of the discussion could apply to DC grids as well. Many mini-grids include energy storage, though some rely solely on real-time generation.

  3. A sustainable development of a city electrical grid via a non-contractual Demand-Side Management

    NASA Astrophysics Data System (ADS)

    Samoylenko, Vladislav O.; Pazderin, Andrew V.

    2017-06-01

    An increasing energy consumption of large cities as well as an extreme high density of city electrical loads leads to the necessity to search for an alternative approaches to city grid development. The ongoing implementation of the energy accounting tariffs with differentiated rates depending upon the market conditions and changing in a short-term perspective, provide the possibility to use it as a financial incentive base of a Demand-Side Management (DSM). Modern hi-technology energy metering and accounting systems with a large number of functions and consumer feedback are supposed to be the good means of DSM. Existing systems of Smart Metering (SM) billing usually provide general information about consumption curve, bills and compared data, but not the advanced statistics about the correspondence of financial and electric parameters. Also, consumer feedback is usually not fully used. So, the efforts to combine the market principle, Smart Metering and a consumer feedback for an active non-contractual load control are essential. The paper presents the rating-based multi-purpose system of mathematical statistics and algorithms of DSM efficiency estimation useful for both the consumers and the energy companies. The estimation is performed by SM Data processing systems. The system is aimed for load peak shaving and load curve smoothing. It is focused primarily on a retail market support. The system contributes to the energy efficiency and a distribution process improvement by the manual management or by the automated Smart Appliances interaction.

  4. Demand-side management project for Tenaga Nasional Berhad. Energy efficiency guidelines. Progress report No. 3. Volume 1. Final report. Export trade information

    SciTech Connect

    1993-05-01

    This study, conducted by the California Energy Commission, was funded by the U.S. Trade and Development Agency. The report summarizes a demand-side management study performed for the Tenaga Nasional Berhad Headquarters Building. The purpose of the study was to identify and evaluate demand side management measures (DSMs) that would reduce energy costs of the facility. Volume 1 is divided into the following sections: (1.0) Executive Summary; (2.0) Facility Background; (3.0) Ventilating and Air Conditioning Systems Description; (4.0) Lightning System Description; Figures, Tables, and Appendices.

  5. Demand-Side Response from Industrial Loads

    SciTech Connect

    Starke, Michael R; Alkadi, Nasr E; Letto, Daryl; Johnson, Brandon; Dowling, Kevin; George, Raoule; Khan, Saqib

    2013-01-01

    Through a research study funded by the Department of Energy, Smart Grid solutions company ENBALA Power Networks along with the Oak Ridge National Laboratory (ORNL) have geospatially quantified the potential flexibility within industrial loads to leverage their inherent process storage to help support the management of the electricity grid. The study found that there is an excess of 12 GW of demand-side load flexibility available in a select list of top industrial facilities in the United States. Future studies will expand on this quantity of flexibility as more in-depth analysis of different industries is conducted and demonstrations are completed.

  6. Disruptive innovation: the demand side.

    PubMed

    Havighurst, Clark C

    2008-01-01

    The notion of disruptive innovation provides a welcome framework for considering the prospects for low-cost alternatives in American medicine. Such innovations as have been seen, however, are largely the result of demand by patients paying their own bills because they have high-deductible coverage or are uninsured. Many other cost-saving innovations are discouraged by financing systems that are themselves largely immune to competition from disruptive innovators.

  7. Evaluating the impact of demand-side management on water resources under changing climatic conditions and increasing population.

    PubMed

    Dawadi, Srijana; Ahmad, Sajjad

    2013-01-15

    This study investigated the effect of increasing population and changing climatic conditions on the water resources of a semi-arid region, the Las Vegas Valley (LVV) in southern Nevada. A system dynamics model was developed for the LVV from 1989 to 2035. The impact of climate change on water demand and the water supply from the Colorado River was modeled, using projections from 16 global climate models for 3 emission scenarios. Variability in water demand and supply under different scenarios of population growth and demand management, including water conservation and water pricing, was evaluated. With the population growth that was projected, if no further demand management policies were implemented, the LVV would not be able to meet the water demand in the near future. However, by combining water conservation and pricing policies, the available supply could last well into the future. The reduction in water demand in 2035 was predicted to be 327 million cubic meters (MCM) for 'status quo' population growth, or 30.6%; 408 MCM for 50% of the projected growth, or 38%; and 511 MCM for no population growth, or 47.8%. Water supply reliability decreased significantly with changing climatic conditions. Therefore, major challenges to water sustainability in the LVV would be due to rapid population growth as well as to climate variability. However, with the combination of reduced population growth rate and water conservation policies, the Colorado River supply could meet the future demand of the LVV most of the time.

  8. DEMONSTRATION OF THE ENVIRONMENTAL AND DEMAND-SIDE MANAGEMENT BENEFITS OF GRID-CONNECTED PHOTOVOLTAIC POWER SYSTEMS SITED ON MILITARY BASES

    EPA Science Inventory

    The report gives results of an investigation into the pollutant emission reduction and demand-side management potential of three photovoltaic (PV) systems installed at Ft. Huachuca, AZ, Ft. Dix, NJ, and Hickam Air Force Base, HI, which began operation between January and July 199...

  9. DEMONSTRATION OF THE ENVIRONMENTAL AND DEMAND-SIDE MANAGEMENT BENEFITS OF GRID-CONNECTED PHOTOVOLTAIC POWER SYSTEMS SITED ON MILITARY BASES

    EPA Science Inventory

    The report gives results of an investigation into the pollutant emission reduction and demand-side management potential of three photovoltaic (PV) systems installed at Ft. Huachuca, AZ, Ft. Dix, NJ, and Hickam Air Force Base, HI, which began operation between January and July 199...

  10. Maximizing Energy Savings Reliability in BC Hydro Industrial Demand-side Management Programs: An Assessment of Performance Incentive Models

    NASA Astrophysics Data System (ADS)

    Gosman, Nathaniel

    For energy utilities faced with expanded jurisdictional energy efficiency requirements and pursuing demand-side management (DSM) incentive programs in the large industrial sector, performance incentive programs can be an effective means to maximize the reliability of planned energy savings. Performance incentive programs balance the objectives of high participation rates with persistent energy savings by: (1) providing financial incentives and resources to minimize constraints to investment in energy efficiency, and (2) requiring that incentive payments be dependent on measured energy savings over time. As BC Hydro increases its DSM initiatives to meet the Clean Energy Act objective to reduce at least 66 per cent of new electricity demand with DSM by 2020, the utility is faced with a higher level of DSM risk, or uncertainties that impact the costeffective acquisition of planned energy savings. For industrial DSM incentive programs, DSM risk can be broken down into project development and project performance risks. Development risk represents the project ramp-up phase and is the risk that planned energy savings do not materialize due to low customer response to program incentives. Performance risk represents the operational phase and is the risk that planned energy savings do not persist over the effective measure life. DSM project development and performance risks are, in turn, a result of industrial economic, technological and organizational conditions, or DSM risk factors. In the BC large industrial sector, and characteristic of large industrial sectors in general, these DSM risk factors include: (1) capital constraints to investment in energy efficiency, (2) commodity price volatility, (3) limited internal staffing resources to deploy towards energy efficiency, (4) variable load, process-based energy saving potential, and (5) a lack of organizational awareness of an operation's energy efficiency over time (energy performance). This research assessed the capacity

  11. Impacts of Western Area Power Administration`s power marketing alternatives on utility demand-side management and conservation and renewable energy programs

    SciTech Connect

    Cavallo, J.D.; Germer, M.F.; Tompkins, M.M.

    1995-03-01

    The Western Area Power Administration (Western) requires all of its long-term firm power customers to implement programs that promote the conservation of electric energy or facilitate the use of renewable energy resources. Western has also proposed that all customers develop integrated resource plans that include cost-effective demand-side management programs. As part of the preparation of Western`s Electric Power Marketing Environmental Impact Statement, Argonne National Laboratory (ANL) developed estimates of the reductions in energy demand resulting from Western`s conservation and renewable energy activities in its Salt Lake City Area Office. ANL has also estimated the energy-demand reductions from cost-effective, demand-side management programs that could be included in the integrated resource plans of the customers served by Western`s Salt Lake City Area Office. The results of this study have been used to adjust the expected hourly demand for Western`s major systems in the Salt Lake City Area. The expected hourly demand served as the basis for capacity expansion plans develops with ANL`s Production and Capacity Expansion (PACE) model.

  12. Electricity decision-making: New techniques for calculating statewide economic impacts from new power supply and demand-side management programs

    NASA Astrophysics Data System (ADS)

    Tegen, Suzanne Isabel Helmholz

    This dissertation introduces new techniques for calculating and comparing statewide economic impacts from new coal, natural gas and wind power plants, as well as from demand-side management programs. The impetus for this work was two-fold. First, reviews of current literature and projects revealed that there was no standard way to estimate statewide economic impacts from new supply- and demand-side electricity options. Second, decision-makers who were interviewed stated that they were overwhelmed with data in general, but also lacked enough specific information about economic development impacts to their states from electricity, to make informed choices. This dissertation includes chapters on electricity decision-making and on economic impacts from supply and demand. The supply chapter compares different electricity options in three states which vary in natural resource content: Arizona, Colorado and Michigan. To account for differing capacity factors, resources are compared on a per-megawatt-hour basis. The calculations of economic impacts from new supply include: materials and labor for construction, operations, maintenance, fuel extraction, fuel transport, as well as property tax, financing and landowner revenues. The demand-side chapter compares residential, commercial and industrial programs in Iowa. Impact calculations include: incremental labor and materials for program planning, installation and operations, as well as sales taxes and electricity saved. Results from supply-side calculations in the three states analyzed indicate that adding new wind power can have a greater impact to a state's economy than adding new gas or coal power due to resource location, taxes and infrastructure. Additionally, demand-side management programs have a higher relative percentage of in-state dollar flow than supply-side solutions, though demand-side programs typically involve fewer MWh and dollars than supply-side generation. Methods for this dissertation include researching

  13. The planning and implementation of a demand-side management/distribution automation system at Taiwan Power Company

    SciTech Connect

    Liu, S.S.; Chen, Yun-Wu

    1994-12-31

    This paper would describe the Taipower`s experience of DSM/DAS development. For the past 5 years, the demand of electricity has maintained a high annual growth rate of 8.45% due to economic prosperity in Taiwan. As the environmental protection consciousness has recently made Taipower difficult to develope and construct new power plants, substations, transmission and distribution lines, and our power grid is an independent system, we do need to concern how to do DSM to manage the load problems. Since 1984, Taipower has established two pilot systems and these systems performed the functions of fault detect and isolation certainly good for Distribution Automation. With the rapid development of computer, communication and control technology, the concept of the DAS has gradually been implemented in real cases. Taipower organized an engineering task group to study DAS several years ago, and based on the operation experience of the existing systems, today Taipower is planning to launch a new DAS project for Tai-Chung area. According to Taipower requirements, the DAS will have the functions of feeder automation, automatic meter reading, load management and disteibution system analysis.

  14. Impact of a solar domestic hot water demand-side management program on an electric utility and its customers

    SciTech Connect

    Trzesniewski, J.; Mitchell, J.W.; Klein, S.A.; Beckman, W.A.

    1996-11-01

    A methodology to assess the economic and environmental impacts of a large scale implementation of solar domestic hot water (SDHW) systems is developed. Energy, emission and demand reductions and their respective savings are quantified. It is shown that, on average, an SDHW system provides an energy reduction of about 3,200 kWH, avoided emissions of about 2 tons and a capacity contribution of 0.7 kW to a typical Wisconsin utility that installs 5,000 SDHW systems. The annual savings from these reductions to utility is $385,m000, providing a return on an investment of over 20%. It is shown that, on average, a consumer will save $211 annually in hot water heating bills.

  15. Promoting healthcare innovation on the demand side

    PubMed Central

    Eisenberg, Rebecca S.

    2017-01-01

    Abstract Innovation policy often focuses on fortifying the incentives of firms that develop and sell new products by offering them lucrative rights to exclude competitors from the market. Regulators also rely on these same firms—and on similar incentives—to develop information about the effects of their products in patients, despite their obvious conflict of interest. The result may be a distorted understanding that leads to overuse of expensive new medical technologies. Recent technological advances have put healthcare payers in an excellent position to play a larger role in future innovation to improve healthcare and reduce its costs. Insurance companies and integrated healthcare providers have custody of treasure troves of data about healthcare provision and outcomes that can yield valuable insights about the effects of medical treatment without the need to conduct costly clinical trials. Some integrated healthcare systems have seized upon this advantage to make notable discoveries about the effects of particular products that have changed the standard of care. Moreover, to the extent that healthcare payers can profit from reducing costs, they will seek to avoid inappropriate use of costly technologies. Greater involvement of payers in healthcare innovation thus offers a potential counterweight to the incentives of product sellers to promote excessive use of costly new products. In recent years, the federal government has sought to promote innovation through analysis of healthcare records in a series of initiatives; some picture insurers as passive data repositories, while others provide opportunities for insurers to take a more active role in innovation. In this paper, we examine the role of health insurers in developing new knowledge about the provision and effects of healthcare—what we call ‘demand-side innovation’. We address the contours of this underexplored area of innovation and describe the behavior of participating firms. We examine the

  16. Promoting healthcare innovation on the demand side.

    PubMed

    Eisenberg, Rebecca S; Price, W Nicholson

    2017-04-01

    Innovation policy often focuses on fortifying the incentives of firms that develop and sell new products by offering them lucrative rights to exclude competitors from the market. Regulators also rely on these same firms-and on similar incentives-to develop information about the effects of their products in patients, despite their obvious conflict of interest. The result may be a distorted understanding that leads to overuse of expensive new medical technologies. Recent technological advances have put healthcare payers in an excellent position to play a larger role in future innovation to improve healthcare and reduce its costs. Insurance companies and integrated healthcare providers have custody of treasure troves of data about healthcare provision and outcomes that can yield valuable insights about the effects of medical treatment without the need to conduct costly clinical trials. Some integrated healthcare systems have seized upon this advantage to make notable discoveries about the effects of particular products that have changed the standard of care. Moreover, to the extent that healthcare payers can profit from reducing costs, they will seek to avoid inappropriate use of costly technologies. Greater involvement of payers in healthcare innovation thus offers a potential counterweight to the incentives of product sellers to promote excessive use of costly new products. In recent years, the federal government has sought to promote innovation through analysis of healthcare records in a series of initiatives; some picture insurers as passive data repositories, while others provide opportunities for insurers to take a more active role in innovation. In this paper, we examine the role of health insurers in developing new knowledge about the provision and effects of healthcare-what we call 'demand-side innovation'. We address the contours of this underexplored area of innovation and describe the behavior of participating firms. We examine the effects of current legal

  17. "Souls of the ancestor that knock us out" and other tales. A qualitative study to identify demand-side factors influencing malaria case management in Cambodia.

    PubMed

    O'Connell, Kathryn A; Samandari, Ghazaleh; Phok, Sochea; Phou, Mean; Dysoley, Lek; Yeung, Shunmay; Allen, Henrietta; Littrell, Megan

    2012-10-05

    Appropriate case management of suspected malaria in Cambodia is critical given anti-malarial drug resistance in the region. Improving diagnosis and the use of recommended malarial treatments is a challenge in Cambodia where self-treatment and usage of drug cocktails is widespread, a notable difference from malaria treatment seeking in other countries. This qualitative study adds to the limited evidence base on Cambodian practices, aiming to understand the demand-side factors influencing treatment-seeking behaviour, including the types of home treatments, perceptions of cocktail medicines and reasons for diagnostic testing. The findings may help guide intervention design. The study used in-depth interviews (IDIs) (N = 16) and focus group discussions (FGDs) (N = 12) with Cambodian adults from malaria-endemic areas who had experienced malaria fever in the previous two weeks. Data were analysed using NVivo software. Findings suggest that Cambodians initially treat suspected malaria at home with home remedies and traditional medicines. When seeking treatment outside the home, respondents frequently reported receiving a cocktail of medicines from trusted providers. Cocktails are perceived as less expensive and more effective than full-course, pre-packaged medicines. Barriers to diagnostic testing include a belief in the ability to self-diagnose based on symptoms, cost and reliance on providers to recommend a test. Factors that facilitate testing include recommendation by trusted providers and a belief that anti-malarial treatment for illnesses other than malaria can be harmful. Treatment-seeking behaviour for malaria in Cambodia is complex, driven by cultural norms, practicalities and episode-related factors. Effective malaria treatment programmes will benefit from interventions and communication materials that leverage these demand-side factors, promoting prompt visits to facilities for suspected malaria and challenging patients' misconceptions about the effectiveness

  18. “Souls of the ancestor that knock us out” and other tales. A qualitative study to identify demand-side factors influencing malaria case management in Cambodia

    PubMed Central

    2012-01-01

    Background Appropriate case management of suspected malaria in Cambodia is critical given anti-malarial drug resistance in the region. Improving diagnosis and the use of recommended malarial treatments is a challenge in Cambodia where self-treatment and usage of drug cocktails is widespread, a notable difference from malaria treatment seeking in other countries. This qualitative study adds to the limited evidence base on Cambodian practices, aiming to understand the demand-side factors influencing treatment-seeking behaviour, including the types of home treatments, perceptions of cocktail medicines and reasons for diagnostic testing. The findings may help guide intervention design. Methods The study used in-depth interviews (IDIs) (N = 16) and focus group discussions (FGDs) (N = 12) with Cambodian adults from malaria-endemic areas who had experienced malaria fever in the previous two weeks. Data were analysed using NVivo software. Results Findings suggest that Cambodians initially treat suspected malaria at home with home remedies and traditional medicines. When seeking treatment outside the home, respondents frequently reported receiving a cocktail of medicines from trusted providers. Cocktails are perceived as less expensive and more effective than full-course, pre-packaged medicines. Barriers to diagnostic testing include a belief in the ability to self-diagnose based on symptoms, cost and reliance on providers to recommend a test. Factors that facilitate testing include recommendation by trusted providers and a belief that anti-malarial treatment for illnesses other than malaria can be harmful. Conclusions Treatment-seeking behaviour for malaria in Cambodia is complex, driven by cultural norms, practicalities and episode-related factors. Effective malaria treatment programmes will benefit from interventions and communication materials that leverage these demand-side factors, promoting prompt visits to facilities for suspected malaria and challenging

  19. Hawaii Energy Strategy: Program guide. [Contains special sections on analytical energy forecasting, renewable energy resource assessment, demand-side energy management, energy vulnerability assessment, and energy strategy integration

    SciTech Connect

    Not Available

    1992-09-01

    The Hawaii Energy Strategy program, or HES, is a set of seven projects which will produce an integrated energy strategy for the State of Hawaii. It will include a comprehensive energy vulnerability assessment with recommended courses of action to decrease Hawaii's energy vulnerability and to better prepare for an effective response to any energy emergency or supply disruption. The seven projects are designed to increase understanding of Hawaii's energy situation and to produce recommendations to achieve the State energy objectives of: Dependable, efficient, and economical state-wide energy systems capable of supporting the needs of the people, and increased energy self-sufficiency. The seven projects under the Hawaii Energy Strategy program include: Project 1: Develop Analytical Energy Forecasting Model for the State of Hawaii. Project 2: Fossil Energy Review and Analysis. Project 3: Renewable Energy Resource Assessment and Development Program. Project 4: Demand-Side Management Program. Project 5: Transportation Energy Strategy. Project 6: Energy Vulnerability Assessment Report and Contingency Planning. Project 7: Energy Strategy Integration and Evaluation System.

  20. Managing Chemotherapy Side Effects: Pain

    MedlinePlus

    ... ational C ancer I nstitute Managing Chemotherapy Side Effects Pain It’s important to treat pain. If you ... to pay for pain medicine. Managing Chemotherapy Side Effects: Pain Keep track of the pain. Each day, ...

  1. Managing Chemotherapy Side Effects: Infection

    MedlinePlus

    ... ational C ancer I nstitute Managing Chemotherapy Side Effects Infection “I am extra careful to stay away ... doctor or nurse right away. Managing Chemotherapy Side Effects: Infection Take these steps to lower your chances ...

  2. Side Effects (Management)

    MedlinePlus

    ... Cancer is Treated Side Effects Dating, Sex, and Reproduction Advanced Cancer For Children For Teens For Young ... Cancer is Treated Side Effects Dating, Sex, and Reproduction Advanced Cancer For Children For Teens For Young ...

  3. Demand management and case management: a conservation strategy.

    PubMed

    Bryant, C D R Anna K

    2007-01-01

    This article reviews the history and development of managed competition, and explores the possibilities of a new demand management strategy in the context of nurse case management to offer less costly, higher quality care for a greater number of patients. The article examines the history and principles of healthcare demand management, its implementation in the hospital and clinical practices of nurse case managers, and its impacts in reducing costs while maintaining care levels. The article develops and analyzes the conflicts and common ground between demand management and case management. First, demand-side strategies can be effective in reducing costs while maintaining quality of nursing care; second, nurse case managers should employ patient education, self-care, and staffing solutions to manage demand. Nurse case managers must apply demand management principles carefully. Their goal is not to restrict care, but to maintain the highest levels of care possible within the limits of their practice's resources and staffing. Two critical themes emerge: (1) demand management is a potential alternative to market-driven managed competition and (2) nursing case management can affect an effective form of demand management. However, the long-term implications of these nursing case management strategies on healthcare staffing need further exploration.

  4. Empowering the demand side: from regulation to purchasing.

    PubMed

    Kronick, R

    1992-01-01

    The primary justification for private insurance is the hypothesis that competition among private insurers will lead to an environment in which physicians and hospitals will continually strive to improve the quality and economy of the care they provide, and to be responsive to the preferences of the consumers they serve. However, to date, competition among private insurers has failed miserably in achieving this goal. In order to achieve this goal, competition among insurers must be regulated in an entirely different manner than it is currently. This article describes the ways in which health insurance is currently regulated, and argues that passive regulation directed at assuring financial solvency of insurers should be transformed into an active purchasing authority. This purchasing authority would empower the demand side, creating an environment of managed competition that rewarded those provider groups able to offer high quality, economical care.

  5. Physiological and skill demands of 'on-side' and 'off-side' games.

    PubMed

    Gabbett, Tim J; Jenkins, David G; Abernethy, Bruce

    2010-11-01

    This study investigated the physiological and skill demands of 'on-side' and 'off-side' games in elite rugby league players. Sixteen male rugby league players participated in 'on-side' and 'off-side' games. Both small-sided games were played in a 40- × 40-m playing area. The 'off-side' game permitted players to have 3 'plays' while in possession of the ball. Players were permitted to pass backward or forward (to an 'off-side' player). The 'on-side' game also permitted players to have 3 'plays' while in possession of the ball. However, players were only permitted to pass backward to players in an 'on-side' position. Heart rate and movement patterns (via global positioning system) were recorded continuously throughout both games. Data were collected on the distance covered, number of high-acceleration and velocity efforts, and recovery between efforts. Video footage was also taken to track the performance of the players. Post hoc inspection of the footage was undertaken to count the number of possessions and the number and quality of disposals. In comparison to 'on-side' games, 'off-side' games had a greater number of involvements ("touches"), passes, and effective passes. However, the cognitive demands of 'on-side' games were greater than 'off-side' games. 'Off-side' games resulted in a greater total distance covered, greater distance covered in mild and moderate accelerations, and greater distance covered in low, moderate, and high-velocity efforts. There were also a greater number of short duration recovery periods between efforts in 'off-side' games. The results of this study demonstrate that 'off-side' games provide greater physiological and skill demands than 'on-side' games. 'Off-side' games may provide a practical alternative to 'on-side' games for the development of skill and fitness in elite rugby league players.

  6. Hawaii demand-side management resource assessment. Final report, Reference Volume 3 -- Residential and commercial sector DSM analyses: Detailed results from the DBEDT DSM assessment model; Part 1, Technical potential

    SciTech Connect

    1995-04-01

    The Hawaii Demand-Side Management Resource Assessment was the fourth of seven projects in the Hawaii Energy Strategy (HES) program. HES was designed by the Department of Business, Economic Development, and Tourism (DBEDT) to produce an integrated energy strategy for the State of Hawaii. The purpose of Project 4 was to develop a comprehensive assessment of Hawaii`s demand-side management (DSM) resources. To meet this objective, the project was divided into two phases. The first phase included development of a DSM technology database and the identification of Hawaii commercial building characteristics through on-site audits. These Phase 1 products were then used in Phase 2 to identify expected energy impacts from DSM measures in typical residential and commercial buildings in Hawaii. The building energy simulation model DOE-2.1E was utilized to identify the DSM energy impacts. More detailed information on the typical buildings and the DOE-2.1E modeling effort is available in Reference Volume 1, ``Building Prototype Analysis``. In addition to the DOE-2.1E analysis, estimates of residential and commercial sector gas and electric DSM potential for the four counties of Honolulu, Hawaii, Maui, and Kauai through 2014 were forecasted by the new DBEDT DSM Assessment Model. Results from DBEDTs energy forecasting model, ENERGY 2020, were linked with results from DOE-2.1E building energy simulation runs and estimates of DSM measure impacts, costs, lifetime, and anticipated market penetration rates in the DBEDT DSM Model. Through its algorithms, estimates of DSM potential for each forecast year were developed. Using the load shape information from the DOE-2.1E simulation runs, estimates of electric peak demand impacts were developed. Numerous tables and figures illustrating the technical potential for demand-side management are included.

  7. Demand-Side Job Development and System Change.

    ERIC Educational Resources Information Center

    Gilbride, Dennis; Stensrud, Robert

    1999-01-01

    Authors discuss demand-side job development as a model for improving and providing rehabilitation services to consumers and employers. It stresses quality employment outcomes, consumer choice and empowerment, and a productive partnership between consumer and counselor. Delineates systemic challenges this model poses to traditional vocational…

  8. Development of robust building energy demand-side control strategy under uncertainty

    NASA Astrophysics Data System (ADS)

    Kim, Sean Hay

    including both historical archive and online sources and ii) adaptive Multiple model-based controls (MMC) to mitigate detrimental impacts of varying scenario uncertainties. The proposed robust demand-side control strategy verifies its outstanding demand-side control performance in varied and non-indigenous conditions compared to the existing control strategies including deterministic optimal controls. This result reemphasizes importance of the demand-side control for a building in the global carbon economy. It also demonstrates a capability of risk management of the proposed robust demand-side controls in highly uncertain situations, which eventually attains the maximum benefit in both theoretical and practical perspectives.

  9. Hawaii demand-side management resource assessment. Final report, Reference Volume 4: The DBEDT DSM assessment model user`s manual

    SciTech Connect

    1995-04-01

    The DBEDT DSM Assessment Model (DSAM) is a spreadsheet model developed in Quattro Pro for Windows that is based on the integration of the DBEDT energy forecasting model, ENERGY 2020, with the output from the building energy use simulation model, DOE-2. DOE-2 provides DSM impact estimates for both energy and peak demand. The ``User`s Guide`` is designed to assist DBEDT staff in the operation of DSAM. Supporting information on model structure and data inputs are provided in Volumes 2 and 3 of the Final Report. DSAM is designed to provide DBEDT estimates of the potential DSM resource for each county in Hawaii by measure, program, sector, year, and levelized cost category. The results are provided for gas and electric and for both energy and peak demand. There are two main portions of DSAM, the residential sector and the commercial sector. The basic underlying logic for both sectors are the same. However, there are some modeling differences between the two sectors. The differences are primarily the result of (1) the more complex nature of the commercial sector, (2) memory limitations within Quattro Pro, and (3) the fact that the commercial sector portion of the model was written four months after the residential sector portion. The structure for both sectors essentially consists of a series of input spreadsheets, the portion of the model where the calculations are performed, and a series of output spreadsheets. The output spreadsheets contain both detailed and summary tables and graphs.

  10. Improving financial and patient outcomes: the future of demand management.

    PubMed

    Marosits, M J

    1997-08-01

    Demand management has evolved from early managed care models that sought to curtail rising costs through demand-side utilization controls. The first generation of demand management relied heavily on financial incentives for consumers and physicians to demand fewer and less costly resources. The second generation of demand management complemented financial incentives with clinically focused strategies. Often, these strategies were implemented directly by the payer on through a primary care physician gatekeeper. The current and coming generation of demand management activities emphasizes informed consumer choice and active participation in preventative health care, resource utilization decisions, and customization of healthcare services. This personal health management aligns financial incentives, clinical care protocols, and consumer decision-support systems to balance outcomes and resource consumption.

  11. Essays on measurement and evaluation of demand side management programs in the electricity industry, and impacts of firm strategy on stock price in the biotechnology industry

    NASA Astrophysics Data System (ADS)

    Bandres Motola, Miguel A.

    Essay one estimates changes in small business customer energy consumption (kWh) patterns resulting from a seasonally differentiated pricing structure. Econometric analysis leverages cross-sectional time series data across the entire population of affected customers, from 2007 through the present. Observations include: monthly energy usage (kWh), relevant customer segmentations, local daily temperature, energy price, and region-specific economic conditions, among other variables. The study identifies the determinants of responsiveness to seasonal price differentiation. In addition, estimated energy consumption changes occurring during the 2010 summer season are reported for the average customer and in aggregate grouped by relevant customer segments, climate zone, and total customer base. Essay two develops an econometric modeling methodology to evaluate load impacts for short duration demand response events. The study analyzes time series data from a season of direct load control program tests aimed at integrating demand response into the wholesale electricity market. I have combined "fuzzy logic" with binary variables to create "fuzzy indicator variables" that allow for measurement of short duration events while using industry standard model specifications. Typically, binary variables for every hour are applied in load impact analysis of programs dispatched in hourly intervals. As programs evolve towards integration with the wholesale market, event durations become irregular and often occur for periods of only a few minutes. This methodology is innovative in that it conserves the degrees of freedom in the model while allowing for analysis of high frequency data using fixed effects. Essay three examines the effects of strategies, intangibles, and FDA news on the stocks of young biopharmaceutical firms. An event study methodology is used to explore those effects. This study investigates 20,839 announcements from 1990 to 2005. Announcements on drug development

  12. Development of cold seawater air conditioning systems for application as a demand side management tool for Hawaii and other subtropical climates

    SciTech Connect

    Kaya, M.H.

    1996-10-01

    Because of the proximity to deep cold seawater for many coastal regions in Hawaii and the high demand for air conditioning in large buildings, seawater air conditioning (SWAC) is a major potential sustainable energy resource for Hawaii and other subtropical regions of the world. The basic concept of seawater air conditioning is the use deep cold seawater to cool the chilled water in one or more air conditioned buildings as opposed to using energy intensive refrigeration systems. The economic viability of the seawater air conditioning is determined by comparing the construction and operating costs of the seawater supply system to the construction and operating costs of conventional air conditioning systems. The State of Hawaii commissioned an analysis to identify the technical and economic opportunities and limitations in the use of SWAC in Hawaii. The result of this work is a feasibility analysis of SWAC systems in the state and the potential associated energy savings. The study looked at the prospects of installing such a system at a major new resort development on Oahu called West Beach.

  13. Hawaii demand-side management resource assessment. Final report, Reference Volume 5: The DOETRAN user`s manual; The DOE-2/DBEDT DSM forecasting model interface

    SciTech Connect

    1995-04-01

    The DOETRAN model is a DSM database manager, developed to act as an intermediary between the whole building energy simulation model, DOE-2, and the DBEDT DSM Forecasting Model. DOETRAN accepts output data from DOE-2 and TRANslates that into the format required by the forecasting model. DOETRAN operates in the Windows environment and was developed using the relational database management software, Paradox 5.0 for Windows. It is not necessary to have any knowledge of Paradox to use DOETRAN. DOETRAN utilizes the powerful database manager capabilities of Paradox through a series of customized user-friendly windows displaying buttons and menus with simple and clear functions. The DOETRAN model performs three basic functions, with an optional fourth. The first function is to configure the user`s computer for DOETRAN. The second function is to import DOE-2 files with energy and loadshape data for each building type. The third main function is to then process the data into the forecasting model format. As DOETRAN processes the DOE-2 data, graphs of the total electric monthly impacts for each DSM measure appear, providing the user with a visual means of inspecting DOE-2 data, as well as following program execution. DOETRAN provides three tables for each building type for the forecasting model, one for electric measures, gas measures, and basecases. The optional fourth function provided by DOETRAN is to view graphs of total electric annual impacts by measure. This last option allows a comparative view of how one measure rates against another. A section in this manual is devoted to each of the four functions mentioned above, as well as computer requirements and exiting DOETRAN.

  14. Overcoming barriers to health service access: influencing the demand side.

    PubMed

    Ensor, Tim; Cooper, Stephanie

    2004-03-01

    Evidence suggests that demand-side barriers may be as important as supply factors in deterring patients from obtaining treatment. Yet relatively little attention is given, either by policy makers or researchers, to ways of minimizing their effect. These barriers are likely to be more important for the poor and other vulnerable groups, where the costs of access, lack of information and cultural barriers impede them from benefiting from public spending. Demand barriers present in low- and middle-income countries and evidence on the effectiveness of interventions to overcome these obstacles are reviewed. Demand barriers are also shown to be important in richer countries, particularly among vulnerable groups. This suggests that while barriers are plentiful, there is a dearth of evidence on ways to reduce them. Where evidence does exist, the data and methodology for evaluating effectiveness and cost-effectiveness is insufficient. An increased focus on obtaining robust evidence on effective interventions could yield high returns. The likely nature of the interventions means that pragmatic policy routes that go beyond the traditional boundaries of the public health sector are required for implementing the findings.

  15. Electric utility demand side programs and integrated resource planning: visits to ten utilities

    SciTech Connect

    Hirst, E.

    1986-03-01

    During fall 1985, the author visited ten investor-owned electric utilities in California, Nevada, Washington, Wisconsin, New Jersey, New York, Connecticut, Massachusetts, and Maine. Purpose of thes visits was to discuss electric utility demand-side planning and programs, and to learn more about utility efforts to establish integrated resource planning processes. The author also attended a course on the Load Management Strategy Testing Model, developed for the Electric Power Research Institute. Finally, the author reviewed three other integrated resource planning models. This report presents my impressions of current electric utility activities in conservation and load management program planning, analysis, and evaluation; and in integrated demand/supply planning.

  16. Prediction-based manufacturing center self-adaptive demand side energy optimization in cyber physical systems

    NASA Astrophysics Data System (ADS)

    Sun, Xinyao; Wang, Xue; Wu, Jiangwei; Liu, Youda

    2014-05-01

    Cyber physical systems(CPS) recently emerge as a new technology which can provide promising approaches to demand side management(DSM), an important capability in industrial power systems. Meanwhile, the manufacturing center is a typical industrial power subsystem with dozens of high energy consumption devices which have complex physical dynamics. DSM, integrated with CPS, is an effective methodology for solving energy optimization problems in manufacturing center. This paper presents a prediction-based manufacturing center self-adaptive energy optimization method for demand side management in cyber physical systems. To gain prior knowledge of DSM operating results, a sparse Bayesian learning based componential forecasting method is introduced to predict 24-hour electric load levels for specific industrial areas in China. From this data, a pricing strategy is designed based on short-term load forecasting results. To minimize total energy costs while guaranteeing manufacturing center service quality, an adaptive demand side energy optimization algorithm is presented. The proposed scheme is tested in a machining center energy optimization experiment. An AMI sensing system is then used to measure the demand side energy consumption of the manufacturing center. Based on the data collected from the sensing system, the load prediction-based energy optimization scheme is implemented. By employing both the PSO and the CPSO method, the problem of DSM in the manufacturing center is solved. The results of the experiment show the self-adaptive CPSO energy optimization method enhances optimization by 5% compared with the traditional PSO optimization method.

  17. Design of demand side response model in energy internet demonstration park

    NASA Astrophysics Data System (ADS)

    Zhang, Q.; Liu, D. N.

    2017-08-01

    The implementation of demand side response can bring a lot of benefits to the power system, users and society, but there are still many problems in the actual operation. Firstly, this paper analyses the current situation and problems of demand side response. On this basis, this paper analyses the advantages of implementing demand side response in the energy Internet demonstration park. Finally, the paper designs three kinds of feasible demand side response modes in the energy Internet demonstration park.

  18. Managing Chemotherapy Side Effects: Memory Changes

    MedlinePlus

    ... C ancer I nstitute Managing Chemotherapy Side Effects Memory Changes What is causing these changes? Your doctor ... thinking or remembering things Managing Chemotherapy Side Effects: Memory Changes Get help to remember things. Write down ...

  19. Managing Chemotherapy Side Effects: Swelling (Fluid Retention)

    MedlinePlus

    ... ational C ancer I nstitute Managing Chemotherapy Side Effects Swelling (Fluid retention) “My hands and feet were ... too much at one time. Managing Chemotherapy Side Effects: Swelling (Fluid retention) Weigh yourself. l Weigh yourself ...

  20. Impacts of Demand-Side Resources on Electric Transmission Planning

    SciTech Connect

    Hadley, Stanton W.; Sanstad, Alan H.

    2015-01-01

    Will demand resources such as energy efficiency (EE), demand response (DR), and distributed generation (DG) have an impact on electricity transmission requirements? Five drivers for transmission expansion are discussed: interconnection, reliability, economics, replacement, and policy. With that background, we review the results of a set of transmission studies that were conducted between 2010 and 2013 by electricity regulators, industry representatives, and other stakeholders in the three physical interconnections within the United States. These broad-based studies were funded by the US Department of Energy and included scenarios of reduced load growth due to EE, DR, and DG. While the studies were independent and used different modeling tools and interconnect-specific assumptions, all provided valuable results and insights. However, some caveats exist. Demand resources were evaluated in conjunction with other factors, and limitations on transmission additions between scenarios made understanding the role of demand resources difficult. One study, the western study, included analyses over both 10- and 20-year planning horizons; the 10-year analysis did not show near-term reductions in transmission, but the 20-year indicated fewer transmission additions, yielding a 36percent capital cost reduction. In the eastern study the reductions in demand largely led to reductions in local generation capacity and an increased opportunity for low-cost and renewable generation to export to other regions. The Texas study evaluated generation changes due to demand, and is in the process of examining demand resource impacts on transmission.

  1. Review of demand-side bidding programs: Impacts, costs, and cost-effectiveness

    SciTech Connect

    Goldman, C.A.; Kito, M.S.

    1994-05-01

    In December 1987, Central Maine Power (CMP) instituted the first competitive bidding program that allowed developers to propose installation of conservation measures. Since then, about 30 utilities in 14 states have solicited bids from energy service companies (ESCOs) and customers to reduce energy demand in residential homes and in commercial and industrial facilities. Interest in the use of competitive procurement mechanisms for demand-side resources continues to grow. In this study, the authors build upon earlier work conducted by LBL in collaboration with others (Goldman and Busch 1992; Wolcott and Goldman 1992). They have developed methods to compare bid prices and program costs among utilities. They also characterize approaches used by utilities and developers to allocate risks associated with DSM resources based on their review of a large sample of signed contracts. These contracts are analyzed in some detail because they provide insights into the evolving roles and responsibilities of utilities, customers, and third party contractors in providing demand-side management (DSM) services. The analysis also highlights differences in the allocation of risks between traditional utility rebate programs and DSM bidding programs.

  2. Decentralization of Education: Demand-Side Financing. Directions in Development.

    ERIC Educational Resources Information Center

    Patrinos, Harry A.; Ariasingam, David L.

    Central governments' supply-side expansions of schooling have not equally benefited all members of society, especially girls, indigenous peoples, tribal groups, disadvantaged minorities, and the poor. Public spending on education is often inefficient, higher education is subsidized at primary education's expense, and costs are becoming…

  3. Supply-side and demand-side cost sharing in deregulated social health insurance: which is more effective?

    PubMed

    Trottmann, Maria; Zweifel, Peter; Beck, Konstantin

    2012-01-01

    Microeconomic theory predicts that if patients are fully insured and providers are paid fee-for-service, utilization of medical services exceeds the efficient level ('moral hazard effect'). In Switzerland, both demand-side and supply-side cost sharing have been introduced to mitigate this problem. Analyzing a panel dataset of about 160,000 adults, we find both types of cost sharing to be effective in curtailing the use of medical services. However, when moral hazard mitigation is traded off against risk selection, the minimum-deductible, supply-side cost sharing option ranks first, followed by the medium-deductible demand-side alternative, making the supply-side option somewhat more effective. Copyright © 2011 Elsevier B.V. All rights reserved.

  4. Evidence is growing on demand side of an oil peak

    SciTech Connect

    2009-07-15

    After years of continued growth, the number of miles driven by Americans started falling in December 2007. Not only are the number of miles driven falling, but as cars become more fuel efficient, they go further on fewer gallons - further reducing demand for gasoline. This trend is expected to accelerate. Drivers include, along with higher-efficiency cars, mass transit, reversal in urban sprawl, biofuels, and plug-in hybrid vehicles.

  5. Research on electricity market operation mechanism and its benefit of demand side participation

    NASA Astrophysics Data System (ADS)

    Han, Shuai; Yan, Xu; Qin, Li-juan; Lin, Xi-qiao; Zeng, Bo

    2017-08-01

    Demand response plays an important role in maintaining the economic stability of the system, and has the characteristics of high efficiency, low cost, fast response, good environmental benefits and so on. Demand side resource is an important part of electricity market. The research of demand side resources in our country is still in the initial stage, but the opening of the electricity sales side provides a broad prospect for the development of electricity market. This paper summarizes the main types of demand side resources in our country, analyzes the economic principle of demand response from the micro perspective, puts forward some suggestions on the operation mechanism of China’s demand side resources participating in the electricity market under the condition of electricity sales side opening, analyzes the current situation of pricing in the electricity wholesale market and sets up the pricing strategy of the centralized wholesale market with the demand side power supply participating in quotation, which makes the social and economic benefits reach the maximum.

  6. Methods for the identification, prioritization of demand side technology measures

    SciTech Connect

    Fletcher, K.

    1996-12-31

    ETSU is the UK national Energy Agency with a major role in planning and running both energy efficiency and environmental control programs. For energy and emissions forecasting and strategic planning they use modelling systems extensively, including technology assessment and diffusion models, simulation models and linear optimization modelling. A key objective is to provide consistency between the various projection models, thereby providing detailed bottom-up technology information for program planning. This paper describes a set of these models which is proving to be of significance in the UK as an emissions forecasting and technology foresight tool, operating at a more detailed level of demand and technology analysis than that available from more conventional modelling approaches.

  7. Other side of color management

    NASA Astrophysics Data System (ADS)

    Lavendel, Larry A.

    1996-03-01

    As we witness the coming to maturity of color management technology, questions still remain: have we really solved the big problem of color use on the computer? Is the current solution in the right solution? What are the real obstacles in making computerized color work productive? Color fidelity between devices has been (still is?) a big problem and much effort and progress has been made towards solving it. Are there other problems with color work on the computer? For most people using color is difficult. Instead of being easier, working with color on the computer is more arduous and complex than when using traditional methods. How can we make working with color less of an effort and more enjoyable for computer users? What are the obstacles preventing computer developers from doing this? How do we really empower computer color users? By transforming the way that color work is done: redefine the place color takes in computer systems, provide real tools to manage color work, and provide tools that make computerized color work natural, creative and satisfying.

  8. Supply-side and demand-side policies for biosimilars: an overview in 10 European member states

    PubMed Central

    Rémuzat, Cécile; Kapuśniak, Anna; Caban, Aleksandra; Ionescu, Dan; Radière, Guerric; Mendoza, Cyril; Toumi, Mondher

    2017-01-01

    ABSTRACT Objective: This study aimed to provide an overview of biosimilar policies in 10 EU MSs. Methods: Ten EU MS pharmaceutical markets (Belgium, France, Germany, Greece, Hungary, Italy, Poland, Spain, Sweden, and the UK) were selected. A comprehensive literature review was performed to identify supply-side and demand-side policies in place in the selected countries. Results: Supply-side policies for biosimilars commonly include price linkage, price re-evaluation, and tendering; the use of internal or external reference pricing varies between countries; health technology assessment is conducted in six countries. Regarding demand-side policies, pharmaceutical prescription budgets or quotas and monitoring of prescriptions (with potential financial incentives or penalties) are in place in eight and in seven countries respectively. Switching is generally allowed, but is solely the physician’s responsibility. Automatic substitution is not recommended, or even forbidden, in most EU MSs. Prescription conditions or guidelines that apply to biosimilars are established in nearly all surveyed EU MSs. Conclusions: Important heterogeneity in policies on biosimilars was seen between (and even within) selected countries, which may partly explain variations in biosimilar uptake. Supply-side policies targeting price have been reported to limit biosimilar penetration in the long term, despite short-term savings, while demand-side policies are considered to positively impact uptake. PMID:28740617

  9. A Hierarchical Framework for Demand-Side Frequency Control

    SciTech Connect

    Moya, Christian; Zhang, Wei; Lian, Jianming; Kalsi, Karanjit

    2014-06-02

    With large-scale plans to integrate renewable generation, more resources will be needed to compensate for the uncertainty associated with intermittent generation resources. Under such conditions, performing frequency control using only supply-side resources become not only prohibitively expensive but also technically difficult. It is therefore important to explore how a sufficient proportion of the loads could assume a routine role in frequency control to maintain the stability of the system at an acceptable cost. In this paper, a novel hierarchical decentralized framework for frequency based load control is proposed. The framework involves two decision layers. The top decision layer determines the optimal droop gain required from the aggregated load response on each bus using a robust decentralized control approach. The second layer consists of a large number of devices, which switch probabilistically during contingencies so that the aggregated power change matches the desired droop amount according to the updated gains. The proposed framework is based on the classical nonlinear multi-machine power system model, and can deal with timevarying system operating conditions while respecting the physical constraints of individual devices. Realistic simulation results based on a 68-bus system are provided to demonstrate the effectiveness of the proposed strategy.

  10. Buildings sector demand-side efficiency technology summaries

    SciTech Connect

    Koomey, J.G.; Johnson, F.X.; Schuman, J.

    1994-03-01

    This report provides descriptions of the following energy efficiency technologies: energy management systems; electronic fluorescent ballasts; compact fluorescent lamps; lighting controls; room air conditioners; high albedo materials, coatings and paints; solar domestic water heaters; heat pump water heaters; energy-efficient motors; adjustable-speed drives; energy-efficient refrigerators; daylight control glazing; insulating glazing; solar control glazing; switchable glazing; tree planting; and advanced insulation. For each technology, the report provides a description of performance characteristics, consumer utility, development status, technology standards, equipment cost, installation, maintenance, conservation programs, and environmental impacts.

  11. Draft Evaluation, Measurement and Verification Guidance for Demand-Side Energy Efficiency

    EPA Pesticide Factsheets

    EPA is sharing draft Evaluation, Measurement and Verification Guidance for Demand-Side Energy Efficiency for public comment. This guidance is not a regulatory document, and is intended to supplement information provided in the Clean Power Plan.

  12. Energy economics, demand management, and conservation policy

    SciTech Connect

    Munasinghe, M.; Schramm, G.

    1983-01-01

    In the first half of their book, the authors identify the demand factor within the overall view of the energy economy, widen the field of investigation to take in the other major links in the energy chain represented by reserves and production facilities, and analyze demand within the framework of overall energy policy. They stress that pricing policy is the main instrument of demand management, then proceed to explain how long-run marginal cost is the practical pricing basis and how energy-saving measures are the most logical way to check any rise in consumption. They then highlight the close interrelationship between supply and demand. The second part of the book presents case histories on Sri Lanka, Thailand, Bangladesh, the US, Costa Rica, and Brazil. 500 references, 62 figures, 109 tables.

  13. Mining residential water and electricity demand data in Southern California to inform demand management strategies

    NASA Astrophysics Data System (ADS)

    Cominola, A.; Spang, E. S.; Giuliani, M.; Castelletti, A.; Loge, F. J.; Lund, J. R.

    2016-12-01

    Demand side management strategies are key to meet future water and energy demands in urban contexts, promote water and energy efficiency in the residential sector, provide customized services and communications to consumers, and reduce utilities' costs. Smart metering technologies allow gathering high temporal and spatial resolution water and energy consumption data and support the development of data-driven models of consumers' behavior. Modelling and predicting resource consumption behavior is essential to inform demand management. Yet, analyzing big, smart metered, databases requires proper data mining and modelling techniques, in order to extract useful information supporting decision makers to spot end uses towards which water and energy efficiency or conservation efforts should be prioritized. In this study, we consider the following research questions: (i) how is it possible to extract representative consumers' personalities out of big smart metered water and energy data? (ii) are residential water and energy consumption profiles interconnected? (iii) Can we design customized water and energy demand management strategies based on the knowledge of water- energy demand profiles and other user-specific psychographic information? To address the above research questions, we contribute a data-driven approach to identify and model routines in water and energy consumers' behavior. We propose a novel customer segmentation procedure based on data-mining techniques. Our procedure consists of three steps: (i) extraction of typical water-energy consumption profiles for each household, (ii) profiles clustering based on their similarity, and (iii) evaluation of the influence of candidate explanatory variables on the identified clusters. The approach is tested onto a dataset of smart metered water and energy consumption data from over 1000 households in South California. Our methodology allows identifying heterogeneous groups of consumers from the studied sample, as well as

  14. Demand management implementation in Southeast Asia

    SciTech Connect

    Tanaboriboon, Y.

    1995-12-31

    The need to apply transportation system management, to developing countries is urgent. Attempts to alleviate severe traffic congestion in their metropolises have so far failed to provide adequate solutions. The countries are faced with many difficulties because of the lack of sufficient financial resources together with their complex internal administrative and political problems. They are incapable of providing sufficient road space to cope with the escalating demand in private automobiles. This has led to excessive delays in urban traveling, environmental pollution problems, decline of road-based public transit services and deterioration of the quality of life in these metropolises. Demand management, in use for decades in the Western world, has also been recognized in Singapore`s famous area licensing scheme (ALS) making other Southeast Asian Metropolises aware of its advantages as an alternative in solving their chaotic traffic problems. However, realization is far different from implementation and still many metropolises are not able to apply the technique. Singapore and Thailand, two leaders among many other Southeast Asian regions in economics, tourism, trade and industry handle their problems far differently, especially the traffic congestion problem. While a number of demand management schemes have been implemented successfully in Singapore since 1975, Bangkok is still struggling to implement such measures to alleviate severe traffic congestion problems. This article intends to high light the successful practices and unsuccessful attempts of demand management techniques applied in Singapore and Bangkok.

  15. Demand management and test request rationalization.

    PubMed

    Smellie, W S A

    2012-07-01

    Demand for laboratory testing is increasing disproportionately to medical activity, and the tests involved are becoming increasingly complex. When this phenomenon is seen in parallel with declining teaching of laboratory medicine in the medical curriculum, a need emerges to manage demand to avoid unnecessary expenditure and improve the use of laboratory services: 'the right test in the right patient at the right time.' Various methods have been tried to manage demand, with success depending on the medical context, type of health service and preintervention situation. Because many factors contribute to demand, and the different settings in which these exist, it is not realistic to meta-analyse the studies and we are limited to trying to identify trends in results in particular situations. The studies suggest that education combined with facilitating interventions, such as feedback, prompts and changes to laboratory request forms are the most successful. From the perspective of a whole health service, it is important that results are not exaggerated by assessing benefits in terms of total rather than marginal cost. It would be desirable, although difficult, to include the impact on downstream clinical activity caused or avoided by the interventions. Advances in information and web technology may make the elusive goal of achieving substantial demand control more achievable.

  16. Co-optimization of Energy and Demand-Side Reserves in Day-Ahead Electricity Markets

    NASA Astrophysics Data System (ADS)

    Surender Reddy, S.; Abhyankar, A. R.; Bijwe, P. R.

    2015-04-01

    This paper presents a new multi-objective day-ahead market clearing (DAMC) mechanism with demand-side reserves/demand response (DR) offers, considering realistic voltage-dependent load modeling. The paper proposes objectives such as social welfare maximization (SWM) including demand-side reserves, and load served error (LSE) minimization. In this paper, energy and demand-side reserves are cleared simultaneously through co-optimization process. The paper clearly brings out the unsuitability of conventional SWM for DAMC in the presence of voltage-dependent loads, due to reduction of load served (LS). Under such circumstances multi-objective DAMC with DR offers is essential. Multi-objective Strength Pareto Evolutionary Algorithm 2+ (SPEA 2+) has been used to solve the optimization problem. The effectiveness of the proposed scheme is confirmed with results obtained from IEEE 30 bus system.

  17. Managing Chemotherapy Side Effects: Hair Loss (Alopecia)

    MedlinePlus

    ... C ancer I nstitute Managing Chemotherapy Side Effects Hair Loss (Alopecia) “Losing my hair was hard at first. Then I got used ... uncovered.” Questions other people have asked: Why does hair fall out? Chemotherapy can harm the cells that ...

  18. Managing Chemotherapy Side Effects: Nerve Changes

    MedlinePlus

    ... ational C ancer I nstitute Managing Chemotherapy Side Effects Nerve Changes “My fingers and toes felt numb and tingly. It was hard to button shirts. I got help from my wife. To keep from getting cuts, I always wore shoes.” u.s. Department of health anD human services national ...

  19. Dynamic Inventory Management with Demand Information Updating

    NASA Astrophysics Data System (ADS)

    Liu, Jian; Luo, Chunlin

    This chapter considers the dynamic inventory problem for a single product over a finite horizon and with periodic review. When stockout occurs, the customer may accept a substitute product. The demand can be observed and is assumed to be continuous with a probability density function of a known functional form, but with an unknown parameter. The inventory manager updates the knowledge of the unknown parameter by Bayesian rule and the observed value of demand. We show that the dynamic inventory problem with observed demand can be reduced to a sequence of single-period problem. Based on the result, we get the optimal order level of each period when the substitution probability is known. When the substitution probability is not known, we use the sufficient statistic to update the estimate of the substitution probability and get the similar result.

  20. Sustainable Ecosystems: Enabled by Supply and Demand Management

    NASA Astrophysics Data System (ADS)

    Patel, Chandrakant D.

    Continued population growth, coupled with increased per capita consumption of resources, poses a challenge to the quality of life of current and future generations. We cannot expect to meet the future needs of society simply by extending existing infrastructures. The necessary transformation can be enabled by a sustainable IT ecosystem made up of billions of service-oriented client devices and thousands of data centers. The IT ecosystem, with data centers at its core and pervasive measurement at the edges, will need to be seamlessly integrated into future communities to enable need-based provisioning of critical resources. Such a transformation requires a systemic approach based on supply and demand of resources. A supply side perspective necessitates using local resources of available energy, alongside design and management that minimizes the energy required to extract, manufacture, mitigate waste, transport, operate and reclaim components. The demand side perspective requires provisioning resources based on the needs of the user by using flexible building blocks, pervasive sensing, communications, knowledge discovery and policy-based control. This paper presents a systemic framework for supply-demand management in IT - in particular, on building sustainable data centers - and suggests how the approach can be extended to manage resources at the scale of urban infrastructures.

  1. Telephone triage improves demand management effectiveness.

    PubMed

    Sabin, M

    1998-08-01

    Telephone triage, or telephone advice counseling, is becoming a key managed care point-of-entry tool for patients and health plan members accessing the health system. Telephone triage functions as a logical front-end for health plans, integrated physician groups, or integrated delivery systems that want to shift their managed care efforts toward demand management. Key components of telephone triage include patient education, patient information, and guided access to appropriate care. Telephone triage generally requires 24-hour staffing by registered nurses and a computer software package based on either clinical protocols or clinical algorithms. Organizations can either install an in-house system or purchase this service from a vendor, health plan, or another provider. The decision to develop a telephone triage service in-house or to out-source it is determined largely by volume and the user's strategy for moving to successive levels of risk management.

  2. Demand-side policies to encourage the use of generic medicines: an overview.

    PubMed

    Dylst, Pieter; Vulto, Arnold; Simoens, Steven

    2013-02-01

    Demand-side policies to encourage the use of generic medicines are important to increase their use. A plethora of different demand-side policies has already been initiated by European governments, thereby targeting physicians, pharmacists and patients. This review aims to give an overview of the different demand-side policies which governments have at their disposal and to evaluate their impact on the use of generic medicines. Positive knowledge and perceptions of physicians, pharmacists and patients of generic medicines are necessary prerequisites to increase the use of generic medicines and governments should initiate policies to achieve this. These policies should be combined with policies to increase their financial responsibility to the healthcare system and policies to facilitate the prescribing of generic medicines.

  3. The future of the photovoltaic market (demand side/supply side)

    SciTech Connect

    Zahedi, A.

    1998-07-01

    At present the main PV application market sectors are communications, leisure, boating, solar home systems, and water pumping. It is predicted that in the future, the largest photovoltaic market segments will be solar home photovoltaic systems, grid-connected small-scale photovoltaic systems, grid-connected medium-to-large scale photovoltaic systems, the communications sector and in the electrification of remote and isolated areas. The main factors favoring photovoltaic technology in remote and isolated areas result from: the high costs of conventional energy sources in remote locations; the loss of a scale-economy effect, which means specific costs of small photovoltaic systems are not much higher than those of larger photovoltaic systems; price of fuel, fuel transportation and spare part supplies. The major factors inhibiting the photovoltaic technology include high initial costs, lack of skilled man power, lack of good quality data and social acceptance. A roof top mounted photovoltaic system is one type of PV system which has attracted lots of interest among the people of north America and Europe. The generation of electricity by this system is attractive because: generation is on-site. This results in reduction of transmission costs and transmission losses; the cost of roofing tiles can be eliminated by using mounted PV systems instead; there is no need for additional land for power generation; visual impacts are limited. The objective of this paper is to review the development of the photovoltaic market in the recent 10 year period and discuss the future markets for this technology with respect to supply and demand.

  4. Training needs for water demand management

    NASA Astrophysics Data System (ADS)

    Gumbo, Bekithemba; van der Zaag, Pieter; Robinson, Peter; Jonker, Lewis; Buckle, Hannes

    There is no doubt that delivery of education and training is essential in increasing awareness and equipping various stakeholders with the necessary skills and tools to implement Water Demand Management (WDM) in the Southern African region. At present there is limited capacity in the region to drive WDM programmes. One of the identified major constraints to the adoption of Water Demand Management (WDM) measures is the absence of well structured educational and training programmes or courses suitably targeted to all stakeholders in the water management chain. As one unpacks the Pandora’s Box of education and training certain key questions arise. What form of education and training in required? How does it fit in broader programmes like Integrated Water Resources Management (IWRM)? Who should be educated or trained and what are the target figures? And, importantly, who funds the exercise? As much as WDM awareness has been given due attention, education and training to move beyond the barriers to implementation have been lacking. This paper describes the development of the IUCN-WaterNet WDM Tertiary Training Module for middle and senior managers in institutions within the Southern Africa Development Community (SADC). The paper outlines the structure of the module and the philosophy which guided its development and selection of content. The results of relevant training needs surveys are also highlighted. Human development indicators for the SADC member states are provided as background information to contextualise the challenges facing the region. There are a number of constraints and threats to building WDM human resource capital. Recommendations are made for possible co-operation among the educators and trainers, public and private sectors, and possibly within the framework and mandate of the SADC Water Sector Co-ordinating Unit. Cooperation would ensure that WDM knowledge and skills are imparted to a significant number of water professionals in the region within

  5. Controlling market power and price spikes in electricity networks: Demand-side bidding

    PubMed Central

    Rassenti, Stephen J.; Smith, Vernon L.; Wilson, Bart J.

    2003-01-01

    In this article we report an experiment that examines how demand-side bidding can discipline generators in a market for electric power. First we develop a treatment without demand-side bidding; two large firms are allocated baseload and intermediate cost generators such that either firm might unilaterally withhold the capacity of its intermediate cost generators from the market to benefit from the supracompetitive prices that would result from only selling its baseload units. In a converse treatment, ownership of some of the intermediate cost generators is transferred from each of these firms to two other firms such that no one firm could unilaterally restrict output to spawn supracompetitive prices. Having established a well controlled data set with price spikes paralleling those observed in the naturally occurring economy, we also extend the design to include demand-side bidding. We find that demand-side bidding completely neutralizes the exercise of market power and eliminates price spikes even in the presence of structural market power. PMID:16576750

  6. Controlling market power and price spikes in electricity networks: Demand-side bidding.

    PubMed

    Rassenti, Stephen J; Smith, Vernon L; Wilson, Bart J

    2003-03-04

    In this article we report an experiment that examines how demand-side bidding can discipline generators in a market for electric power. First we develop a treatment without demand-side bidding; two large firms are allocated baseload and intermediate cost generators such that either firm might unilaterally withhold the capacity of its intermediate cost generators from the market to benefit from the supracompetitive prices that would result from only selling its baseload units. In a converse treatment, ownership of some of the intermediate cost generators is transferred from each of these firms to two other firms such that no one firm could unilaterally restrict output to spawn supracompetitive prices. Having established a well controlled data set with price spikes paralleling those observed in the naturally occurring economy, we also extend the design to include demand-side bidding. We find that demand-side bidding completely neutralizes the exercise of market power and eliminates price spikes even in the presence of structural market power.

  7. Water demand management research: A psychological perspective

    NASA Astrophysics Data System (ADS)

    Russell, Sally; Fielding, Kelly

    2010-05-01

    The availability of fresh water for human consumption is a critical global issue and one that will be exacerbated by the impacts of climate change. Water demand management has an important role to play in reducing the vulnerability of freshwater supplies to climate change impacts. In this paper, we argue that the field of psychology and environmental psychology in particular can make a vital contribution in understanding further the drivers of residential water demand. A growing body of literature in environmental psychology has examined the determinants of water conservation behavior, and this research has many potential applications for water demand policy. In this paper we offer a review of current psychological research that examines the five broad causes of residential water conservation behaviors: attitudes, beliefs, habits or routines, personal capabilities, and contextual factors. We assess how psychologists have studied water conservation behavior to date, identify shortcomings, and indicate how this research can be used to further promote residential water conservation and to inform evidence-based policy and practice.

  8. Managing electricity demand through dynamic pricing

    NASA Astrophysics Data System (ADS)

    Peddie, Robert A.; Bulleit, Douglas A.

    1985-11-01

    As electrical energy cannot be stored in large quantities with current technology, the energy balance of the electricity supply system has to be maintained continually by adjustments in supply to meet an unrestricted customer demand. Electricity over the projected peak tends to be very expensive, so utilities have sought to restrict demand during such periods to improve internal economic efficiency. The techniques used can be shown to be inefficient and disruptive if widely applied. Due to the way the utility and the regulators have homogenized costs, rate structures provide the customer no useful cost message as motivation to economically control utilization. Advances in microelectronics and communications remove these restrictions by allowing the customer to be informed continually of the cost of a kiloWatt hour (kWh) at the time of use. For the first time, the ensuing control of demand by the customer enables efficient utilization and simplifies the dynamic control of the electric system. This paper describes the method of formulating dynamic prices, the main elements and examples of the system, and how it can be introduced. The enumerated benefits show that greater customer satisfaction and improved economic management of the nation's resources and the utility's assets would result.

  9. Demand-side strategies to deal with moral hazard in public insurance for long-term care.

    PubMed

    Bakx, Pieter; Chernichovsky, Dov; Paolucci, Francesco; Schokkaert, Erik; Trottmann, Maria; Wasem, Juergen; Schut, Frederik

    2015-07-01

    Moral hazard in public insurance for long-term care may be counteracted by strategies influencing supply or demand. Demand-side strategies may target the patient or the insurer. Various demand-side strategies and how they are implemented in four European countries (Germany, Belgium, Switzerland and the Netherlands) are described, highlighting the pros and cons of each strategy. Patient-oriented strategies to counteract moral hazard are used in all four countries but their impact on efficiency is unclear and crucially depends on their design. Strategies targeted at insurers are much less popular: Belgium and Switzerland have introduced elements of managed competition for some types of long-term care, as has the Netherlands in 2015. As only some elements of managed competition have been introduced, it is unclear whether it improves efficiency. Its effect will depend on the feasibility of setting appropriate financial incentives for insurers using risk equalization and the willingness of governments to provide insurers with instruments to manage long-term care. © The Author(s) 2015.

  10. Simulation of demand management and grid balancing with electric vehicles

    NASA Astrophysics Data System (ADS)

    Druitt, James; Früh, Wolf-Gerrit

    2012-10-01

    This study investigates the potential role of electric vehicles in an electricity network with a high contribution from variable generation such as wind power. Electric vehicles are modelled to provide demand management through flexible charging requirements and energy balancing for the network. Balancing applications include both demand balancing and vehicle-to-grid discharging. This study is configured to represent the UK grid with balancing requirements derived from wind generation calculated from weather station wind speeds on the supply side and National Grid data from on the demand side. The simulation models 1000 individual vehicle entities to represent the behaviour of larger numbers of vehicles. A stochastic trip generation profile is used to generate realistic journey characteristics, whilst a market pricing model allows charging and balancing decisions to be based on realistic market price conditions. The simulation has been tested with wind generation capacities representing up to 30% of UK consumption. Results show significant improvements to load following conditions with the introduction of electric vehicles, suggesting that they could substantially facilitate the uptake of intermittent renewable generation. Electric vehicle owners would benefit from flexible charging and selling tariffs, with the majority of revenue derived from vehicle-to-grid participation in balancing markets.

  11. Addressing maternal healthcare through demand side financial incentives: experience of Janani Suraksha Yojana program in India.

    PubMed

    Gopalan, Saji S; Durairaj, Varatharajan

    2012-09-15

    Demand side financing (DSF) is a widely employed strategy to enhance utilization of healthcare. The impact of DSF on health care seeking in general and that of maternal care in particular is already known. Yet, its effect on financial access to care, out-of-pocket spending (OOPS) and provider motivations is not considerably established. Without such evidence, DSFs may not be recommendable to build up any sustainable healthcare delivery approach. This study explores the above aspects on India's Janani Suraksha Yojana (JSY) program. This study employed design and was conducted in three districts of Orissa, selected through a three-stage stratified sampling. The quantitative method was used to review the Health Management Information System (HMIS). The qualitative methods included focus groups discussions with beneficiaries (n = 19) and community intermediaries (n = 9), and interviews (n = 7) with Ministry of Health officials. HMIS data enabled to review maternal healthcare utilization. Group discussions and interviews explored the perceived impact of JSY on in-facility delivery, OOPS, healthcare costs, quality of care and performance motivation of community health workers. The number of institutional deliveries, ante-and post-natal care visits increased after the introduction of JSY with an annual net growth of 18.1%, 3.6% and 5% respectively. The financial incentive provided partial financial risk-protection as it could cover only 25.5% of the maternal healthcare cost of the beneficiaries in rural areas and 14.3% in urban areas. The incentive induced fresh out-of-pocket spending for some mothers and it could not address maternal care requirements comprehensively. An activity-based community worker model was encouraging to augment maternal healthcare consumption. However, the existing level of financial incentives and systemic support were inadequate to motivate the volunteers optimally on their performance. Demand side financial incentive could enhance financial

  12. Addressing maternal healthcare through demand side financial incentives: experience of Janani Suraksha Yojana program in India

    PubMed Central

    2012-01-01

    Background Demand side financing (DSF) is a widely employed strategy to enhance utilization of healthcare. The impact of DSF on health care seeking in general and that of maternal care in particular is already known. Yet, its effect on financial access to care, out-of-pocket spending (OOPS) and provider motivations is not considerably established. Without such evidence, DSFs may not be recommendable to build up any sustainable healthcare delivery approach. This study explores the above aspects on India’s Janani Suraksha Yojana (JSY) program. Methods This study employed design and was conducted in three districts of Orissa, selected through a three-stage stratified sampling. The quantitative method was used to review the Health Management Information System (HMIS). The qualitative methods included focus groups discussions with beneficiaries (n = 19) and community intermediaries (n = 9), and interviews (n = 7) with Ministry of Health officials. HMIS data enabled to review maternal healthcare utilization. Group discussions and interviews explored the perceived impact of JSY on in-facility delivery, OOPS, healthcare costs, quality of care and performance motivation of community health workers. Results The number of institutional deliveries, ante-and post-natal care visits increased after the introduction of JSY with an annual net growth of 18.1%, 3.6% and 5% respectively. The financial incentive provided partial financial risk-protection as it could cover only 25.5% of the maternal healthcare cost of the beneficiaries in rural areas and 14.3% in urban areas. The incentive induced fresh out-of-pocket spending for some mothers and it could not address maternal care requirements comprehensively. An activity-based community worker model was encouraging to augment maternal healthcare consumption. However, the existing level of financial incentives and systemic support were inadequate to motivate the volunteers optimally on their performance. Conclusion Demand

  13. Linking Continuous Energy Management and Open Automated Demand Response

    SciTech Connect

    Piette, Mary Ann; Kiliccote, Sila; Ghatikar, Girish

    2008-10-03

    Advances in communications and control technology, the strengthening of the Internet, and the growing appreciation of the urgency to reduce demand side energy use are motivating the development of improvements in both energy efficiency and demand response (DR) systems. This paper provides a framework linking continuous energy management and continuous communications for automated demand response (Auto-DR) in various times scales. We provide a set of concepts for monitoring and controls linked to standards and procedures such as Open Automation Demand Response Communication Standards (Open Auto-DR or OpenADR). Basic building energy science and control issues in this approach begin with key building components, systems, end-uses and whole building energy performance metrics. The paper presents a framework about when energy is used, levels of services by energy using systems, granularity of control, and speed of telemetry. DR, when defined as a discrete event, requires a different set of building service levels than daily operations. We provide examples of lessons from DR case studies and links to energy efficiency.

  14. Vaccine demand driven by vaccine side effects: dynamic implications for SIR diseases.

    PubMed

    d'Onofrio, Alberto; Manfredi, Piero

    2010-05-21

    For infections for which the perceived risk of serious disease is steadily low, the perceived risk of suffering some vaccine side effects might become the driving force of the vaccine demand. We investigate the dynamics of SIR infections in homogeneously mixing populations where the vaccine uptake is a decreasing function of the current (or past) incidence, or prevalence, of vaccine side effects. We define an appropriate model where vaccine side-effects are modelled as functions of the age since vaccination. It happens that the vaccine uptake follows its own dynamics independent of epidemiological variables. We show the conditions under which the vaccine uptake lands on a globally stable equilibrium, or steadily oscillates, and the implications of such behaviour for the dynamics of epidemiological variables. We finally report some unexpected scenarios caused by trends in vaccine side effects.

  15. Analyzing demand-side efficiency in global health: an application to maternal care in Vietnam.

    PubMed

    Radin, Elizabeth; Ariana, Proochista; Broekel, Tom; Tran, Toan Khanh

    2016-11-01

    This article investigates demand-side efficiency in global health-or the efficiency with which health system users convert public health resources into health outcomes. We introduce and explain the concept of demand-side efficiency as well as quantitative methods to empirically estimate it. Using a robust nonparametric form of technical efficiency analysis, we estimate demand side efficiency and its social determinants. We pilot these methods looking at how efficiently pregnant women in Northern Vietnam convert public health resources into appropriate maternal care as defined by national policy. We find that women who live in non-mountainous geographies, who are formally employed, who are pregnant with a boy and who are ethnic minorities are all more likely to be efficient at achieving appropriate care. We find no significant association between wealth or education and efficiency. Our results suggest that, in the Vietnamese context, women who are the most likely to achieve appropriate maternal care, are not necessarily the most likely to do so efficiently. Women who live in non-mountainous geographies and who are formally employed are both more likely to achieve appropriate care and to do so efficiently. Yet ethnic minority women, who do not systematically achieve better care, are more likely to be efficient or to achieve better care when compared with those with the same endowment of public health resources. On the methodological level, the pilot highlights that this approach can provide useful information for policy by identifying which groups of people are more and less likely to be efficient. By understanding which groups are more likely to be efficient-and in turn how and why-it may be possible to devise policies to promote the drivers of, or conversely address the constraints to, optimizing demand-side efficiency.

  16. Negotiating a demand side bid: City of San Jose case study

    SciTech Connect

    Not Available

    1993-06-01

    This report emphasizes the transferability of the gathered information to other local municipal governments. The report provides: general background information on demand side bidding; advantages and disadvantages of participation; alternative and ``ideal`` scenarios for bidding; review of potential pitfalls and lessons learned; and a general framework of information based on this particular request for DSB proposals and the City of San Joe`s response experience.

  17. Snakes survive starvation by employing supply- and demand-side economic strategies.

    PubMed

    McCue, Marshall D

    2007-01-01

    Animals vary widely in their abilities to tolerate extended periods of food limitation. Although some snakes are known for their unique ability to survive periods of inanition that last up to 2 years, very little is known about the biological mechanisms that allow them to do this. Consequently, the present study examined physiological, compositional, and morphological responses to 168 days of starvation among three distantly related snake species (i.e., ball python, Python regius; ratsnake, Elaphe obsoleta; and western diamondback rattlesnake, Crotalus atrox). Results revealed that each of these species was able to successfully tolerate starvation by adaptively utilizing supply- and demand-side regulatory strategies. Effective demand-side strategies included the ability of snakes to depress their resting metabolic demands by up to 72%. Moreover, supply-side regulation of resources was evidenced by the ability of snakes to spare their structurally critical protein stores at the expense of lipid catabolism. Such physiological strategies for minimizing endogenous mass and energy flux during periods of resource limitation might help explain the evolutionary persistence of snakes over the past 100 million years, as well as the repeated radiation of snake lineages into relatively low-energy environments. The final section of this study outlines a novel modeling approach developed to characterize material and chemical flux through animals during complete inanition. This approach was used to make comparisons about the efficacy of various supply- and demand-side starvation strategies among the three species examined, but could also be used to make similar comparisons among other types of animals.

  18. Health sector demand-side financial incentives in low- and middle-income countries: a systematic review on demand- and supply-side effects.

    PubMed

    Gopalan, Saji S; Mutasa, Ronald; Friedman, Jed; Das, Ashis

    2014-01-01

    Demand-side financial incentive (DSF) is an emerging strategy to improve health seeking behavior and health status in many low- and middle-income countries. This narrative synthesis assessed the demand- and supply-side effects of DSF. Forty one electronic data bases were searched to screen relevant experimental and quasi-experimental study designs. Out of the 64 selected papers, 28 were eligible for this review and they described 19 DSF initiatives across Asia, Africa and Latin America. There were three categories of initiatives, namely long-run multi-sectoral programs or LMPs (governmental); long-run health-exclusive programs (governmental); and short-run health-exclusive initiatives (both governmental and non-governmental). Irrespective of the nature of incentives and initiatives, all DSF programs could achieve their expected behavioral outcomes on healthcare seeking and utilization substantially. However, there existed a few negative and perverse outcomes on health seeking behavior and DSF's impact on continuous health seeking choices (e.g. bed net use and routine adult health check-ups) was mixed. Their effects on maternal health status, diarrhea, malaria and out-of-pocket expenditure were under-explored; while chronic non-communicable diseases were not directly covered by any DSF programs. DSF could reduce HIV prevalence and child deaths, and enhance nutritional and growth status of children. The direction and magnitude of their effects on health status was elastic to the evaluation design employed. On health system benefits, despite prioritizing on vulnerable groups, DSF's substantial effect on the poorest of the poor was mixed compared to that on the relatively richer groups. Though DSF initiatives intended to improve service delivery status, many could not optimally do so, especially to meet the additionally generated demand for care. Causal pathways of DSF's effects should be explored in-depth for mid-course corrections and cross-country learning on their

  19. Demonstrating a small utility approach to demand-side program implementation

    SciTech Connect

    Not Available

    1991-10-01

    The US DOE awarded a grant to the Burlington Electric Department (B.E.D.) to test a demand-side management (DSM) demonstration program designed to quickly save a significant amount of power with little disruption to the utility's customers or its normal operations. B.E.D. is a small municipal utility located in northern Vermont, with a lengthy history of successful DSM involvement. In our grant application, we proposed to develop a replicable program and approach to DSM that might be useful to other small utilities and to write a report to enable such replication. We believe that this DSM program and/or individual program components are replicable. This report is designed to allow other utilities interested in DSM to replicate this program or specific program design features to meet their DSM goals. We also wanted to use the opportunity of this grant to test the waters of residential heating fuel-switching. We hoped to test the application of one fuel-switching technology, and to benefit from the lessons learned in developing a full-scale DSM program for this end- use. To this end the pilot effort has been very successful. In the pilot pressure we installed direct-vent gas fired space heaters sized as supplemental heating units in 44 residences heated solely by electric resistance heat. We installed the gas space heating units at no cost to the owners or residents. We surveyed participating customers. The results of those surveys are included in this report and preliminary estimates of winter peak capacity load reductions are also noted in this report.

  20. Managing the demands of professional life.

    PubMed

    Dickey, Jamie; Ungerleider, Ross

    2007-09-01

    't forgive, we create toxic relationships, both with ourselves and with others. It is the heaviness of resentment that prevents us from being at ease. The final concept concerns management of stress. We should learn to recognize when we are stressed. We cannot manage what we don't know. It is our belief that attention to these features will help you better manage the numerous demands of your life.

  1. Information management - Assessing the demand for information

    NASA Technical Reports Server (NTRS)

    Rogers, William H.

    1991-01-01

    Information demand is defined in terms of both information content (what information) and form (when, how, and where it is needed). Providing the information richness required for flight crews to be informed without overwhelming their information processing capabilities will require a great deal of automated intelligence. It is seen that the essence of this intelligence is comprehending and capturing the demand for information.

  2. Information management - Assessing the demand for information

    NASA Technical Reports Server (NTRS)

    Rogers, William H.

    1991-01-01

    Information demand is defined in terms of both information content (what information) and form (when, how, and where it is needed). Providing the information richness required for flight crews to be informed without overwhelming their information processing capabilities will require a great deal of automated intelligence. It is seen that the essence of this intelligence is comprehending and capturing the demand for information.

  3. Access to health care in developing countries: breaking down demand side barriers.

    PubMed

    O'Donnell, Owen

    2007-12-01

    Effective health care interventions are underutilized in the developing world, and income-related disparities in use are large. The evidence concerning this access problem is summarized and its demand side causes are identified. Broad strategies that have been proposed to tackle the access problem through changes in economic incentives are considered. It is argued that there is a need to go beyond the identification of broad strategies to the design and evaluation of specific policy measures. Only through experimentation and evaluation will we learn what works in raising health care utilization, particularly among the poor in the developing world.

  4. Influence of wrestling on the physiological and skill demands of small-sided games.

    PubMed

    Gabbett, Tim J; Jenkins, David G; Abernethy, Bruce

    2012-01-01

    This study investigated the influence of wrestling on the physiological and skill demands of small-sided games. Twenty-eight elite rugby league players ([mean ± SE] age, 21.6 ± 0.5 years) participated in this within-subject crossover study. On day 1, 14 players played 2, 8-minute small-sided games, whereas the remaining 14 players played identical games with intermittent wrestling throughout. Each game was separated by 90 seconds. On day 2, the groups were crossed over. Movement was recorded by a global positioning system unit (miniMaxX, Catapult Innovations, Melbourne, Australia), sampling at 5 Hz. Each small-sided game was filmed to track the number of possessions and the number and quality of disposals. The games without wrestling resulted in a greater (p < 0.05) total distance covered (2,475 ± 31 vs. 1,964 ± 27 m) and greater distance covered in low (930 ± 19 vs. 842 ± 19 m), moderate (1,120 ± 28 vs. 752 ± 26 m), high (332 ± 16 vs. 240 ± 12 m), and very-high (24 ± 4 vs. 15 ± 3 m) velocity movement intensities. Conversely, the games with wrestling resulted in a significantly greater (p < 0.05) distance covered in mild, moderate, and maximal accelerations and a greater number of repeated high-intensity effort bouts (2.1 ± 0.2 bouts vs. 0.2 ± 0.1 bouts). No significant differences (p > 0.05) were detected between games with and without wrestling for the total number of involvements, receives, passes, effective passes, ineffective passes, and disposal efficiency. The results of this study demonstrate that intermittent wrestling reduces the running demands but increases the repeated high-intensity effort demands of small-side games. Furthermore, these physiological changes occur without compromising the volume of skill executions, the number of errors, or disposal efficiency. From a practical perspective, these results suggest that intermittent wrestling may be a useful supplement to small-sided games to concurrently train repeated-effort ability and

  5. Tapping Alternatives: The Benefits of Managing Urban Water Demands.

    ERIC Educational Resources Information Center

    Dziegielewski, Benedykt; Baumann, Duane D.

    1992-01-01

    Presents the California plan for water demand management. Water conservation techniques are used to balance demand with supply. Discusses the implementation process: (1) water-use and service area analysis; (2) water-use forecasts; (3) benefit-cost analysis; (4) and development of a long-term water management plan. (17 references) (MCO)

  6. Tapping Alternatives: The Benefits of Managing Urban Water Demands.

    ERIC Educational Resources Information Center

    Dziegielewski, Benedykt; Baumann, Duane D.

    1992-01-01

    Presents the California plan for water demand management. Water conservation techniques are used to balance demand with supply. Discusses the implementation process: (1) water-use and service area analysis; (2) water-use forecasts; (3) benefit-cost analysis; (4) and development of a long-term water management plan. (17 references) (MCO)

  7. GAME DEMANDS OF 7-A-SIDE SOCCER IN YOUNG PLAYERS.

    PubMed

    Barbero-Alvarez, José Carlos; López, Maite Gómez; Castagna, Carlo; Barbero-Alvarez, Verónica; Romero, David Viejo; Blanchfield, Anthony William; Nakamura, Fábio Yuzo

    2015-09-01

    The aim of this study was to examine the activity patterns and physiological demands of 7-a-side youth soccer matches across two chronological age categories (U12 and U14). Twenty-two soccer players of a national youth soccer academy were investigated. Players of each age category performed two training match (2 x 25 min) and were monitored by GPS and heart rate monitor units. Players of both categories covered similar total distance (5348 ± 307 m), at similar mean heart rate values (86 ± 4% of maximum). However, the number of high-intensity runs (82.5 ± 17.4 vs. 69.7 ± 15.2) and total distance covered during sprints (264 ± 207 vs. 128 ± 74 m) were significantly (p<0.05) higher in U14 compared with U12. The results suggest a highly demanding nature of 7-a-side soccer for skilled players, with physical maturity possibly influencing the match related high intensity performance at these ages.

  8. ICT Solutions for Highly-Customized Water Demand Management Strategies

    NASA Astrophysics Data System (ADS)

    Giuliani, M.; Cominola, A.; Castelletti, A.; Fraternali, P.; Guardiola, J.; Barba, J.; Pulido-Velazquez, M.; Rizzoli, A. E.

    2016-12-01

    The recent deployment of smart metering networks is opening new opportunities for advancing the design of residential water demand management strategies (WDMS) relying on improved understanding of water consumers' behaviors. Recent applications showed that retrieving information on users' consumption behaviors, along with their explanatory and/or causal factors, is key to spot potential areas where targeting water saving efforts, and to design user-tailored WDMS. In this study, we explore the potential of ICT-based solutions in supporting the design and implementation of highly customized WDMS. On one side, the collection of consumption data at high spatial and temporal resolutions requires big data analytics and machine learning techniques to extract typical consumption features from the metered population of water users. On the other side, ICT solutions and gamifications can be used as effective means for facilitating both users' engagement and the collection of socio-psychographic users' information. This latter allows interpreting and improving the extracted profiles, ultimately supporting the customization of WDMS, such as awareness campaigns or personalized recommendations. Our approach is implemented in the SmartH2O platform and demonstrated in a pilot application in Valencia, Spain. Results show how the analysis of the smart metered consumption data, combined with the information retrieved from an ICT gamified web user portal, successfully identify the typical consumption profiles of the metered users and supports the design of alternative WDMS targeting the different users' profiles.

  9. Studying the demand-side vis-à-vis the supply-side of urban water systems--case study of Oslo, Norway.

    PubMed

    Venkatesh, G; Brattebø, Helge

    2014-01-01

    The research focus of resource consumption and emissions from urban water services has, by and large, been restricted to what comes under the domain of the urban water utilities - the upstream sub-systems of water treatment and supply and the downstream sub-systems of wastewater collection, treatment and disposal. However, the material and energy flows necessitated by activities in the water demand sub-system (households, for instance) are by no means negligible. This paper studies the per-capita material and energy requirements, and the related emissions and life cycle environmental impacts, associated with water consumption in households of the city of Oslo for the year 2009. For example, the per-capita energy consumption in the household consumption phase, at 1.38 MWh per year, is eight times more than the corresponding consumption for the entire water-wastewater utility. All findings, taken together, clearly demonstrate the imperativeness of paying more attention to the demand-side management issues.

  10. Time management for today's workplace demands.

    PubMed

    Thomack, Bill

    2012-05-01

    As the work force decreases, the workload remains the same or, in many cases, increases. An effective employee must arrange work time to accomplish what needs to be done in the time available. The best way to manage time is to set a goal, develop a plan, and measure the outcome. To manage time requires determining where time is currently spent, taking time at the end of the day to prepare for the next morning, managing appointments, carefully planning projects, and managing phone, electronic, and paper mail. Organization is another step in effectively managing time. An organizational system decreases wasted time. Keeping the desk clear and creating a system to organize mail improves efficiency. Time management also focuses on balance, an overall purpose, and supporting principles. Personal or professional effectiveness does not depend solely on the effort expended, but whether the effort is in the right direction. The challenge of time management is to manage not only time, but also oneself.

  11. Is demand-side financing equity enhancing? Lessons from a maternal health voucher scheme in Bangladesh.

    PubMed

    Ahmed, Shakil; Khan, M Mahmud

    2011-05-01

    Demand-side financing (DSF) is used in the less-developed countries of the world to improve access to healthcare and to encourage market supply. Under DSF, households receive vouchers that can be used to pay for healthcare services. This study evaluated the effects of a universal DSF on maternal healthcare service utilization in Bangladesh. A household survey was conducted in and around the voucher scheme area one year after the initiation of the project. Women who gave birth within a year prior to the survey were interviewed. The utilization rates of maternal health services were found to be higher for all socioeconomic groups in the project area than in the comparison areas. Voucher recipients in the project area were 3.6 times more likely to be assisted by skilled health personnel during delivery, 2.5 times more likely to deliver the baby in a health facility, 2.8 times more likely to receive postnatal care (PNC), 2.0 times more likely to get antenatal care (ANC) services and 1.5 times more likely to seek treatment for obstetric complications than pregnant women not in the program. The degree of socioeconomic inequality in maternal health service utilization was also lower in the project area than in the comparison area. The use of vouchers evidenced much stronger demand-increasing effects on the poor. Poor voucher recipients were 4.3 times more likely to deliver in a health facility and two times more likely to use skilled health personnel at delivery than the non-poor recipients. Contrary to the inverse equity hypothesis, the voucher scheme reduced inequality even in the short run. Despite these improvements, socioeconomic disparity in the use of maternal health services has remained pro-rich, implying that demand-side financing alone will be insufficient to achieve the Millennium Development Goal for maternal health. A comprehensive system-wide approach, including supply-side strengthening, will be needed to adequately address maternal health concerns in poor

  12. NHS direct: managing demand for primary care?

    PubMed

    Mark, Annabelle L; Shepherd, Ifan D H

    2004-01-01

    This paper considers how NHS Direct is affecting demand for primary care in particular out-of-hours services from GPs. This is reviewed through a 3-year study of NHS Direct and HARMONI, the integrated telephone health helpline based in West London. It describes the policy background and development of the services on the site, and some of the outcomes of the HARMONI commissioned research to answer the question 'Has NHS Direct increased the workload for HARMONI doctors?'. The research adopted both a qualitative and quantitative approach using cross-sectional and longitudinal analysis of the data collected. The analysis of the data reveals the issues as both complex and dynamic in nature. The research shows that while there has been no significant change to the total volume of activity, changes within patient groups notably the elderly and children, and in individual GP practices may be significant. In addition, the changes in organizational arrangements may influence significant changes in referral patterns such as GP out-of-hours visits. This was confirmed in the interview data indicating a link between the change in nurses' role from gatekeeper to patient advocate, which happened when they ceased to be employees of the part-time co-op and began to work instead for the 24 hours, 7 days a week NHS Direct service. The conclusions drawn are that behavioural and organizational changes are at least as significant as the evidence-based computerized decision support software in changing the demand for primary care. Further evidence cited is that a different demand pattern of calls was experienced by those local GPs not integrated into out-of-hours provision at NHS Direct West London at the time of the study.

  13. Comparison of agility demands of small-sided games in elite Australian football.

    PubMed

    Davies, Michael J; Young, Warren; Farrow, Damian; Bahnert, Andrew

    2013-03-01

    To compare the agility demands of 4 small-sided games (SSGs) and evaluate the variability in demands for elite Australian Football (AF). Fourteen male elite Australian Football League (AFL) players (mean ± SD; 21.7 ± 3.1 y, 189.6 ± 9.0 cm, 88.7 ± 10.0 kg, 39.4 ± 57.1 games) completed 4 SSGs of 3 × 45-s bouts each with modified designs. Video notational analysis, GPS at 5 Hz, and triaxial accelerometer data expressed the external player loads within games. Three comparisons were made using a paired t test (P < .05), and magnitudes of differences were reported with effect size (ES) statistics. Reduced area per player (increased density) produced a small increase in total agility maneuvers (SSG1, 7.2 ± 1.3; SSG2, 8.8 ± 4.1), while a large 2D player load was accumulated (P < .05, ES = 1.22). A reduction in players produced a moderate (ES = 0.60) total number of agility maneuvers (SSG 3, 11.3 ± 6.1; SSG 2, 8.3 ± 3.6); however, a greater variability was found. The implementation of a 2-handed-tag rule resulted in a somewhat trivial decline (P > .05, ES = 0.16) in agility events compared with normal AFL tackling rules (SSG 2, 8.3 ± 3.6; SSG 4, 7.8 ± 2.6). SSG characteristics can influence agility-training demand, which can vary considerably for individuals. Coaches should carefully consider SSG design to maximize the potential to develop agility for all players.

  14. Demand management in healthcare IT. Controlling IT demand to meet constrained IT resource supply.

    PubMed

    Mohrmann, Gregg; Schlusberg, Craig; Kropf, Roger

    2007-01-01

    Healthcare is behind other industries in the ability to manage and control increasing demand for IT services, and to ensure that IT staff are available when and where needed. From everyday support requests to large capital projects, the IT department's ability to meet demand is limited. Organizational and IT leaders need to proactively address this issue and do a better job of predicting when services will be needed and whether appropriate resources will be available. This article describes the common issues that healthcare IT departments face in the efficient delivery of services as a result of factors such as budget constraints, skill sets and project dependencies. Best practices for controlling demand are discussed, including resource allocation, governance processes and a graphical analysis of forecasted vs. actual thresholds. Using specific healthcare provider examples, the article intends to provide IT management with an approach to predicting and controlling resource demand.

  15. Preparing Psychotherapy Students for the New Demands of Managed Care.

    ERIC Educational Resources Information Center

    Chambliss, Catherine

    The wildly varying utilization and quality control practices that make up "managed care" make it difficult to generalize new rules and requirements. Information that can aid counselor trainees in understanding the demands of managed health care is presented. The text explores the following questions: (1) "What do managed care…

  16. Clinical-outcome-based demand management in health services.

    PubMed

    Brogan, C; Lawrence, D; Mayhew, L

    2008-01-01

    THE PROBLEM OF MANAGING DEMAND: Most healthcare systems have 'third-party payers' who face the problem of keeping within budgets despite pressures to increase resources due to the ageing population, new technologies and patient demands to lower thresholds for care. This paper uses the UK National Health Service as a case study to suggest techniques for system-based demand management, which aims to control demand and costs whilst maintaining the cost-effectiveness of the system. The technique for managing demand in primary, elective and urgent care consists of managing treatment thresholds for appropriate care, using a whole-systems approach and costing the care elements in the system. It is important to analyse activity in relation to capacity and demand. Examples of using these techniques in practice are given. The practical effects of using such techniques need evaluation. If these techniques are not used, managing demand and limiting healthcare expenditure will be at the expense of clinical outcomes and unmet need, which will perpetuate financial crises.

  17. Market Demand for Sustainability in Management Education

    ERIC Educational Resources Information Center

    Gitsham, Matthew; Clark, Timothy S.

    2014-01-01

    Purpose: This paper aims to contribute to the ongoing debate about the relevance of sustainability in management education through exploration of the needs and expectations of a key group of business schools' stakeholders--senior executives of leading corporations. Design/methodology/approach: The paper presents findings from a survey regarding…

  18. Market Demand for Sustainability in Management Education

    ERIC Educational Resources Information Center

    Gitsham, Matthew; Clark, Timothy S.

    2014-01-01

    Purpose: This paper aims to contribute to the ongoing debate about the relevance of sustainability in management education through exploration of the needs and expectations of a key group of business schools' stakeholders--senior executives of leading corporations. Design/methodology/approach: The paper presents findings from a survey regarding…

  19. A hybrid inventory management system respondingto regular demand and surge demand

    SciTech Connect

    Mohammad S. Roni; Mingzhou Jin; Sandra D. Eksioglu

    2014-06-01

    This paper proposes a hybrid policy for a stochastic inventory system facing regular demand and surge demand. The combination of two different demand patterns can be observed in many areas, such as healthcare inventory and humanitarian supply chain management. The surge demand has a lower arrival rate but higher demand volume per arrival. The solution approach proposed in this paper incorporates the level crossing method and mixed integer programming technique to optimize the hybrid inventory policy with both regular orders and emergency orders. The level crossing method is applied to obtain the equilibrium distributions of inventory levels under a given policy. The model is further transformed into a mixed integer program to identify an optimal hybrid policy. A sensitivity analysis is conducted to investigate the impact of parameters on the optimal inventory policy and minimum cost. Numerical results clearly show the benefit of using the proposed hybrid inventory model. The model and solution approach could help healthcare providers or humanitarian logistics providers in managing their emergency supplies in responding to surge demands.

  20. Managing Chemotherapy Side Effects: Sexual and Fertility Changes in Women

    MedlinePlus

    N ational C ancer I nstitute Managing Chemotherapy Side Effects Sexual and Fertility Changes in Women “Talk with your doctor before you start treatment. Ask how chemotherapy could affect your ability ...

  1. Managing Chemotherapy Side Effects: Sexual and Fertility Changes in Men

    MedlinePlus

    ... C ancer I nstitute Managing Chemotherapy Side Effects Sexual and Fertility Changes in Men “I talked with ... or nurse before treatment starts to learn what sexual changes or changes to your fertility you may ...

  2. Can demand-side policies stop the tobacco industry's damage? Lessons from Turkey.

    PubMed

    Gultekin-Karakas, Derya

    2015-01-01

    Trade and investment liberalisation in the post-1980 period allowed the penetration of transnational tobacco companies into the Turkish market. State control over the market was gradually removed and tobacco farming, manufacturing, trade and consumption were reshaped in line with the needs of transnational tobacco companies. The resultant increase in product proliferation and aggressive marketing strategies led to a dramatic rise in cigarette consumption in the 1990s, making Turkey a market with one of the sharpest consumption increases in the world. While Turkey implemented demand-side tobacco control policies to reduce consumption after 1996, it continued to stimulate manufacturing and trade in a conflicting way. The Turkish case verifies that the liberalisation process facilitated by the state under the auspices of international institutions conflicts with tobacco control. Liberalisation paves the way for market expansions of transnational tobacco companies that resist tobacco control in their drive for profit. Current global tobacco control policies, with no interest in controlling manufacturing, have limited effect on consumption. The Turkish case indicates the necessity of establishing public control over tobacco manufacturing and trade from a public health perspective.

  3. The hard side of change management.

    PubMed

    Sirkin, Harold L; Keenan, Perry; Jackson, Alan

    2005-10-01

    Everyone agrees that managing change is tough, but few can agree on how to do it. Most experts are obsessed with "soft" issues, such as culture and motivation, but, say the authors, focusing on these issues alone won't bring about change. Companies also need to consider the hard factors-like the time it takes to complete a change initiative, the number of people required to execute it, and so forth. When the authors studied change initiatives at 225 companies, they found a consistent correlation between the outcomes of change programs (success versus failure) and four hard factors, which they called DICE: project duration, particularly the time between project reviews; integrity of performance, or the capabilities of project teams; the level of commitment of senior executives and staff; and the additional effort required of employees directly affected by the change. The DICE framework is a simple formula for calculating how well a company is implementing, or will be able to implement, its change initiatives. The framework comprises a set of simple questions that help executives score their projects on each of the four factors; the lower the score, the more likely the project will succeed. Companies can use DICE assessments to force conversations a bout projects, to gauge whether projects are on track or in trouble, and to manage project portfolios. The authors have used these four factors to predict the outcomes and guide the execution of more than 1,000 change management programs worldwide. Not only has the correlation held, but no other factors (or combination of factors) have predicted outcomes as successfully.

  4. Managing demand for laboratory tests: a laboratory toolkit.

    PubMed

    Fryer, Anthony A; Smellie, W Stuart A

    2013-01-01

    Healthcare budgets worldwide are facing increasing pressure to reduce costs and improve efficiency, while maintaining quality. Laboratory testing has not escaped this pressure, particularly since pathology investigations cost the National Health Service £2.5 billion per year. Indeed, the Carter Review, a UK Department of Health-commissioned review of pathology services in England, estimated that 20% of this could be saved by improving pathology services, despite an average annual increase of 8%-10% in workload. One area of increasing importance is managing the demands for pathology tests and reducing inappropriate requesting. The Carter Review estimated that 25% of pathology tests were unnecessary, representing a huge potential waste. Certainly, the large variability in levels of requesting between general practitioners suggests that inappropriate requesting is widespread. Unlocking the key to this variation and implementing measures to reduce inappropriate requesting would have major implications for patients and healthcare resources alike. This article reviews the approaches to demand management. Specifically, it aims to (a) define demand management and inappropriate requesting, (b) assess the drivers for demand management, (c) examine the various approaches used, illustrating the potential of electronic requesting and (d) provide a wider context. It will cover issues, such as educational approaches, information technology opportunities and challenges, vetting, duplicate request identification and management, the role of key performance indicators, profile composition and assessment of downstream impact of inappropriate requesting. Currently, many laboratories are exploring demand management using a plethora of disparate approaches. Hence, this review seeks to provide a 'toolkit' with the view to allowing laboratories to develop a standardised demand management strategy.

  5. Toward achieving optimal response: understanding and managing antidepressant side effects

    PubMed Central

    Kelly, Karen; Posternak, Michael; Jonathan, E. Alpert

    2008-01-01

    The safety and tolerability of antidepressants have improved considerably over the past two decades, Nevertheless, antidepressant side effects are still common and problematic. The majority of patients treated with contemporary agents experience one or more bothersome side effects. These side effects often create barriers to achieving depressive remission, as well as to preventing relapse and recurrence. Clinicians tend to underestimate the prevalence of side effects, and as many as one quarter of patients discontinue their antidepressants because of difficult-to-tolerate side effects; others may continue on antidepressant therapy but experience diminished quality of life related to troublesome side effects. This article reviews the prevalence of side effects, the impact of side effects on treatment adherence, and methodological issues including the challenge of distinguishing side effects from residual depressive symptoms, discontinuation effects, and general medical problems. In addition, we address the most common side effects such as sexual dysfunction, gastrointestinal problems, sleep disturbance, apathy, and fatigue, and offer strategies for management that may help patients achieve optimal response to pharmacotherapy. PMID:19170398

  6. Importance of food-demand management for climate mitigation

    NASA Astrophysics Data System (ADS)

    Bajželj, Bojana; Richards, Keith S.; Allwood, Julian M.; Smith, Pete; Dennis, John S.; Curmi, Elizabeth; Gilligan, Christopher A.

    2014-10-01

    Recent studies show that current trends in yield improvement will not be sufficient to meet projected global food demand in 2050, and suggest that a further expansion of agricultural area will be required. However, agriculture is the main driver of losses of biodiversity and a major contributor to climate change and pollution, and so further expansion is undesirable. The usual proposed alternative--intensification with increased resource use--also has negative effects. It is therefore imperative to find ways to achieve global food security without expanding crop or pastureland and without increasing greenhouse gas emissions. Some authors have emphasized a role for sustainable intensification in closing global `yield gaps' between the currently realized and potentially achievable yields. However, in this paper we use a transparent, data-driven model, to show that even if yield gaps are closed, the projected demand will drive further agricultural expansion. There are, however, options for reduction on the demand side that are rarely considered. In the second part of this paper we quantify the potential for demand-side mitigation options, and show that improved diets and decreases in food waste are essential to deliver emissions reductions, and to provide global food security in 2050.

  7. Demand-Side Financing in Education: a Critical Examination of a Girls' Scholarship Program in Malawi--(Case Study)

    ERIC Educational Resources Information Center

    Sineta, Abraham

    2012-01-01

    Despite the push for universal education, many disadvantaged and poor children in developing countries still do not have access to basic education. This among other reasons is due to poverty where poor families cannot afford the cost of basic education even when it is "free" of tuition (McDonald, 2007). Demand-side financing…

  8. Demand-Side Financing in Education: a Critical Examination of a Girls' Scholarship Program in Malawi--(Case Study)

    ERIC Educational Resources Information Center

    Sineta, Abraham

    2012-01-01

    Despite the push for universal education, many disadvantaged and poor children in developing countries still do not have access to basic education. This among other reasons is due to poverty where poor families cannot afford the cost of basic education even when it is "free" of tuition (McDonald, 2007). Demand-side financing…

  9. Demand-side financing measures to increase maternal health service utilisation and improve health outcomes: a systematic review of evidence from low- and middle-income countries.

    PubMed

    Murray, Susan F; Hunter, Benjamin M; Bisht, Ramila; Ensor, Tim; Bick, Debra

    2012-01-01

    , observational and descriptive), qualitative studies (including designs based on phenomenology, grounded theory, ethnography, action research and feminist research), and economic studies (cost-effectiveness, cost-utility and costs studies). The Joanna Briggs Institute methodology for mixed-method systematic reviews was adopted. A three-step systematic search strategy was used to: 1) identify key terms, 2) search bibliographic databases and 3) retrieve additional publications from reference lists and sources of grey literature. Data were extracted from papers included in the review using the standardised data extraction tools for quantitative, qualitative and economic data from the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information. The quantitative and economic findings are presented in narrative form. Qualitative research findings were pooled using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. This involved the aggregation or synthesis of findings to generate a set of statements that represent that aggregation, through assembling the findings (Level 1 findings), and categorising these findings on the basis of similarity in meaning (Level 2 findings). These categories were then subjected to a meta-synthesis in order to produce a single comprehensive set of synthesised findings (Level 3 findings) that can be used as a basis for evidence-based practice or policy. Seventy-two studies were included in the review. Drawing on work from several continents, many of the included studies were reports and evaluations for relevant government or funding agencies and represented important lesson-learning about implementation issues. However, fewer than half were published in peer reviewed journals and few were of high research quality.For three modes of demand-side financing (conditional cash transfers, payments to offset costs of access to maternal healthcare, and vouchers for maternity services) we found evidence

  10. [Opioid Therapy and Management of Side Effects Associated with Opioids].

    PubMed

    Nakatani, Toshihiko

    2017-04-01

    Opioids are very useful medications to reduce suffering of cancer patients such as refractory pain and dyspnea. We physicians have to use opioids to have good management of pain and suffering associated with cancer including management of side effects caused by opioids. Opioids couple opioid receptors and affect several pharmacological effects. Other than analgesic effect, opioids have some side effects of constipation, nausea and vomiting, respiratory depression. In this chapter, I take important side effects of constipation, nausea and vomiting and respiratory depression. Next, serotonin syndrome caused by tramadol combined with anti-depressants is remarked as assignable syndrome. As advancing in chemotherapy for cancer treatment, cancer survivors live longer with opioid therapy. We have to pay attention to the side effects and another dysfunction caused by long use of opioids. It is important that we physician use opioids effectively to keep activity of daily living(ADL) of patients and families as team approach.

  11. Flexible Demand Management under Time-Varying Prices

    NASA Astrophysics Data System (ADS)

    Liang, Yong

    In this dissertation, the problem of flexible demand management under time-varying prices is studied. This generic problem has many applications, which usually have multiple periods in which decisions on satisfying demand need to be made, and prices in these periods are time-varying. Examples of such applications include multi-period procurement problem, operating room scheduling, and user-end demand scheduling in the Smart Grid, where the last application is used as the main motivating story throughout the dissertation. The current grid is experiencing an upgrade with lots of new designs. What is of particular interest is the idea of passing time-varying prices that reflect electricity market conditions to end users as incentives for load shifting. One key component, consequently, is the demand management system at the user-end. The objective of the system is to find the optimal trade-off between cost saving and discomfort increment resulted from load shifting. In this dissertation, we approach this problem from the following aspects: (1) construct a generic model, solve for Pareto optimal solutions, and analyze the robust solution that optimizes the worst-case payoffs, (2) extend to a distribution-free model for multiple types of demand (appliances), for which an approximate dynamic programming (ADP) approach is developed, and (3) design other efficient algorithms for practical purposes of the flexible demand management system. We first construct a novel multi-objective flexible demand management model, in which there are a finite number of periods with time-varying prices, and demand arrives in each period. In each period, the decision maker chooses to either satisfy or defer outstanding demand to minimize costs and discomfort over a certain number of periods. We consider both the deterministic model, models with stochastic demand or prices, and when only partial information about the stochastic demand or prices is known. We first analyze the stochastic

  12. A Many-Objective Analysis of Supply and Demand Management Options for the Thames Basin

    NASA Astrophysics Data System (ADS)

    Huskova, I.; Matrosov, E.; Kasprzyk, J. R.; Harou, J. J.; Reed, P. M.

    2012-12-01

    In this study we link water basin simulation and many-objective evolutionary optimization to evaluate tradeoffs for the water stressed Thames water supply system in South East England which includes the city of London. We consider both infrastructure additions and demand management options to satisfy the future supply/demand balance, in order to develop management alternatives that can meet a range of fiscal and performance constraints under future supply and demand trajectories. The suite of new infrastructure options includes a new reservoir, water transfers, conjunctive use of groundwater, wastewater reuse and brackish groundwater desalination. Additionally, demand management options include leakage reduction, compulsory metering and the introduction of seasonal tariffs. Infrastructure options are evaluated using quantitative performance measures that minimize costs and energy use while maximizing engineering, social and environmental performance, subject to supply reliability constraints set by the local water utility and the Environment Agency regulator. Pareto approximate trade-off curves show the tradeoffs between engineering, cost, social and environmental performance measures. We use interactive visual analytics to show the performance of solutions across a broad range of performance measures and interrogate the impact of the infrastructure portfolios on the performance measures. Using an optimization—simulation framework enables the consideration of non-linear and rule-based phenomena, which are frequently useful or necessary to accurately describe how real water systems are managed. Results suggest that a diverse portfolio of supply-side and demand side options can aid water management in the UK. The Thames basin is modeled using a generalized computationally efficient open-source water resource simulator, Interactive River-Aquifer Simulation-2010 (IRAS-2010). The IRAS-2010 Thames system model is linked via a C++ wrapper to the Epsilon Dominance

  13. The design of optimal electric power demand management contracts

    NASA Astrophysics Data System (ADS)

    Fahrioglu, Murat

    1999-11-01

    Our society derives a quantifiable benefit from electric power. In particular, forced outages or blackouts have enormous consequences on society, one of which is loss of economic surplus. Electric utilities try to provide reliable supply of electric power to their customers. Maximum customer benefit derives from minimum cost and sufficient supply availability. Customers willing to share in "availability risk" can derive further benefit by participating in controlled outage programs. Specifically, whenever utilities foresee dangerous loading patterns, there is a need for a rapid reduction in demand either system-wide or at specific locations. The utility needs to get relief in order to solve its problems quickly and efficiently. This relief can come from customers who agree to curtail their loads upon request in exchange for an incentive fee. This thesis shows how utilities can get efficient load relief while maximizing their economic benefit. This work also shows how estimated customer cost functions can be calibrated, using existing utility data, to help in designing efficient demand management contracts. In order to design such contracts, optimal mechanism design is adopted from "Game Theory" and applied to the interaction between a utility and its customers. The idea behind mechanism design is to design an incentive structure that encourages customers to sign up for the right contract and reveal their true value of power. If a utility has demand management contracts with customers at critical locations, most operational problems can be solved efficiently. This thesis illustrates how locational attributes of customers incorporated into demand management contract design can have a significant impact in solving system problems. This kind of demand management contracts can also be used by an Independent System Operator (ISO). During times of congestion a loss of economic surplus occurs. When the market is too slow or cannot help relieve congestion, demand management

  14. Understanding international postgraduate studies. Drivers from the supply and the demand side.

    PubMed

    Delgado-Serrano, M M; Gomez-Bruque, J L; Ambrosio-Albala, M J; Llamas-Moreno, B

    2010-01-01

    Changes in the global political and socioeconomic scenario are fostering the internationalization of master and doctoral programme as one of the current priorities for Universities. Changes in European higher education such as those stimulated by the Bologna process and the introduction of double, multiple or joint Master degree programmes together with the Erasmus Mundus programme are enhancing the competition of European universities in the global education market place. Universities compete to attract the best students, both national and international, to their postgraduate programmes. However, the design and launch of international masters or doctorates imply working with a different logic to the one used in national programmes. Complexity, diversity and differentiation are drivers of international education and as happens in complex systems the properties and features of the final products are different from the existing in the individual components. The aim of this paper is to understand international studies as complex systems and to analyze and identify factors affecting to the different components involved in the implementation of these programmes. The new approaches and the interrelations in aspects such as academic, administrative or economic management, quality assurance and marketing issues are examined and drivers, challenges and good practices where possible are identified. The analysis has been carried out considering the point of view of both Universities (supply-led approach) and students and employers (demand-led approach). From the analysis have emerged important questions that show the interrelation pattern and that can be useful when designing and implementing international postgraduate studies. Universities and students tend to agree about many issues however, some divergences have also been identified which make the results of the research more valuable.

  15. On the forest cover–water yield debate: from demand- to supply-side thinking

    PubMed Central

    Ellison, David; N Futter, Martyn; Bishop, Kevin

    2012-01-01

    Several major articles from the past decade and beyond conclude the impact of reforestation or afforestation on water yield is negative: additional forest cover will reduce and removing forests will raise downstream water availability. A second group of authors argue the opposite: planting additional forests should raise downstream water availability and intensify the hydrologic cycle. Obtaining supporting evidence for this second group of authors has been more difficult due to the larger scales at which the positive effects of forests on the water cycle may be seen. We argue that forest cover is inextricably linked to precipitation. Forest-driven evapotranspiration removed from a particular catchment contributes to the availability of atmospheric moisture vapor and its cross-continental transport, raising the likelihood of precipitation events and increasing water yield, in particular in continental interiors more distant from oceans. Seasonal relationships heighten the importance of this phenomenon. We review the arguments from different scales and perspectives. This clarifies the generally beneficial relationship between forest cover and the intensity of the hydrologic cycle. While evidence supports both sides of the argument – trees can reduce runoff at the small catchment scale – at larger scales, trees are more clearly linked to increased precipitation and water availability. Progressive deforestation, land conversion from forest to agriculture and urbanization have potentially negative consequences for global precipitation, prompting us to think of forest ecosystems as global public goods. Policy-making attempts to measure product water footprints, estimate the value of ecosystem services, promote afforestation, develop drought mitigation strategies and otherwise manage land use must consider the linkage of forests to the supply of precipitation.

  16. Increasing access to institutional deliveries using demand and supply side incentives: early results from a quasi-experimental study

    PubMed Central

    2011-01-01

    Background Geographical inaccessibility, lack of transport, and financial burdens are some of the demand side constraints to maternal health services in Uganda, while supply side problems include poor quality services related to unmotivated health workers and inadequate supplies. Most public health interventions in Uganda have addressed only selected supply side issues, and universities have focused their efforts on providing maternal services at tertiary hospitals. To demonstrate how reforms at Makerere University College of Health Sciences (MakCHS) can lead to making systemic changes that can improve maternal health services, a demand and supply side strategy was developed by working with local communities and national stakeholders. Methods This quasi-experimental trial is conducted in two districts in Eastern Uganda. The supply side component includes health worker refresher training and additions of minimal drugs and supplies, whereas the demand side component involves vouchers given to pregnant women for motorcycle transport and the payment to service providers for antenatal, delivery, and postnatal care. The trial is ongoing, but early analysis from routine health information systems on the number of services used is presented. Results Motorcyclists in the community organized themselves to accept vouchers in exchange for transport for antenatal care, deliveries and postnatal care, and have become actively involved in ensuring that women obtain care. Increases in antenatal, delivery, and postnatal care were demonstrated, with the number of safe deliveries in the intervention area immediately jumping from <200 deliveries/month to over 500 deliveries/month in the intervention arm. Voucher revenues have been used to obtain needed supplies to improve quality and to pay health workers, ensuring their availability at a time when workloads are increasing. Conclusions Transport and service vouchers appear to be a viable strategy for rapidly increasing maternal care

  17. The Human Side of Knowledge Management: An Annotated Bibliography.

    ERIC Educational Resources Information Center

    Mayer, Pamela S.

    This annotated bibliography lists books and articles that have direct application to managing the human side of knowledge acquisition, transfer, and application. What is meant by the human dimension of knowledge is how motivation and learning affect the acquisition and transfer of knowledge and how group dynamics mediate the role of knowledge in…

  18. An Economic Evalution of Demand-side Energy Storage Systems by using a Multi-agent based Electricity Market

    NASA Astrophysics Data System (ADS)

    Furusawa, Ken; Sugihara, Hideharu; Tsuji, Kiichiro

    Opened wholesale electric power market in April 2005, deregulation of electric power industry in Japan has faced a new competitive environment. In the new environment, Independent Power Producer (: IPP), Power Producer and Supplier (: PPS), Load Service Entity (: LSE) and electric utility can trade electric energy through both bilateral contracts and single-price auction at the electricity market. In general, the market clearing price (: MCP) is largely changed by amount of total load demand in the market. The influence may cause price spike, and consequently the volatility of MCP will make LSEs and their customers to face a risk of revenue and cost. DSM is attracted as a means of load leveling, and has effect on decreasing MCP at peak load period. Introducing Energy Storage systems (: ES) is one of DSM in order to change demand profile at customer-side. In case that customers decrease their own demand at jumped MCP, a bidding strategy of generating companies may be changed their strategy. As a result, MCP is changed through such complex mechanism. In this paper the authors evaluate MCP by multi-agent. It is considered that customer-side ES has an effect on MCP fluctuation. Through numerical examples, this paper evaluates the influence on MCP by controlling customer-side ES corresponding to variation of MCP.

  19. Modeling and managing urban water demand through smart meters: Benefits and challenges from current research and emerging trends

    NASA Astrophysics Data System (ADS)

    Cominola, A.; Giuliani, M.; Castelletti, A.; Piga, D.; Rizzoli, A. E.

    2015-12-01

    Urban population growth, climate and land use change are expected to boost residential water demand in urban contexts in the next decades. In such a context, developing suitable demand-side management strategies is essential to meet future water demands, pursue water savings, and reduce the costs for water utilities. Yet, the effectiveness of water demand management strategies (WDMS) relies on our understanding of water consumers' behavior, their consumption habits, and the water use drivers. While low spatial and temporal resolution water consumption data, as traditionally gathered for billing purposes, hardly support this understanding, the advent of high-resolution, smart metering technologies allowed for quasi real-time monitoring water consumption at the single household level. This, in turn, is advancing our ability in characterizing consumers' behavior, modeling, and designing user-oriented residential water demand management strategies. Several water smart metering programs have been rolled-out in the last two decades worldwide, addressing one or more of the following water demand management phases: (i) data gathering, (ii) water end-uses characterization, (iii) user modeling, (iv) design and implementation of personalized WDMS. Moreover, the number of research studies in this domain is quickly increasing and big economic investments are currently being devoted worldwide to smart metering programs. With this work, we contribute the first comprehensive review of more than 100 experiences in the field of residential water demand modeling and management, and we propose a general framework for their classification. We revise consolidated practices, identify emerging trends and highlight the challenges and opportunities for future developments given by the use of smart meters advancing residential water demand management. Our analysis of the status quo of smart urban water demand management research and market constitutes a structured collection of information

  20. Docetaxel-related side effects and their management.

    PubMed

    Baker, Jackie; Ajani, Jaffer; Scotté, Florian; Winther, Dorte; Martin, Miguel; Aapro, Matti S; von Minckwitz, Gunter

    2009-02-01

    Docetaxel is an effective treatment approved in five key cancers, but its effectiveness in clinical practice can be compromised by sub-optimal side-effect management. The aim of this review was to investigate the extent of the published work on specific docetaxel-related side effects and to provide, where possible, evidence-based recommendations for their prevention and management. PubMed and the American Society of Clinical Oncology (ASCO) databases were systematically searched for articles published in English over the past 5 years and 2 years, respectively, and pertaining to six side effects identified as being common to the majority of docetaxel regimens and indications and of particular relevance to the oncology nurse. The Cochrane library was also searched. A total of 103 citations were identified, 14 of which discussed strategies for the prevention or management of febrile neutropenia (n=6), hypersensitivity reactions (3), fluid retention (1) and nail changes (4). No articles were identified that related to asthenia or neuropathy. Based on the literature review, evidence/guidelines-based advice for the use of G-CSF in febrile neutropenia is provided. The evidence base with respect to the other side effects does not permit the formulation of recommendations. It is the experience of the authors, however, that the severity of symptoms experienced by patients is generally mild and the side effects are for the most part easily managed with prophylactic and supportive care measures. It is, therefore, important to share and build on experiences, through research and discussion, to maximise the healthcare professional's ability to offer the best standard of care to patients.

  1. An evaluation of two large scale demand side financing programs for maternal health in India: the MATIND study protocol.

    PubMed

    Sidney, Kristi; de Costa, Ayesha; Diwan, Vishal; Mavalankar, Dileep V; Smith, Helen

    2012-08-27

    High maternal mortality in India is a serious public health challenge. Demand side financing interventions have emerged as a strategy to promote access to emergency obstetric care. Two such state run programs, Janani Suraksha Yojana (JSY)and Chiranjeevi Yojana (CY), were designed and implemented to reduce financial access barriers that preclude women from obtaining emergency obstetric care. JSY, a conditional cash transfer, awards money directly to a woman who delivers in a public health facility. This will be studied in Madhya Pradesh province. CY, a voucher based program, empanels private obstetricians in Gujarat province, who are reimbursed by the government to perform deliveries of socioeconomically disadvantaged women. The programs have been in operation for the last seven years. The study outlined in this protocol will assess and compare the influence of the two programs on various aspects of maternal health care including trends in program uptake, institutional delivery rates, maternal and neonatal outcomes, quality of care, experiences of service providers and users, and cost effectiveness. The study will collect primary data using a combination of qualitative and quantitative methods, including facility level questionnaires, observations, a population based survey, in-depth interviews, and focus group discussions. Primary data will be collected in three districts of each province. The research will take place at three levels: the state health departments, obstetric facilities in the districts and among recently delivered mothers in the community. The protocol is a comprehensive assessment of the performance and impact of the programs and an economic analysis. It will fill existing evidence gaps in the scientific literature including access and quality to services, utilization, coverage and impact. The implementation of the protocol will also generate evidence to facilitate decision making among policy makers and program managers who currently work with or

  2. Organization by Design: Supply- and Demand-Side Models of Mathematics Course Taking

    ERIC Educational Resources Information Center

    McFarland, Daniel A.; Rodan, Simon

    2009-01-01

    Prior work has proposed different theoretical mechanisms to explain students' course-taking patterns in schools. On the one hand, there are oversocialized accounts that claim that rules, social background factors, and supply-side factors shape observed career patterns. On the other hand, there are undersocialized accounts that claim that the…

  3. Designing cost effective water demand management programs in Australia.

    PubMed

    White, S B; Fane, S A

    2002-01-01

    This paper describes recent experience with integrated resource planning (IRP) and the application of least cost planning (LCP) for the evaluation of demand management strategies in urban water. Two Australian case studies, Sydney and Northern New South Wales (NSW) are used in illustration. LCP can determine the most cost effective means of providing water services or alternatively the cheapest forms of water conservation. LCP contrasts to a traditional approach of evaluation which looks only at means of increasing supply. Detailed investigation of water usage, known as end-use analysis, is required for LCP. End-use analysis allows both rigorous demand forecasting, and the development and evaluation of conservation strategies. Strategies include education campaigns, increasing water use efficiency and promoting wastewater reuse or rainwater tanks. The optimal mix of conservation strategies and conventional capacity expansion is identified based on levelised unit cost. IRP uses LCP in the iterative process, evaluating and assessing options, investing in selected options, measuring the results, and then re-evaluating options. Key to this process is the design of cost effective demand management programs. IRP however includes a range of parameters beyond least economic cost in the planning process and program designs, including uncertainty, benefit partitioning and implementation considerations.

  4. [Rare side effects in management of hyperthyroidism. Case report].

    PubMed

    Sohár, Gábor; Kovács, Mónika; Györkös, Andrea; Gasztonyi, Beáta

    2016-05-29

    The authors present the case history of a patient suffering from hyperthyroidism. The diagnostic procedures revealed the presence of propylthiouracyl induced vasculitis with renal involvement, that recovered completely after the withdrawal of propylthiouracyl and corticosteroid treatment. Thereafter, the patient was treated with thiamasol, that caused agranulocytosis with fever. After transient litium carbonate therapy a succesful thyreoidectomy was performed. Cumulative serious side effects of antithyroid drugs are rare. This case highlights some of the challenges and complications encountered in the management of hyperthyroidism.

  5. What makes Health Demand-Side Financing Schemes Work in Low-and Middle-Income Countries? A Realist Review

    PubMed Central

    Gopalan, Saji S.; Das, Ashis; Mutasa, Ronald

    2014-01-01

    This realist review explored causal pathways of the possible consumer effects of health sector demand-side financial (DSF) incentives, their contextual factors and mechanisms in low-and-middle-income countries. We searched six electronic data bases and identified 659 abstracts with different evaluation designs. Based on methodological rigor and content relevance, only 24 studies published up to April 2013 were selected for the final review. A conceptual framework consisting of various program theories on potential context-mechanism-outcome (C-M-O) configuration of DSF initiative was designed, tested and adapted during the review. Synthesized results were presented as a C-M-O configuration for each of the consumer –side effect. DSF was effective to improve health seeking behaviour considerably and health status to some extent. The causal pathway of DSF’s functioning and effectiveness was not linear. Key demand-side contextual factors which affected DSF’s consumer-side effects were background characteristics of the beneficiaries including their socio-cultural beliefs, motivations, and level of health awareness. At the supply-side, service availability status and provider incentives were contextual determinants. The mechanisms which enabled the interaction of contextual influence were consumer and provider accountability and consumer trust on providers. In order to enhance DSF programs’ effectiveness, their design and implementation should carefully consider the potential contextual elements that may influence the causal pathways. Significance for public health This article focuses on a rare topic i.e. Realist Review, which is an emerging concept to explore causal factors behind every intervention that make it effective or ineffective. This manuscript is a first attempt on a Realist Review of health sector demand-side financing (DSF) in a number of low-and middle-income countries. DSF is a widely employed health promotion strategy in many countries to improve

  6. Androgen deprivation therapy: evidence-based management of side effects.

    PubMed

    Ahmadi, Hamed; Daneshmand, Siamak

    2013-04-01

    metabolic changes. Toremifene improves the lipid profile. Intermittent ADT improves early side effects, such as hot flashes, sexual activity, fatigue, and quality of life, although its effect on long-term side effects remains inconclusive. Despite significant improvement in management strategies for the side effects of ADT, the best way of preventing side effects is to use ADT only when it is absolutely indicated. © 2013 BJU International.

  7. An overview of US energy options: Supply- and demand-side history and prospects

    NASA Technical Reports Server (NTRS)

    Hirshberg, A. S.

    1977-01-01

    An overview was provided of nonsolar energy policy options available to the United States until solar energy conversion and utilization devices can produce power at a cost competitive with that obtained from fossil fuels. The economics of the development of new fossil fuel sources and of mandatory conservation measures in energy usage were clarified in the context of the historic annual rate of increase in U.S. energy demand. An attempt was made to compare the costs and relative efficiencies of energy obtainable from various sources by correlating the many confusing measurement units in current use.

  8. Customer delight and demand management: can they be integrated?

    PubMed

    Willis, A K

    1996-11-01

    This article will supply methods of becoming trading partners in today's global market and will provide world-class approaches to improved responsiveness and customer satisfaction. Guidelines and actual how-to's for implementing and managing a customer-driven supply chain will be offered. Examples will be given of how both large and small organizations have increased profitability by eliminating non-value-added paperwork, improved their ability to respond to customer demand, and reduced procurement cycle times along the entire supply chain.

  9. Acute Management of Nutritional Demands after Spinal Cord Injury

    PubMed Central

    Thibault-Halman, Ginette; Casha, Steven; Singer, Shirley

    2011-01-01

    Abstract A systematic review of the literature was performed to address pertinent clinical questions regarding nutritional management in the setting of acute spinal cord injury (SCI). Specific metabolic challenges are present following spinal cord injury. The acute stage is characterized by a reduction in metabolic activity, as well as a negative nitrogen balance that cannot be corrected, even with aggressive nutritional support. Metabolic demands need to be accurately monitored to avoid overfeeding. Enteral feeding is the optimal route following SCI. When oral feeding is not possible, nasogastric, followed by nasojejunal, then by percutaneous endoscopic gastrostomy, if necessary, is suggested. PMID:20373845

  10. Optometry services in Ontario: supply - and demand-side factors from 2011 to 2036.

    PubMed

    Leonard, Philip Sj; Sweetman, Arthur; Zhang, Xue Helen

    2014-01-01

    Optometric labour market projections are provided. First, population growth and ageing-based estimates of the rate of increase of eye-care services in Ontario from 2011 to 2$ are presented, holding the age-sex structure of utilization constant. Then, using data on the 2011 supply and working hours of Ontario's optometrists, the number of optometrists needed to keep the level of optometric services per age-sex-adjusted person comparable over time is estimated. The projections suggest that the number of Ontario optometrists should grow by approximately 30-40 full-time equivalents per year; to offset retirements and account for decreasing work hours, this suggests 77-90 new practitioners are required each year. However, in recent years, the number of Ontario optometrists has been growing faster than this, suggesting either that demand has exceeded supply and/or surpluses will accumulate if this trend continues.

  11. Building a demand-driven, vendor-managed supply chain.

    PubMed

    Haavik, S

    2000-02-01

    Vendor-managed inventory (VMI) software can help both stand-alone and IDS-based hospitals significantly reduce supply-chain management costs. The software tracks an organization's actual supply demand and generates automatic purchase orders, providing the supplies on an as-needed basis. As a result, a hospital's inventory-carrying and purchase-order processing costs may be reduced significantly. To make optimum use of the VMI software, IDSs and hospitals first need to ensure that their methods of collecting data on supply consumption are efficient and accurate. They then need to either establish a relationship with a distributor offering VMI capability or, if the organization is a large IDS with its own distribution center, acquire the software for internal use. A collaboration with a distributor requires establishing effective electronic communications for data sharing.

  12. The role of PV in demand-site management: Policy and industry challenges

    NASA Astrophysics Data System (ADS)

    Byrne, John; Hadjilambrinos, Constantine; Wang, Young-Doo

    1992-12-01

    Most electric utility planners consider photovoltaics to be a frontier technology which is not yet mature enough to contribute to the U.S. electric generation market. Over the past decade, utilities and their regulators have begun to emphasize demand-side management (DMS) to meet an increasing proportion of their service needs. For PV to be a valued technology in the electricity sector, DSM applications need to be identified that can provide a significant market for this technology. DSM programs of 20 of the most active utilities in the DSM market are analyzed in this research to determine the size, prices, demand, and impact of policy. Target PV-DSM markets are identified and the policy and industry challenges that must be met are defined.

  13. [Evaluation of Nurse Demand Management in Primary Care].

    PubMed

    Brugués Brugués, Alba; Peris Grao, Antoni; Pavón Rodríguez, Francisca; Mateo Viladomat, Enric; Gascón Ferret, Jordi; Flores Mateo, Gemma

    2016-03-01

    to evaluate the health outcomes of nurse demand management on unscheduled patients in a Primary Care Centre, following a clinical guide designed by the whole primary care team. Cross-sectional study. A primary care team from Castelldefels. Barcelona, Spain. A random sample of 558 patients requesting a consultation for the same day in a Primary Care setting, attended between May 1st, 2011 and January 31st, 2012. The guide includes 23 health problems that can be dealt by a nurse autonomously, 18 of them possibly requiring an emergency intervention, and shared decision with the physician. Each health problem is divided into three sections: a) a brief definition of the problem; b) an intervention algorithm; and c) nursing diagnoses of North American Nursing Diagnosis Association for each health problem and a description of the possible nursing interventions. We studied 558 patients with a mean age of 42.5 years old (SD 17.7). The most commonly consulted problems were upper respiratory tract symptoms (19.4%), followed by nausea/vomiting (16.5%), and burns/wounds (12.5%). 73.3% of the problems were resolved autonomously by a nurse. 65,8% of the patients attended received health advice. Nurse demand management has shown to be highly effective at handling the conditions attended, while it provides a high percentage of health advice and education during consultations. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  14. Emergency management of malignant acute left-sided colonic obstruction.

    PubMed

    Trompetas, Vasileios

    2008-04-01

    The management of acute left-sided colonic obstruction still remains a challenging problem despite significant progress. A literature search was undertaken using PubMed and the Cochrane Library regarding the options in emergency management of left-sided colonic obstruction focusing on outcomes such as mortality, morbidity, long-term prognosis and cost effectiveness. Colonic stenting is the best option either for palliation or as a bridge to surgery. It reduces morbidity and mortality rate and the need for colostomy formation. Stenting is likely to be cost effective, but data are variable depending on the individual healthcare system. Nevertheless, surgical management remains relevant as colonic stenting has a small rate of failure, and it is not always available. There are various surgical options. One-stage primary resection and anastomosis is the preferred choice for low-risk patients. Intra-operative colonic irrigation has no proven benefit. Subtotal colectomy is useful in cases of proximal bowel damage or synchronous tumours. Hartmann's procedure should be reserved for high-risk patients. Simple colostomy has no role other than for use in very ill patients who are not fit for any other procedure.

  15. Emergency Management of Malignant Acute Left-Sided Colonic Obstruction

    PubMed Central

    Trompetas, Vasileios

    2008-01-01

    INTRODUCTION The management of acute left-sided colonic obstruction still remains a challenging problem despite significant progress. METHODS A literature search was undertaken using PubMed and the Cochrane Library regarding the options in emergency management of left-sided colonic obstruction focusing on outcomes such as mortality, morbidity, long-term prognosis and cost effectiveness. DISCUSSION Colonic stenting is the best option either for palliation or as a bridge to surgery. It reduces morbidity and mortality rate and the need for colostomy formation. Stenting is likely to be cost effective, but data are variable depending on the individual healthcare system. Nevertheless, surgical management remains relevant as colonic stenting has a small rate of failure, and it is not always available. There are various surgical options. One-stage primary resection and anastomosis is the preferred choice for low-risk patients. Intra-operative colonic irrigation has no proven benefit. Subtotal colectomy is useful in cases of proximal bowel damage or synchronous tumours. Hartmann's procedure should be reserved for high-risk patients. Simple colostomy has no role other than for use in very ill patients who are not fit for any other procedure. PMID:18430330

  16. Operation of Battery Energy Storage System in Demand Side using Local Load Forecasting

    NASA Astrophysics Data System (ADS)

    Hida, Yusuke; Yokoyama, Ryuichi; Shimizukawa, Jun; Iba, Kenji; Tanaka, Kouji; Seki, Tomomichi

    Recently, the various political movements, which reduce CO2-emission, have been proposed against global warming. Therefore, battery energy storage systems (BESSs) such as NAS (sodium and sulfur) battery are attracting attention around the world. The first purpose of BESS was the improvement of load factors. The second purpose is the improvement of power quality, especially against voltage-sag. The recent interest is oriented to utilize BESS to mitigate the intermittency of renewable energy. NAS battery has two operation modes. The first one is a fixed pattern operation, which is time-schedule in advance. The second mode is the load following operation. Although this mode can perform more the flexible operation by adjusting the change of load, it has the risks of shortage/surplus of battery energy. In this paper, an accurate demand forecasting method, which is based on multiple regression models, is proposed. Using this load forecasting, the more advanced control of load following operation for NAS battery is proposed.

  17. Integration of Renewables Via Demand Management: Highly Dispatchable and Distributed Demand Response for the Integration of Distributed Generation

    SciTech Connect

    2012-02-11

    GENI Project: AutoGrid, in conjunction with Lawrence Berkeley National Laboratory and Columbia University, will design and demonstrate automated control software that helps manage real-time demand for energy across the electric grid. Known as the Demand Response Optimization and Management System - Real-Time (DROMS-RT), the software will enable personalized price signal to be sent to millions of customers in extremely short timeframes—incentivizing them to alter their electricity use in response to grid conditions. This will help grid operators better manage unpredictable demand and supply fluctuations in short time-scales —making the power generation process more efficient and cost effective for both suppliers and consumers. DROMS-RT is expected to provide a 90% reduction in the cost of operating demand response and dynamic pricing Projects in the U.S.

  18. Emergency management training in Korea: combining and balancing supply- and demand-centered paradigms.

    PubMed

    Ha, Kyoo-Man; Park, Sosoon; Yoon, Yi; Nam, Ki-Hun; Oh, Hyeon-Mun

    2015-01-01

    This article aims to encourage NEMA (or newly named as MPSS) to combine its supply-centered paradigm with a newly proposed "demand-centered paradigm" in the Korean field of emergency management training (EMT). Based on qualitative content analysis, this paper defined the current field of EMT to be a supply-centered paradigm via three components: locations, courses, and participants. This paradigm focuses on EMT provision as supplied and dictated by the national government. On the other hand, a demand-centered model is about looking into stakeholders' actual needs for EMT. In this regard, alternatives with reference to the demand-centered paradigm via the same three components were discussed and considered. The key tenet is that having revealed that NEMA has unequivocally focused on the results side or effectiveness of EMT via a supply-centered paradigm, Korea should address and consider the same three components, this time by fusing and incorporating a fair process of EMT by enlisting active roles from the local community, academic scholars, and civilian training attendees in a demand-centered paradigm.

  19. A Distributed Intelligent Automated Demand Response Building Management System

    SciTech Connect

    Auslander, David; Culler, David; Wright, Paul; Lu, Yan; Piette, Mary

    2013-03-31

    The goal of the 2.5 year Distributed Intelligent Automated Demand Response (DIADR) project was to reduce peak electricity load of Sutardja Dai Hall at UC Berkeley by 30% while maintaining a healthy, comfortable, and productive environment for the occupants. We sought to bring together both central and distributed control to provide “deep” demand response1 at the appliance level of the building as well as typical lighting and HVAC applications. This project brought together Siemens Corporate Research and Siemens Building Technology (the building has a Siemens Apogee Building Automation System (BAS)), Lawrence Berkeley National Laboratory (leveraging their Open Automated Demand Response (openADR), Auto-­Demand Response, and building modeling expertise), and UC Berkeley (related demand response research including distributed wireless control, and grid-­to-­building gateway development). Sutardja Dai Hall houses the Center for Information Technology Research in the Interest of Society (CITRIS), which fosters collaboration among industry and faculty and students of four UC campuses (Berkeley, Davis, Merced, and Santa Cruz). The 141,000 square foot building, occupied in 2009, includes typical office spaces and a nanofabrication laboratory. Heating is provided by a district heating system (steam from campus as a byproduct of the campus cogeneration plant); cooling is provided by one of two chillers: a more typical electric centrifugal compressor chiller designed for the cool months (Nov-­ March) and a steam absorption chiller for use in the warm months (April-­October). Lighting in the open office areas is provided by direct-­indirect luminaries with Building Management System-­based scheduling for open areas, and occupancy sensors for private office areas. For the purposes of this project, we focused on the office portion of the building. Annual energy consumption is approximately 8053 MWh; the office portion is estimated as 1924 MWh. The maximum peak load

  20. Price-responsive demand management for a smart grid world

    SciTech Connect

    Chao, Hung-po

    2010-01-15

    Price-responsive demand is essential for the success of a smart grid. However, existing demand-response programs run the risk of causing inefficient price formation. This problem can be solved if each retail customer could establish a contract-based baseline through demand subscription before joining a demand-response program. (author)

  1. Guide to transportation-demand management plans for employers

    SciTech Connect

    Anderson, S.M.; Gerwig, K.L.; Shirazi, E.

    1988-09-01

    This guide is designed to introduce employers, transportation agencies, consultants, government officials and others to the elements of transportation demand management (TDM) plans. TDM plans use a variety of strategies to orchestrate employees' commute-related activities, including use of carpools, vanpools, bicycles, and buses, use of variable work hours to spread or reduce peak hour congestion, and telecommuting (working from home or a satellite office). The guide contains a description of the typical elements in a TDM plan, including an assessment of the current employee transportation program, methods for measuring vehicle occupancy, strategies for program improvement, and implementing and monitoring the transportation program. The procedure is illustrated for a fictitious employer in the Los Angeles Central Business District.

  2. Supply- and Demand-Side Factors Influencing Utilization of Infant and Young Child Feeding Counselling Services in Viet Nam

    PubMed Central

    Nguyen, Phuong H.; Kim, Sunny S.; Nguyen, Tuan T.; Tran, Lan M.; Hajeebhoy, Nemat; Frongillo, Edward A.; Ruel, Marie T.; Rawat, Rahul; Menon, Purnima

    2016-01-01

    Adequate utilization of services is critical to maximize the impact of counselling on infant and young child feeding (IYCF), but little is known about factors affecting utilization. Our study examined supply- and demand-side factors associated with the utilization of IYCF counselling services in Viet Nam. We used survey data from mothers with children <2y (n = 1,008) and health staff (n = 60) from the evaluation of a program that embedded IYCF counseling into the existing government health system. The frequency of never users, one-time users, repeat users, and achievers of the recommended minimum number of visits at health facilities were 45.1%, 13.0%, 28.4% and 13.5%, respectively. Poisson regression showed that demand-generation strategies, especially invitation cards, were the key factors determining one-time use (Prevalence ratio, PR 3.0, 95% CI: 2.2–4.2), repeated use (PR 3.2, 95% CI: 2.4–4.2), and achievement of minimum visits (PR 5.5, 95% CI: 3.6–8.4). Higher maternal education was associated with higher utilization both for one-time and repeated use. Being a farmer, belonging to an ethnic minority, and having a wasted child were associated with greater likelihood of achieving the minimum recommended number of visits, whereas child stunting or illness were not. Distance to health center was a barrier to repeated visits. Among supply-side factors, good counselling skills (PR: 1.3–1.8) was the most important factor associated with any service use, whereas longer employment duration and greater work pressure of health center staff were associated with lower utilization. Population attributable risk estimations showed that an additional 25% of the population would have achieved the minimum number of visits if exposed to three demand-generation strategies, and further increased to 49% if the health staff had good counseling skills and low work pressure. Our study provides evidence that demand-generation strategies are essential to increase utilization of

  3. Supply- and Demand-Side Factors Influencing Utilization of Infant and Young Child Feeding Counselling Services in Viet Nam.

    PubMed

    Nguyen, Phuong H; Kim, Sunny S; Nguyen, Tuan T; Tran, Lan M; Hajeebhoy, Nemat; Frongillo, Edward A; Ruel, Marie T; Rawat, Rahul; Menon, Purnima

    2016-01-01

    Adequate utilization of services is critical to maximize the impact of counselling on infant and young child feeding (IYCF), but little is known about factors affecting utilization. Our study examined supply- and demand-side factors associated with the utilization of IYCF counselling services in Viet Nam. We used survey data from mothers with children <2y (n = 1,008) and health staff (n = 60) from the evaluation of a program that embedded IYCF counseling into the existing government health system. The frequency of never users, one-time users, repeat users, and achievers of the recommended minimum number of visits at health facilities were 45.1%, 13.0%, 28.4% and 13.5%, respectively. Poisson regression showed that demand-generation strategies, especially invitation cards, were the key factors determining one-time use (Prevalence ratio, PR 3.0, 95% CI: 2.2-4.2), repeated use (PR 3.2, 95% CI: 2.4-4.2), and achievement of minimum visits (PR 5.5, 95% CI: 3.6-8.4). Higher maternal education was associated with higher utilization both for one-time and repeated use. Being a farmer, belonging to an ethnic minority, and having a wasted child were associated with greater likelihood of achieving the minimum recommended number of visits, whereas child stunting or illness were not. Distance to health center was a barrier to repeated visits. Among supply-side factors, good counselling skills (PR: 1.3-1.8) was the most important factor associated with any service use, whereas longer employment duration and greater work pressure of health center staff were associated with lower utilization. Population attributable risk estimations showed that an additional 25% of the population would have achieved the minimum number of visits if exposed to three demand-generation strategies, and further increased to 49% if the health staff had good counseling skills and low work pressure. Our study provides evidence that demand-generation strategies are essential to increase utilization of facility

  4. Demand- and supply-side determinants of diphtheria-pertussis-tetanus nonvaccination and dropout in rural India.

    PubMed

    Ghosh, Arpita; Laxminarayan, Ramanan

    2017-02-15

    Although 93% of 12- to 23-month-old children in India receive at least one vaccine, typically Bacillus Calmette-Guérin, only 75% complete the recommended three doses of diphtheria-pertussis-tetanus (DPT, also referred to as DTP) vaccine. Determinants can be different for nonvaccination and dropout but have not been examined in earlier studies. We use the three-dose DPT series as a proxy for the full sequence of recommended childhood vaccines and examine the determinants of DPT nonvaccination and dropout between doses 1 and 3. We analyzed data on 75,728 6- to 23-month-old children in villages across India to study demand- and supply-side factors determining nonvaccination with DPT and dropout between DPT doses 1 and 3, using a multilevel approach. Data come from the District Level Household and Facility Survey 3 (2007-08). Individual- and household-level factors were associated with both DPT nonvaccination and dropout between doses 1 and 3. Children whose mothers had no schooling were 2.3 times more likely not to receive any DPT vaccination and 1.5 times more likely to drop out between DPT doses 1 and 3, compared with children whose mothers had 10 or more years of schooling. Although supply-side factors related to availability of public health facilities and immunization-related health workers in villages were not correlated with dropout between DPT doses 1 and 3, children in districts where 46% or more villages had a healthcare subcentre were 1.5 times more likely to receive at least one dose of DPT vaccine compared with children in districts where 30% or fewer villages had subcentres. Nonvaccination with DPT in India is influenced by village- and district-level contextual factors over and above individuals' background characteristics. Dropout between DPT doses 1 and 3 is associated more strongly with demand-side factors than with village- and district-level supply-side factors. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  5. Managing immune checkpoint-blocking antibody side effects.

    PubMed

    Postow, Michael A

    2015-01-01

    Immune checkpoint-blocking antibodies that enhance the immune system's ability to fight cancer are becoming important components of treatment for patients with a variety of malignancies. Cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) was the first immune checkpoint to be clinically targeted, and ipilimumab, an inhibitor of CTLA-4, was approved by the U.S. Food and Drug Administration (FDA) for patients with advanced melanoma. The programmed cell death-1 (PD-1) receptor and one of its ligands, PD-L1, more recently have shown great promise as therapeutic targets in a variety of malignancies. Nivolumab and pembrolizumab recently have been FDA- approved for patients with melanoma and additional approvals within this therapeutic class are expected. The use of anti-CTLA-4 and anti-PD-1/PD-L1 antibodies is associated with side effects known as immune-related adverse events (irAEs). Immune-related adverse events affect the dermatologic, gastrointestinal, hepatic, endocrine, and other organ systems. Temporary immunosuppression with corticosteroids, tumor necrosis factor-alpha antagonists, mycophenolate mofetil, or other agents can be effective treatment. This article describes the side-effect profile of the checkpoint-blocking antibodies that target CTLA-4 and PD-1/PD-L1 and provides suggestions on how to manage specific irAEs.

  6. When the 'soft-path' gets hard: demand management and financial instability for water utilities

    NASA Astrophysics Data System (ADS)

    Zeff, H. B.; Characklis, G. W.

    2014-12-01

    In the past, cost benefit analysis (CBA) has been viewed as an effective means of evaluating water utility strategies, particularly those that were dependent on the construction of new supply infrastructure. As water utilities have begun to embrace 'soft-path' approaches as a way to reduce the need for supply-centric development, CBA fails to recognize some important financial incentives affected by reduced water consumption. Demand management, both as a short-term response to drought and in longer-term actions to accommodate demand growth, can introduce revenue risks that adversely affect a utility's ability to repay debt, re-invest in aging infrastructure, or maintain reserve funds for use in a short-term emergency. A utility that does not generate sufficient revenue to support these functions may be subject to credit rating downgrades, which in turn affect the interest rate it pays on its debt. Interest rates are a critical consideration for utility managers in the capital-intensive water sector, where debt payments for infrastructure often account for a large portion of a utility's overall costs. Even a small increase in interest rates can add millions of dollars to the cost of new infrastructure. Recent studies have demonstrated that demand management techniques can lead to significant revenue variability, and credit rating agencies have begun to take notice of drought response plans when evaluating water utility credit ratings, providing utilities with a disincentive to fully embrace soft-path approaches. This analysis examines the impact of demand management schemes on key credit rating metrics for a water utility in Raleigh, North Carolina. The utility's consumer base is currently experiencing rapid population growth, and demand management has the potential to reduce the dependence on costly new supply infrastructure but could lead to financial instability that will significantly increase the costs of financing future projects. This work analyzes how 'soft

  7. Prevention and management of glucocorticoid-induced side effects: A comprehensive review: Gastrointestinal and endocrinologic side effects.

    PubMed

    Caplan, Avrom; Fett, Nicole; Rosenbach, Misha; Werth, Victoria P; Micheletti, Robert G

    2017-01-01

    Part 2 of this 4-part continuing medical education series continues with a discussion of the prevention and management of gastrointestinal side effects associated with corticosteroid use, including peptic ulcer disease, gastrointestinal bleeding, and pancreatitis, followed by a review of corticosteroid-related endocrinologic side effects, such as diabetes, adrenal suppression, and Cushing syndrome. Copyright © 2016 American Academy of Dermatology, Inc. All rights reserved.

  8. Efficient Buffer Management for Scalable Media-on-Demand

    NASA Astrophysics Data System (ADS)

    Waldvogel, Marcel; Deng, Wei; Janakiraman, Ramaprabhu

    2003-01-01

    Widespread availability of high-speed networks and fast, cheap computation have rendered high-quality Media-on-Demand (MoD) feasible. Research on scalable MoD has resulted in many efficient schemes that involve segmentation and asynchronous broadcast of media data, requiring clients to buffer and reorder out-of-order segments efficiently for serial playout. In such schemes, buffer space requirements run to several hundred megabytes and hence require efficient buffer management techniques involving both primary memory and secondary storage: while disk sizes have increased exponentially, access speeds have not kept pace at all. The conversion of out-of-order arrival to in-order playout suggests the use of external memory priority queues, but their content-agnostic nature prevents them from performing well under MoD loads. In this paper, we propose and evaluate a series of simple heuristic schemes which, in simulation studies and in combination with our scalable MoD scheme, achieve significant improvements in storage performance over existing schemes.

  9. Resilience building and water demand management for drought mitigation

    NASA Astrophysics Data System (ADS)

    Rockström, Johan

    Doughts resulting in complete crop failure are common in Eastern and Southern Africa. We are at present experiencing a regional crisis, where crop failures related to drought are threatening the lives of millions of people in several countries in Southern Africa. A major challenge is to seek ways of mitigating and coping with droughts in small-holder farming systems, particularly in semi-arid regions which are most hardly hit by the effects of drought. An entry-point for drought mitigation is to build water resilience of present rainfed farming systems. The water balance is a good starting point to assess the options. As has been argued for decades, the term drought is very debated, and the boundaries between droughts being politically and biophysically defined is not sharp. Often crop failures and social suffering are blamed on drought, while in reality the causes are more complex than only a decline in rainfall. A challenge is to find management strategies to deal with the unreliable and extremely variable rainfall in savannah environments. In this paper examples of small-scale management practices to mitigate drought in semi-arid rainfed farming are presented. Focus is on water harvesting systems for supplemental irrigation. It is shown that with relatively simple and cheap means it is possible to build resilience to deal with water scarcity in semi-arid farming systems. If such measures are combined with efforts of maximising plant water availability and plant water uptake capacity, there are good chances of mitigating certain droughts. Conservation tillage systems have proven to maximise rainfall infiltration and storage of water in the soil, enabling even crops lacking supplemental irrigation to bridge severe dry spells. Interestingly, building resilience in rainfed farming systems is also a means of water demand management. More crop is produced per drop of water in resilient farming systems, which reduces the amount of water needed to produce food. Despite

  10. The Good Daughter Dilemma: Latinas Managing Family and School Demands

    ERIC Educational Resources Information Center

    Espinoza, Roberta

    2010-01-01

    This study documents strategies employed by Latina doctoral graduate students to balance family relationships with the demands of school to maintain their status of a "good daughter". In-depth interviews reveal some women integrate family and school by explaining the demands placed on them to enlist support while others keep their two social…

  11. Evaluation of Orange and Rockland Utilities, Inc.`s competitive bidding program for demand-side resources. Final report

    SciTech Connect

    Peters, J.S.; Stucky, L.; Seratt, P.; Darden-Butler, D.

    1993-02-01

    The process evaluation reports on the implementation of Orange and Rockland Utilities demand-side bidding program in New York State during 1991 and 1992. The program is implemented by two energy service companies in Orange and rockland`s New York State service territory. The process evaluation methodology included interviews with utility staff (3), energy service company staff (2), and participating (6) and nonparticipating (7) utility customers. The two energy service companies had enrolled 14 customers in the program by summer 1992. One company had achieved 90% of their 2.75 MW bid and the other had achieved less than 90% of their 6.9 MW bid. Critical factors in success were determination of a reasonable bid amount for the market and marketing to the appropriate customers. Customers most interested in the program included those with limited access to capital and medium-sized firms with poor cash flows, particularly schools and hospitals. The findings also show that due to the incentive structure and associated need for substantial customer contributions, lighting measures dominate all installations. Customers, however, were interested in the potential savings and six of the nonparticipants chose to either install measures on their own or enroll in the utility`s rebate program.

  12. A Study of Economic Evaluation of Demand-side Energy Storage System in Consideration of Market Clearing Price

    NASA Astrophysics Data System (ADS)

    Furusawa, Ken; Sugihara, Hideharu; Tsuji, Kiichiro; Mitani, Yasunori

    In Japan electricity market will open on 1st April 2004. Electric utility, Power Producer and Supplier (:PPS) and Load Service Entity (:LSE) will join to the electricity market. LSEs purchase electricity based on Market Clearing Price (:MCP) from electricity market. LSEs supply electricity to the customers contracted with the LSEs on a certain electricity price, and one to the customers introduced Energy Storage System (:ES) on a time of use pricing. It is difficult for LSEs to estimate whether they have incentive to promote customers to introduce ES or not. In this paper, it is evaluated the reduction of LSEs' purchasing cost from electricity market and other LSEs' purchasing cost by introducing customers ES. It is clarified that which kind of customers has the effect of decreasing LSEs' purchasing cost and how much MCP of whole power system the demand-side energy storage systems change. Through numerical examples, this paper evaluates the possibility to give the cost merit to both customers with energy storage systems and LSE by using a real data of yearly MCP.

  13. Data-driven behavioural modelling of residential water consumption to inform water demand management strategies

    NASA Astrophysics Data System (ADS)

    Giuliani, Matteo; Cominola, Andrea; Alshaf, Ahmad; Castelletti, Andrea; Anda, Martin

    2016-04-01

    The continuous expansion of urban areas worldwide is expected to highly increase residential water demand over the next few years, ultimately challenging the distribution and supply of drinking water. Several studies have recently demonstrated that actions focused only on the water supply side of the problem (e.g., augmenting existing water supply infrastructure) will likely fail to meet future demands, thus calling for the concurrent deployment of effective water demand management strategies (WDMS) to pursue water savings and conservation. However, to be effective WDMS do require a substantial understanding of water consumers' behaviors and consumption patterns at different spatial and temporal resolutions. Retrieving information on users' behaviors, as well as their explanatory and/or causal factors, is key to spot potential areas for targeting water saving efforts and to design user-tailored WDMS, such as education campaigns and personalized recommendations. In this work, we contribute a data-driven approach to identify household water users' consumption behavioural profiles and model their water use habits. State-of-the-art clustering methods are coupled with big data machine learning techniques with the aim of extracting dominant behaviors from a set of water consumption data collected at the household scale. This allows identifying heterogeneous groups of consumers from the studied sample and characterizing them with respect to several consumption features. Our approach is validated onto a real-world household water consumption dataset associated with a variety of demographic and psychographic user data and household attributes, collected in nine towns of the Pilbara and Kimberley Regions of Western Australia. Results show the effectiveness of the proposed method in capturing the influence of candidate determinants on residential water consumption profiles and in attaining sufficiently accurate predictions of users' consumption behaviors, ultimately providing

  14. Use of microcomputers for inventory management with uncertain demand

    SciTech Connect

    Meadows, B F

    1984-01-01

    This paper describes how a microcomputer is used for analysis of inventory trends to optimize inventory investment and customer service level in a distribution environment with uncertain demand, and to support an inventory subsystem resident on a main computer.

  15. A novel medical information management and decision model for uncertain demand optimization.

    PubMed

    Bi, Ya

    2015-01-01

    Accurately planning the procurement volume is an effective measure for controlling the medicine inventory cost. Due to uncertain demand it is difficult to make accurate decision on procurement volume. As to the biomedicine sensitive to time and season demand, the uncertain demand fitted by the fuzzy mathematics method is obviously better than general random distribution functions. To establish a novel medical information management and decision model for uncertain demand optimization. A novel optimal management and decision model under uncertain demand has been presented based on fuzzy mathematics and a new comprehensive improved particle swarm algorithm. The optimal management and decision model can effectively reduce the medicine inventory cost. The proposed improved particle swarm optimization is a simple and effective algorithm to improve the Fuzzy interference and hence effectively reduce the calculation complexity of the optimal management and decision model. Therefore the new model can be used for accurate decision on procurement volume under uncertain demand.

  16. The effect of game design, goal type and player numbers on the physiological and physical demands of hurling specific Small-sided games.

    PubMed

    Malone, Shane; Collins, Kieran

    2016-09-06

    The current study examined the effect that game design modification, goal type and player numbers on the running performance and physiological demands of small-sided hurling games (SSG). Forty-eight hurling players (age 25.5 ± 3.2 years; height 178.9 ± 3.2 cm; body mass 78.5 ± 4.5 kg) performed four types of SSG (possession (P), normal play (NP), regular Goals (RG) and small goals (SG) in four-a-side, five-a-side and six-a-side formats. Heart rate (Polar Electro Oy, Kempele, Finland) and Global positioning system technology (VX Sport, 4-Hz, Lower Hutt, New Zealand) were used to analyse the physical and physiological differences between SSG. Total distance (m), high speed running distance (m) (≥17 km·h), very high speed running distance (≥22 km·h) (m), peak and mean velocity (km·h) were analysed as an indicator of the physical demands of play. The 4-a-side SSG independent of game design and goal type resulted in a significantly higher relative exercise intensity when compared to 5-a-side [mean change: 6 ± 2 %; p = 0.001; d = 1.9 ± 0.2; large] and 6-a-side SSG independent of game design or goal type [mean change: 12 ± 2 %; p = 0.001; d = 2.9 ± 0.8; very large]. 4-a-side SG [619 ± 106-m (419 - 735-m)] resulted in the highest distance when compared all PP [mean change: 141 ± 9 m; p = 0.05; d = 1.9 ± 0.3; moderate] and RG [mean change: 119 ± 39 m; p = 0.004; d = 2.1 ± 0.8; large]. Similar trends were observed for 5-a-side and 6-a-side games with SG resulting in increased total running performance. In conclusion the current observations reveal that 4-a-side NP, SG and RG have the highest physiological demands with 4-a-side SG having increased running performance when contrast to other game design and goal type games. Furthermore, independent of game design and goal type 4-a-side SSG show increased relative intensity when compared to 5-a-side and 6-a-side SSG.

  17. Effect of Game Design, Goal Type, and Player Numbers on the Physiological and Physical Demands of Hurling-Specific Small-Sided Games.

    PubMed

    Malone, Shane; Collins, Kieran D

    2017-06-01

    The current study examined the effect that game design modification, goal type, and player numbers on the running performance and physiological demands of small-sided hurling games (SSG). Forty-eight hurling players (age, 25.5 ± 3.2 years; height, 178.9 ± 3.2 cm; body mass, 78.5 ± 4.5 kg) performed 4 types of SSG (possession [P], normal play [NP], regular goals [RG] and small goals [SG]) in 4-a-side, 5-a-side, and 6-a-side formats. Heart rate (Polar Electro Oy) and global positioning system technology (VX Sport, 4-Hz, Lower Hutt) were used to analyze the physical and physiological differences between SSG. Total distance (m), high-speed running distance (m) (≥17 km·h), very-high speed running distance (≥22 km·h) (m), peak and mean velocity (km·h) were analyzed as an indicator of the physical demands of play. The 4-a-side SSG independent of game design and goal type resulted in a significantly higher relative exercise intensity compared with 5-a-side (mean change: 6 ± 2%; p = 0.001; d = 1.9 ± 0.2; large) and 6-a-side SSG independent of game design or goal type (mean change: 12 ± 2%; p = 0.001; d = 2.9 ± 0.8; very large). The 4-a-side SG (619 ± 106-m [419-735-m]) resulted in the highest distance when compared with all PP (mean change: 141 ± 9 m; p = 0.05; d = 1.9 ± 0.3; moderate) and RG (mean change: 119 ± 39 m; p = 0.004; d = 2.1 ± 0.8; large). Similar trends were observed for 5-a-side and 6-a-side games with SG resulting in increased total running performance. In conclusion, the current observations reveal that 4-a-side NP, SG, and RG have the highest physiological demands with 4-a-side SG having increased running performance in contrast to other game design and goal-type games. Furthermore, independent of game design and goal type, 4-a-side SSG show increased relative intensity compared with 5-a-side and 6-a-side SSG.

  18. Differences in strength and speed demands between 4v4 and 8v8 small-sided football games.

    PubMed

    Rebelo, António Natal Campos; Silva, Pedro; Rago, Vincenzo; Barreira, Daniel; Krustrup, Peter

    2016-12-01

    The aims of this study were (i) to characterise the acceleration demands of two different formats of small-sided game (SSG), i.e., 4v4 + goalkeepers (4v4 + GK) and 8v8 + goalkeepers (8v8 + GK); (ii) to analyse the correlation between performance in power-based tests and acceleration-based physical loading during the two different SSG formats and (iii) to analyse the neuromuscular-induced fatigue. Eighteen adult male footballers participated in the study (20.7 ± 1.0 years, 178 ± 5 cm and 71.4 ± 2.1 kg). Baseline measurements were obtained from countermovement jumps, 15 s repeated jumps and 5 and 15 m sprints. A total of 36 min was analysed for each SSG (4v4 + GK: two sets of 3 × 6 min, and 8v8 + GK: 2 × 18 min). Heart rate, blood lactate, perceived exertion and movement pattern (GPS) were analysed. Distances covered by very-high-intensity activities and very-high-speed running were lower in 4v4 + GK than in 8v8 + GK (effect sizes (ES) = -0.69 ± 0.67 and -1.04 ± 0.67, respectively; very likely), while accelerations and decelerations were higher in 4v4 + GK than in 8v8 + GK (ES = 1.13-1.52; almost certainly). Blood lactate concentrations were higher (ES = 1.40 ± 0.58; almost certainly) and players perceived themselves to be more tired (ES = 0.80-2.31; almost certainly) after 4v4 + GK than after 8v8 + GK. Sprint ability in 5 and 15 m tests decreased (ES = 0.87 ± 0.58 and 0.89 ± 0.58, respectively; almost certainly) only after 4v4 + GK. This SSG format appeared more demanding in relation to repetitions and fatigue development of muscle power-based actions than 8v8 + GK. It may therefore be logical to use the former type of SSG to target development of power-related football actions.

  19. Managing Residential Electricity Demand Through Provision of Better Feedback

    NASA Astrophysics Data System (ADS)

    Collins, Myles

    New and affordable technology for providing detailed feedback on household electricity usage presents a host of opportunities for utilities and policy-makers to manage demand. This dissertation examines ways to use these devices to reduce - and shift the timing of - energy use in the residential sector by influencing consumers' behavior. The first portion of the study analyzes the impact of programmable thermostats (PTs) on energy use, focusing on residents' knowledge of climate control settings in the dwelling. I found that of households with natural gas heating systems, young households with PTs used 17 percent less heating energy on average. In addition, residents who did not know their thermostat settings tended to use 10 percent more energy for heating. The main portion of the dissertation focuses specifically on the potential for better feedback on electricity usage to reduce household energy consumption. The existing literature suggests that feedback can reduce electricity consumption in homes by 5 to 20 percent, but that significant uncertainties remain in our knowledge of the effectiveness of feedback. These uncertainties include the variation in feedback effectiveness between demographic groups and consumers in different climate regions. This analysis uses these uncertainties to perform an exploratory analysis to determine the conditions under which the benefits of feedback outweigh the costs and to compare the cost-effectiveness of providing feedback against that of other DSM programs. I found that benefits would likely outweigh costs for enhanced monthly billing and real-time feedback and that cost-effectiveness was superior to that of other DSM programs for these types of feedback. For feedback that is disaggregated by appliance type, cost effectiveness was competitive with other DSM programs under a limited set of cases. This study also examines how energy consumption devices should display feedback on GHG emissions from electricity use under a real

  20. Vouchers as demand side financing instruments for health care: a review of the Bangladesh maternal voucher scheme.

    PubMed

    Schmidt, Jean-Olivier; Ensor, Tim; Hossain, Atia; Khan, Salam

    2010-07-01

    Demand side financing (DSF) mechanisms transfer purchasing power to specified groups for defined goods and services in order to increase access to specified services. This is an important innovation in health care systems where access remains poor despite substantial subsidies towards the supply side. In Bangladesh, a maternal health DSF pilot in 33 sub-districts was launched in 2007. We report the results of a rapid review of this scheme undertaken during 2008 after 1 year of its setup. Quantitative data collected by DSF committees, facilities and national information systems were assessed alongside qualitative data, i.e. key informant interviews and focus group discussions with beneficiaries and health service providers on the operation of the scheme in 6 sub-districts. The scheme provides vouchers to women distributed by health workers that entitle mainly poor women to receive skilled care at home or a facility and also provide payments for transport and food. After initial setbacks voucher distribution rose quickly. The data also suggest that the rise in facility based delivery appeared to be more rapid in DSF than in other non-DSF areas, although the methods do not allow for a strict causal attribution as there might be co-founding effects. Fears that the financial incentives for surgical delivery would lead to an over emphasis on Caesarean section appear to be unfounded although the trends need further monitoring. DSF provides substantial additional funding to facilities but remains complex to administer, requiring a parallel administrative mechanism putting additional work burden on the health workers. There is little evidence that the mechanism encourages competition due to the limited provision of health care services. The main question outstanding is whether the achievements of the DSF scheme could be achieved more efficiently by adapting the regular government funding rather than creating an entirely new mechanism. Also, improving the quality of health

  1. Demand-Side Financing--A Focus on Vouchers in Post-Compulsory Education and Training: Discussion Paper and Case Studies. CEDEFOP Dossier.

    ERIC Educational Resources Information Center

    West, Anne; Sparkes, Jo; Balabanov, Todor

    The use of demand-side financing mechanisms and vouchers for postcompulsory secondary-level education was examined through case studies of funding practices in the following countries: Austria; France; the United Kingdom; the United States; and Wallonia (the French community of Belgium). Different models of voucher use were identified in the…

  2. Time management behavior as a moderator for the job demand-control interaction.

    PubMed

    Peeters, Miranda A G; Rutte, Christel G

    2005-01-01

    The interaction effects of time management, work demands, and autonomy on burnout were investigated in a survey study of 123 elementary teachers. A 3-way interaction between time management, work demands, and autonomy was hypothesized: The combination of high work demands and low autonomy was predicted to lead to burnout for teachers low in time management and not, or to a lesser extent, for those high in time management. This hypothesis is confirmed for emotional exhaustion, the most predictive dimension of teacher burnout, and partly confirmed for the personal accomplishment dimension. Generalizability to other contactual occupations is discussed.

  3. Decentralisation de l'enseignement: Financements Axes sur la Demande. Le Developpement en Marche. (Decentralization of Education. Demand Side Financing. Directions in Development.)

    ERIC Educational Resources Information Center

    Patrinos, Harry Anthony; Ariasingam, David Lakshmanan

    Central governments' supply-side expansions of schooling have not equally benefited all members of society, especially girls, indigenous peoples, tribal groups, disadvantaged minorities, and the poor. Public spending on education is often inefficient, higher education is subsidized at primary education's expense, and costs are becoming…

  4. Decentralisation de l'enseignement: Financements Axes sur la Demande. Le Developpement en Marche. (Decentralization of Education. Demand Side Financing. Directions in Development.)

    ERIC Educational Resources Information Center

    Patrinos, Harry Anthony; Ariasingam, David Lakshmanan

    Central governments' supply-side expansions of schooling have not equally benefited all members of society, especially girls, indigenous peoples, tribal groups, disadvantaged minorities, and the poor. Public spending on education is often inefficient, higher education is subsidized at primary education's expense, and costs are becoming…

  5. Grid operators' newest nightmare: managing low-demand periods

    SciTech Connect

    2009-08-15

    As more renewable energy resources are added in many parts of the world, a new and even more daunting challenge is likely to face grid operators in the future - how to get through the minimum demand periods. This is especially a problem in systems where the difference between the daytime peak, usually in the early to late summer afternoons, and minimum load, usually in the late evening and early morning hours, is significant.

  6. Complementary Strategies for the Management of Radiation Therapy Side Effects

    PubMed Central

    Stubbe, Christine E.; Valero, Meighan

    2013-01-01

    Patients with cancer utilize complementary and alternative medicine (CAM) for a variety of purposes, one of which is the reduction of side effects of conventional treatment. With a large number of their patients using CAM, it is important for advanced practitioners in oncology to have an understanding of these therapies to better guide their patients. Side effects of radiation therapy that may have dose-limiting poten­tial include diarrhea, mucositis, skin toxicity, and xerostomia. A com­mon side effect that is not necessarily dose-limiting but considerably troublesome to patients is cancer- and treatment-related fatigue. The CAM therapies that may alleviate some of the side effects of radiation therapy include probiotics, psyllium, exercise, melatonin, honey, acu­puncture, and calendula. Therapies that require more research or have been shown to be ineffective include aloe vera, glutamine, and deglyc­yrrhizinated licorice. This article provides an overview of these thera­pies as well as related research and analysis. PMID:25032003

  7. Complementary strategies for the management of radiation therapy side effects.

    PubMed

    Stubbe, Christine E; Valero, Meighan

    2013-07-01

    Patients with cancer utilize complementary and alternative medicine (CAM) for a variety of purposes, one of which is the reduction of side effects of conventional treatment. With a large number of their patients using CAM, it is important for advanced practitioners in oncology to have an understanding of these therapies to better guide their patients. Side effects of radiation therapy that may have dose-limiting poten-tial include diarrhea, mucositis, skin toxicity, and xerostomia. A com-mon side effect that is not necessarily dose-limiting but considerably troublesome to patients is cancer- and treatment-related fatigue. The CAM therapies that may alleviate some of the side effects of radiation therapy include probiotics, psyllium, exercise, melatonin, honey, acu-puncture, and calendula. Therapies that require more research or have been shown to be ineffective include aloe vera, glutamine, and deglyc-yrrhizinated licorice. This article provides an overview of these thera-pies as well as related research and analysis.

  8. Data Science in Supply Chain Management: Data-Related Influences on Demand Planning

    ERIC Educational Resources Information Center

    Jin, Yao

    2013-01-01

    Data-driven decisions have become an important aspect of supply chain management. Demand planners are tasked with analyzing volumes of data that are being collected at a torrential pace from myriad sources in order to translate them into actionable business intelligence. In particular, demand volatilities and planning are vital for effective and…

  9. A Masters Programme in Telecommunications Management--Demand-Based Curriculum Design

    ERIC Educational Resources Information Center

    Gharaibeh, Khaled M.; Kaylani, Hazem; Murphy, Noel; Brennan, Conor; Itradat, Awni; Al-Bataineh, Mohammed; Aloqlah, Mohammed; Salhieh, Loay; Altarazi, Safwan; Rawashdeh, Nathir; del Carmen Bas Cerdá, María; Conchado Peiró, Andrea; Al-Zoubi, Asem; Harb, Bassam; Bany Salameh, Haythem

    2015-01-01

    This paper presents a curriculum design approach for a Masters Programme in Telecommunications Management based on demand data obtained from surveying the needs of potential students of the proposed programme. Through online surveys disseminated at telecom companies in Jordan, it was possible to measure the demand for such a programme and to…

  10. Effective Management of High-Use/High-Demand Space Using Restaurant-Style Pagers

    ERIC Educational Resources Information Center

    Gonzalez, Adriana

    2012-01-01

    The library landscape is changing at a fast pace, with an increase in the demand for study space including quiet, individualized study space; open group study space; and as enclosed group study space. In large academic libraries, managing limited high-demand resources is crucial and is partially being driven by the greater emphasis on group…

  11. Effective Management of High-Use/High-Demand Space Using Restaurant-Style Pagers

    ERIC Educational Resources Information Center

    Gonzalez, Adriana

    2012-01-01

    The library landscape is changing at a fast pace, with an increase in the demand for study space including quiet, individualized study space; open group study space; and as enclosed group study space. In large academic libraries, managing limited high-demand resources is crucial and is partially being driven by the greater emphasis on group…

  12. Data Science in Supply Chain Management: Data-Related Influences on Demand Planning

    ERIC Educational Resources Information Center

    Jin, Yao

    2013-01-01

    Data-driven decisions have become an important aspect of supply chain management. Demand planners are tasked with analyzing volumes of data that are being collected at a torrential pace from myriad sources in order to translate them into actionable business intelligence. In particular, demand volatilities and planning are vital for effective and…

  13. A Masters Programme in Telecommunications Management--Demand-Based Curriculum Design

    ERIC Educational Resources Information Center

    Gharaibeh, Khaled M.; Kaylani, Hazem; Murphy, Noel; Brennan, Conor; Itradat, Awni; Al-Bataineh, Mohammed; Aloqlah, Mohammed; Salhieh, Loay; Altarazi, Safwan; Rawashdeh, Nathir; del Carmen Bas Cerdá, María; Conchado Peiró, Andrea; Al-Zoubi, Asem; Harb, Bassam; Bany Salameh, Haythem

    2015-01-01

    This paper presents a curriculum design approach for a Masters Programme in Telecommunications Management based on demand data obtained from surveying the needs of potential students of the proposed programme. Through online surveys disseminated at telecom companies in Jordan, it was possible to measure the demand for such a programme and to…

  14. Simulation of demand-response power management in smart city

    NASA Astrophysics Data System (ADS)

    Kadam, Kshitija

    Smart Grids manage energy efficiently through intelligent monitoring and control of all the components connected to the electrical grid. Advanced digital technology, combined with sensors and power electronics, can greatly improve transmission line efficiency. This thesis proposed a model of a deregulated grid which supplied power to diverse set of consumers and allowed them to participate in decision making process through two-way communication. The deregulated market encourages competition at the generation and distribution levels through communication with the central system operator. A software platform was developed and executed to manage the communication, as well for energy management of the overall system. It also demonstrated self-healing property of the system in case a fault occurs, resulting in an outage. The system not only recovered from the fault but managed to do so in a short time with no/minimum human involvement.

  15. Greywater reuse: A strategy for water demand management in Harare?

    NASA Astrophysics Data System (ADS)

    Madungwe, Emaculate; Sakuringwa, Saniso

    Greywater is wastewater from baths, sinks and washing machines, accounting for about 60% of the outflow from homes. It contains little pathogens and 90% less nitrogen than toilet water, so does not require the same treatment process. With the increasing demand for freshwater, its use may reduce irrigation water needs, increasing its availability of freshwater for other primary uses. Agriculture is the main water consumer in Africa, which cannot be compromised due to its role in domestic food security and export supplies. The purpose of this paper is to demonstrate findings of the research done on benefits of greywater reuse in some countries, applicable to African countries. In Australia, greywater reuse has reduced freshwater demand, strain on wastewater treatment plants and energy consumption. Aquifer recharge has improved due to increased infiltration flows from greywater uses. In Lebanon, greywater is a valuable resource for encouraging plant growth from nutrients that may otherwise have been wasted. Palestine shares similar climate and water scarcity conditions with most arid sub-Saharan African countries, yet utilizes grey water in production of crops and citrus fruits. Thus use of grey water should be possible in African cities such as Harare, where nearly two thirds of the population rely on agriculture for livelihoods. The problem of blue green algae in sewerage ponds and water reservoirs is significantly reduced by household reuse of grey water in Mexico. Water savings are increased and expenses reduced, as illustrated by the reduction in consumption of municipality freshwater supplies in South African urban areas. Rural communities and schools in Namibia and Egypt have raised funds from grey water reuse in banana plantations. A possible constraint to this strategy could be the unavailability of appropriate technology for primary treatment of grey water before reuse. This strategy may pose health risks where water quality tests are unknown or unavailable

  16. Managing Demands on Counseling Services: The Colorado State University Experience.

    ERIC Educational Resources Information Center

    Dworkin, Daniel S.; Lyddon, William J.

    1991-01-01

    Describes the development of a time-limited and managed care treatment policy at the university counseling center at Colorado State University. It is offered as one agency's attempt to become more proactive in defining its responsibilities and limits regarding emerging challenges and changes on college campuses. (Author/LLL)

  17. Density management in the 21st century: west side story

    Treesearch

    Paul D. Anderson; Kathryn L. Ronnenberg

    2013-01-01

    Since adoption of the Northwest Forest Plan (NWFP) in the early 1990s, there has been a fundamental shift in forest management practices on federal lands in western Oregon and Washington. Commodity driven clearcut regeneration harvests have given way to thinnings intended to enhance development of late-successional forest habitats and to conserve important aquatic and...

  18. A new approach for the management of bladder injury in retropubic slings: one side transobturator/ one side retropubic sling.

    PubMed

    Aksakal, Orhan Seyfi; Cavkaytar, Sabri; Kokanalı, Mahmut Kuntay; Tasdemir, Umit; Topcu, Hasan Onur; Doganay, Melike

    2014-11-01

    The aim of this study was to establish a new management modality for bladder perforation during retropubic slings. In 2013, among 102 retropubic slings, there were five bladder injuries. All procedures were performed by one of the fourth year residents under direct supervision of experienced surgeons. Bladder perforation was detected in cystoscopic examination. In the bladder perforated side, tape was retracted and placed by transobturator approach and the Foley catheter remained in place for seven days. Demographic features, preoperative urodynamic examination, and preoperative and postoperative life quality questionnaires (IIQ-7 and UDI-6) were recorded. The mean age of the patients was 44 ± 2.5 years and body mass index was 29.4 ± 1.7 kg/ m2. Mean parity was 2.8 ± 1.8 and all the patients delivered with vaginal route. None of the patients were in menopause. Of the five bladder perforations, 40%(2) occurred on the right side, 60%(3) on the left side. All the surgeons were right handed. All patients underwent other vaginal reconstructive procedures like anterior colporraphy and posterior colporraphy. None of the patients had previous anti-incontinence surgery. Mean follow-up was 10.2 ± 2.4 months. All patients had negative stress tests and improvement in IIQ-7 and UDI-6 at postoperative sixth month. There was no postoperative voiding dysfunction in any of the patients. If bladder perforation occurs in patients who undergo retropubic sling, the tape can be placed by transobturator approach in the bladder perforated side.

  19. Combined side-to-end anastomosis with temporary end colostomy for the management of selected left-sided colonic emergencies.

    PubMed

    Safioleas, Michael; Stamatakos, Michael; Safioleas, Panayoitis; Safioleas, Konstantinos; Sakorafas, George H

    2011-04-01

    Management of surgical emergencies of the left colon commonly requires excision of the colonic segment bearing the lesion, creation of an end colostomy, and closure of the rectosigmoid stump. Closure of the end stoma may be technically challenging. During this study, we used a new surgical technique involving the creation of an end-to-side anastomosis of the rectosigmoid stump to the base of the proximal colonic segment in association with an end colostomy. During a 15-year period, 23 patients were offered this type of surgery. Mortality was zero. Complications were observed in seven patients (morbidity, 7/23). Mean hospitalization time was 12.3 days. Closure of the colostomy was performed approximately 1 month after initial surgery and was easily performed using a mechanical stapler, either intraperitoneally or even extraperitoneally. No complications were observed after closure of the colostomy. The described technique is a useful alternative for the management of selected patients with left-sided colonic surgical emergencies. Its main advantage is that it greatly facilitates colostomy closure, which is performed earlier compared with the colostomy closure after a typical Hartmann's procedure.

  20. [Antidepressant and tolerance: Determinants and management of major side effects].

    PubMed

    David, D J; Gourion, D

    2016-12-01

    Antidepressant therapy aims to reach remission of depressive symptoms while reducing the complications and risks of relapse. Even though they have proven their efficacy, it takes several weeks for antidepressants to demonstrate full effectiveness, and adverse effects occur more quickly or (quicker) which can be a source of poor compliance. This latest aspect often leads to dose reduction and/or change of molecule that have the effect of delaying remission. This review attempts to present, from the pharmacological properties of the major classes of antidepressants (monoamine oxidase inhibitor [MAOI], tricyclic antidepressants [TCA], selective serotonin reuptake inhibitor [SSRI] and serotonin and noradrenaline reuptake inhibitor [SNRI]), to the pharmacological mechanisms involved in adverse effects by focusing on sexual dysfunction, nausea/vomiting, and weight changes and sleep disruption. If the activation of dopamine D1/2 or norepinephrine receptors through the autonomic nervous system controls and facilitates sexual desire, increasing serotoninergic transmission through 5-HT1B/2A/2C receptors activation inhibits this process. The pharmacological properties of drugs inducing nausea/vomiting activate opiate receptors μ, increase dopaminergic and serotoninergic transmission activating the dopamine D2 and serotonin 5-HT3 receptors, respectively. Among the causes responsible for weight gain under antidepressant therapy, monoamine neurotransmission still plays an important role. The blockade of serotonin 5-HT2C or histamine H1 receptors is directly responsible for weight gain. Finally, the activation of 5-HT1A/1B/3/7 serotoninergique receptors modulates wakefulness, raid eyes movement or sleep duration. In conclusion, if antidepressant activity of SERT or MAO inhibitors is an indirect consequence of postsynaptic 5-HT, DA, NA receptor activation, it is also responsible for side effects, causes of poor compliance and hence therapeutic failures. Finally, we need to

  1. Grid Data Management and Customer Demands at MeteoSwiss

    NASA Astrophysics Data System (ADS)

    Rigo, G.; Lukasczyk, Ch.

    2010-09-01

    Data grids constitute the required input form for a variety of applications. Therefore, customers increasingly expect climate services to not only provide measured data, but also grids of these with the required configurations on an operational basis. Currently, MeteoSwiss is establishing a production chain for delivering data grids by subscription directly from the data warehouse in order to meet the demand for precipitation data grids by governmental, business and science customers. The MeteoSwiss data warehouse runs on an Oracle database linked with an ArcGIS Standard edition geodatabase. The grids are produced by Unix-based software written in R called GRIDMCH which extracts the station data from the data warehouse and stores the files in the file system. By scripts, the netcdf-v4 files are imported via an FME interface into the database. Currently daily and monthly deliveries of daily precipitation grids are available from MeteoSwiss with a spatial resolution of 2.2km x 2.2km. These daily delivered grids are a preliminary based on 100 measuring sites whilst the grid of the monthly delivery of daily sums is calculated out of about 430 stations. Crucial for the absorption by the customers is the understanding of and the trust into the new grid product. Clearly stating needs which can be covered by grid products, the customers require a certain lead time to develop applications making use of the particular grid. Therefore, early contacts and a continuous attendance as well as flexibility in adjusting the production process to fulfill emerging customer needs are important during the introduction period. Gridding over complex terrain can lead to temporally elevated uncertainties in certain areas depending on the weather situation and coverage of measurements. Therefore, careful instructions on the quality and use and the possibility to communicate the uncertainties of gridded data proofed to be essential especially to the business and science customers who require

  2. School and nursing service managers' ability to hold their own amidst daily demands.

    PubMed

    Myburgh, C P; Niehaus, L; Poggenpoel, M

    1999-09-01

    Improving quality of life itself subsumes the experience, maintenance, and continuous enhancement of physical and psychological health. It is therefore important for the physical and psychological health of school and nursing service managers that they are able to hold their own successfully, both personally and professionally. Bearing this in mind, the question of the extent to which school and nursing service managers succeed in holding their own (coping) successfully remains. Does their profession (field of work) influence school and nursing service managers' personal beliefs, perceptions of their coping ability amidst daily demands and their use of different types of coping strategies. The purpose of this research project was to address these issues. An empirical investigation was undertaken with reference to a theoretical framework to assess school and nursing service managers' personal beliefs, perceptions of their coping ability amidst daily demands and the coping strategies they use. Consecutive factor analytical procedures, item analyses, Hotelling T2-tests and Student t-tests were conducted on the data. The results of the analyses indicated, inter alia, that nursing service managers and, especially school managers, do not quite perceive themselves capable enough to cope with interpersonal demands. School managers find it significantly more difficult than nursing service managers to cope with demands arising from professional and personal relationships.

  3. Managing capacity and demand across the patient journey.

    PubMed

    Allder, Steven; Silvester, Kate; Walley, Paul

    2010-02-01

    Bed availability remains the main operational focus for managers and clinicians on a day-to-day basis within the NHS. There is now published research that establishes a lack of bed stock is too simplistic an explanation of the situation. Other reasons for bed shortage include the daily and weekly lack of synchronisation of admissions and discharges, the large variation in bed occupancy over time, the downtime during weekends and holiday periods, wasted time during inpatient stays and the variation in patient length of stay. So far most of what little work has been done has focused on the front end of the process, to 'buffer' unplanned admissions through the use of short-stay facilities, such as medical assessment units, as a short-term solution. This paper reviews the evidence for the hypothesis that bed availability problems can be solved by actions other than the addition of more beds to the system.

  4. Influence of field size on the physiological and skill demands of small-sided games in junior and senior rugby league players.

    PubMed

    Gabbett, Tim J; Abernethy, Bruce; Jenkins, David G

    2012-02-01

    The purpose of this study was to investigate the effect of changes in field size on the physiological and skill demands of small-sided games in elite junior and senior rugby league players. Sixteen elite senior rugby league players ([mean ± SE] age, 23.6 ± 0.5 years) and 16 elite junior rugby league players ([mean ± SE] age, 17.3 ± 0.3 years) participated in this study. On day 1, 2 teams played an 8-minute small-sided game on a small field (10-m width × 40-m length), whereas the remaining 2 teams played the small-sided game on a larger sized field (40-m width × 70-m length). On day 2, the groups were crossed over. Movement was recorded by a global positioning system unit sampling at 5 Hz. Games were filmed to count the number of possessions and the number and quality of disposals. The games played on a larger field resulted in a greater (p < 0.05) total distance covered, and distances covered in moderate, high, and very-high velocity movement intensities. Senior players covered more distance at moderate, high, and very-high intensities, and less distance at low and very-low intensities during small-sided games than junior players. Although increasing field size had no significant influence (p > 0.05) over the duration of recovery periods for junior players, larger field size significantly reduced (p < 0.05) the amount of short-, moderate-, and long-duration recovery periods in senior players. No significant between-group differences (p > 0.05) were detected for games played on a small or large field for the number or quality of skill involvements. These results suggest that increases in field size serve to increase the physiological demands of small-sided games but have minimal influence over the volume or quality of skill executions in elite rugby league players.

  5. Effects of demand-side financing on utilisation, experiences and outcomes of maternity care in low- and middle-income countries: a systematic review.

    PubMed

    Murray, Susan F; Hunter, Benjamin M; Bisht, Ramila; Ensor, Tim; Bick, Debra

    2014-01-17

    Demand-side financing, where funds for specific services are channelled through, or to, prospective users, is now employed in health and education sectors in many low- and middle-income countries. This systematic review aimed to critically examine the evidence on application of this approach to promote maternal health in these settings. Five modes were considered: unconditional cash transfers, conditional cash transfers, short-term payments to offset costs of accessing maternity services, vouchers for maternity services, and vouchers for merit goods. We sought to assess the effects of these interventions on utilisation of maternity services and on maternal health outcomes and infant health, the situation of underprivileged women and the healthcare system. The protocol aimed for collection and synthesis of a broad range of evidence from quantitative, qualitative and economic studies. Nineteen health and social policy databases, seven unpublished research databases and 27 websites were searched; with additional searches of Indian journals and websites. Studies were included if they examined demand-side financing interventions to increase consumption of services or goods intended to impact on maternal health, and met relevant quality criteria. Quality assessment, data extraction and analysis used Joanna Briggs Institute standardised tools and software. Outcomes of interest included maternal and infant mortality and morbidity, service utilisation, factors required for successful implementation, recipient and provider experiences, ethical issues, and cost-effectiveness. Findings on Effectiveness, Feasibility, Appropriateness and Meaningfulness were presented by narrative synthesis. Thirty-three quantitative studies, 46 qualitative studies, and four economic studies from 17 countries met the inclusion criteria. Evidence on unconditional cash transfers was scanty. Other demand-side financing modes were found to increase utilisation of maternal healthcare in the index

  6. Effects of demand-side financing on utilisation, experiences and outcomes of maternity care in low- and middle-income countries: a systematic review

    PubMed Central

    2014-01-01

    Background Demand-side financing, where funds for specific services are channelled through, or to, prospective users, is now employed in health and education sectors in many low- and middle-income countries. This systematic review aimed to critically examine the evidence on application of this approach to promote maternal health in these settings. Five modes were considered: unconditional cash transfers, conditional cash transfers, short-term payments to offset costs of accessing maternity services, vouchers for maternity services, and vouchers for merit goods. We sought to assess the effects of these interventions on utilisation of maternity services and on maternal health outcomes and infant health, the situation of underprivileged women and the healthcare system. Methods The protocol aimed for collection and synthesis of a broad range of evidence from quantitative, qualitative and economic studies. Nineteen health and social policy databases, seven unpublished research databases and 27 websites were searched; with additional searches of Indian journals and websites. Studies were included if they examined demand-side financing interventions to increase consumption of services or goods intended to impact on maternal health, and met relevant quality criteria. Quality assessment, data extraction and analysis used Joanna Briggs Institute standardised tools and software. Outcomes of interest included maternal and infant mortality and morbidity, service utilisation, factors required for successful implementation, recipient and provider experiences, ethical issues, and cost-effectiveness. Findings on Effectiveness, Feasibility, Appropriateness and Meaningfulness were presented by narrative synthesis. Results Thirty-three quantitative studies, 46 qualitative studies, and four economic studies from 17 countries met the inclusion criteria. Evidence on unconditional cash transfers was scanty. Other demand-side financing modes were found to increase utilisation of maternal

  7. Influence of the Type of Marking and the Number of Players on Physiological and Physical Demands During Sided Games in Soccer

    PubMed Central

    Casamichana, David; Román-Quintana, Jaime San; Castellano, Julen; Calleja-González, Julio

    2015-01-01

    The aim of this research was to examine the influence of two variables, the type of marking (with or without man-marking) and the number of players per team (3, 6, or 9) on the physical and physiological demands of sided games in soccer. Eighteen amateur players were monitored with GPS and heart rate devices. The following variables were analyzed: a maximum heart rate, a mean heart rate, time spent in each intensity range, total distance covered and distance covered in different speed ranges, a player load, maximum speed reached, and a work:rest ratio. The results showed that the type of marking influenced the physical demands of players, with greater total distance, a player load and a work:rest ratio when man-marking was used in the 3 vs. 3 (737 m, 95 Arbitrary Units (AU) and 3.4 AU, respectively) and 6 vs. 6 (783 m, 95 AU and 5.3 AU, respectively) games (p<0.05). The number of players also had an effect on physiological intensity, with more time being spent at the <80%HRmax during the 9 vs. 9 and 6 vs. 6 games (more than 30%) compared with the 3 vs. 3 format (less than 15%) (p<0.05). These findings could help coaches to understand how the modification of different variables in sided games influences the physical and physiological demands of players. PMID:26557209

  8. Immune checkpoint inhibitors renal side effects and management.

    PubMed

    Rassy, Elie El; Kourie, Hampig R; Rizkallah, Jamale; Karak, Fadi El; Hanna, Colette; Chelala, Dania N; Ghosn, Marwan

    2016-12-01

    The choice of immunotherapy in the treatment of cancer has improved the prognosis of many patients affected by various malignancies. The high expectations foreseen with immunotherapy have led to fast approvals despite the incomplete understanding of the toxicity profiles in the different organs, including the kidneys. The high prevalence of chronic kidney disease in cancer patients complicates the issue further and requires a better knowledge of the renal safety profile to ensure an optimal safe treatment. This review summarizes the present knowledge of renal adverse events secondary to immune checkpoint inhibitors and discusses their pathophysiology, clinical presentation and adequate management. We also advocate the need for a multidisciplinary approach in patients with immune-related toxic adverse events.

  9. Damage to the dorsomedial thalamic nucleus, central lateral intralaminar thalamic nucleus, and midline thalamic nuclei on the right-side impair executive function and attention under conditions of high demand but not low demand.

    PubMed

    Edelstyn, N M J; Mayes, A R; Ellis, S J

    2014-04-01

    This study reports a patient, OG, with a unilateral right-sided thalamic lesion. High resolution 3T magnetic resonance imaging revealed damage to the parvicellular and magnocellular subdivisions of the dorsomedial thalamus (DMT), the central lateral intralaminar nucleus (also known as the paralamellar DMT), the paraventricular and the central medial midline thalamic nuclei. According to the neuropsychological literature, the DMT, the midline and intralaminar thalamic nuclei influence a wide array of cognitive functions by virtue of their modulatory influences on executive function and attention, and this is particularly indicated under conditions of low arousal or high cognitive demand. We explored this prediction in OG, and compared his performance on a range of low and high demand versions of tests that tapped executive function and attention to a group of 6 age- and IQ-matched controls. OG, without exception, significantly under performed on the high-demand attention and executive function tasks, but performed normally on the low-demand versions. These findings extend and refine current understanding of the effects of thalamic lesion on attention and executive function.

  10. Handbook of evaluation of utility DSM programs. [Demand-Side Management (DSM)

    SciTech Connect

    Hirst, E.; Reed, J.; Bronfman, B.; Fitzpatrick, G.; Hicks, E.; Hirst, E.; Hoffman, M.; Keating, K.; Michaels, H.; Nadel, S.; Peters, J.; Reed, J.; Saxonis, W.; Schoen, A.; Violette, D.

    1991-12-01

    Program evaluation has become a central issue in the world of utility integrated resource planning. The DSM programs that utilities were operating to meet federal requirements or to improve customer relations are now becoming big business. DSM is being considered an important resource in a utility's portfolio of options. In the last five years, the amount of money that utilities have invested in DSM has grown exponentially in most regulatory jurisdictions. Market analysts are now talking about DSM being a $30 billion industry by the end of the decade. If the large volume of DSM-program investments was not enough to highlight the importance of evaluation, then the introduction of regulatory incentives has really focused the spotlight. This handbook was developed through a process that involved many of those people who represent the diverse constituencies of DSM-program evaluation. We have come to recognize the many technical disciplines that must be employed to evaluate DSM programs. An analysis might start out based on the principles of utility load research to find out what happened, but a combination of engineering and statistical methods must be used to triangulate'' an estimate of what would have happened without the program. The difference, of course, is that elusive but prized result of evaluation: what happened as the direct result of the DSM program. Technical performance of DSM measures is not the sole determinant of the answer, either. We also recognize the importance of such behavioral attributes of DSM as persistence and free ridership. Finally, DSM evaluation is meaningless without attention to planning an approach, communicating results to relevant decision-makers, and focusing as much on the process as the impacts of the program. These topics are all covered in this handbook.

  11. DSM/Federal Energy Efficiency Partnership Program at Fort Lewis, Washington. [Demand Side Management (DSM)

    SciTech Connect

    Parker, G.B.; Secrest, T.J. ); Flood, N. ); Gillespie, A. )

    1992-06-01

    The Energy Systems Modernization Office at Pacific Northwest Laboratory is developing and applying the Federal Energy Decision Screening (FEDS) system for federal installations in cooperation with the servicing utility(s). In the process, we conduct an installation-wide, fuel-blind energy-efficiency resource assessment, identify the most life-cycle cost-effective technologies, work with the servicing utility to develop a program to implement energy conservation projects and technologies, evaluate rates and rate structures, and contribute to the design and implementation of an energy savings verification procedure to evaluate the impact of installed technologies. Fort Lewis was identified as a site for a pilot program which would result in a model approach to apply to other federal installations. Fort Lewis, a large (population 35,000) military installation in Tacoma, Washington, purchases electricity through Tacoma Public Utilities (TPU). TPU in turn purchases electricity through the Bonneville Power Administration. Fort Lewis has an annual electric load of about 195,000 megawatt-hours (MWh)([approximately]40 MW). An energy conservation supply curve for the Fort was developed showing the amount of electric energy savings that can be achieved at different prices for energy saved. From these data, a proposal was prepared for acquiring approximately 43,000 kilowatt-hours of annual cost-effective electric energy savings. This proposal identified investment requirements at the Fort and the likely energy and dollar savings which will result from the investment. Approximately $10 million of investment in electrical energy efficient end-use technology was estimated to be cost-effective at Fort Lewis under this arrangement. The result is that Fort Lewis will see a reduction in its electric bill of approximately $500,000/year.

  12. Demand-side management implementation and verification at Fort Drum, New York

    SciTech Connect

    Armstrong, P.R.; Dixon, D.R.; Richman, E.E.; Rowley, S.E.

    1994-12-01

    Through the Facility Energy Decision Screening (FEDS) process, the US Army Forces Command (FORSCOM) has identified present value savings of nearly $47 million in cost-effective energy conservation measures (ECMs) at Fort Drum, New York. With associated costs of more than $16 million (1992 $), the measures provide a net present value of $30.6 million for all identified projects. By implementing all cost-effective ECMs, Fort Drum can reduce its annual energy use by more than 230,000 MBtu (11% of its fossil energy consumption) and more than 27,000 MWh (32% of its electric energy consumption). The annual cost of energy services will decrease by $2.8 million (20%) at current energy rates. The servicing utility (Niagara Mohawk Power Corporation) has informally agreed to finance and implement cost-effective ECMs and to participate in the verification of energy savings. Verification baselining is under way; implementation of retrofit projects is expected to begin in late 1994. The utility-administered financing and contracting arrangements and the alternative federal programs for implementing the projects are described. The verification protocols and sampling plans for audit, indirect, and direct measurement levels of verification and the responsibilities of Fort Drum, the utility, the energy service companies (ESCOs), and Pacific Northwest Laboratory (PNL) in the verification process are also presented. A preliminary weather-normalized model of baseline energy consumption has been developed based on a full year`s metered data.

  13. SINGLEFAMILY MANAGERS' HOUSES ON EAST SIDE OF 2ND STREET, LOOKING ...

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

    SINGLE-FAMILY MANAGERS' HOUSES ON EAST SIDE OF 2ND STREET, LOOKING NORTH; THE MINE SUPERINTENDENT, ASSISTANT SUPERINTENDENT AND OTHER HIGH-RANKING MANAGERS LIVED IN THESE HOUSES WHICH ARE ALSO CONSTRUCTED OF CONCRETE - Town of Cairnbrook, Cairnbrook, Somerset County, PA

  14. Quantifying the "Softer Side" of Management Education: An Example Using Teamwork Competencies

    ERIC Educational Resources Information Center

    Halfhill, Terry R.; Nielsen, Tjai M.

    2007-01-01

    During the past 5 years, we have reexamined what we teach in management education, placing a much stronger emphasis on interpersonal skills than in the past. We must now reexamine how we teach these skills and demonstrate their value quantitatively. This article presents one method of quantifying the "softer side" of management education. It…

  15. Demand management: another marketing tool or a way to quality care?

    PubMed

    Mohler, M J; Harris, J M

    1998-05-01

    Demand management tools are population-based strategies used to control costs and improve utilization of services by assisting health consumers in maintaining their health and seeking appropriate health care. These tools are increasingly used by health care delivery systems and, in the US, by fiscal intermediaries, such as insurance companies. If these tools are not properly applied, there is a clear possibility that their use may lead a reduction of health care services with no improvement in clinical, humanistic, or economic outcomes. Demand management effectiveness has not been rigorously examined by the medical industry or academia. Before adopting or purchasing demand management technologies, health care systems should examine them carefully to determine how the tools were developed and who they were intended to serve. Once implemented, careful tracking of population outcomes is as necessary with these technologies as with any other technologies that can affect health care.

  16. Coupling Agent-Based and Groundwater Modeling to Explore Demand Management Strategies for Shared Resources

    NASA Astrophysics Data System (ADS)

    Al-Amin, S.

    2015-12-01

    Municipal water demands in growing population centers in the arid southwest US are typically met through increased groundwater withdrawals. Hydro-climatic uncertainties attributed to climate change and land use conversions may also alter demands and impact the replenishment of groundwater supply. Groundwater aquifers are not necessarily confined within municipal and management boundaries, and multiple diverse agencies may manage a shared resource in a decentralized approach, based on individual concerns and resources. The interactions among water managers, consumers, and the environment influence the performance of local management strategies and regional groundwater resources. This research couples an agent-based modeling (ABM) framework and a groundwater model to analyze the effects of different management approaches on shared groundwater resources. The ABM captures the dynamic interactions between household-level consumers and policy makers to simulate water demands under climate change and population growth uncertainties. The groundwater model is used to analyze the relative effects of management approaches on reducing demands and replenishing groundwater resources. The framework is applied for municipalities located in the Verde River Basin, Arizona that withdraw groundwater from the Verde Formation-Basin Fill-Carbonate aquifer system. Insights gained through this simulation study can be used to guide groundwater policy-making under changing hydro-climatic scenarios for a long-term planning horizon.

  17. Analytical optimization of demand management strategies across all urban water use sectors

    NASA Astrophysics Data System (ADS)

    Friedman, Kenneth; Heaney, James P.; Morales, Miguel; Palenchar, John

    2014-07-01

    An effective urban water demand management program can greatly influence both peak and average demand and therefore long-term water supply and infrastructure planning. Although a theoretical framework for evaluating residential indoor demand management has been well established, little has been done to evaluate other water use sectors such as residential irrigation in a compatible manner for integrating these results into an overall solution. This paper presents a systematic procedure to evaluate the optimal blend of single family residential irrigation demand management strategies to achieve a specified goal based on performance functions derived from parcel level tax assessor's data linked to customer level monthly water billing data. This framework is then generalized to apply to any urban water sector, as exponential functions can be fit to all resulting cumulative water savings functions. Two alternative formulations are presented: maximize net benefits, or minimize total costs subject to satisfying a target water savings. Explicit analytical solutions are presented for both formulations based on appropriate exponential best fits of performance functions. A direct result of this solution is the dual variable which represents the marginal cost of water saved at a specified target water savings goal. A case study of 16,303 single family irrigators in Gainesville Regional Utilities utilizing high quality tax assessor and monthly billing data along with parcel level GIS data provide an illustrative example of these techniques. Spatial clustering of targeted homes can be easily performed in GIS to identify priority demand management areas.

  18. Discriminating between west-side sources of nutrients and organiccarbon contributing to algal growth and oxygen demand in the San JoaquinRiver

    SciTech Connect

    Wstringfellow@lbl.gov

    2002-07-24

    The purpose of this study was to investigate the Salt and Mud Slough tributaries as sources of oxygen demanding materials entering the San Joaquin River (SJR). Mud Slough and Salt Slough are the main drainage arteries of the Grasslands Watershed, a 370,000-acre area west of the SJR, covering portions of Merced and Fresno Counties. Although these tributaries of the SJR are typically classified as agricultural, they are also heavily influenced by Federal, State and private wetlands. The majority of the surface water used for both irrigation and wetland management in the Grassland Watershed is imported from the Sacramento-San Joaquin Delta through the Delta-Mendota Canal. In this study, they measured algal biomass (as chlorophyll a), organic carbon, ammonia, biochemical oxygen demand (BOD), and other measures of water quality in drainage from both agricultural and wetland sources at key points in the Salt Slough and Mud Slough tributaries. This report includes the data collected between June 16th and October 4th, 2001. The objective of the study was to compare agricultural and wetland drainage in the Grasslands Watershed and to determine the relative importance of each return flow source to the concentration and mass loading of oxygen demanding materials entering the SJR. Additionally, they compared the quality of water exiting our study area to water entering our study area. This study has demonstrated that Salt and Mud Sloughs both contribute significant amounts of oxygen demand to the SJR. Together, these tributaries could account for 35% of the oxygen demand observed below their confluence with the SJR. This study has characterized the sources of oxygen demanding materials entering Mud Slough and evaluated the oxygen demand conditions in Salt Slough. Salt Slough was found to be the dominant source of oxygen demand load in the study area, because of the higher flows in this tributary. The origins of oxygen demand in Salt Slough still remain largely uninvestigated

  19. Mobile Phone Based System Opportunities to Home-based Managing of Chemotherapy Side Effects

    PubMed Central

    Davoodi, Somayeh; Mohammadzadeh, Zeinab; Safdari, Reza

    2016-01-01

    Objective: Applying mobile base systems in cancer care especially in chemotherapy management have remarkable growing in recent decades. Because chemotherapy side effects have significant influences on patient’s lives, therefore it is necessary to take ways to control them. This research has studied some experiences of using mobile phone based systems to home-based monitor of chemotherapy side effects in cancer. Methods: In this literature review study, search was conducted with keywords like cancer, chemotherapy, mobile phone, information technology, side effects and self managing, in Science Direct, Google Scholar and Pub Med databases since 2005. Results: Today, because of the growing trend of the cancer, we need methods and innovations such as information technology to manage and control it. Mobile phone based systems are the solutions that help to provide quick access to monitor chemotherapy side effects for cancer patients at home. Investigated studies demonstrate that using of mobile phones in chemotherapy management have positive results and led to patients and clinicians satisfactions. Conclusion: This study shows that the mobile phone system for home-based monitoring chemotherapy side effects works well. In result, knowledge of cancer self-management and the rate of patient’s effective participation in care process improved. PMID:27482134

  20. Mobile Phone Based System Opportunities to Home-based Managing of Chemotherapy Side Effects.

    PubMed

    Davoodi, Somayeh; Mohammadzadeh, Zeinab; Safdari, Reza

    2016-06-01

    Applying mobile base systems in cancer care especially in chemotherapy management have remarkable growing in recent decades. Because chemotherapy side effects have significant influences on patient's lives, therefore it is necessary to take ways to control them. This research has studied some experiences of using mobile phone based systems to home-based monitor of chemotherapy side effects in cancer. In this literature review study, search was conducted with keywords like cancer, chemotherapy, mobile phone, information technology, side effects and self managing, in Science Direct, Google Scholar and Pub Med databases since 2005. Today, because of the growing trend of the cancer, we need methods and innovations such as information technology to manage and control it. Mobile phone based systems are the solutions that help to provide quick access to monitor chemotherapy side effects for cancer patients at home. Investigated studies demonstrate that using of mobile phones in chemotherapy management have positive results and led to patients and clinicians satisfactions. This study shows that the mobile phone system for home-based monitoring chemotherapy side effects works well. In result, knowledge of cancer self-management and the rate of patient's effective participation in care process improved.

  1. [Perioperative patient management. Evaluation of subjective stress and demands of patients undergoing elective gynaecological surgery].

    PubMed

    Gauter-Fleckenstein, B; Kaviani, R; Weiss, C; Burges, A; Korell, M; Anthuber, C; Hermann, H-D; Weninger, E; Kreimeier, U

    2007-06-01

    The aim of this investigation was to assess the extent of stress and demands in patients during preparation for general anesthesia for elective surgical procedures. A total of 52 female patients scheduled for elective gynecological surgery under general anesthesia were included in this prospective study. The extent and time course of actual demands describing perceived emotional stress was assessed at close intervals using the German version of the Questionnaire for Actual Demands (KAB). Pre-operative and postoperative anxiety was assessed using part one of Spielberger's state-trait-anxiety inventory (STAI-X1). This was compared to hemodynamic (heart rate und blood pressure) and endocrinal stress parameters [cortisol concentration in serum and saliva, prolactin and dehydroepiandrosteronesulfate (DHEA-S) in serum]. Postoperatively, all patients were asked to rate the quality of care during preparation for general anesthesia. The extent of patients' demands and stress during preparation for general anesthesia could be quantified by the short questionnaire for the actual demands (KAB). So-called objective stress parameters like hemodynamic and endocrinal data alone did not correlate with perceived stress. However, the subjective information correlated with the nature of the underlying diagnosis. The postoperative assessment of quality of care during preparation for general anesthesia did not correlate with the course of actual demands and stress. In future studies assessing the perioperative management of patients and quality of care, standardized testing questionnaires should be preferred, instead of vegetative parameters alone, to reliably evaluate perioperative demands and stress in surgical patients.

  2. Treatment strategy: Role of enfuvirtide in managing treatment-limiting side effects

    PubMed Central

    Tsoukas, Christos

    2007-01-01

    Side effects can limit the options available to physicians for the treatment of HIV infection. Management of these side effects is essential, to avoid cessation of treatment. The entry inhibitor enfuvirtide can be useful as one of three active agents in an HIV treatment regimen as a way to both reduce treatment-limiting side effects and provide an efficacious agent for viral control. In the present case, the patient had a problematic and lengthy treatment history, with numerous concomitant conditions. His latest regimen, which includes an agent in a new drug class (enfuvirtide), has maintained HIV suppression while minimizing toxicity. PMID:23365593

  3. Treatment strategy: Role of enfuvirtide in managing treatment-limiting side effects.

    PubMed

    Tsoukas, Christos

    2007-01-01

    Side effects can limit the options available to physicians for the treatment of HIV infection. Management of these side effects is essential, to avoid cessation of treatment. The entry inhibitor enfuvirtide can be useful as one of three active agents in an HIV treatment regimen as a way to both reduce treatment-limiting side effects and provide an efficacious agent for viral control. In the present case, the patient had a problematic and lengthy treatment history, with numerous concomitant conditions. His latest regimen, which includes an agent in a new drug class (enfuvirtide), has maintained HIV suppression while minimizing toxicity.

  4. NY TBO Research: Integrated Demand Management (IDM): IDM Concept, Tools, and Training Package

    NASA Technical Reports Server (NTRS)

    Smith, Nancy

    2016-01-01

    A series of human-in-the-loop simulation sessions were conducted in the Airspace Operations Laboratory (AOL) to evaluate a new traffic management concept called Integrated Demand Management (IDM). The simulation explored how to address chronic equity, throughput and delay issues associated with New Yorks high-volume airports by operationally integrating three current and NextGen capabilities the Collaborative Trajectory Options Program (CTOP), Time-Based Flow Management (TBFM) and Required Time of Arrival (RTA) in order to better manage traffic demand within the National Air Traffic System. A package of presentation slides was developed to describe the concept, tools, and training materials used in the simulation sessions. The package will be used to outbrief our stakeholders by both presenting orally and disseminating of the materials via email.

  5. Optimal management of water resources demand and supply in irrigated agriculture from plot to regional scale

    NASA Astrophysics Data System (ADS)

    Schütze, Niels; Wagner, Michael

    2016-04-01

    Growing water scarcity in agriculture is an increasing problem in future in many regions of the world. For assessing irrigation as a measure to increase agricultural water security a generalized stochastic optimization framework for a spatial distributed estimation of future irrigation water demand is proposed, which ensures safe yields and a high water productivity at the same time. Different open loop and closed loop control strategies are evaluated within this stochastic optimization framework in order to generate reliable stochastic crop water production functions (SCWPF). The resulting database of SCWPF can serve as a central decision support tool for both, (i) a cost benefit analysis of farm irrigation modernization on a local scale and (ii) a regional water demand management using a multi-scale approach for modeling and implementation. The new approach is applied using the example of a case study in Saxony, which is dealing with the sustainable management of future irrigation water demands and its implementation.

  6. Self-Selection as a Tool for Managing the Demands on Department of Defense (DOD) Personnel

    DTIC Science & Technology

    2010-11-01

    management structure, including planning and demand forecasting, and discipline, that is available to billets filled through normal force management...Improved theater planning , forecasting, and communications are needed to enable supplying institutions to fill needs with self-selectees. In...particular, CENTCOM is filling 24,000 billets through requests for individuals who are neither in doctrinal units, nor planned or programmed for by the

  7. Ultimate biochemical oxygen demand in semi-intensively managed shrimp pond waters

    USDA-ARS?s Scientific Manuscript database

    Three independent studies were conducted to quantified ultimate biochemical oxygen demand (UBOD) and the corresponding decomposition rate constant for production pond (average 21.5 ha each) waters and effluents on six semi-intensively managed marine shrimp (Litopenaeus vannamei) farms in Honduras. S...

  8. Water demand and supply co-adaptation to mitigate climate change impacts in agricultural water management

    NASA Astrophysics Data System (ADS)

    Giuliani, Matteo; Mainardi, Matteo; Castelletti, Andrea; Gandolfi, Claudio

    2013-04-01

    Agriculture is the main land use in the world and represents also the sector characterised by the highest water demand. To meet projected growth in human population and per-capita food demand, agricultural production will have to significantly increase in the next decades. Moreover, water availability is nowadays a limiting factor for agricultural production, and is expected to decrease over the next century due to climate change impacts. To effectively face a changing climate, agricultural systems have therefore to adapt their strategies (e.g., changing crops, shifting sowing and harvesting dates, adopting high efficiency irrigation techniques). Yet, farmer adaptation is only one part of the equation because changes in water supply management strategies, as a response to climate change, might impact on farmers' decisions as well. Despite the strong connections between water demand and supply, being the former dependent on agricultural practices, which are affected by the water available that depends on the water supply strategies designed according to a forecasted demand, an analysis of their reciprocal feedbacks is still missing. Most of the recent studies has indeed considered the two problems separately, either analysing the impact of climate change on farmers' decisions for a given water supply scenario or optimising water supply for different water demand scenarios. In this work, we explicitly connect the two systems (demand and supply) by activating an information loop between farmers and water managers, to integrate the two problems and study the co-evolution and co-adaptation of water demand and water supply systems under climate change. The proposed approach is tested on a real-world case study, namely the Lake Como serving the Muzza-Bassa Lodigiana irrigation district (Italy). In particular, given an expectation of water availability, the farmers are able to solve a yearly planning problem to decide the most profitable crop to plant. Knowing the farmers

  9. Multiple policies to enhance prescribing efficiency for established medicines in Europe with a particular focus on demand-side measures: findings and future implications

    PubMed Central

    Godman, Brian; Wettermark, Bjorn; van Woerkom, Menno; Fraeyman, Jessica; Alvarez-Madrazo, Samantha; Berg, Christian; Bishop, Iain; Bucsics, Anna; Campbell, Stephen; Finlayson, Alexander E.; Fürst, Jurij; Garuoliene, Kristina; Herholz, Harald; Kalaba, Marija; Laius, Ott; Piessnegger, Jutta; Sermet, Catherine; Schwabe, Ulrich; Vlahović-Palčevski, Vera V.; Markovic-Pekovic, Vanda; Vončina, Luka; Malinowska, Kamila; Zara, Corinne; Gustafsson, Lars L.

    2014-01-01

    Introduction: The appreciable growth in pharmaceutical expenditure has resulted in multiple initiatives across Europe to lower generic prices and enhance their utilization. However, considerable variation in their use and prices. Objective: Assess the influence of multiple supply and demand-side initiatives across Europe for established medicines to enhance prescribing efficiency before a decision to prescribe a particular medicine. Subsequently utilize the findings to suggest potential future initiatives that countries could consider. Method: An analysis of different methodologies involving cross national and single country retrospective observational studies on reimbursed use and expenditure of PPIs, statins, and renin-angiotensin inhibitor drugs among European countries. Results: Nature and intensity of the various initiatives appreciably influenced prescribing behavior and expenditure, e.g., multiple measures resulted in reimbursed expenditure for PPIs in Scotland in 2010 56% below 2001 levels despite a 3-fold increase in utilization and in the Netherlands, PPI expenditure fell by 58% in 2010 vs. 2000 despite a 3-fold increase in utilization. A similar picture was seen with prescribing restrictions, i.e., (i) more aggressive follow-up of prescribing restrictions for patented statins and ARBs resulted in a greater reduction in the utilization of patented statins in Austria vs. Norway and lower utilization of patented ARBs vs. generic ACEIs in Croatia than Austria. However, limited impact of restrictions on esomeprazole in Norway with the first prescription or recommendation in hospital where restrictions do not apply. Similar findings when generic losartan became available in Western Europe. Conclusions: Multiple demand-side measures are needed to influence prescribing patterns. When combined with supply-side measures, activities can realize appreciable savings. Health authorities cannot rely on a “spill over” effect between classes to affect changes in

  10. Gold and Silver Health Plans: Accommodating Demand Heterogeneity in Managed Competition

    PubMed Central

    Glazer, Jacob; McGuire, Thomas G.

    2011-01-01

    New regulation of health insurance markets creates multiple levels of health plans, with designations like “Gold” and “Silver”. The underlying rationale for the heavy-metal approach to insurance regulation is that heterogeneity in demand for health care is not only due to health status (sick demand more than the healthy) but also to other, “taste” related factors (rich demand more than the poor). This paper models managed competition with demand heterogeneity to consider plan payment and enrollee premium policies in relation to efficiency (net consumer benefit) and fairness (the European concept of “solidarity”). Specifically, this paper studies how to implement a “Silver” and “Gold” health plan efficiently and fairly in a managed competition context. We show that there are sharp tradeoffs between efficiency and fairness. When health plans cannot or may not (because of regulation) base premiums on any factors affecting demand, enrollees do not choose the efficient plan. When taste (e.g. income) can be used as a basis of payment, a simple tax can achieve both efficiency and fairness. When only health status (and not taste) can be used as a basis of payment, health status-based taxes and subsidies are required and efficiency can only be achieved with a modified version of fairness we refer to as “weak solidarity.” An overriding conclusion is that the regulation of premiums for both the basic and the higher level plans is necessary for efficiency. PMID:21767887

  11. Gold and silver health plans: accommodating demand heterogeneity in managed competition.

    PubMed

    Glazer, Jacob; McGuire, Thomas G

    2011-09-01

    New regulation of health insurance markets creates multiple levels of health plans, with designations like "Gold" and "Silver." The underlying rationale for the heavy-metal approach to insurance regulation is that heterogeneity in demand for health care is not only due to health status (sick demand more than the healthy) but also to other, "taste" related factors (rich demand more than the poor). This paper models managed competition with demand heterogeneity to consider plan payment and enrollee premium policies in relation to efficiency (net consumer benefit) and fairness (the European concept of "solidarity"). Specifically, this paper studies how to implement a "Silver" and "Gold" health plan efficiently and fairly in a managed competition context. We show that there are sharp tradeoffs between efficiency and fairness. When health plans cannot or may not (because of regulation) base premiums on any factors affecting demand, enrollees do not choose the efficient plan. When taste (e.g., income) can be used as a basis of payment, a simple tax can achieve both efficiency and fairness. When only health status (and not taste) can be used as a basis of payment, health status-based taxes and subsidies are required and efficiency can only be achieved with a modified version of fairness we refer to as "weak solidarity." An overriding conclusion is that the regulation of premiums for both the basic and the higher level plans is necessary for efficiency.

  12. Using demand analysis and system status management for predicting ED attendances and rostering.

    PubMed

    Ong, Marcus Eng Hock; Ho, Khoy Kheng; Tan, Tiong Peng; Koh, Seoh Kwee; Almuthar, Zain; Overton, Jerry; Lim, Swee Han

    2009-01-01

    It has been observed that emergency department (ED) attendances are not random events but rather have definite time patterns and trends that can be observed historically. To describe the time demand patterns at the ED and apply systems status management to tailor ED manpower demand. Observational study of all patients presenting to the ED at the Singapore General Hospital during a 3-year period was conducted. We also conducted a time series analysis to determine time norms regarding physician activity for various severities of patients. The yearly ED attendances increased from 113387 (2004) to 120764 (2005) and to 125773 (2006). There was a progressive increase in severity of cases, with priority 1 (most severe) increasing from 6.7% (2004) to 9.1% (2006) and priority 2 from 33.7% (2004) to 35.1% (2006). We noticed a definite time demand pattern, with seasonal peaks in June, weekly peaks on Mondays, and daily peaks at 11 to 12 am. These patterns were consistent during the period of the study. We designed a demand-based rostering tool that matched doctor-unit-hours to patient arrivals and severity. We also noted seasonal peaks corresponding to public holidays. We found definite and consistent patterns of patient demand and designed a rostering tool to match ED manpower demand.

  13. Time-motion analysis of acceleration demands of 4v4 small-sided soccer games played on different pitch sizes.

    PubMed

    Hodgson, Craig; Akenhead, Richard; Thomas, Kevin

    2014-02-01

    We aimed to quantify the time-motion characteristics and technical demands of small-sided soccer games (SSGs) played on small, medium and large pitches using a high frequency non-differential global positioning system (NdGPS) that allowed assessment of acceleration and deceleration patterns. Eight male soccer players competed in SSGs comprising 4×4min quarters (3min recovery) on small (30×20m) medium (40×30m) and large (50×40m) pitch sizes. Time motion analysis using a NdGPS positioning system quantified distance covered sprinting (⩾6.7ms(-1)), high speed running (⩾5.8ms(-1)) and low (1-2ms(-2)), medium (2-3ms(-2)) and high (>3ms(-2)) acceleration. The frequency of common technical actions (passing, turning, dribbling, shooting, tackling, heading and interceptions) was performed using a hand notation system. SSGs played on medium and large pitches had a greater physical demand than on small pitches, with significantly more distance covered in all movement categories. Total distance covered in acceleration categories ranged from 230±111 (small pitch) to 356±72m (medium pitch). The small pitch imposed a greater technical demand on players (more passes, shots and tackles) compared to medium and large pitches. The study provides novel data demonstrating the acceleration patterns observed in SSGs are relatively greater than those observed during professional match play. Thus SSGs might offer a "density" type conditioning stimulus. Practitioners should be aware that changes in pitch size impact both the physical and technical demands of SSGs. Copyright © 2013 Elsevier B.V. All rights reserved.

  14. Water Demand Management Strategies and Challenges in the Upper Colorado River Basin

    NASA Astrophysics Data System (ADS)

    Kuhn, R. E.

    2016-12-01

    Under the 1922 Colorado River Compact, the Upper Basin (Colorado, New Mexico, Utah, and Wyoming) has flow obligations at Lee Ferry to downstream states and Mexico. The Colorado River Storage Project Act (CRSPA) of 1956 led to the construction of four large storage reservoirs. These provide river regulation to allow the Upper Basin to meet its obligations. Lake Powell, the largest and most important, and Lake Mead are now operated in a coordinated manner under the 2007 Interim Guidelines. Studies show that at current demand levels and if the hydrologic conditions the Basin has experienced since the mid-1980s continue or get drier, reservoir operations, alone, may not provide the necessary water to meet the Upper Basin's obligations. Therefore, the Upper Basin states are now studying demand management strategies that will reduce consumptive uses when total system reservoir storage reaches critically low levels. Demand management has its own economic, political and technical challenges and limitations and will provide new opportunities for applied research. This presentation will discuss some of those strategies, their challenges, and the kinds of information that research could provide to inform demand management.

  15. Incremental cost of increasing access to maternal health care services: perspectives from a demand and supply side intervention in Eastern Uganda.

    PubMed

    Mayora, Chrispus; Ekirapa-Kiracho, Elizabeth; Bishai, David; Peters, David H; Okui, Olico; Baine, Sebastian Olikira

    2014-01-01

    High maternal and infant mortality continue to be major challenges to the attainment of the Millennium Development Goals for many low and middle-income countries. There is now evidence that voucher initiatives can increase access to maternal health services. However, a dearth of knowledge exists on the cost implications of voucher schemes. This paper estimates the incremental costs of a demand and supply side intervention aimed at increasing access to maternal health care services. This costing study was part of a quasi-experimental voucher study conducted in two districts in Eastern Uganda to explore the impact of demand and supply - side incentives on increasing access to maternal health services. The provider's perspective was used and the ingredients approach to costing was employed. Costs were based on market prices as recorded in program records. Total, unit, and incremental costs were calculated. The estimated total financial cost of the intervention for the one year of implementation was US$525,472 (US$1 = 2200UgShs). The major cost drivers included costs for transport vouchers (35.3%), health system strengthening (29.2%) and vouchers for maternal health services (18.2%). The average cost of transport per woman to and from the health facility was US$4.6. The total incremental costs incurred on deliveries (excluding caesarean section) was US$317,157 and US$107,890 for post natal care (PNC). The incremental costs per additional delivery and PNC attendance were US$23.9 and US$7.6 respectively. Subsidizing maternal health care costs through demand and supply - side initiatives may not require significant amounts of resources contrary to what would be expected. With Uganda's Gross Domestic Product (GDP) per capita of US$55` (2012), the incremental cost per additional delivery (US$23.9) represents about 5% of GDP per capita to save a mother and probably her new born. For many low income countries, this may not be affordable, yet reliance on donor funding is often

  16. Analysing water use patterns for demand management: the case of the city of Masvingo, Zimbabwe

    NASA Astrophysics Data System (ADS)

    Dube, Emmanuel; van der Zaag, Pieter

    Water use in urban centres is dynamic, fluctuates, differs between high and low-income users, and tends to increase over time. Supply infrastructure can often hardly keep pace with increased water consumption. Given (a) the high cost of infrastructure development, (b) the recent emphasis on demand management, and (c) the social obligation to provide water services to the poor, urban water providers are faced with an important choice: whether to go the demand management route, or to continue constructing new infrastructure. This paper sheds light on some of the possibilities and constraints of both choices by providing a case study of the city of Masvingo in Zimbabwe. The paper analyses water use patterns in this city with a population of 70,000, located in a drought prone region of average rainfall of 600 mm/a. Water consumption has reached the limits of the water supply capacity. The paper first looks at the long-term water use pattern of the city as a whole and the factors that have caused the observed pattern using multiple linear regression. The paper then analyses the patterns of water use of rich and poor households, and attempts to assess the (im)possibilities of influencing these by means of an appropriate tariff structure. In projecting future demand, the paper then considers a number of interventions that could influence demand, which include leakage control, pressure management, awareness campaigns, free technical advice to water users, as well as a new tariff structure. It also discusses when new supply infrastructure should be available, depending on the various demand management measures taken.

  17. Side Effects

    Cancer.gov

    Side effects are problems that occur when treatment affects healthy tissues or organs. Learn about side effects caused by cancer treatment. Know what signs and symptoms to call your doctor about, ways to manage these problems, and treatment options.

  18. Effectiveness of demand and supply side interventions in promoting institutional deliveries--a quasi-experimental trial from rural north India.

    PubMed

    Amudhan, Senthil; Mani, Kalaivani; Rai, Sanjay K; Pandav, Chandrakant S; Krishnan, Anand

    2013-06-01

    We assessed the differential and sequential effects of a Government of India conditional cash transfer scheme for the socio-economically disadvantaged (Janani Suraksha Yojana; JSY) and the strengthening of the primary health centre (PHC) network to provide 24/7 obstetric care in promoting institutional deliveries. This study used 7796 births from the Ballabgarh Health and Demographic Surveillance Site between April 2006 and March 2010 when both schemes were implemented in a staggered manner. The multiple baseline design took advantage of interventions separated by time and geographical zone to compute difference in differences in the rate of institutional deliveries. Logistic regression was used to estimate increases in the odds of institutional deliveries after adjustment for caste and maternal education. Compared with villages with poor access, institutional deliveries nearly doubled among villages with access to 24/7 delivery services; odds ratio (OR) 1.9 [95% confidence interval (CI): 1.3, 2.6]. Introduction of JSY in villages with poor access resulted in a 1.4-fold (95% CI: 1.1, 1.8) increase in institutional deliveries and a 1.1-fold (95% CI: 0.9, 1.4) increase in villages served by PHCs 24/7. However, the introduction of PHC 24/7 care to villages served by JSY doubled the rate of institutional deliveries; OR 2.1 (95% CI: 1.5, 2.8). Among the disadvantaged, institutional deliveries increased by 34.4%, compared with 24.8% among the non-disadvantaged. Introduction of PHC 24/7 care in this group increased institutional deliveries 4-fold; OR 4.2 (95% CI: 1.9, 9.0) compared with 3-fold for JSY alone; OR 3.2 (95% CI: 1.8, 5.6). Both demand and supply side strategies are effective and promote equity. Improving service delivery in a population previously primed by demand side intervention appears to be the most useful.

  19. Safety behavior: Job demands, job resources, and perceived management commitment to safety.

    PubMed

    Hansez, Isabelle; Chmiel, Nik

    2010-07-01

    The job demands-resources model posits that job demands and resources influence outcomes through job strain and work engagement processes. We test whether the model can be extended to effort-related "routine" safety violations and "situational" safety violations provoked by the organization. In addition we test more directly the involvement of job strain than previous studies which have used burnout measures. Structural equation modeling provided, for the first time, evidence of predicted relationships between job strain and "routine" violations and work engagement with "routine" and "situational" violations, thereby supporting the extension of the job demands-resources model to safety behaviors. In addition our results showed that a key safety-specific construct 'perceived management commitment to safety' added to the explanatory power of the job demands-resources model. A predicted path from job resources to perceived management commitment to safety was highly significant, supporting the view that job resources can influence safety behavior through both general motivational involvement in work (work engagement) and through safety-specific processes.

  20. Costs of integrating demand-based reproductive health commodity model into the Government and NGO service delivery systems in Bangladesh: a supply side perspective.

    PubMed

    Islam, Ziaul; Sarker, Abdur Razzaque; Anwar, Shahela; Kabir, Humayun; Gazi, Rukhsana

    2015-01-01

    To estimate additional total cost and average cost of integrating the demand-based reproductive health commodity model into the existing Government and NGO facilities in Bangladesh. Activity based cost analysis was conducted during 2006-2008 in two low performing rural sub-districts (Nabigong and Raipur sub-district) and one urban slum area in Dhaka city, Bangladesh. Activity-based cost data were collected using ingredient approach, which comprised of listing all types of inputs by activity, quantities and prices for each input. Total cost was presented according to capital and recurrent items. The supply side perspective was considered for entire analysis. The total cost of integrating demand-based reproductive health commodity (DBRHC) model into the Government and NGO service delivery system was estimated to BDT 18,667,634 (US$274,524). The proportion of capital cost was 59 % and the recurrent cost was 41 % of the total cost. The average cost per beneficiaries was BDT 230 (US$3.38) only for introducing this model into the existing health system. The built-in interventions of DBRHC model were doable at low-cost at the selected Government and NGO settings at the grass-root level. The model has potential of further cost containment during scaling up-if the intervention costs are adjusted with the existing functionaries of the Government and NGOs.

  1. A study protocol: using demand-side financing to meet the birth spacing needs of the underserved in Punjab Province in Pakistan

    PubMed Central

    2014-01-01

    Background High fertility rates, unwanted pregnancies, low modern contraceptive prevalence and a huge unmet need for contraception adversely affect women’s health in Pakistan and this problem is compounded by limited access to reliable information and quality services regarding birth spacing especially in rural and underserved areas. This paper presents a study protocol that describes an evaluation of a demand-side financing (DSF) voucher approach which aims to increase the uptake of modern contraception among women of the lowest two wealth quintiles in Punjab Province, Pakistan. Methods/Design This study will use quasi-experimental design with control arm and be implemented in: six government clinics from the Population Welfare Department; 24 social franchise facilities branded as ‘Suraj’ (Sun), led by Marie Stopes Society (a local non-governmental organization); and 12 private sector clinics in Chakwal, Mianwali and Bhakkar districts. The study respondents will be interviewed at baseline and endline subject to voluntary acceptance and medical eligibility. In addition, health service data will record each client visit during the study period. Discussion The study will examine the impact of vouchers in terms of increasing the uptake of modern contraception by engaging private and public sector service providers (mid-level and medical doctors). If found effective, this approach can be a viable solution to satisfying the current demand and meeting the unmet need for contraception, particularly among the poorest socio-economic group. PMID:24885657

  2. A study protocol: using demand-side financing to meet the birth spacing needs of the underserved in Punjab Province in Pakistan.

    PubMed

    Azmat, Syed Khurram; Ali, Moazzam; Hameed, Waqas; Mustafa, Ghulam; Abbas, Ghazanfer; Ishaque, Muhammad; Bilgrami, Mohsina; Temmerman, Marleen

    2014-05-30

    High fertility rates, unwanted pregnancies, low modern contraceptive prevalence and a huge unmet need for contraception adversely affect women's health in Pakistan and this problem is compounded by limited access to reliable information and quality services regarding birth spacing especially in rural and underserved areas. This paper presents a study protocol that describes an evaluation of a demand-side financing (DSF) voucher approach which aims to increase the uptake of modern contraception among women of the lowest two wealth quintiles in Punjab Province, Pakistan. This study will use quasi-experimental design with control arm and be implemented in: six government clinics from the Population Welfare Department; 24 social franchise facilities branded as 'Suraj' (Sun), led by Marie Stopes Society (a local non-governmental organization); and 12 private sector clinics in Chakwal, Mianwali and Bhakkar districts. The study respondents will be interviewed at baseline and endline subject to voluntary acceptance and medical eligibility. In addition, health service data will record each client visit during the study period. The study will examine the impact of vouchers in terms of increasing the uptake of modern contraception by engaging private and public sector service providers (mid-level and medical doctors). If found effective, this approach can be a viable solution to satisfying the current demand and meeting the unmet need for contraception, particularly among the poorest socio-economic group.

  3. Parent perceptions of managing child behavioural side-effects of cancer treatment: a qualitative study.

    PubMed

    Williams, L K; McCarthy, M C

    2015-07-01

    Very little research has examined the role of parenting in managing behavioural side-effects of cancer treatment. The purpose of this paper was to explore parent perceptions of (a) parenting in the context of childhood cancer; (b) the parenting strategies used in the context of managing child behavioural side-effects of cancer treatment; and (c) the perceived impact that cancer-specific parenting strategies have on child behaviour. Participants were 15 mothers of children aged 2-6 years in the maintenance phase of treatment for acute lymphoblastic leukaemia at the Royal Children's Hospital Children's Cancer Centre, Melbourne, Australia. Mothers participated in a one-on-one semi-structured telephone interview using an interview guide which included questions on parenting in the context of childhood cancer, specifically in relation to behavioural side-effects (problems with behaviour, sleep and eating) and any perceived impact cancer-specific parenting may have on the ill child. Many parents reported that following their child's cancer diagnosis, they had to implement a suite of 'new' strategies that 'pre-diagnosis' were used only in moderation, if at all. The most salient theme that emerged was parents' perception that their parenting became more lax since their child's diagnosis. Parents further reported specific parenting strategies for each of the main child behavioural side-effects of cancer treatment. Data from the current qualitative exploratory study highlight the role of specific parenting strategies in managing or assisting child behavioural side-effects of cancer treatment. Further quantitative research is needed to more fully examine the association between parenting and child behavioural outcomes in order to develop modifiable approaches to improving child behavioural side-effects in a paediatric oncology context. © 2014 John Wiley & Sons Ltd.

  4. WSES Guidelines for the management of acute left sided colonic diverticulitis in the emergency setting.

    PubMed

    Sartelli, Massimo; Catena, Fausto; Ansaloni, Luca; Coccolini, Federico; Griffiths, Ewen A; Abu-Zidan, Fikri M; Di Saverio, Salomone; Ulrych, Jan; Kluger, Yoram; Ben-Ishay, Ofir; Moore, Frederick A; Ivatury, Rao R; Coimbra, Raul; Peitzman, Andrew B; Leppaniemi, Ari; Fraga, Gustavo P; Maier, Ronald V; Chiara, Osvaldo; Kashuk, Jeffry; Sakakushev, Boris; Weber, Dieter G; Latifi, Rifat; Biffl, Walter; Bala, Miklosh; Karamarkovic, Aleksandar; Inaba, Kenji; Ordonez, Carlos A; Hecker, Andreas; Augustin, Goran; Demetrashvili, Zaza; Melo, Renato Bessa; Marwah, Sanjay; Zachariah, Sanoop K; Shelat, Vishal G; McFarlane, Michael; Rems, Miran; Gomes, Carlos Augusto; Faro, Mario Paulo; Júnior, Gerson Alves Pereira; Negoi, Ionut; Cui, Yunfeng; Sato, Norio; Vereczkei, Andras; Bellanova, Giovanni; Birindelli, Arianna; Di Carlo, Isidoro; Kok, Kenneth Y; Gachabayov, Mahir; Gkiokas, Georgios; Bouliaris, Konstantinos; Çolak, Elif; Isik, Arda; Rios-Cruz, Daniel; Soto, Rodolfo; Moore, Ernest E

    2016-01-01

    Acute left sided colonic diverticulitis is one of the most common clinical conditions encountered by surgeons in acute setting. A World Society of Emergency Surgery (WSES) Consensus Conference on acute diverticulitis was held during the 3rd World Congress of the WSES in Jerusalem, Israel, on July 7th, 2015. During this consensus conference the guidelines for the management of acute left sided colonic diverticulitis in the emergency setting were presented and discussed. This document represents the executive summary of the final guidelines approved by the consensus conference.

  5. Managing patients with side effects and adverse events to immunoglobulin therapy.

    PubMed

    Azizi, Gholamreza; Abolhassani, Hassan; Asgardoon, Mohammad Hossein; Shaghaghi, Shiva; Negahdari, Babak; Mohammadi, Javad; Rezaei, Nima; Aghamohammadi, Asghar

    2016-01-01

    Immunoglobulin therapy has not only served as a lifesaving approach for the prevention and treatment of infections in primary and secondary immunodeficiency diseases, but has also been used as an immunomodulatory agent for autoimmune and inflammatory disorders and to provide passive immunity for some infectious diseases. Most of the adverse effects associated with immunoglobulin therapy are mild, transient and self-limiting. However, serious side effects also occur. Therefore, to minimize the adverse events of immunoglobulin therapy, specialist review of patient clinical status and immunoglobulin products, in addition to selection of appropriate treatment strategy for the management of patients with associated side effects and adverse events, are crucial.

  6. Exercise for the Management of Side Effects and Quality of Life among Cancer Survivors

    PubMed Central

    Mustian, Karen M.; Sprod, Lisa K.; Palesh, Oxana G.; Peppone, Luke J.; Janelsins, Michelle C.; Mohile, Supriya G.; Carroll, Jennifer

    2010-01-01

    Physical activity may play an important role in the rehabilitation of cancer survivors during and following treatment. Current research suggests numerous beneficial outcomes are experienced in cancer survivors undergoing exercise interventions during or following cancer treatment. Exercise not only plays a role in managing side effects but also improves functional capacity and quality of life. The purpose of this article is to provide an overview of the oncology literature supporting the use of exercise as an effective intervention for improving cancer-related fatigue, other side effects, functional capacity, and quality of life among cancer survivors. PMID:19904073

  7. Demand-side financing for maternal and newborn health: what do we know about factors that affect implementation of cash transfers and voucher programmes?

    PubMed

    Hunter, Benjamin M; Murray, Susan F

    2017-08-31

    Demand-side financing (DSF) interventions, including cash transfers and vouchers, have been introduced to promote maternal and newborn health in a range of low- and middle-income countries. These interventions vary in design but have typically been used to increase health service utilisation by offsetting some financial costs for users, or increasing household income and incentivising 'healthy behaviours'. This article documents experiences and implementation factors associated with use of DSF in maternal and newborn health. A secondary analysis (using an adapted Supporting the Use of Research Evidence framework - SURE) was performed on studies that had previously been identified in a systematic review of evidence on DSF interventions in maternal and newborn health. The article draws on findings from 49 quantitative and 49 qualitative studies. The studies give insights on difficulties with exclusion of migrants, young and multiparous women, with demands for informal fees at facilities, and with challenges maintaining quality of care under increasing demand. Schemes experienced difficulties if communities faced long distances to reach participating facilities and poor access to transport, and where there was inadequate health infrastructure and human resources, shortages of medicines and problems with corruption. Studies that documented improved care-seeking indicated the importance of adequate programme scope (in terms of programme eligibility, size and timing of payments and voucher entitlements) to address the issue of concern, concurrent investments in supply-side capacity to sustain and/or improve quality of care, and awareness generation using community-based workers, leaders and women's groups. Evaluations spanning more than 15 years of implementation of DSF programmes reveal a complex picture of experiences that reflect the importance of financial and other social, geographical and health systems factors as barriers to accessing care. Careful design of DSF

  8. Health promotion and disease prevention: a look at demand management programs.

    PubMed

    Fronstin, P

    1996-09-01

    This Issue Brief describes employers' efforts to contain health expenditures through demand management programs. These programs are designed to reduce utilization by focusing on disease prevention and health promotion. Demand management includes work site health promotion, wellness programs, and access management. Work site health promotion is a comprehensive approach to improving health and includes awareness, health education, behavioral change, and organizational health initiatives. Wellness programs usually include stress management, smoking cessation, weight management, back care, health screenings, nutrition education, work place safety, prenatal and well baby care, CPR and first aid classes, and employee assistance programs (EAPs). These programs are often viewed positively by workers and can have long-term benefits for employers above and beyond health care cost containment. Demand management can benefit employers by increasing productivity, employee retention, and employee morale and by reducing turnover, absenteeism, future medical claims, and ultimately expenditures on health care. Even though a growing number of employers are offering wellness programs, only 37 percent of full-time workers employed in medium and large private establishments were eligible for wellness programs by 1993. However, a recent survey found that 88 percent of major employers have introduced some form of health promotion, disease prevention, or early intervention initiative to encourage healthy lifestyles among their salaried employees. Distinctions must be drawn between short- and long-term strategies. Demand management can be thought of as a short-term strategy when the focus of the program is on creating more appropriate and efficient health care utilization. Disease prevention is characterized by longer-term health improvement objectives. Whether the purpose is to reduce utilization in the short term or in the long term, the ultimate goal remains the same: to reduce health

  9. Water use trends and demand projections in the Northwest Florida Water Management District

    USGS Publications Warehouse

    Marella, R.L.; Mokray, M.F.; Hallock-Solomon, Michael

    1998-01-01

    The Northwest Florida Water Management District is located in the western panhandle of Florida and encompasses about 11,200 square miles. In 1995, the District had an estimated population of 1.13 million, an increase of about 47 percent from the 1975 population of 0.77 million. Over 50 percent of the resident population lives within 10 miles of the coast. In addition, hundreds of thousands of visitors come to the coastal areas of the panhandle during the summer months for recreation or vacation purposes. Water withdrawn to meet demands for public supply, domestic self-supplied, commercial-industrial, agricultural irrigation, and recreational irrigation purposes in the District increased 18 percent (52 million gallons per day) between 1970 and 1995. The greatest increases were for public supply and domestic self-supplied (99 percent increase) and for agricultural irrigation (60 percent increase) between 1970 and 1995. In 1995, approximately 70 percent of the water withdrawn was from ground-water sources, with the majority of this from the Floridan aquifer system. The increasing water demands have affected water levels in the Floridan aquifer system, especially along the coastal areas. The Northwest Florida Water Management District is mandated under the Florida Statutes (Chapter 373) to protect and manage the water resources in this area of the State. The mandate requires that current and future water demands be met, while water resources and water-dependent natural systems are sustained. For this project, curve fitting and extrapolation were used to project most of the variables (population, population served by public supply, and water use) to the years 2000, 2005, 2010, 2015, and 2020. This mathematical method involves fitting a curve to historical population or water-use data and then extending this curve to arrive at future values. The population within the region is projected to reach 1,596,888 by the year 2020, an increase of 41 percent between 1995 and 2020

  10. Balancing opioid-induced gastrointestinal side effects with pain management: Insights from the online community.

    PubMed

    Whitman, Cynthia B; Reid, Mark W; Arnold, Corey; Patel, Haridarshan; Ursos, Lyann; Sa'adon, Roee; Pourmorady, Jonathan; Spiegel, Brennan M R

    2015-01-01

    Opioids cause gastrointestinal (GI) symptoms such as nausea, vomiting, pain, and (in 40 percent) constipation that diminish patients' quality of life. Outside traditional surveys, little is known about the opioid-induced constipation (OIC) patient experience and its impact on pain management. The purpose of this study was to use data from social media platforms to qualitatively examine patient beliefs about OIC and other prominent GI side effects, their impact on effective pain management and doctor-patient interaction. The authors collected Tweets from March 25 to July 31, 2014, and e-forum posts from health-related social networking sites regardless of timestamp. The authors identified specific keywords related to opioids and GI side effects to locate relevant content in the dataset, which was then manually coded using ATLAS.ti software. The authors examined 2,519,868 Tweets and more than 1.8 billion e-forum posts, of which, 88,586 Tweets and 9,767 posts satisfied the search criteria. Three thousand three individuals experienced opioidinduced GI side effects, mostly related to phenanthrenes (n = 1,589), and 1,274 (42.4 percent) individuals described constipation. Over-the-counter medications and nonevidence-based natural approaches were most commonly used to alleviate constipation. Many individuals questioned, rotated, reduced, or stopped their opioid treatments as a result of their GI side effects. Investigation of social media reveals a struggle to balance pain management with opioid-induced GI side effects, especially constipation. Individuals are often unprepared to treat OIC, to modify opioid regiments without medical advice, and to resort to using natural remedies and treatments lacking scientific evidence of effectiveness. These results identify opportunities to improve physician-patient communication and explore effective treatment alternatives.

  11. Crisis management systems: staff nurses demand more support from their supervisors.

    PubMed

    Tzeng, Huey-Ming; Yin, Chang-Yi

    2008-08-01

    This study illustrates the contributions of the necessity, comprehensiveness, and difference (between necessity and comprehensiveness) levels of crisis management systems to participants' general satisfaction with their working institutions' nursing-related crisis management activities. Crisis management systems include strategic, technical/structural, assessment, public communication, and psychological/cultural aspects. An effective institutional crisis management system might help to decrease the number of incidents related to medical disputes or to prevent a crisis from worsening and becoming disastrous. A cross-sectional survey was administered during a nursing conference held in Taipei, Taiwan, on June 27, 2005. Two hundred ninety questionnaires were distributed, and 121 were retrieved (response rate, 41.7%; nursing administrators and staff). Univariate and multivariate analyses were performed. Ordinal logistic regression analyses show that being a public hospital managed by the government and having more difference on the strategic aspect between the necessity and comprehensiveness levels contribute to lower satisfaction with nursing-related crisis management activities (Nagelkerke R(2) = .441). In addition, staff nurses perceive higher necessity levels on all five aspects compared to nursing administrators. This study provides important insights into how the policies and activities of a medical institution's crisis management system can be prioritized and implemented. It is also important for students in nursing programs and for currently employed nurses to learn how to manage disputes related to nursing practice, so that early resolution can be achieved and crises can be avoided. These results suggest that staff nurses demand more support from their supervisors.

  12. Managing the oral side-effects of medications used to treat multiple sclerosis.

    PubMed

    Cockburn, N; Pateman, K; Taing, M W; Pradhan, A; Ford, P J

    2017-09-01

    Many medications used to manage multiple sclerosis (MS) affect oral health. This review aimed to identify the oral side-effects of the current drugs recommended in Australia to treat MS and make dental practitioners aware of the range of symptoms. The Australian Therapeutic Guidelines and the Australian Medicines Handbook were searched for medications used to treat MS. For each medication, the generic name, class, route of administration, dosage and drug company reported side-effects were extracted from the online Monthly Index of Medical Specialties (MIMs) database. Meyler's Side-effect of Drugs Encyclopaedia was used to identify any additional oral adverse reactions to medications used to treat MS. Fourteen drugs were identified for the treatment of MS progression and 13 drugs for the treatment of MS symptoms. For these medications, 18 oral side-effects were documented: xerostomia was the most common, followed by dysgeusia, dysphagia, mouth ulceration and sinusitis. Anticholinergic drugs caused xerostomia while immunosuppressants resulted in more infection-related side-effects. Dental practitioners should be aware of the range of symptoms likely to be reported by this population. Clinicians are encouraged to continue providing dental care for their patients who develop MS and refer complex cases to specialists. © 2017 Australian Dental Association.

  13. Demand Response Spinning Reserve Demonstration

    SciTech Connect

    Eto, Joseph H.; Nelson-Hoffman, Janine; Torres, Carlos; Hirth,Scott; Yinger, Bob; Kueck, John; Kirby, Brendan; Bernier, Clark; Wright,Roger; Barat, A.; Watson, David S.

    2007-05-01

    The Demand Response Spinning Reserve project is a pioneeringdemonstration of how existing utility load-management assets can providean important electricity system reliability resource known as spinningreserve. Using aggregated demand-side resources to provide spinningreserve will give grid operators at the California Independent SystemOperator (CAISO) and Southern California Edison (SCE) a powerful, newtool to improve system reliability, prevent rolling blackouts, and lowersystem operating costs.

  14. Immunotherapy with BCG administered by scarification: standardization of reactions and management of side effects.

    PubMed

    Hortobagyi, G N; Richman, S P; Dandridge, K; Gutterman, J U; Blumenschein, G R; Hersh, E M

    1978-11-01

    The method of administering BCG by scarification is described in detail. A system of classifying the intensity of local reactions is proposed to standardize administration. The experience of the M.D. Anderson Hospital involving over 2700 patients is reviewed. Administration of BCG by scarification has been accomplished with safety and has been well tolerated and accepted. The most commonly observed side effects are discussed as well as their management.

  15. Integrating fire management into land management planning for west-side forests

    Treesearch

    Peter D. Teensma

    1996-01-01

    Fire management's integration into land management planning is critical to the successful management of nearly all wildland ecosystems, including westside forests, which lie west of the Cascade crest in Oregon and the northern coastal ranges in California. Restoration and maintenance of fire as an ecosystem process is critical to retention of biological diversity...

  16. Integrated management of water resources demand and supply in irrigated agriculture from plot to regional scale

    NASA Astrophysics Data System (ADS)

    Schütze, Niels; Wagner, Michael

    2016-05-01

    Growing water scarcity in agriculture is an increasing problem in future in many regions of the world. Recent trends of weather extremes in Saxony, Germany also enhance drought risks for agricultural production. In addition, signals of longer and more intense drought conditions during the vegetation period can be found in future regional climate scenarios for Saxony. However, those climate predictions are associated with high uncertainty and therefore, e.g. stochastic methods are required to analyze the impact of changing climate patterns on future crop water requirements and water availability. For assessing irrigation as a measure to increase agricultural water security a generalized stochastic approach for a spatial distributed estimation of future irrigation water demand is proposed, which ensures safe yields and a high water productivity at the same time. The developed concept of stochastic crop water production functions (SCWPF) can serve as a central decision support tool for both, (i) a cost benefit analysis of farm irrigation modernization on a local scale and (ii) a regional water demand management using a multi-scale approach for modeling and implementation. The new approach is applied using the example of a case study in Saxony, which is dealing with the sustainable management of future irrigation water demands and its implementation.

  17. Two sides of the same coin--an interview study of Swedish obstetricians' experiences using ultrasound in pregnancy management.

    PubMed

    Åhman, Annika; Persson, Margareta; Edvardsson, Kristina; Lalos, Ann; Graner, Sophie; Small, Rhonda; Mogren, Ingrid

    2015-11-20

    The extended use of ultrasound that is seen in maternity care in most Western countries has not only affected obstetric care but also impacted on the conception of the fetus in relation to the pregnant woman. This situation has also raised concerns regarding the pregnant woman's reproductive freedom. The purpose of this study was to explore Swedish obstetricians' experiences and views on the role of obstetric ultrasound particularly in relation to clinical management of complicated pregnancy, and in relation to situations where the interests of maternal and fetal health conflict. A qualitative study design was applied, and data were collected in 2013 through interviews with 11 obstetricians recruited from five different obstetric clinics in Sweden. Data were analysed using qualitative content analysis. The theme that emerged in the analysis 'Two sides of the same coin' depicts the view of obstetric ultrasound as a very important tool in obstetric care while it also was experienced as having given rise to new and challenging issues in the management of pregnancy. This theme was built on three categories: I. Ultrasound is essential and also demanding; II. A woman's health interest is prioritised in theory, but not always in practice; and III. Ultrasound is rewarding but may also cause unwarranted anxiety. The widespread use of ultrasound in obstetric care has entailed new challenges for clinicians due to enhanced possibilities to diagnose and treat fetal conditions, which in turn might conflict with the health interests of the pregnant woman. There is a need for further ethical discussions regarding the obstetrician's position in management of situations where maternal and fetal health interests conflict. The continuing advances in the potential of ultrasound to impact on pregnancy management will also increase the need for adequate and appropriate information and counselling. Together with other health care professionals, obstetricians therefore need to develop

  18. A Demand-Driven Approach for a Multi-Agent System in Supply Chain Management

    NASA Astrophysics Data System (ADS)

    Kovalchuk, Yevgeniya; Fasli, Maria

    This paper presents the architecture of a multi-agent decision support system for Supply Chain Management (SCM) which has been designed to compete in the TAC SCM game. The behaviour of the system is demand-driven and the agents plan, predict, and react dynamically to changes in the market. The main strength of the system lies in the ability of the Demand agent to predict customer winning bid prices - the highest prices the agent can offer customers and still obtain their orders. This paper investigates the effect of the ability to predict customer order prices on the overall performance of the system. Four strategies are proposed and compared for predicting such prices. The experimental results reveal which strategies are better and show that there is a correlation between the accuracy of the models' predictions and the overall system performance: the more accurate the prediction of customer order prices, the higher the profit.

  19. A Masters Programme in telecommunications management - demand-based curriculum design

    NASA Astrophysics Data System (ADS)

    Gharaibeh, Khaled M.; Kaylani, Hazem; Murphy, Noel; Brennan, Conor; Itradat, Awni; Al-Bataineh, Mohammed; Aloqlah, Mohammed; Salhieh, Loay; Altarazi, Safwan; Rawashdeh, Nathir; Bas Cerdá, María del Carmen; Conchado Peiró, Andrea; Al-Zoubi, Asem; Harb, Bassam; Bany Salameh, Haythem

    2015-05-01

    This paper presents a curriculum design approach for a Masters Programme in Telecommunications Management based on demand data obtained from surveying the needs of potential students of the proposed programme. Through online surveys disseminated at telecom companies in Jordan, it was possible to measure the demand for such a programme and to determine the required programme contents and specifications. The curriculum design is based on definition of programme outcomes and on using a house of quality approach (HOQ) to determine the list of courses required in the programme. Surveyed competencies are mapped to a long list of proposed courses in a HOQ in order to determine the importance of each of these courses. A final list of core and elective courses is then developed considering the contribution to programme outcomes and the academic standards.

  20. Reducing Gridlock on the Grid: Utility Trends in Managing Peak Electric Load through Residential Demand Response

    NASA Astrophysics Data System (ADS)

    McDonald, Betsy

    Utilities across the United States are piloting residential demand response programs to help manage peak electric demand. Using publicly available program evaluations, this thesis analyzes nine such programs to uncover and synthesize the range of program offerings, goals, enrollment strategies, and customer experiences. This review reveals that program participation, components, and results differ based on a variety of factors, including geographic characteristics, program goals, and implementation strategies. The diversity of program designs and evaluation findings suggests an underlying tension between the need to generate cost-effective program impacts and the desire to increase accessibility so that program benefits are not exclusive to certain segments of the population. For more significant and impactful engagement, program goals may need to shift. State level policy support could help shift program goals toward increasing program accessibility. Future research should explore creative strategies that target existing barriers and allow for more inclusive deployment.

  1. Pressure management as a leakage reduction and water demand management tool: The case of the City of Mutare, Zimbabwe

    NASA Astrophysics Data System (ADS)

    Marunga, Antony; Hoko, Zvikomborero; Kaseke, Evans

    Water is now considered a scarce but essential resource, which should be managed in an integrated manner. The traditional approaches of resource development are now considered as unsustainable. Water demand management (WDM), the new approach, aims at influencing demand, thus improving distribution efficiency. Leakage control and pressure management are some of the WDM strategies. The study was carried out in Mutare and investigated the potential for leakage control through pressure management. The city experiences high water losses due to an aged system of reticulation, faulty metering of 25% and high system pressures. Unaccounted for water (UFW) for the city during the study period averaged 57%. UFW for the two specific study areas in Chikanga averaged 47% and 32%. One of the areas was investigated for leakage reduction through pressure management. The normal operating pressure in the system was 75-80 m. Epanet was used for modelling pressure distribution. Results from logged minimum night flows (MNF) show that at 77 m UFW due to leakage was 25%. A pressure reduction from 77 m to 50 m resulted in 25% reduction in MNF. Further reduction of pressure below 50 m resulted in deterioration of service. No flow was received at the highest point when the pressure was set at 30 m. At this pressure, results from Epanet gave -0.84 m pressure at the highest point. The hydraulic model predicted 50 m as minimum pressure for an acceptable minimum pressure in the system. It was concluded that operating the system at 50 m in the area under pressure management reduced the MNF by 25% without affecting the service. There is great potential for leakage control through pressure management. It is recommended that leakage control through pressure management be investigated in other parts of the city using Epanet as a tool. Replacement of very old pipes should be considered together with other strategies.

  2. Sunitinib therapy for metastatic renal cell carcinoma: recommendations for management of side effects

    PubMed Central

    Kollmannsberger, C; Soulieres, D; Wong, R; Scalera, A; Gaspo, R; Bjarnason, G

    2007-01-01

    Sunitinib, a new vascular endothelial growth factor receptor inhibitor, has demonstrated high activity in renal cell carcinoma (RCC) and is now widely used for patients with metastatic disease. Although generally well tolerated and associated with a low incidence of common toxicity criteria grade 3 or 4 toxicities, sunitinib exhibits a distinct pattern of novel side effects that require monitoring and management. This article summarizes the most important side effects and proposes recommendations for their monitoring, prevention and treatment, based on the existing literature and on suggestions made by an expert group of Canadian oncologists. Fatigue, diarrhea, anorexia, oral changes, skin toxicity and hypertension seem to be the most clinically relevant toxicities of sunitinib. Fatigue may be partly related to the development of hypothyroidism during sunitinib therapy for which patients should be observed and, if necessary, treated. Hypertension can be treated with standard antihypertensive therapy and rarely requires treatment discontinuation. Neutropenia and thrombocytopenia usually do not require intervention, in particular no episodes of neutropenic fever have been reported to date. A decrease in left ventricular ejection fraction is a rare, but potentially life-threatening side effect. Because of its metabolism by cytochrome P450 3A4 a number of drugs can potentially interact with sunitinib. Clinical response and toxicity should be carefully observed when sunitinib is combined with either a cytochrome P450 3A4 inducer or inhibitor and doses adjusted as necessary. Knowledge about side effects, as well as the proactive assessment and consistent management of sunitinib-related side effects, is critical to ensure optimal benefit from sunitinib treatment. PMID:18542784

  3. Left-sided portal hypertension: Successful management by laparoscopic splenectomy following splenic artery embolization

    PubMed Central

    Patrono, Damiano; Benvenga, Rosa; Moro, Francesco; Rossato, Denis; Romagnoli, Renato; Salizzoni, Mauro

    2014-01-01

    INTRODUCTION Left-sided portal hypertension is a rare clinical condition most often associated with a pancreatic disease. In case of hemorrhage from gastric fundus varices, splenectomy is indicated. Commonly, the operation is carried out by laparotomy, as portal hypertension is considered a relative contraindication to laparoscopic splenectomy (LS). Although some studies have reported the feasibility of the laparoscopic approach in the setting of cirrhosis-related portal hypertension, experience concerning LS in left-sided portal hypertension is lacking. PRESENTATION OF CASE A 39-year-old man was admitted to the Emergency Department for haemorrhagic shock due to acute hemorrhage from gastric fundus varices. Diagnostic work up revealed a chronic pancreatitis-related splenic vein thrombosis causing left-sided portal hypertension with gastric fundus varices and splenic cavernoma. Following splenic artery embolization (SAE), the case was successfully managed by LS. DISCUSSION The advantages of laparoscopic over open splenectomy include lower complication rate, quicker recovery and shorter hospital stay. Splenic artery embolization prior to LS has been used to reduce intraoperative blood losses and conversion rate, especially in complex cases of splenomegaly or cirrhosis-related portal hypertension. We report a case of complicated left-sided portal hypertension managed by LS following SAE. In spite of the presence of large varices at the splenic hilum, the operation was performed by laparoscopy without any major intraoperative complication, thanks to the reduced venous pressure achieved by SAE. CONCLUSION Splenic artery embolization may be a valuable adjunct in case of left-sided portal hypertension requiring splenectomy, allowing a safe dissection of the splenic vessels even by laparoscopy. PMID:25194596

  4. An Interactive Computer Tool for Teaching About Desalination and Managing Water Demand in the US

    NASA Astrophysics Data System (ADS)

    Ziolkowska, J. R.; Reyes, R.

    2016-12-01

    This paper presents an interactive tool to geospatially and temporally analyze desalination developments and trends in the US in the time span 1950-2013, its current contribution to satisfying water demands and its future potentials. The computer tool is open access and can be used by any user with Internet connection, thus facilitating interactive learning about water resources. The tool can also be used by stakeholders and policy makers for decision-making support and with designing sustainable water management strategies. Desalination technology has been acknowledged as a solution to a sustainable water demand management stemming from many sectors, including municipalities, industry, agriculture, power generation, and other users. Desalination has been applied successfully in the US and many countries around the world since 1950s. As of 2013, around 1,336 desalination plants were operating in the US alone, with a daily production capacity of 2 BGD (billion gallons per day) (GWI, 2013). Despite a steady increase in the number of new desalination plants and growing production capacity, in many regions, the costs of desalination are still prohibitive. At the same time, the technology offers a tremendous potential for `enormous supply expansion that exceeds all likely demands' (Chowdhury et al., 2013). The model and tool are based on data from Global Water Intelligence (GWI, 2013). The analysis shows that more than 90% of all the plants in the US are small-scale plants with the capacity below 4.31 MGD. Most of the plants (and especially larger plants) are located on the US East Coast, as well as in California, Texas, Oklahoma, and Florida. The models and the tool provide information about economic feasibility of potential new desalination plants based on the access to feed water, energy sources, water demand, and experiences of other plants in that region.

  5. Overcoming constraints to the implementation of water demand management in southern Africa

    NASA Astrophysics Data System (ADS)

    Mwendera, E. J.; Hazelton, D.; Nkhuwa, D.; Robinson, P.; Tjijenda, K.; Chavula, G.

    This paper presents results of a study on water demand management status and overcoming constraints to implementation of water demand management in the southern African region, as part of Phase II of water demand management (WDM) programme implemented by the IUCN (The World Conservation Union). The study was conducted in Malawi, Namibia, South Africa, Swaziland, Zambia and Zimbabwe. The study methodology consisted of a survey of literature, and interviewing and communicating with stakeholders in order to learn from stakeholders on the critical constraints to WDM implementation and strategies to overcome them. The study has shown that, despite the potential savings that would accrue from implementation of WDM, the water sector across the southern African region continues to focus on water supply augmentation. There are inadequate financial and human resources for rehabilitation, operation and maintenance of water conveyance systems resulting in system leaks, which contribute to high levels of unaccounted-for water, a situation that masks the potential benefits of WDM. In most countries, the water sector operates on ad-hoc sub-sector water user objectives, which provided guidelines only for development and management purposes. Most of the institutional frameworks have remained diffuse, resulting into poor performance in the sector, and into crisis management in the water resources development. Though the WDM policy in most countries is already accessible through guidelines for catchment management institutions and water supply institutions; there is a lack of broad commitment to implementing them. In other countries the instruments are relatively new and have not been applied widely. Similarly, the effectiveness of instruments has not been well evaluated in most countries. In countries where policy is weak there is often a lack of clarity as to who is responsible for WDM implementation, and even less clarity on who is responsible for facilitating and monitoring

  6. National survey addressing the information needs of primary care physicians: Side effect management of patients on androgen deprivation therapy.

    PubMed

    Soeyonggo, Tony; Locke, Jennifer; Giudice, Maria Elizabeth Del; Alibhai, Shabbir; Fleshner, Neil Eric; Warde, Padraig

    2014-03-01

    Androgen deprivation therapy (ADT) is a common treatment for prostate cancer with numerous side effects. We assess primary care physicians' (PCPs) knowledge of ADT side effects and their interest in increasing their knowledge in this area. A list of active Canadian PCPs was obtained using the Canadian Medical Directory. A cross-sectional survey was distributed to 600 randomly selected physicians. We collected PCPs' demographic information, experience with ADT management, knowledge regarding ADT side effects and desired sources for obtaining knowledge on ADT management. In total, we received 103 completed questionnaires. Of these, 89% of PCPs had patients on ADT. One-third of respondents prescribed ADT and over half of them administered ADT annually. Thirty-eight percent felt their knowledge of ADT side effects was inadequate and 50% felt uncomfortable counselling patients on ADT. Many PCPs were less familiar with the incidence of functional side effects of ADT (i.e., hot flashes, fatigue and erectile dysfunction) compared to life-threatening side effects (i.e., cardiovascular events, metabolic syndrome, fractures). In terms of increasing their knowledge of ADT side effects, 82% of PCPs would use educational resources if they were available (52% and 32% preferred continued medical education [CME] events and educational pamphlets, respectively). PCPs play an important role in managing ADT side effects. There is poor awareness of the prevalence of ADT side effects, and many are uncomfortable in managing these side effects. These areas may be addressed through CME programs and educational pamphlets.

  7. [Implementation of nurse demand managment in primary health care service providers in Catalonia].

    PubMed

    Brugués Brugués, Alba; Cubells Asensio, Irene; Flores Mateo, Gemma

    2017-04-14

    To describe and analyse the implementaction of nurse demand managment (NDM) among health care providers in Catalonia from 2005 to 2014. Cross sectional survey. Participants All service providers in Catalonia (n=37). Main measurements Interviews with nurse manager of each health care provides about ht barriers and facilitators concerning NDM. Facilitators and barriers were classified into 3 types: (i)health professional (competence, attitudes, motivation for change and individual characteristics); (ii)social context (patients and companions), and (iii)system related factors (organization and structure, economic incentives). Of the 37 providers, 26 (70.3%) have implemented the Demand Management Nurse (NDM). The main barriers identified are the nurse prescriptin regulation, lack of knowledge and skills of nurses, and the lack of protocols at the start of implantation. Among the facilitators are the specific training of professionals, a higher ratio of nurses to doctors, consensus circuits with all professionals and linking the implementation of NDM to economic incentives. NDM is consolidated in Catalonia. However, the NDM should be included in the curricula of nursing degree and continuing education programs in primary care teams. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  8. Managing variation in demand: lessons from the UK National Health Service.

    PubMed

    Walley, Paul; Silvester, Kate; Steyn, Richard

    2006-01-01

    Managers within the U.S. healthcare system are becoming more aware of the impact of variation in demand on healthcare processes. The UK National Health Service provides a prime example of a system that has experienced the consequences when the issue is not dealt with satisfactorily, having suffered from excessive queues for a prolonged period. These delays are mostly caused by a lack of attention to variation and inappropriate responses to the queues, rather than a capacity shortage. A number of collaborative programs recently have come to grips with many of the causes of the queues in both elective care and emergency care. Although there are still areas that need large-scale improvement, good progress has been made, especially within emergency care. The authors of this article have acted as technical advisors to a number of these improvement programs and have been able to document many of the practices that have helped to reduce or eliminate unnecessary queues and delays across the 200 sites in England that have 24-hour emergency care facilities. Local program managers at these sites continuously reported progress for a period of 18 months. A number of important lessons for both the design and control of healthcare processes have emerged from the collaborative work. These lessons focus on understanding and measurement of demand, capacity planning, reduction of introduced variation, segmentation and streaming of work, process design, capacity yield management, and measurement of variation.

  9. Understanding the side effects of emission trading: implications for waste management.

    PubMed

    Braschel, Nina; Posch, Alfred; Pierer, Magdalena

    2014-01-01

    The trading of emission allowances is an important market instrument in climate policy. However, the inclusion of certain branches of industry in the trading system not only provides incentives for emission reduction, it also entails unwanted side effects. Thus, the objective of the present study is to identify such side effects-positive and negative-by examining the potential impact of waste management inclusion in the European Union Emissions Trading Scheme (EU ETS). Desk research was supplemented with qualitative and quantitative empirical analysis (based on expert interviews and a questionnaire) in order to analyse the related perceptions and expectations of actors and stakeholders. The impact of waste management inclusion in the EU ETS is analysed in terms of the following three areas: (i) costs and cost pass-through, (ii), competitiveness and market position, and (iii) carbon leakage. Concerning expectations in the area of costs, both the interviewed experts and the practitioners surveyed thought that costs were likely to increase or that they could be passed on to customers. However, experts and practitioners differed with respect to the possibility of carbon leakage. Clearly, increased knowledge of the possible impact arising from inclusion of the waste sector in the EU ETS would enable managers to become more proactive and to manage waste streams and treatment options more economically.

  10. Interrole conflict and self-efficacy to manage work and family demands mediate the relationships of job and family demands with stress in the job and family domains.

    PubMed

    Smoktunowicz, Ewelina; Cieslak, Roman; Demerouti, Evangelia

    2017-09-01

    This study derives from Work-Home Resources model (ten Brummelhuis, L. L., & Bakker, A. B. (2012). A resource perspective on the work-home interface: The work-home resources model. American Psychologist, 67(7), 545-556. doi: 10.1037/a0027974 ) and Social Cognitive Theory (Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ, US: Prentice-Hall, Inc.) to investigate mechanisms responsible for the effect of job and family demands on work- and family-related perceived stress. We hypothesized that interrole conflict and self-efficacy to manage work and family demands operate either independently or sequentially transmitting the effects of demands on perceived stress. A sample of 100 employees of various occupations participated in the study conducted online in two waves: Time 1 (T1) and Time 2 (T2) with a three-month interval. Regression analysis with bootstrapping was applied. Interrole conflict (T1) did not mediate the relationships between demands (T1) and perceived stress (T2), whereas self-efficacy (T1) mediated only those between family demands (T1) and stress (T2). However, data supported the sequential mediation hypotheses: Demands (T1) were associated with increased interrole conflict (T1) which in turn decreased self-efficacy (T1) and ultimately resulted in the elevated perceived stress at work and in the family (T2). Demands originating in one domain can impact stress both in the same and other life areas through the sequence of interrole conflict and context-specific self-efficacy.

  11. Electrical power distribution control methods, electrical energy demand monitoring methods, and power management devices

    DOEpatents

    Chassin, David P.; Donnelly, Matthew K.; Dagle, Jeffery E.

    2006-12-12

    Electrical power distribution control methods, electrical energy demand monitoring methods, and power management devices are described. In one aspect, an electrical power distribution control method includes providing electrical energy from an electrical power distribution system, applying the electrical energy to a load, providing a plurality of different values for a threshold at a plurality of moments in time and corresponding to an electrical characteristic of the electrical energy, and adjusting an amount of the electrical energy applied to the load responsive to an electrical characteristic of the electrical energy triggering one of the values of the threshold at the respective moment in time.

  12. Electrical power distribution control methods, electrical energy demand monitoring methods, and power management devices

    DOEpatents

    Chassin, David P [Pasco, WA; Donnelly, Matthew K [Kennewick, WA; Dagle, Jeffery E [Richland, WA

    2011-12-06

    Electrical power distribution control methods, electrical energy demand monitoring methods, and power management devices are described. In one aspect, an electrical power distribution control method includes providing electrical energy from an electrical power distribution system, applying the electrical energy to a load, providing a plurality of different values for a threshold at a plurality of moments in time and corresponding to an electrical characteristic of the electrical energy, and adjusting an amount of the electrical energy applied to the load responsive to an electrical characteristic of the electrical energy triggering one of the values of the threshold at the respective moment in time.

  13. Side effects of aesthetic therapy by lasers and IPL source: a dark side of the correct management of the patients

    NASA Astrophysics Data System (ADS)

    Oskarbski, George V.

    2004-09-01

    A medical practice by laser or IPL device means professional experience, reputation, strong economical investment, while a patient needs results for the bill he pays. In front of a publicity of non-invasive solutions for a broad base of clinical applications, the everyday practice offers embarrassing side effects about which it is better to prepare the users. Inefficiency, hypo-hyper-pigmentations, scars show that we need to have clear instructions and experienced studies, before emphasizing good results.

  14. Web-based energy information systems for energy management and demand response in commercial buildings

    SciTech Connect

    Motegi, Naoya; Piette, Mary Ann; Kinney, Satkartar; Herter, Karen

    2003-04-18

    Energy Information Systems (EIS) for buildings are becoming widespread in the U.S., with more companies offering EIS products every year. As a result, customers are often overwhelmed by the quickly expanding portfolio of EIS feature and application options, which have not been clearly identified for consumers. The object of this report is to provide a technical overview of currently available EIS products. In particular, this report focuses on web-based EIS products for large commercial buildings, which allow data access and control capabilities over the Internet. EIS products combine software, data acquisition hardware, and communication systems to collect, analyze and display building information to aid commercial building energy managers, facility managers, financial managers and electric utilities in reducing energy use and costs in buildings. Data types commonly processed by EIS include energy consumption data; building characteristics; building system data, such as heating, ventilation, and air-conditioning (HVAC) and lighting data; weather data; energy price signals; and energy demand-response event information. This project involved an extensive review of research and trade literature to understand the motivation for EIS technology development. This study also gathered information on currently commercialized EIS. This review is not an exhaustive analysis of all EIS products; rather, it is a technical framework and review of current products on the market. This report summarizes key features available in today's EIS, along with a categorization framework to understand the relationship between EIS, Energy Management and Control Systems (EMCSs), and similar technologies. Four EIS types are described: Basic Energy Information Systems (Basic-EIS); Demand Response Systems (DRS); Enterprise Energy Management (EEM); and Web-based Energy Management and Control Systems (Web-EMCS). Within the context of these four categories, the following characteristics of EIS are

  15. Daily Use of Energy Management Strategies and Occupational Well-being: The Moderating Role of Job Demands

    PubMed Central

    Parker, Stacey L.; Zacher, Hannes; de Bloom, Jessica; Verton, Thomas M.; Lentink, Corine R.

    2017-01-01

    We examine the relationships among employees’ use of energy management strategies and two occupational well-being outcomes: job satisfaction and emotional exhaustion. Based on conservation of resources theory, it was hypothesized that employees with high job demands would benefit more from using energy management strategies (i.e., including prosocial, organizing, and meaning-related strategies), compared to employees with low job demands. We tested this proposition using a quantitative diary study. Fifty-four employees provided data twice daily across one work week (on average, 7 daily entries). Supporting the hypotheses, prosocial energy management was positively related to job satisfaction. Moreover, employees with high job demands were less emotionally exhausted when using prosocial strategies. Contrary to predictions, when using organizing strategies, employees with low job demands had higher job satisfaction and lower emotional exhaustion. Under high job demands, greater use of organizing strategies was associated with lower job satisfaction and higher emotional exhaustion. Finally, use of meaning-related strategies was associated with higher emotional exhaustion when job demands were low. With this research, we position energy management as part of a resource investment process aimed at maintaining and improving occupational well-being. Our findings show that this resource investment will be more or less effective depending on the type of strategy used and the existing drain on resources (i.e., job demands). This is the first study to examine momentary effects of distinct types of work-related energy management strategies on occupational well-being. PMID:28912741

  16. Daily Use of Energy Management Strategies and Occupational Well-being: The Moderating Role of Job Demands.

    PubMed

    Parker, Stacey L; Zacher, Hannes; de Bloom, Jessica; Verton, Thomas M; Lentink, Corine R

    2017-01-01

    We examine the relationships among employees' use of energy management strategies and two occupational well-being outcomes: job satisfaction and emotional exhaustion. Based on conservation of resources theory, it was hypothesized that employees with high job demands would benefit more from using energy management strategies (i.e., including prosocial, organizing, and meaning-related strategies), compared to employees with low job demands. We tested this proposition using a quantitative diary study. Fifty-four employees provided data twice daily across one work week (on average, 7 daily entries). Supporting the hypotheses, prosocial energy management was positively related to job satisfaction. Moreover, employees with high job demands were less emotionally exhausted when using prosocial strategies. Contrary to predictions, when using organizing strategies, employees with low job demands had higher job satisfaction and lower emotional exhaustion. Under high job demands, greater use of organizing strategies was associated with lower job satisfaction and higher emotional exhaustion. Finally, use of meaning-related strategies was associated with higher emotional exhaustion when job demands were low. With this research, we position energy management as part of a resource investment process aimed at maintaining and improving occupational well-being. Our findings show that this resource investment will be more or less effective depending on the type of strategy used and the existing drain on resources (i.e., job demands). This is the first study to examine momentary effects of distinct types of work-related energy management strategies on occupational well-being.

  17. Automated Demand Response Approaches to Household Energy Management in a Smart Grid Environment

    NASA Astrophysics Data System (ADS)

    Adika, Christopher Otieno

    The advancement of renewable energy technologies and the deregulation of the electricity market have seen the emergence of Demand response (DR) programs. Demand response is a cost-effective load management strategy which enables the electricity suppliers to maintain the integrity of the power grid during high peak periods, when the customers' electrical load is high. DR programs are designed to influence electricity users to alter their normal consumption patterns by offering them financial incentives. A well designed incentive-based DR scheme that offer competitive electricity pricing structure can result in numerous benefits to all the players in the electricity market. Lower power consumption during peak periods will significantly enhance the robustness of constrained networks by reducing the level of power of generation and transmission infrastructure needed to provide electric service. Therefore, this will ease the pressure of building new power networks as we avoiding costly energy procurements thereby translating into huge financial savings for the power suppliers. Peak load reduction will also reduce the inconveniences suffered by end users as a result of brownouts or blackouts. Demand response will also drastically lower the price peaks associated with wholesale markets. This will in turn reduce the electricity costs and risks for all the players in the energy market. Additionally, DR is environmentally friendly since it enhances the flexibility of the power grid through accommodation of renewable energy resources. Despite its many benefits, DR has not been embraced by most electricity networks. This can be attributed to the fact that the existing programs do not provide enough incentives to the end users and, therefore, most electricity users are not willing to participate in them. To overcome these challenges, most utilities are coming up with innovative strategies that will be more attractive to their customers. Thus, this dissertation presents various

  18. Australian case managers' perceptions of mental health consumers use of antipsychotic medications and associated side-effects.

    PubMed

    Morrison, Paul; Meehan, Tom; Stomski, Norman Jay

    2015-04-01

    The present study explores Australian case managers' perceptions of mental health consumers' use of antipsychotic medications and the side-effects resulting from these medications. Semistructured interviews were used to elicit material from nine case managers in a community care setting in South-East Queensland, Australia. Content analysis was used to examine the transcripts, and the audio-recordings were replayed to identify important contextual cues. The analysis identified several main themes, including perceptions of the use of antipsychotic medications and associated side-effects, the provision of information about antipsychotic medication side-effects; the assessment of antipsychotic medication side-effects; and the promotion of effective management of antipsychotic medication side-effects. The participants believed that antipsychotic medication provided clear benefits to mental health consumers. Most participants believed that consumers adapted to side-effects and came to accept them. The case managers themselves often felt poorly informed about antipsychotic medication side-effects, leading them to request more succinct types of information. It was notable to find that there was a lack of systematic approach to the assessment of side-effects. This finding highlighted the need to incorporate the routine structured assessment of antipsychotic medication side-effects in providing care to mental health consumers in the community. © 2015 Australian College of Mental Health Nurses Inc.

  19. A Cumulative Energy Demand indicator (CED), life cycle based, for industrial waste management decision making

    SciTech Connect

    Puig, Rita; Fullana-i-Palmer, Pere; Bala, Alba

    2013-12-15

    Highlights: • We developed a methodology useful to environmentally compare industrial waste management options. • The methodology uses a Net Energy Demand indicator which is life cycle based. • The method was simplified to be widely used, thus avoiding cost driven decisions. • This methodology is useful for governments to promote the best environmental options. • This methodology can be widely used by other countries or regions around the world. - Abstract: Life cycle thinking is a good approach to be used for environmental decision-support, although the complexity of the Life Cycle Assessment (LCA) studies sometimes prevents their wide use. The purpose of this paper is to show how LCA methodology can be simplified to be more useful for certain applications. In order to improve waste management in Catalonia (Spain), a Cumulative Energy Demand indicator (LCA-based) has been used to obtain four mathematical models to help the government in the decision of preventing or allowing a specific waste from going out of the borders. The conceptual equations and all the subsequent developments and assumptions made to obtain the simplified models are presented. One of the four models is discussed in detail, presenting the final simplified equation to be subsequently used by the government in decision making. The resulting model has been found to be scientifically robust, simple to implement and, above all, fulfilling its purpose: the limitation of waste transport out of Catalonia unless the waste recovery operations are significantly better and justify this transport.

  20. Managing patient demand: a qualitative study of appointment making in general practice.

    PubMed

    Gallagher, M; Pearson, P; Drinkwater, C; Guy, J

    2001-04-01

    Managing patients' requests for appointments is an important general practice activity. No previous research has systematically observed how patients and receptionists negotiate appointments. To observe appointment making and investigate patients' and professionals' experiences of appointment negotiations. A qualitative study using participant observation. Three general practices on Tyneside; a single-handed practice, a practice comprising three doctors, and a seven-doctor practice. Participant observation sessions, consisting of 35 activity recordings and 34 periods of observation and 38 patient and 15 professional interviews, were set up. Seven groups of patients were selected for interview. These included patients attending an 'open access' surgery, patients who complained about making an appointment, and patients who complimented the receptionists. Appointment making is a complex social process. Outcomes are dependent on the process of negotiation and factors, such as patients' expectations and appointment availability. Receptionists felt that patients in employment, patients allocated to the practice by the Health Authority, and patients who did not comply with practice appointment rules were most demanding. Appointment requests are legitimised by receptionists enforcing practice rules and requesting clinical information. Patients volunteer information to provide evidence that their complaint is appropriate and employ strategies, such as persistence, assertiveness, and threats, to try and persuade receptionists to grant appointments. Appointment making is a complex social process where outcomes are negotiated. Receptionists have an important role in managing patient demand. Practices should be explicit about how appointments are allocated, including publishing practice criteria.

  1. An experimental test of voluntary strategies to promote urban water demand management.

    PubMed

    Fielding, Kelly S; Spinks, Anneliese; Russell, Sally; McCrea, Rod; Stewart, Rodney; Gardner, John

    2013-01-15

    In light of the current and future threats to global water security the current research focuses on trialing interventions to promote urban water conservation. We report an experimental study designed to test the long-term impact of three different interventions on household water consumption in South East Queensland. Participants from 221 households were recruited and completed an initial survey, and their houses were fitted with smart water meters which measured total water usage at 5 s intervals. Households were allocated into one of four conditions: a control group and three interventions groups (water saving information alone, information plus a descriptive norm manipulation, and information plus tailored end-user feedback). The study is the first to use smart water metering technology as a tool for behaviour change as well as a way to test the effectiveness of demand management interventions. Growth curve modelling revealed that compared to the control, the three intervention groups all showed reduced levels of household consumption (an average reduction of 11.3 L per person per day) over the course of the interventions, and for some months afterwards. All interventions led to significant water savings, but long-term household usage data showed that in all cases, the reduction in water use resulting from the interventions eventually dissipated, with water consumption returning to pre-intervention levels after approximately 12 months. Implications for water demand management programs are discussed.

  2. Coordinating Demand-Side Efficiency Evaluation, Measurement and Verification Among Western States: Options for Documenting Energy and Non-Energy Impacts for the Power Sector

    SciTech Connect

    Schiller, Steven R.; Schwartz, Lisa C.

    2016-06-22

    Demand-side energy efficiency (efficiency) represents a low-cost opportunity to reduce electricity consumption and demand and provide a wide range of non-energy benefits, including avoiding air pollution. Efficiency-related energy and non-energy impacts are determined and documented by implementing evaluation, measurement and verification (EM&V) systems. This technical brief describes efficiency EM&V coordination strategies that Western states can consider taking on together, outlines EM&V-related products that might be appropriate for multistate coordination, and identifies some implications of coordination. Coordinating efficiency EM&V activities can save both time and costs for state agencies and stakeholders engaged in efficiency activities and can be particularly beneficial for multiple states served by the same utility. First, the brief summarizes basic information on efficiency, its myriad potential benefits and EM&V for assessing those benefits. Second, the brief introduces the concept of multistate EM&V coordination in the context of assessing such benefits, including achievement of state and federal goals to reduce air pollutants.1 Next, the brief presents three coordination strategy options for efficiency EM&V: information clearinghouse/exchange, EM&V product development, and a regional energy efficiency tracking system platform. The brief then describes five regional EM&V products that could be developed on a multistate basis: EM&V reporting formats, database of consistent deemed electricity savings values, glossary of definitions and concepts, efficiency EM&V methodologies, and EM&V professional standards or accreditation processes. Finally, the brief discusses options for next steps that Western states can take to consider multistate coordination on efficiency EM&V. Appendices provide background information on efficiency and EM&V, as well as definitions and suggested resources on the covered topics. This brief is intended to inform state public

  3. Managing Non-Standard Force Demands: Risk Implications of the Global Force Management System

    DTIC Science & Technology

    2012-04-26

    GLOBAL FORCE MANAGEMENT SYSTEM by James C. Wright GS-14, Department of Defense A paper submitted to the Faculty of the Joint Advanced Warfighting...School in partial satisfaction of the requirements of a Master of Science Degree in Joint Campaign Planning and Strategy. The contents of this paper ...reflect my own personal views and are not necessarily endorsed by the Joint Forces Staff College or the Department of Defense. This paper is entirely

  4. Specific side effects of long-term imipramine management of panic disorder.

    PubMed

    Mavissakalian, Matig; Perel, James; Guo, Shenyang

    2002-04-01

    In a recent study, the authors suggested that tachycardia, dry mouth, and sweating continued to burden patients with panic disorder with agoraphobia who have shown marked and stable response to 6 months of imipramine treatment at the fixed, weight-adjusted dose of 2.25 mg/kg/day. Although sexual dysfunction and weight gain were not a significant burden in that study, they are important problems in long-term treatment with antidepressant drugs. In the present study, in the context of a randomized, double-blind, placebo-controlled, 1-year discontinuation and maintenance study of 53 patients with panic disorder with agoraphobia who respond to imipramine, the authors examine the extent and the specificity of these five side effects of imipramine maintenance using data at pretreatment, at the end of 24 weeks of open imipramine treatment (or month 0 of randomization), and at months 2, 4, 6, 8, 10, and 12 of randomized treatment. Hierarchical linear modeling and repeated measures of analyses of variance in subsamples of completers confirmed that dry mouth, sweating, and increased heart rate constitute a significant and specific enduring burden of imipramine maintenance treatment. The data also revealed that weight gain is a significant and specific side effect of 1-year imipramine maintenance treatment; however, the likelihood of reporting sexual dysfunction decreased over time, with no difference between the placebo and imipramine maintenance conditions. The results are discussed in the context of previous studies of imipramine side effects in the management of depression and the available literature of sexual and weight side effects of antidepressant medications in the treatment of anxiety disorders.

  5. Management of side effects during and post-treatment in breast cancer survivors.

    PubMed

    Palesh, Oxana; Scheiber, Caroline; Kesler, Shelli; Mustian, Karen; Koopman, Cheryl; Schapira, Lidia

    2017-08-27

    Cancer-related fatigue, insomnia, and cancer-related cognitive impairment are commonly experienced symptoms that share psychological and physical manifestations. One or more of these symptoms will affect nearly all patients at some point during their course of treatment or survivorship. These side effects are burdensome and reduce patients' quality of life well beyond their cancer diagnosis and associated care treatments. Cancer-related fatigue, insomnia, and cancer-related cognitive impairment are likely to have multiple etiologies that make it difficult to identify the most effective method to manage them. In this review, we summarized the information on cancer-related fatigue, insomnia, and cancer-related cognitive impairment incidence and prevalence among breast cancer patients and survivors as well as recent research findings on pharmaceutical, psychological, and exercise interventions that have shown effectiveness in the treatment of these side effects. Our review revealed that most current pharmaceutical interventions tend to ameliorate symptoms only temporarily without addressing the underlying causes. Exercise and behavioral interventions are consistently more effective at managing chronic symptoms and possibly address an underlying etiology. Future research is needed to investigate effective interventions that can be delivered directly in clinic to a large portion of patients and survivors. © 2017 Wiley Periodicals, Inc.

  6. Sensor Management for Applied Research Technologies (SMART)-On Demand Modeling (ODM) Project

    NASA Technical Reports Server (NTRS)

    Goodman, M.; Blakeslee, R.; Hood, R.; Jedlovec, G.; Botts, M.; Li, X.

    2006-01-01

    NASA requires timely on-demand data and analysis capabilities to enable practical benefits of Earth science observations. However, a significant challenge exists in accessing and integrating data from multiple sensors or platforms to address Earth science problems because of the large data volumes, varying sensor scan characteristics, unique orbital coverage, and the steep learning curve associated with each sensor and data type. The development of sensor web capabilities to autonomously process these data streams (whether real-time or archived) provides an opportunity to overcome these obstacles and facilitate the integration and synthesis of Earth science data and weather model output. A three year project, entitled Sensor Management for Applied Research Technologies (SMART) - On Demand Modeling (ODM), will develop and demonstrate the readiness of Open Geospatial Consortium (OGC) Sensor Web Enablement (SWE) capabilities that integrate both Earth observations and forecast model output into new data acquisition and assimilation strategies. The advancement of SWE-enabled systems (i.e., use of SensorML, sensor planning services - SPS, sensor observation services - SOS, sensor alert services - SAS and common observation model protocols) will have practical and efficient uses in the Earth science community for enhanced data set generation, real-time data assimilation with operational applications, and for autonomous sensor tasking for unique data collection.

  7. Sensor Management for Applied Research Technologies (SMART) On Demand Modeling (ODM) Project

    NASA Astrophysics Data System (ADS)

    Goodman, M.; Blakeslee, R.; Hood, R.; Jedlovec, G.; Botts, M.; Li, X.

    2006-12-01

    NASA requires timely on-demand data and analysis capabilities to enable practical benefits of Earth science observations. However, a significant challenge exists in accessing and integrating data from multiple sensors or platforms to address Earth science problems because of the large data volumes, varying sensor scan characteristics, unique orbital coverage, and the steep "learning curve" associated with each sensor and data type. The development of sensor web capabilities to autonomously process these data streams (whether real- time or archived) provides an opportunity to overcome these obstacles and facilitate the integration and synthesis of Earth science data and weather model output. A three year project, entitled Sensor Management for Applied Research Technologies (SMART) On Demand Modeling (ODM), will develop and demonstrate the readiness of Open Geospatial Consortium (OGC) Sensor Web Enablement (SWE) capabilities that integrate both Earth observations and forecast model output into new data acquisition and assimilation strategies. The advancement of SWE-enabled systems (i.e., use of SensorML, sensor planning services - SPS, sensor observation services - SOS, sensor alert services - SAS and common observation model protocols) will have practical and efficient uses in the Earth science community for enhanced data set generation, real-time data assimilation with operational applications, and for autonomous sensor tasking for unique data collection.

  8. Sensor Management for Applied Research Technologies (SMART)-On Demand Modeling (ODM) Project

    NASA Technical Reports Server (NTRS)

    Goodman, M.; Blakeslee, R.; Hood, R.; Jedlovec, G.; Botts, M.; Li, X.

    2006-01-01

    NASA requires timely on-demand data and analysis capabilities to enable practical benefits of Earth science observations. However, a significant challenge exists in accessing and integrating data from multiple sensors or platforms to address Earth science problems because of the large data volumes, varying sensor scan characteristics, unique orbital coverage, and the steep learning curve associated with each sensor and data type. The development of sensor web capabilities to autonomously process these data streams (whether real-time or archived) provides an opportunity to overcome these obstacles and facilitate the integration and synthesis of Earth science data and weather model output. A three year project, entitled Sensor Management for Applied Research Technologies (SMART) - On Demand Modeling (ODM), will develop and demonstrate the readiness of Open Geospatial Consortium (OGC) Sensor Web Enablement (SWE) capabilities that integrate both Earth observations and forecast model output into new data acquisition and assimilation strategies. The advancement of SWE-enabled systems (i.e., use of SensorML, sensor planning services - SPS, sensor observation services - SOS, sensor alert services - SAS and common observation model protocols) will have practical and efficient uses in the Earth science community for enhanced data set generation, real-time data assimilation with operational applications, and for autonomous sensor tasking for unique data collection.

  9. Literacy demands and formatting characteristics of opioid contracts in chronic nonmalignant pain management.

    PubMed

    Roskos, Steven E; Keenum, Amy J; Newman, Lindsay M; Wallace, Lorraine S

    2007-10-01

    Chronic nonmalignant pain affects a significant number of adults, with many requiring opioid medications to manage their symptoms. Although the content of typical opioid contracts (OCs) has been explored, no studies have examined the literacy demands and formatting characteristics of OCs currently used throughout the United States. We evaluated 162 English-language OCs submitted to us by current American Pain Society members residing in the United States. OCs were evaluated for reading grade level and formatting characteristics. The mean readability of OCs was at grade level 13.8 +/- 1.3 (range = 10-17), whereas the average text point size was 11.0 +/- 1.4 (range = 6-16). Active voice was used exclusively in almost half of OCs (n = 79, 48.8%). Most OCs contained not only sophisticated medical language but multisyllable, nonmedical terms and vocabulary not used in typical everyday conversation. Overall, most OCs reviewed presented information at much too high a reading grade level, and with formatting characteristics that probably would make these documents difficult for the average patient to fully comprehend. This study indicates that there is a mismatch between the reading demands of most OCs and the actual health literacy skills of American adults. Accordingly, those developing OCs should be cognizant of the actual literacy abilities of their patient population and design and evaluate OCs accordingly.

  10. Integrated modeling of water supply and demand under management options and climate change scenarios in Chifeng City, China

    Treesearch

    Lu Hao; Ge Sun; Yongqiang Liu; Hong Qian

    2015-01-01

    Water resource management is becoming increasingly challenging in northern China because of the rapid increase in water demand and decline in water supply due to climate change. We provide a case study demonstrating the importance of integrated watershed management in sustaining water resources in Chifeng City, northern China. We examine the consequences of various...

  11. [Evaluation of disease management programs--current deficits, demands and methods].

    PubMed

    Gerlach, Ferdinand M; Beyer, Martin; Szecsenyi, Joachim; Raspe, Heiner

    2003-10-01

    The evaluation of disease management programmes is necessary and has been made obligatory in Germany by the Fifth Book of Social Code. So far there has been extensive ambiguity as regards the precise definition of suitable strategies for the evaluation. Considering the scientific evaluation of the diabetes contract in North-Rhine current deficits of the evaluation of already existing programmes for chronically ill patients are exemplarily described. On the basis of international experience reasonable demands are discussed that ought to be accomplished when evaluating the effectiveness and benefit of the programmes. Taking the British Medical Research Council as an example, a four-step model will be suggested as a loophole in the methodological dilemma of varying suitable study designs, which allows for the adequate evaluation of even complex interventions.

  12. A review of the surgical management of right-sided aortic arch aneurysms

    PubMed Central

    Barr, James G.; Sepehripour, Amir H.; Jarral, Omar A.; Tsipas, Pantelis; Kokotsakis, John; Kourliouros, Antonios; Athanasiou, Thanos

    2016-01-01

    Aneurysms and dissections of the right-sided aortic arch are rare and published data are limited to a few case reports and small series. The optimal treatment strategy of this entity and the challenges associated with their management are not yet fully investigated and conclusive. We performed a systematic review of the literature to identify all patients who underwent surgical or endovascular intervention for right aortic arch aneurysms or dissections. The search was limited to the articles published only in English. We focused on presentation and critically assessed different management strategies and outcomes. We identified 74 studies that reported 99 patients undergoing surgical or endovascular intervention for a right aortic arch aneurysm or dissection. The median age was 61 years. The commonest presenting symptoms were chest or back pain and dysphagia. Eighty-eight patients had an aberrant left subclavian artery with only 11 patients having the mirror image variant of a right aortic arch. The commonest pathology was aneurysm arising from a Kommerell's diverticulum occurring in over 50% of the patients. Twenty-eight patients had dissections, 19 of these were Type B and 9 were Type A. Eighty-one patients had elective operations while 18 had emergency procedures. Sixty-seven patients underwent surgical treatment, 20 patients had hybrid surgical and endovascular procedures and 12 had totally endovascular procedure. There were 5 deaths, 4 of which were in patients undergoing emergency surgery and none in the endovascular repair group. Aneurysms and dissections of a right-sided aortic arch are rare. Advances in endovascular treatment and hybrid surgical and endovascular management are making this rare pathology amenable to these approaches and may confer improved outcomes compared with conventional extensive repair techniques. PMID:27001673

  13. A Decision Support System for Demand Management of the Rio Conchos Basin, Mexico

    NASA Astrophysics Data System (ADS)

    Stewart, S.; Valdes, J.; Gastelum, J.; Brookshire, D.; Aparicio, J.; Hidalgo, J.; Velazco, I.

    2003-12-01

    that will provide a tool to simulate hydrological profiles, ecosystem variability, changes in irrigation technology, and changes in management regimes within the basin and will serve to inform decision-makers of the water demand and supply changes necessary to meet the needs of international obligations and growing populations in the short and long term. The initial set of available management options include water banking and water trading within each country as well as irrigation standards, application efficiency, and water banking across borders.

  14. Where does the Albumin go? Human Albumin Solution usage following the implementation of a demand management programme.

    PubMed

    Yazdani, M S; Retter, A; Maggs, T; Li, P; Robson, M G; Reid, C; Holmes, P; Garood, T; Robinson, S E

    2017-06-01

    To outline the Guy's and St Thomas' NHS Foundation Trust (GSTFT) and Evelina London Children's Hospital (ELCH) demand management plan for human albumin solution (HAS) and usage. There is no UK-wide guidance governing the use of HAS. A severe shortage in 2015 prompted a Trust demand management programme. Indications were categorised according to locally agreed colour code and ASFA categories. Following the implementation of the demand management programme, a 6-month audit of HAS usage was completed. A total of 1303.1 L of HAS was used in 1139 infusions; 737 infusions were 20% HAS, accounting for 175.7 L (13.5%) in 181 patients. Indications for 20% HAS were red in 53.9% (94.7 L), blue in 26.5% (46.5 L) and grey in 19.6% (34.5 L). The remaining 1127.4 L (86.5%) infused were of 4.5 and 5 % HAS. A total of 1102.3 L (97.8%) was used for plasma exchange, 941.4 L (85.4%) ASFA category I, 93.7 L (8.5%) category II, 25.5 L (2.3%) category IV and 41.7 L (3.8%) for indications not specified according to ASFA; 25.1 L (2.2%) were used for a grey indication (volume resuscitation for hypovolaemia). The demand management programme provides surveillance of indications and retrospective verification of appropriate use. The majority of HAS indications were appropriate. Plasma exchange accounted for 84.6% of HAS usage and will be the focus of further demand management strategies. The demand management programme whilst aiming to promote best transfusion practice also ensures a tool to manage future shortages according to indication and available supply. © 2017 British Blood Transfusion Society.

  15. Water demand management in Yemen and Jordan: addressing power and interests.

    PubMed

    Zeitoun, Mark; Allan, Tony; Al Aulaqi, Nasser; Jabarin, Amer; Laamrani, Hammou

    2012-01-01

    This paper investigates the extent to which entrenched interests of stakeholder groups both maintain water use practice, and may be confronted. The focus is on the agricultural sectors of Yemen and Jordan, where water resource policymakers face resistance in their attempts to reduce water use to environmentally sustainable levels through implementation of water demand management (WDM) activities. Some farmers in both countries that have invested in irrigated production of high-value crops (such as qat and bananas) benefit from a political economy that encourages increased rather than reduced water consumption. The resultant over-exploitation of water resources affects groups in unequal measures. Stakeholder analysis demonstrates that the more ‘powerful’ groups (chiefly the large landowners and the political elites, as well as the ministries of irrigation over which they exert influence) are generally opposed to reform in water use, while the proponents of WDM (e.g. water resource managers, environmental ministries and NGOs, and the international donor community) are found to have minimal influence over water use policy and decisionmaking. Efforts and ideas attempted by this latter group to challenge the status quo are classified here as either (a) influencing or (b) challenging the power asymmetry, and the merits and limits of both approaches are discussed. The interpretation of evidence suggests current practice is likely to endure, but may be more effectively challenged if a long-term approach is taken with an awareness of opportunities generated by windows of opportunity and the participation of ‘overlap groups’.

  16. Foresee: A user-centric home energy management system for energy efficiency and demand response

    DOE PAGES

    Jin, Xin; Baker, Kyri A.; Christensen, Dane T.; ...

    2017-08-23

    This paper presents foresee, a user-centric home energy management system that can help optimize how a home operates to concurrently meet users' needs, achieve energy efficiency and commensurate utility cost savings, and reliably deliver grid services based on utility signals. Foresee is built on a multiobjective model predictive control framework, wherein the objectives consist of energy cost, thermal comfort, user convenience, and carbon emission. Foresee learns user preferences on different objectives and acts on their behalf to operate building equipment, such as home appliances, photovoltaic systems, and battery storage. In this work, machine-learning algorithms were used to derive data-driven appliancemore » models and usage patterns to predict the home's future energy consumption. This approach enables highly accurate predictions of comfort needs, energy costs, environmental impacts, and grid service availability. Simulation studies were performed on field data from a residential building stock data set collected in the Pacific Northwest. Results indicated that foresee generated up to 7.6% whole-home energy savings without requiring substantial behavioral changes. When responding to demand response events, foresee was able to provide load forecasts upon receipt of event notifications and delivered the committed demand response services with 10% or fewer errors. Foresee fully utilized the potential of the battery storage and controllable building loads and delivered up to 7.0-kW load reduction and 13.5-kW load increase. As a result, these benefits are provided while maintaining the occupants' thermal comfort or convenience in using their appliances.« less

  17. Sensor Management for Applied Research Technologies (SMART) On Demand Modeling (ODM) Project

    NASA Astrophysics Data System (ADS)

    Conover, H.; Berthiau, G.; Blakeslee, R.; Botts, M.; Goodman, M.; Hood, R.; Jedlovec, G.; Li, X.; Lu, J.; Maskey, M.

    2007-12-01

    On-demand data processing and analysis of Earth science observations will facilitate timely decision making that can lead to the realization of the practical benefits of satellite instruments, airborne and surface remote sensing systems. However, a significant challenge exists in accessing and integrating data from multiple sensors or platforms to address Earth science problems because of the large data volumes, varying sensor scan characteristics, unique orbital coverage, and the steep learning curve associated with each sensor, data type and associated products. The development of sensor web capabilities to autonomously process these data streams (whether real-time or archived) provides an opportunity to overcome these obstacles and facilitate the integration and synthesis of Earth science data and weather model output. The authors will present initial results from Sensor Management for Applied Research Technologies (SMART) On Demand Modeling (ODM). This NASA- funded project is developing and demonstrating the readiness of Open Geospatial Consortium Sensor Web Enablement (SWE) capabilities that integrate both Earth observations and forecast model output into new data acquisition and assimilation strategies. First year accomplishments include development of numerous Sensor Observation Services (SOS) and an SOS registry for sensor data discovery and access, as well as a prototype user application, built on these services, for validating cloud types as observed by multiple instruments. The three-year goal of this project is to demonstration how SWE-enabled systems can have practical and efficient uses in the Earth science community for enhanced data set generation, real-time data assimilation with operational applications, and for autonomous sensor tasking for unique data collection.

  18. Nonoperative management of displaced olecranon fractures in low-demand elderly patients.

    PubMed

    Duckworth, Andrew D; Bugler, Kate E; Clement, Nicholas D; Court-Brown, Charles M; McQueen, Margaret M

    2014-01-01

    The aim of this study was to document both the short and the long-term outcomes following primary nonoperative management of isolated displaced fractures of the olecranon. We identified, from our prospective trauma database, all patients who had been managed nonoperatively for a displaced olecranon fracture over a thirteen-year period. Inclusion criteria included all isolated fractures of the olecranon with >2-mm displacement of the articular surface. The primary short-term outcome measure was the Broberg and Morrey Elbow Score. The primary long-term outcome measure was the Disabilities of the Arm, Shoulder and Hand (DASH) score. There were forty-three patients with a mean age of seventy-six years (range, forty to ninety-eight years) in the study cohort. A low-energy fall from a standing height accounted for 84% of all injuries, and one or more comorbidities were documented in thirty-eight patients (88%). At a mean of four months (range, 1.5 to ten months) following injury, the mean Broberg and Morrey score was 83 points (range, 48 to 100 points), with 72% of the patients having an excellent or good short-term outcome. No patient underwent surgery for a symptomatic nonunion. At a mean of six years (range, two to fifteen years) postinjury, the mean DASH score was 2.9 points (range, 0 to 33.9 points) and the mean Oxford Elbow Score was 47 points (range, 42 to 48 points); 91% (twenty-one) of twenty-three patients available for follow-up expressed satisfaction with the result of the procedure. We found satisfactory short-term and long-term outcomes following the nonoperative management of isolated displaced olecranon fractures in older, lower-demand patients.

  19. Capacity building in water demand management as a key component for attaining millennium development goals

    NASA Astrophysics Data System (ADS)

    Gumbo, Bekithemba; Forster, Laura; Arntzen, Jaap

    Successful water demand management (WDM) implementation as a component of integrated water resource management (IWRM) can play a significant role in the alleviation of poverty through more efficient use of available water resources. The urban population in Southern African cities is characterised by so-called ‘water poor’ communities who typically expend a high percentage of their household income on poor quality water. Usually they have no access to an affordable alternative source. Although WDM as a component of IWRM is not a panacea for poverty, it can help alleviate poverty by facilitating water services management by municipal water supply agencies (MWSAs) in the region. WDM is a key strategy for achieving the millennium development goals (MDGs) and, as such, should be given due attention in the preparation of national IWRM and water efficiency plans. Various studies in the Southern African region have indicated that capacity building is necessary for nations to develop IWRM and water-use efficiency plans to meet the targets set out in the MDGs. WDM education and training of water professionals and end-users is particularly important in developing countries, which are resource and information-access poor. In response to these findings, The World Conservation Union (IUCN) and its consulting partners, the Training and Instructional Design Academy of South Africa (TIDASA), and Centre for Applied Research (CAR) designed, developed and presented a pilot WDM Guideline Training Module for MWSAs as part of Phase II of IUCN’s Southern Africa regional WDM project. Pilot training was conducted in July 2004 in Lusaka, Zambia for a group of 36 participants involved in municipal water supply from nine Southern African countries. This paper looks at the links between building the capacity of professionals, operational staff and other role-players in the municipal water supply chain to implement WDM as part of broader IWRM strategies, and the subsequent potential for

  20. Responsible management of tropical peatlands: balancing competing demands on a fragile resource

    NASA Astrophysics Data System (ADS)

    Page, Susan; Evans, Christopher; Gauci, Vincent

    2017-04-01

    In 2010 the International Peatland Society published a strategy for responsible peatland management, with the following guiding principles: (i) ensure that high conservation value peatlands are identified and conserved, (ii) manage 'utilised' peatlands responsibly, and (iii) rehabilitate or restore drained, degraded or otherwise irreversibly changed peatlands to restore as many ecological and landscape functions as possible. At the time of its publication, the main focus of the strategy was on northern peatlands, although a few partner organisations in SE Asia were involved in the strategy consultation process. Given the rapid rate of peatland development in SE Asia in the last 7 years and the growing interest in tropical peatland rehabilitation and restoration, we believe that it is now timely to review what a strategy for responsible tropical peatland management might look like. SE Asia's peatlands cover 250,000 km2 of the region and store 69 Gt C but they are subject to continuing deforestation, biodiversity loss, land subsidence/flooding, increasing greenhouse gas (GHG) emissions, and health impacts due to air pollution from land-clearing fires, all of which pose huge regional and global challenges. Around 75% of the peatlands have been deforested in the last 20 years, with 35% of cleared land now under industrial plantation, 34% under smallholder cultivation, and 25% unutilised, largely as a result of uncontrolled land-clearing fires. The production intensity (GHG emissions per calorie produced) of crops grown on SE Asian organic soils is among the highest in the world (Carlson et al. 2016). There are clear tensions between reconciling peatland management for conservation goals (of biodiversity, carbon and natural resources) with economic and livelihood development goals. A balance needs to be struck between the absolute value and distribution of short term economic gains vs. peatland management strategies that deliver longer-term, sustainable and shared

  1. Prevention and management of glucocorticoid-induced side effects: A comprehensive review: A review of glucocorticoid pharmacology and bone health.

    PubMed

    Caplan, Avrom; Fett, Nicole; Rosenbach, Misha; Werth, Victoria P; Micheletti, Robert G

    2017-01-01

    Systemic glucocorticoids are an essential therapy for a range of conditions, but their multiple side effects can produce significant morbidity for patients. The objective of this review is to discuss these side effects while addressing 3 questions: 1) What dose and duration of glucocorticoid therapy should prompt concern for individual side effects?; 2) How should clinicians counsel patients about these complications?; and 3) How can these problems be prevented or managed? To accomplish these objectives, we have created a series of tables and algorithms based on a review of relevant data to guide counseling, prophylaxis, and management of 11 glucocorticoid side effects. The first article in this 4-part continuing medical education series begins with a review of glucocorticoid pharmacology followed by a discussion of bone health (ie, osteoporosis and osteonecrosis).

  2. Challenges in small screening laboratories: implementing an on-demand laboratory information management system.

    PubMed

    Lemmon, Vance P; Jia, Yuanyuan; Shi, Yan; Holbrook, S Douglas; Bixby, John L; Buchser, William

    2011-11-01

    The Miami Project to Cure Paralysis, part of the University of Miami Miller School of Medicine, includes a laboratory devoted to High Content Analysis (HCA) of neurons. The goal of the laboratory is to uncover signaling pathways, genes, compounds, or drugs that can be used to promote nerve growth. HCA permits the quantification of neuronal morphology, including the lengths and numbers of axons. HCA of various libraries on primary neurons requires a team-based approach, a variety of process steps and complex manipulations of cells and libraries to obtain meaningful results. HCA itself produces vast amounts of information including images, well-based data and cell-based phenotypic measures. Documenting and integrating the experimental workflows, library data and extensive experimental results is challenging. For academic laboratories generating large data sets from experiments involving thousands of perturbagens, a Laboratory Information Management System (LIMS) is the data tracking solution of choice. With both productivity and efficiency as driving rationales, the Miami Project has equipped its HCA laboratory with an On Demand or Software As A Service (SaaS) LIMS to ensure the quality of its experiments and workflows. The article discusses how the system was selected and integrated into the laboratory. The advantages of a SaaS based LIMS over a client-server based system are described.

  3. Water demand management in times of drought: What matters for water conservation

    NASA Astrophysics Data System (ADS)

    Maggioni, Elena

    2015-01-01

    Southern California is subject to long droughts and short wet spells. Its water agencies have put in place voluntary, mandatory, and market-based conservation strategies since the 1980s. By analyzing water agencies' data between 2006 and 2010, this research studies whether rebates for water efficient fixtures, water rates, or water ordinances have been effective, and tests whether structural characteristics of water agencies have affected the policy outcome. It finds that mandates to curb outdoor water uses are correlated with reductions in residential per capita water usage, while water rates and subsidies for water saving devices are not. It also confirms that size is a significant policy implementation factor. In a policy perspective, the transition from a water supply to a water demand management-oriented strategy appears guided by mandates and by contextual factors such as the economic cycle and the weather that occur outside the water governance system. Three factors could improve the conservation effort: using prices as a conservation tool, not only as a cost recovering instrument; investing in water efficient tools only when they provide significant water savings; supporting smaller agencies in order to give them opportunities to implement conservation strategies more effectively or to help them consolidate.

  4. Energy management strategy for fuel cell-supercapacitor hybrid vehicles based on prediction of energy demand

    NASA Astrophysics Data System (ADS)

    Carignano, Mauro G.; Costa-Castelló, Ramon; Roda, Vicente; Nigro, Norberto M.; Junco, Sergio; Feroldi, Diego

    2017-08-01

    Offering high efficiency and producing zero emissions Fuel Cells (FCs) represent an excellent alternative to internal combustion engines for powering vehicles to alleviate the growing pollution in urban environments. Due to inherent limitations of FCs which lead to slow transient response, FC-based vehicles incorporate an energy storage system to cover the fast power variations. This paper considers a FC/supercapacitor platform that configures a hard constrained powertrain providing an adverse scenario for the energy management strategy (EMS) in terms of fuel economy and drivability. Focusing on palliating this problem, this paper presents a novel EMS based on the estimation of short-term future energy demand and aiming at maintaining the state of energy of the supercapacitor between two limits, which are computed online. Such limits are designed to prevent active constraint situations of both FC and supercapacitor, avoiding the use of friction brakes and situations of non-power compliance in a short future horizon. Simulation and experimentation in a case study corresponding to a hybrid electric bus show improvements on hydrogen consumption and power compliance compared to the widely reported Equivalent Consumption Minimization Strategy. Also, the comparison with the optimal strategy via Dynamic Programming shows a room for improvement to the real-time strategies.

  5. A cumulative energy demand indicator (CED), life cycle based, for industrial waste management decision making.

    PubMed

    Puig, Rita; Fullana-I-Palmer, Pere; Baquero, Grau; Riba, Jordi-Roger; Bala, Alba

    2013-12-01

    Life cycle thinking is a good approach to be used for environmental decision-support, although the complexity of the Life Cycle Assessment (LCA) studies sometimes prevents their wide use. The purpose of this paper is to show how LCA methodology can be simplified to be more useful for certain applications. In order to improve waste management in Catalonia (Spain), a Cumulative Energy Demand indicator (LCA-based) has been used to obtain four mathematical models to help the government in the decision of preventing or allowing a specific waste from going out of the borders. The conceptual equations and all the subsequent developments and assumptions made to obtain the simplified models are presented. One of the four models is discussed in detail, presenting the final simplified equation to be subsequently used by the government in decision making. The resulting model has been found to be scientifically robust, simple to implement and, above all, fulfilling its purpose: the limitation of waste transport out of Catalonia unless the waste recovery operations are significantly better and justify this transport.

  6. Advertising and the Management of Aggregate Consumer Demand: A Cross-National Test of the Galbraithian Argument.

    ERIC Educational Resources Information Center

    Quarles, Rebecca C.; And Others

    John Kenneth Galbraith maintains that advertising is the prime instrument for the management of total consumer demand and results in increased consumption. Galbraith also maintains that television is a more effective advertising tool, in that it reaches people in all spectrums of intelligence. Other economists disagree, holding that it is actually…

  7. On inclusion of water resource management in Earth system models - Part 1: Problem definition and representation of water demand

    NASA Astrophysics Data System (ADS)

    Nazemi, A.; Wheater, H. S.

    2015-01-01

    Human activities have caused various changes to the Earth system, and hence the interconnections between human activities and the Earth system should be recognized and reflected in models that simulate Earth system processes. One key anthropogenic activity is water resource management, which determines the dynamics of human-water interactions in time and space and controls human livelihoods and economy, including energy and food production. There are immediate needs to include water resource management in Earth system models. First, the extent of human water requirements is increasing rapidly at the global scale and it is crucial to analyze the possible imbalance between water demands and supply under various scenarios of climate change and across various temporal and spatial scales. Second, recent observations show that human-water interactions, manifested through water resource management, can substantially alter the terrestrial water cycle, affect land-atmospheric feedbacks and may further interact with climate and contribute to sea-level change. Due to the importance of water resource management in determining the future of the global water and climate cycles, the World Climate Research Program's Global Energy and Water Exchanges project (WRCP-GEWEX) has recently identified gaps in describing human-water interactions as one of the grand challenges in Earth system modeling (GEWEX, 2012). Here, we divide water resource management into two interdependent elements, related firstly to water demand and secondly to water supply and allocation. In this paper, we survey the current literature on how various components of water demand have been included in large-scale models, in particular land surface and global hydrological models. Issues of water supply and allocation are addressed in a companion paper. The available algorithms to represent the dominant demands are classified based on the demand type, mode of simulation and underlying modeling assumptions. We discuss

  8. Descentralizacion de la educacion: Financiamiento basado en la demanda. Tendencias del Desarrollo. (Decentralization of Education: Demand-Side Financing. Directions in Development.)

    ERIC Educational Resources Information Center

    Patrinos, Harry Anthony; Ariasingam, David Lakshmanan

    Central government's supply-side expansions of schooling have not equally benefited all members of society, especially girls, indigenous peoples, tribal groups, disadvantaged minorities, and the poor. Public spending on education is often inefficient, higher education is subsidized at primary education's expense, and costs are becoming…

  9. Descentralizacion de la educacion: Financiamiento basado en la demanda. Tendencias del Desarrollo. (Decentralization of Education: Demand-Side Financing. Directions in Development.)

    ERIC Educational Resources Information Center

    Patrinos, Harry Anthony; Ariasingam, David Lakshmanan

    Central government's supply-side expansions of schooling have not equally benefited all members of society, especially girls, indigenous peoples, tribal groups, disadvantaged minorities, and the poor. Public spending on education is often inefficient, higher education is subsidized at primary education's expense, and costs are becoming…

  10. Interruptible service system: A demand-side management application for the City of Los Angeles Department of Water & Power

    SciTech Connect

    Leblanc, M.; Sweeney, D.

    1994-12-31

    The Los Angeles Department of Water & Power (LADWP) instituted an electric rate schedule, A3-B, for its largest industrial power consumers in 1985. The A3 rate provides these LADWP customers (2000 Kilowatts or more users) a significant savings on their electric service rate. LADWP benefits by having the capability to interrupt the industrial customer`s load after giving them a 10 minute warning notice of interruption. The Interruptible Service System (ISS) automates this formerly manual process and allows for continuous monitoring of the power used of the power system`s largest power consumers. An ISS remote terminal unit (RTU) is installed at each customer`s site. This RTU communicates with a master computer (desktop PC) at LADWP`s Energy Control Center (ECC). The ECC initiates control, monitoring, and interrupt operations involving all customers on the ISS rate. Communication between the master computer and the various ISS customer RTUs will be accomplished via Pacific Bell Telephone`s advanced digital network (ADN). Future Plans include expansion to monitoring and control of co-generation facilities and monitoring of other large industrial customer power consumption.

  11. Model documentation: Electricity Market Module, Load and Demand-Side Management submodule. Volume 2, Model code listing

    SciTech Connect

    Not Available

    1994-04-07

    Volume II of the documentation contains the actual source code of the LDSM submodule, and the cross reference table of its variables. The code is divided into two parts. The first part contains the main part of the source code. The second part lists the INCLUDE files referenced inside the main part of the code.

  12. Unanticipated teaching demands rise with simulation training: strategies for managing faculty workload.

    PubMed

    Acton, Robert D; Chipman, Jeffrey G; Lunden, Michelle; Schmitz, Connie C

    2015-01-01

    Using simulation to teach and assess learners represents a powerful approach to training, but one that comes with hidden costs in terms of faculty time, even if programs adopt existing curricula. Some simulators are built to be used independently by learners, but much of the surgical simulation curricula developed for cognitive and psychomotor tasks requires active faculty involvement and low learner-to-faculty teaching ratios to ensure sufficient practice with feedback. The authors hypothesize that the added teaching demands related to simulation have resulted in a significant financial burden to surgery training programs. To date, the effect of simulation-based training on faculty workload has not been estimated objectively and reported in the literature. To test their hypothesis, the authors analyzed data from 2 sources: (1) changes over time (2006-2014) in formal teaching hours and estimated faculty costs at the University of Minnesota, General Surgery Department and (2) a 2014 online survey of general surgery program directors on their use of simulation for teaching and assessment and their perceptions of workload effects. At the University of Minnesota, the total number of hours spent by department faculty in resident and student simulation events increased from 81 in annual year 2006 to 365 in annual year 2013. Estimated full-time equivalent faculty costs rose by 350% during the same period. Program directors (n = 48) of Association of Program Directors in Surgery reported either a slight (60%) or a significant (33%) increase in faculty workload with the advent of simulation, and moderate difficulty in finding enough instructors to meet this increase. Calling upon leadership for support, using diverse instructor types, and relying on "the dedicated few" represent the most common strategies. To avoid faculty burnout and successfully sustain faculty investment in simulation-based training over time, programs need to be creative in building, sustaining, and

  13. Water demand management in Malawi: problems and prospects for its promotion

    NASA Astrophysics Data System (ADS)

    Mulwafu, W.; Chipeta, C.; Chavula, G.; Ferguson, A.; Nkhoma, B. G.; Chilima, G.

    This paper discusses the status of water demand management (WDM) in Malawi. Findings from the study indicate that, while WDM is highly advocated in the urban and peri-urban areas, very few aspects of WDM are practiced in the rural areas. The water pricing structure that the supplying institutions established serves as a disincentive for water wastages in the urban areas. Both private firms and individuals use various measures to conserve water as a way of minimizing water consumption. The motives for water conservation range from profit maximization to inadequate financial resources to meet the costs of water respectively. In the rural areas where water is supplied at no cost, the people tend to pay less attention to water conservation. In cases where water providers attempted to institute factors of cost sharing, the rural inhabitants tended to be reluctant to contribute. This is so because people view water as a social good that should be supplied to them free of charge. The paper demonstrates that although some aspects of WDM are being practiced in the country, the existing conditions on the ground militate against its increased expansion as a strategy for promoting an efficient and equitable use of existing water resources. A large section of the population still lack access to potable water and the Malawi government is committed to the provision of basic water services. Yet WDM will become even more critical in future because of the growing competition for water resources, particularly due to the growing population and the increasing economic activities such as farming, industrialization and urbanization. The paper argues that despite the promising benefits that WDM has, its promotion must necessarily be infused with ideas of water supply, considering that the largest population still lacks access to potable water. Coupled with this will be the need for a proper policy framework that promotes public awareness for people to start appreciating the economic value

  14. Industrial water demand management and cleaner production potential: a case of three industries in Bulawayo, Zimbabwe

    NASA Astrophysics Data System (ADS)

    Gumbo, Bekithemba; Mlilo, Sipho; Broome, Jeff; Lumbroso, Darren

    The combination of water demand management and cleaner production concepts have resulted in both economical and ecological benefits. The biggest challenge for developing countries is how to retrofit the industrial processes, which at times are based on obsolete technology, within financial, institutional and legal constraints. Processes in closed circuits can reduce water intake substantially and minimise resource input and the subsequent waste thereby reducing pollution of finite fresh water resources. Three industries were studied in Bulawayo, Zimbabwe to identify potential opportunities for reducing water intake and material usage and minimising waste. The industries comprised of a wire galvanising company, soft drink manufacturing and sugar refining industry. The results show that the wire galvanising industry could save up to 17% of water by recycling hot quench water through a cooling system. The industry can eliminate by substitution the use of toxic materials, namely lead and ammonium chloride and reduce the use of hydrochloric acid by half through using an induction heating chamber instead of lead during the annealing step. For the soft drink manufacturing industry water intake could be reduced by 5% through recycling filter-backwash water via the water treatment plant. Use of the pig system could save approximately 12 m 3/month of syrup and help reduce trade effluent fees by Z30/m 3 of “soft drink”. Use of a heat exchanger system in the sugar refining industry can reduce water intake by approximately 57 m 3/100 t “raw sugar” effluent volume by about 28 m 3/100 t “raw sugar”. The water charges would effectively be reduced by 52% and trade effluent fees by Z3384/100 t “raw sugar” (57%). Proper equipment selection, equipment modification and good house-keeping procedures could further help industries reduce water intake and minimise waste.

  15. Occurrence and current management of side effects in chronic myeloid leukemia patients treated frontline with tyrosine kinase inhibitors.

    PubMed

    Breccia, Massimo; Alimena, Giuliana

    2013-06-01

    Tyrosine kinase inhibitors (TKIs) represent the gold standard therapy of chronic myeloid leukemia and, after being used in imatinib resistant patients, dasatinib and nilotinib are now also used in frontline. In this article, we review data about occurrence of side effects in several trials testing imatinib or second-generation tyrosine kinase inhibitors first line. Literature data about high-dose imatinib used front-line as single treatment or with different combinations is also examined. A literature search for relevant studies was undertaken mainly in PubMed. This review is aimed to summarize the safety of different treatments and to discuss the current management of most common side effects. Literature evidence supports the fact that side effects associated to TKIs seem to differ between agents, but most of side effects reported occur early within the treatment course. Second generation frontline TKIs reduce the incidence of most of side effects reported with imatinib and peculiar events observed are typically manageable through drug dose reduction or treatment interruption.

  16. The prevalence and management of side effects of lithium and anticonvulsants as mood stabilizers in bipolar disorder from a clinical perspective: a review.

    PubMed

    Dols, Annemiek; Sienaert, Pascal; van Gerven, Heleen; Schouws, Sigfried; Stevens, Anja; Kupka, Ralph; Stek, Max L

    2013-11-01

    Side effects are among the most frequent reasons preventing patients from taking their medication. Although the management of side effects is an important issue in clinical practice, particularly in patients with physical comorbidities, research on clinical management of side effects is rather scattered. The aim of this article was to provide an overview on the prevalence and management of various side effects of mood-stabilizing drugs. In December 2012, we carried out a PubMed search for publications reporting side effects in patients with bipolar disorder. Naturalistic studies describing the prevalence of side effects in treatment with mood stabilizers are sparse. We describe the prevalence of neurological, gastrointestinal, metabolic, thyroid, dermatological, nephrogenic, cognitive, sexual, hematological, hepatogenic, and teratogenic side effects of lithium, valproate, carbamazepine, and lamotrigine and discuss their clinical management. There are specific strategies that aim at reducing side effects, but, to date, studies on the efficacy of these interventions are lacking. With age, the renal elimination and hepatic metabolism of drugs reduce and comedication and somatic comorbidity increase, making elderly patients particularly susceptible to side effects. Most side effects can be managed by striving for the lowest possible dose without losing efficacy by lowering the dose below the therapeutic window. Specific measurements to limit certain side effects are available and may ameliorate treatment adherence.

  17. The bright side of snow cover effects on PV production - How to lower the seasonal mismatch between electricity supply and demand in a fully renewable Switzerland

    NASA Astrophysics Data System (ADS)

    Kahl, Annelen; Dujardin, Jérôme; Dupuis, Sonia; Lehning, Michael

    2017-04-01

    One of the major problems with solar PV in the context of a fully renewable electricity production at mid-latitudes is the trend of higher production in summer and lower production in winter. This trend is most often exactly opposite to demand patterns, causing a seasonal mismatch that requires extensive balancing power from other production sources or large storage capacities. Which possibilities do we have to bring PV production into closer correlation with demand? This question motivated our research and in response we investigated the effects of placing PV panels at different tilt angles in regions with extensive snow cover to increase winter production from ground reflected short wave radiation. The aim of this project is therefore to quantify the effect of varying snow cover duration (SCD) and of panel tilt angle on the annual total production and on production during winter months when electricity is most needed. We chose Switzerland as ideal test site, because it has a wide range of snow cover conditions and a high potential for renewable electricity production. But methods can be applied to other regions of comparable conditions for snow cover and irradiance. Our analysis can be separated into two steps: 1. A systematic, GIS and satellite-based analysis for all of Switzerland: We use time series of satellite-derived irradiance, and snow cover characteristics together with land surface cover types and elevation information to quantify the environmental conditions and to estimate potential production and ideal tilt angles. 2. A scenario-based analysis that contrasts the production patterns of different placement scenarios for PV panels in urban, rural and mountainous areas. We invoke a model of a fully renewable electricity system (including Switzerland's large hydropower system) at national level to compute the electricity import and storage capacity that will be required to balance the remaining mismatch between production and demand to further illuminate

  18. Solar radiation management - on feasibility, side effects, and reaching the 2 degree target

    NASA Astrophysics Data System (ADS)

    Korhonen, Hannele; Laakso, Anton; Ekholm, Tommi; Maalick, Zubair; Partanen, Antti-Ilari; Kokkola, Harri; Romakkaniemi, Sami

    2015-04-01

    Solar radiation management (SRM), i.e. artificially increasing the reflectivity of the Earth, has been suggested as a fast-response, low-cost method to mitigate the impacts of potential rapid future climate change. We have used 1) large eddy simulations as well as an aerosol-climate model and an earth system model to investigate the feasibility and side effects of two types of SRM (marine cloud brightening and stratospheric sulfur injections) and 2) a sequential decision-making approach to determine strategies that combine emission reductions and an uncertain SRM option to limit global mean temperature increase to 2 degree. Regarding stratospheric injections, we find that a large explosive volcanic eruption taking place while SRM is in full force would result in overcooling of the planet, as expected; however, the radiative and climate effects would be clearly smaller than could be expected from the sum of the effects from volcanic eruption alone or SRM alone. In addition, the stratospheric sulphur load would recover from the eruption faster under SRM and natural conditions. If the eruption took place in the high latitudes, the resulting global forcing would be highly dependent on the season of the eruption. Furthermore, regarding marine cloud brightening we find that the spraying of sea water drops leads to cooling due to evaporation and leads to delay in particle dispersion. This delay enhances particle scavenging, and can influence the efficacy of cloud seeding. In terms of combining emission reductions and SRM to reach the 2° C warming target, we find that before the termination risk for SRM can be completely excluded, the acceptable greenhouse gas emission pathways remain only slightly higher than in scenarios without SRM. More generally, the uncertainties in SRM start time, acceptable magnitude and sustainability mean that it can be only a limited substitute to greenhouse gas (GHG) emission reductions. If an additional constraint for CO2 concentration to

  19. Attitudes and decision-making about early-infant versus early-adolescent male circumcision: Demand-side insights for sustainable HIV prevention strategies in Zambia and Zimbabwe.

    PubMed

    Sgaier, Sema K; Sharma, Sunny; Eletskaya, Maria; Prasad, Ram; Mugurungi, Owen; Tambatamba, Bushimbwa; Ncube, Getrude; Xaba, Sinokuthemba; Nanga, Alice; Gumede-Moyo, Sehlulekile; Kretschmer, Steve

    2017-01-01

    As countries approach their scale-up targets for the voluntary medical male circumcision program for HIV prevention, they are strategizing and planning for the sustainability phase to follow. Global guidance recommends circumcising adolescent (below 14 years) and/or early infant boys (aged 0-60 days), and countries need to consider several factors before prioritizing a cohort for their sustainability phase. We provide community and healthcare provider-side insights on attitudes and decision-making process as a key input for this strategic decision in Zambia and Zimbabwe. We studied expectant parents, parents of infant boys (aged 0-60 days), family members and neo-natal and ante-natal healthcare providers in Zambia and Zimbabwe. Our integrated methodology consisted of in-depth qualitative and quantitative one-on-one interviews, and a simulated-decision-making game, to uncover attitudes towards, and the decision-making process for, early adolescent or early infant medical circumcision (EAMC or EIMC). In both countries, parents viewed early infancy and early adolescence as equally ideal ages for circumcision (38% EIMC vs. 37% EAMC in Zambia; 24% vs. 27% in Zimbabwe). If offered for free, about half of Zambian parents and almost 2 in 5 Zimbabwean parents indicated they would likely circumcise their infant boy; however, half of parents in each country perceived that the community would not accept EIMC. Nurses believed their facilities currently could not absorb EIMC services and that they would have limited ability to influence fathers, who were seen as having the primary decision-making authority. Our analysis suggests that EAMC is more accepted by the community than EIMC and is the path of least resistance for the sustainability phase of VMMC. However, parents or community members do not reject EIMC. Should countries choose to prioritize this cohort for their sustainability phase, a number of barriers around information, decision-making by parents, and supply side

  20. Attitudes and decision-making about early-infant versus early-adolescent male circumcision: Demand-side insights for sustainable HIV prevention strategies in Zambia and Zimbabwe

    PubMed Central

    Sgaier, Sema K.; Sharma, Sunny; Eletskaya, Maria; Prasad, Ram; Mugurungi, Owen; Tambatamba, Bushimbwa; Ncube, Getrude; Xaba, Sinokuthemba; Nanga, Alice; Gumede-Moyo, Sehlulekile; Kretschmer, Steve

    2017-01-01

    As countries approach their scale-up targets for the voluntary medical male circumcision program for HIV prevention, they are strategizing and planning for the sustainability phase to follow. Global guidance recommends circumcising adolescent (below 14 years) and/or early infant boys (aged 0–60 days), and countries need to consider several factors before prioritizing a cohort for their sustainability phase. We provide community and healthcare provider-side insights on attitudes and decision-making process as a key input for this strategic decision in Zambia and Zimbabwe. We studied expectant parents, parents of infant boys (aged 0–60 days), family members and neo-natal and ante-natal healthcare providers in Zambia and Zimbabwe. Our integrated methodology consisted of in-depth qualitative and quantitative one-on-one interviews, and a simulated-decision-making game, to uncover attitudes towards, and the decision-making process for, early adolescent or early infant medical circumcision (EAMC or EIMC). In both countries, parents viewed early infancy and early adolescence as equally ideal ages for circumcision (38% EIMC vs. 37% EAMC in Zambia; 24% vs. 27% in Zimbabwe). If offered for free, about half of Zambian parents and almost 2 in 5 Zimbabwean parents indicated they would likely circumcise their infant boy; however, half of parents in each country perceived that the community would not accept EIMC. Nurses believed their facilities currently could not absorb EIMC services and that they would have limited ability to influence fathers, who were seen as having the primary decision-making authority. Our analysis suggests that EAMC is more accepted by the community than EIMC and is the path of least resistance for the sustainability phase of VMMC. However, parents or community members do not reject EIMC. Should countries choose to prioritize this cohort for their sustainability phase, a number of barriers around information, decision-making by parents, and supply side

  1. The basin-level water demand management driven by dualistic water cycle and the development of Dualistic Model for Hai River Basin

    NASA Astrophysics Data System (ADS)

    Yang, Guiyu; Wang, Hao; Gan, Hong; Jia, Yangwen

    2010-05-01

    The basin water resources management (BWRM) is a coordinated project focused on the relationship between water supply and demand, which involves a united regulation and coordinated management process to maximize the benefits of available water resources, to improve the relationship between humans and water, and to develop economic systems and ecosystems. However, a water resources management system stresses different content depending on supply requirements, economic development and eco-environment protection policies in different social stages. At present, with high-intensity impact of human activities and natural precipitation reduction, contradiction between supply and demand water resources has become increasing prominent. Water shortage became a global problem. In limited supply condition water demand management becomes the focus of water resources management. However, since there is no need of technical support means, the present water demand management basically focuses on single linkages in the water cycle process, and falls short of investigation into the essence of water demand associated with the entire water cycle process. For the above reasons, selecting Haihe River basin as study area, the paper fully analyzes the "natural-artificial" dual water cycle, put forward the water demand management with "the water consumption (ET) management as the core, the seven total amount control target as the management objective. Addition, the paper achieves the quantitative for "ET management as the core, the seven total amount control indexes" by the development of Haihe River basin-level Dualsitic model

  2. Intermittent and on-demand use of proton pump inhibitors in the management of symptomatic gastroesophageal reflux disease.

    PubMed

    Bardhan, Karna Dev

    2003-03-01

    The epidemic of gastroesophageal reflux disease (GERD) in industrialized nations is currently spreading to less-developed ones, with more than half of the patients having symptomatic or mild erosive GERD. The long-term management of GERD has been dominated by daily maintenance treatment with proton pump inhibitors (PPI) to prevent relapse. It is common, however, for many patients with mild disease and infrequent symptom relapses to use a PPI only when symptoms demand. Patients with symptomatic or mild erosive GERD are therefore ideal for on-demand or intermittent treatment. The efficacy of such a strategy of intermittent treatment, or treatment of symptoms on demand, has recently been evaluated in four randomized controlled studies. These trials demonstrate that such therapeutic strategies reduce symptoms, improve quality of life, and are cost effective. In clinical practice, the author has found these treatment strategies suitable for approximately 60% of newly diagnosed patients with GERD for the long-term management of symptomatic GERD of mild or moderate severity.

  3. Clinical management of clozapine patients in relation to efficacy and side-effects.

    PubMed

    Naber, D; Holzbach, R; Perro, C; Hippius, H

    1992-05-01

    Medical charts of 480 schizophrenic in-patients (581 treatments) were analysed to evaluate the efficacy and side-effects of clozapine. Clozapine treatment lasted for mean 49 (s.d. 38) days. Of the sample, 11.0% showed worsening or no change, 31.5% slight improvement, 53.0% marked improvement and 4.5% almost total reduction of symptoms. At least one major side-effect occurred in 68.0% of patients. A combination of clozapine with classical neuroleptics, antidepressants, benzodiazepines or lithium is tolerated by most patients, but increases the incidence of some side-effects. Clozapine treatment had to be discontinued because of severe side-effects in 8.6% of patients. In 81 schizophrenic out-patients, clozapine significantly reduced the days of in-patient treatment and number of hospital readmissions. Two patients developed leucopenia but had no complications after clozapine withdrawal. This study indicates a satisfactory benefit/risk ratio and compliance in most of the patients.

  4. Future applications of high-resolution MS to meet the demands for pain management drug testing.

    PubMed

    Crews, Bridgit O

    2014-01-01

    Urine specimens submitted for pain management drug testing often contain multiple psychotherapeutic drugs, in addition to opioids. Immunoassay-based screen-and-confirm approaches typically used for clinical drug testing have limited sensitivity to detect therapeutic concentrations of many drugs prescribed in pain management and do not differentiate between drugs in the same class. In addition, screening for all the various illicit and prescription drugs that may be present in the pain management population requires as many as 10-20 individual immunoassays. High-resolution MS approaches have the potential to transform the way clinical drug testing is performed for pain management.

  5. A binational, supply-side evaluation for managing water quality and invasive fouling species on California's coastal boats.

    PubMed

    Johnson, Leigh T; Fernandez, Linda M

    2011-12-01

    Integrated solutions are needed for sustainable management of risks posed by recreational boats to coastal water quality and ecosystems. Fouling organisms roughen vessel hull surfaces, creating friction that slows sailboats and increases fuel consumption by powerboats. Hull fouling control strategies for recreational boats that are stored in the water may include antifouling hull paints, newer alternative hull coatings, periodic in-water hull cleaning, and excluding propagules by surrounding the boat with a slip liner or raising it above water on a lift. Copper discharged to harbor waters from antifouling paints via passive leaching and in-water hull cleaning may elevate dissolved copper levels above government standards. Invasive species carried among boat-hull fouling organisms may be introduced as boats move among coastal areas. Some of these species tolerate copper in antifouling paints and copper-polluted harbor waters. Policy development must consider supply-side capacity, as well as economic and environmental sustainability, in managing these issues. This paper presents a supply-side evaluation useful in developing policies to co-manage water quality and invasive species risks for recreational boats navigating along the coasts of California, the Baja California peninsula and California's Sacramento-San Joaquin Delta. Supply-side perspectives on services, materials, costs, and boat owner behaviors, such as residence and travel patterns, awareness of hull-coating choices and selection of hull coatings, are determined. Analyses include evaluation of risks, risk management capacity and costs, and role of education in risk management. The issues raised are broadly applicable, as they are appearing on research and policy agendas in diverse coastal areas. Copyright © 2011 Elsevier Ltd. All rights reserved.

  6. Haloperidol, risperidone, olanzapine and aripiprazole in the management of delirium: A comparison of efficacy, safety, and side effects.

    PubMed

    Boettger, Soenke; Jenewein, Josef; Breitbart, William

    2015-08-01

    The aim of this study was to compare the efficacy and side-effect profile of the typical antipsychotic haloperidol with that of the atypical antipsychotics risperidone, olanzapine, and aripiprazole in the management of delirium. The Memorial Delirium Assessment Scale (MDAS), the Karnofsky Performance Status (KPS) scale, and a side-effect rating were recorded at baseline (T1), after 2-3 days (T2), and after 4-7 days (T3). Some 21 cases were case-matched by age, preexisting dementia, and baseline MDAS scores, and subsequently analyzed. The baseline characteristics of the medication groups were not different: The mean age of the patients ranged from 64.0 to 69.6 years, dementia was present in between 23.8 and 28.6%, and baseline MDAS scores were 19.9 (haloperidol), 18.6 (risperidone), 19.4 (olanzapine), and 18.0 (aripiprazole). The doses of medication at T3 were 5.5 mg haloperidol, 1.3 mg risperidone, 7.1 mg olanzapine, and 18.3 mg aripiprazole. Over one week, the decline in MDAS scores between medications was equal, and no differences between individual MDAS scores existed at T2 or T3. After one week, the MDAS scores were 6.8 (haloperidol), 7.1 (risperidone), 11.7 (olanzapine), and 8.3 (aripiprazole). At T2, delirium resolution occurred in 42.9-52.4% of cases and at T3 in 61.9-85.7%; no differences in assessments between medications existed. Recorded side effects were extrapyramidal symptoms (EPSs) in haloperidol- and risperidone-managed patients (19 and 4.8%, respectively) and sedation with olanzapine (28.6%). Haloperidol, risperidone, aripiprazole, and olanzapine were equally effective in the management of delirium; however, they differed in terms of their side-effect profile. Extrapyramidal symptoms were most frequently recorded with haloperidol, and sedation occurred most frequently with olanzapine.

  7. Testing water demand management scenarios in a water-stressed basin in South Africa: application of the WEAP model

    NASA Astrophysics Data System (ADS)

    Lévite, Hervé; Sally, Hilmy; Cour, Julien

    Like many river basins in South Africa, water resources in the Olifants river basin are almost fully allocated. Respecting the so-called “reserve” (water flow reservation for basic human needs and the environment) imposed by the Water Law of 1998 adds a further dimension, if not difficulty, to water resources management in the basin, especially during the dry periods. Decision makers and local stakeholders (i.e. municipalities, water users’ associations, interest groups), who will soon be called upon to work together in a decentralized manner within Catchment Management Agencies (CMAs) and Catchment Management Committees (CMCs), must therefore be able to get a rapid and simple understanding of the water balances at different levels in the basin. This paper seeks to assess the pros and cons of using the Water Evaluation and Planning (WEAP) model for this purpose via its application to the Steelpoort sub-basin of the Olifants river. This model allows the simulation and analysis of various water allocation scenarios and, above all, scenarios of users’ behavior. Water demand management is one of the options discussed in more detail here. Simulations are proposed for diverse climatic situations from dry years to normal years and results are discussed. It is evident that the quality of data (in terms of availability and reliability) is very crucial and must be dealt with carefully and with good judgment. Secondly, credible hypotheses have to be made about water uses (losses, return flow) if the results are to be meaningfully used in support of decision-making. Within the limits of data availability, it appears that some water users are not able to meet all their requirements from the river, and that even the ecological reserve will not be fully met during certain years. But the adoption of water demand management procedures offers opportunities for remedying this situation during normal hydrological years. However, it appears that demand management alone will not

  8. Preparing the Host Country Workforce for Expatriate Managers: The Neglected Other Side of the Coin.

    ERIC Educational Resources Information Center

    Vance, Charles M.; Ring, Peter Smith

    1994-01-01

    Using an instructional systems development approach, ways to prepare the host country workforce for the assignment of an expatriate manager are discussed. The model is based on a number of perspectives: exchange theory, participatory management, corporate social responsibility, communication theory, and strategic human resource planning. (SK)

  9. The Legal Side of Campus Threat Assessment and Management: What Student Counselors Need to Know

    ERIC Educational Resources Information Center

    Nolan, Jeffrey J.; Moncure, Thomas M., Jr.

    2012-01-01

    This article identifies what student mental health professionals need to know about legal issues of relevance to threat assessment and management. The article summarizes the common law duties and the common law and statutory standards of care that are likely to apply to the work of college and university threat assessment and management teams. The…

  10. Preparing the Host Country Workforce for Expatriate Managers: The Neglected Other Side of the Coin.

    ERIC Educational Resources Information Center

    Vance, Charles M.; Ring, Peter Smith

    1994-01-01

    Using an instructional systems development approach, ways to prepare the host country workforce for the assignment of an expatriate manager are discussed. The model is based on a number of perspectives: exchange theory, participatory management, corporate social responsibility, communication theory, and strategic human resource planning. (SK)

  11. People and Process: Managing the Human Side of Information Technology Application. Professional Paper Series, #7.

    ERIC Educational Resources Information Center

    Baltzer, Jan A.

    Recognizing that the hard part of making the application of technology successful is the development of appropriate management structures and approaches, this paper reviews the research and writings of several top management and communications professionals and correlates these theories to the information technology environment on campus. Six…

  12. Self-organization versus self-management: two sides of the same coin?

    PubMed

    Clancy, Thomas R

    2009-03-01

    As systems evolve over time, their natural tendency is to become increasingly more complex. Studies in the field of complex systems have generated new perspectives on management in social organizations such as hospitals. Much of this research appears as a natural extension of the cross-disciplinary field of systems theory. This is the eighth in a series of articles applying complex systems science to the traditional management concepts of planning, organizing, directing, coordinating, and controlling. In this article, the author explores self-organization as it relates to self-management in complex social organizations.

  13. Municipal solid waste management: identification and analysis of engineering indexes representing demand and costs generated in virtuous Italian communities.

    PubMed

    Gamberini, R; Del Buono, D; Lolli, F; Rimini, B

    2013-11-01

    The definition and utilisation of engineering indexes in the field of Municipal Solid Waste Management (MSWM) is an issue of interest for technicians and scientists, which is widely discussed in literature. Specifically, the availability of consolidated engineering indexes is useful when new waste collection services are designed, along with when their performance is evaluated after a warm-up period. However, most published works in the field of MSWM complete their study with an analysis of isolated case studies. Conversely, decision makers require tools for information collection and exchange in order to trace the trends of these engineering indexes in large experiments. In this paper, common engineering indexes are presented and their values analysed in virtuous Italian communities, with the aim of contributing to the creation of a useful database whose data could be used during experiments, by indicating examples of MSWM demand profiles and the costs required to manage them. Copyright © 2013 Elsevier Ltd. All rights reserved.

  14. Successful life outcome and management of real-world memory demands despite profound anterograde amnesia

    PubMed Central

    Duff, Melissa C.; Wszalek, Tracey; Tranel, Daniel; Cohen, Neal J.

    2010-01-01

    We describe the case of Angie, a 50 year-old woman with profound amnesia (General Memory Index = 49, Full Scale IQ = 126) following a closed head injury in 1985. This case is unique in comparison to other cases reported in the literature in that, despite the severity of her amnesia, she has developed remarkable real-world life abilities, shows impressive self awareness and insight into the impairment and sparing of various functional memory abilities, and exhibits ongoing maturation of her identity and sense of self following amnesia. The case provides insights into the interaction of different memory and cognitive systems in handling real-world memory demands, and has implications for rehabilitation and for successful life outcome after amnesia. PMID:18608659

  15. Algorithm for dermocosmetic use in the management of cutaneous side-effects associated with targeted therapy in oncology

    PubMed Central

    Dreno, B; Bensadoun, RJ; Humbert, P; Krutmann, J; Luger, T; Triller, R; Rougier, A; Seité, S

    2013-01-01

    Currently, numerous patients who receive targeted chemotherapy for cancer suffer from disabling skin reactions due to cutaneous toxicity, which is a significant problem for an increasing number of patients and their treating physicians. In addition, using inappropriate personal hygiene products often worsens these otherwise manageable side-effects. Cosmetic products for personal hygiene and lesion camouflage are part of a patients’ well-being and an increasing number of physicians feel that they do not have adequate information to provide effective advice on concomitant cosmetic therapy. Although ample information is available in the literature on pharmaceutical treatment for cutaneous side-effects of chemotherapy, little is available for the concomitant use of dermatological skin-care products with medical treatments. The objective of this consensus study is to provide an algorithm for the appropriate use of dermatological cosmetics in the management of cutaneous toxicities associated with targeted chemotherapy such as epidermal growth factor receptor inhibitors and other monoclonal antibodies. These guidelines were developed by a French and German expert group of dermatologists and an oncologist for oncologists and primary care physicians who manage oncology patients. The information in this report is based on published data and the expert group’s opinion. Due to the current lack of clinical evidence, only a review of published recommendations including suggestions for concomitant cosmetic use was conducted. PMID:23368717

  16. Implications of the introduction of laboratory demand management at primary care clinics in South Africa on laboratory expenditure

    PubMed Central

    Lekalakala, Ruth; Asmall, Shaidah; Cassim, Naseem

    2016-01-01

    Background Diagnostic health laboratory services are regarded as an integral part of the national health infrastructure across all countries. Clinical laboratory tests contribute substantially to health system goals of increasing quality of care and improving patient outcomes. Objectives This study aimed to analyse current laboratory expenditures at the primary healthcare (PHC) level in South Africa as processed by the National Health Laboratory Service and to determine the potential cost savings of introducing laboratory demand management. Methods A retrospective cross-sectional analysis of laboratory expenditures for the 2013/2014 financial year across 11 pilot National Health Insurance health districts was conducted. Laboratory expenditure tariff codes were cross-tabulated to the PHC essential laboratory tests list (ELL) to determine inappropriate testing. Data were analysed using a Microsoft Access database and Excel software. Results Approximately R35 million South African Rand (10%) of the estimated R339 million in expenditures was for tests that were not listed within the ELL. Approximately 47% of expenditure was for laboratory tests that were indicated in the algorithmic management of patients on antiretroviral treatment. The other main cost drivers for non-ELL testing included full blood count and urea, as well as electrolyte profiles usually requested to support management of patients on antiretroviral treatment. Conclusions Considerable annual savings of up to 10% in laboratory expenditure are possible at the PHC level by implementing laboratory demand management. In addition, to achieve these savings, a standardised PHC laboratory request form and some form of electronic gatekeeping system that must be supported by an educational component should be implemented. PMID:28879107

  17. Implications of the introduction of laboratory demand management at primary care clinics in South Africa on laboratory expenditure.

    PubMed

    Mahomed, Ozayr H; Lekalakala, Ruth; Asmall, Shaidah; Cassim, Naseem

    2016-01-01

    Diagnostic health laboratory services are regarded as an integral part of the national health infrastructure across all countries. Clinical laboratory tests contribute substantially to health system goals of increasing quality of care and improving patient outcomes. This study aimed to analyse current laboratory expenditures at the primary healthcare (PHC) level in South Africa as processed by the National Health Laboratory Service and to determine the potential cost savings of introducing laboratory demand management. A retrospective cross-sectional analysis of laboratory expenditures for the 2013/2014 financial year across 11 pilot National Health Insurance health districts was conducted. Laboratory expenditure tariff codes were cross-tabulated to the PHC essential laboratory tests list (ELL) to determine inappropriate testing. Data were analysed using a Microsoft Access database and Excel software. Approximately R35 million South African Rand (10%) of the estimated R339 million in expenditures was for tests that were not listed within the ELL. Approximately 47% of expenditure was for laboratory tests that were indicated in the algorithmic management of patients on antiretroviral treatment. The other main cost drivers for non-ELL testing included full blood count and urea, as well as electrolyte profiles usually requested to support management of patients on antiretroviral treatment. Considerable annual savings of up to 10% in laboratory expenditure are possible at the PHC level by implementing laboratory demand management. In addition, to achieve these savings, a standardised PHC laboratory request form and some form of electronic gatekeeping system that must be supported by an educational component should be implemented.

  18. The Educational Needs of and the Future Labor Market Demand for Human Resource Managers

    ERIC Educational Resources Information Center

    Prock, Dan; Henson, Bob

    1977-01-01

    Reports and discusses results of a national survey of professionals from all fields of human resource management (HRM) and college recruiters on the content of HRM education, competency requirements of certain specialists, and the labor market for personnel administration and industrial relations (PAIR/HRM) professionals in the next three years.…

  19. Demand Management: The Primary Care Role at Ireland Army Community Hospital (IACH)

    DTIC Science & Technology

    2005-04-29

    internal medicine, and pediatrics (Kongstvedt, 2001). The principal role of primary care physicians is an inevitable evolution of managed care (Fox... Moron , Bacchetti, Baker & Bindman, 2001; Zhan, Miller, Wong, & Myer, 2004). A study examining the correlation of preventable hospitalizations and...effectiveness of primary care (Gill & Mainous, 1998; Backus, Moron , Bacchetti, Baker & Bindman, 2001; Bindman, et al., 1995; Zhan, Miller, Wong, & Myer, 2004

  20. Ophthalmic Metastasis of Breast Cancer and Ocular Side Effects from Breast Cancer Treatment and Management: Mini Review

    PubMed Central

    Paraskevopoulos, Theodore; Koutsandrea, Chryssanthi; Kardara, Evgenia; Ladas, Dimitrios

    2015-01-01

    Breast cancer is one of the most common malignant diseases occurring in women, and its incidence increases over the years. It is the main site of origin in ocular metastatic disease in women, and, due to its hematogenous nature of metastatic spread, it affects mainly the uveal tissue. The purpose of this paper is to summarize the clinical manifestations of the breast cancer ocular metastatic disease, alongside the side effects of the available treatment options for the management and regression of the systematic and ophthalmic disease. PMID:26078956

  1. Medication therapy management services in North Carolina community pharmacies: current practice patterns and projected demand.

    PubMed

    Hansen, Richard A; Roth, Mary T; Brouwer, Emily S; Herndon, Susan; Christensen, Dale B

    2006-01-01

    To evaluate the types of cognitive services offered and the number of patients being served in community pharmacies, determine the number of pharmacies that plan to offer medication therapy management (MTM) services under the Medicare Part D prescription drug benefit, and assess whether current and expected practices will meet the potential needs of enrollees. Cross-sectional study. North Carolina in January 2005. 1,593 community pharmacy managers. Survey using a Web-based tool. Provision of cognitive services and number of patients for whom services are provided. A total of 262 (16%) pharmacy managers provided usable responses. Approximately 42% of respondents (n = 110) indicated that they provide some type of cognitive service. Comprehensive MTM services, or services consistent with the professionwide consensus definition, were provided by 31% of respondents (n = 81). Independent pharmacies were more likely to offer some type of service compared with chain pharmacies (58% versus 31%, respectively; P < .001). Pharmacy managers with a doctor of pharmacy degree were less likely than pharmacy managers with a bachelor's degree to offer services in their pharmacies (P = .02), and pharmacies with pharmacists on staff who had received certificate training were more likely to offer cognitive services (P = .03). Of all respondents, 28% (n = 73) indicated that they planned to offer MTM services under the Medicare Part D prescription drug benefit. Comparing these results with those of a 1999 survey of North Carolina pharmacists that used some of the same items, the percentage of community pharmacies that provide cognitive services has increased in the intervening years but remains low. Among the services being offered in 2005, most were focused on patient education and training, coordinating and integrating care, and medication regimen reviews. Implementation of MTM services under the Medicare Part D prescription drug benefit should hasten the development and offering of

  2. Bosutinib Therapy in Patients With Chronic Myeloid Leukemia: Practical Considerations for Management of Side Effects.

    PubMed

    Ault, Patricia S; Rose PharmD, John; Nodzon PhD, Lisa A; Kaled, Elizabeth S

    2016-03-01

    The past decade has witnessed great advances in the treatment of chronic myeloid leukemia (CML), brought about in large part by the development of BCR-ABL tyrosine kinase inhibitors (TKIs). Bosutinib joins the armamentarium of approved TKIs for the treatment of chronic phase (CP), accelerated phase (AP), and blast phase (BP) Philadelphia chromosome (Ph)-positive CML resistant to or intolerant of prior therapy. Bosutinib has an adverse-event (AE) profile distinct from that of other TKIs. Diarrhea is the predominant toxicity associated with bosutinib treatment; other commonly reported nonhematologic AEs include rash and liver enzyme elevations. Cardiac events, fluid retention, and electrolyte abnormalities are infrequent. Optimal response to bosutinib requires adherence, which depends, in part, upon optimal management of associated toxicities. The oncology clinician can facilitate this process by providing patient education, timely patient follow-up, and close monitoring to promptly identify and manage AEs. Thus, optimal patient management requires a thorough and current understanding of toxicity profiles and AE management paradigms. This review provides an overview of bosutinib safety data derived from ongoing clinical trials and offers practical clinical strategies currently used to manage toxicities associated with bosutinib treatment in patients with Ph-positive CP, AP, and BP CML.

  3. Managed behavioral health care and supply-side economics. 1998 Carl Taube Lecture.

    PubMed

    Scheffler, Richard M.

    1999-03-01

    BACKGROUND: Within the past decade, the mental health care system in the United States has undergone a significant transformation in terms of delivery, financing and work force configuration. Contracting between managed care organizations (MCOs) and providers has become increasingly prevalent, paralleling the trend in health care in general. These managed care carve-outs in behavioral health depend on networks of providers who agree to capitated rates or discounted fees for service for those patients covered by the carve-out contracts. Moreover, the carve-outs use a broader array of mental health providers than is typically found in traditional indemnity plans, encourage time-limited versus long-term treatments and favor providers who are engaged in outpatient care. This phenomenal growth in managed behavioral health care over the past decade includes the rapid growth and quick consolidation of mental health MCOs. The period 1992-1998 shows steady and substantial annual increases in the number of enrollees in mental health MCOs, the figure more than doubling from 78.1 million people in 1992 to a projected 156.6 million in 1998, or 70% of insured lives. Moreover, these vast numbers of enrollees are becoming increasingly consolidated into a smaller number of firms. In 1997, 12 companies controlled nearly 85% of the managed behavioral health care market, with 60% of the market held by the three largest firms. STUDY AIMS: This article reviews empirical data and draws policy implications from the literature on managed behavioral health care in the United States. Starting with spending and spending trend estimates that show the average annual growth rate of mental health expenditures to be lower than that of health care expenditures in general over the past decade, the author examines utilization and price factors that may account for managed-care-induced cost reductions in behavioral health care, with special attention to hospital use patterns, fee discounting and the

  4. Combined energy production and waste management in manned spacecraft utilizing on-demand hydrogen production and fuel cells

    NASA Astrophysics Data System (ADS)

    Elitzur, Shani; Rosenband, Valery; Gany, Alon

    2016-11-01

    Energy supply and waste management are among the most significant challenges in human spacecraft. Great efforts are invested in managing solid waste, recycling grey water and urine, cleaning the atmosphere, removing CO2, generating and saving energy, and making further use of components and products. This paper describes and investigates a concept for managing waste water and urine to simultaneously produce electric and heat energies as well as fresh water. It utilizes an original technique for aluminum activation to react spontaneously with water at room temperature to produce hydrogen on-site and on-demand. This reaction has further been proven to be effective also when using waste water and urine. Applying the hydrogen produced in a fuel cell, one obtains electric energy as well as fresh (drinking) water. The method was compared to the traditional energy production technology of the Space Shuttle, which is based on storing the fuel cell reactants, hydrogen and oxygen, in cryogenic tanks. It is shown that the alternative concept presented here may provide improved safety, compactness (reduction of more than one half of the volume of the hydrogen storage system), and management of waste liquids for energy generation and drinking water production. Nevertheless, it adds mass compared to the cryogenic hydrogen technology. It is concluded that the proposed method may be used as an emergency and backup power system as well as an additional hydrogen source for extended missions in human spacecraft.

  5. Power management and frequency regulation for microgrid and smart grid: A real-time demand response approach

    NASA Astrophysics Data System (ADS)

    Pourmousavi Kani, Seyyed Ali

    Future power systems (known as smart grid) will experience a high penetration level of variable distributed energy resources to bring abundant, affordable, clean, efficient, and reliable electric power to all consumers. However, it might suffer from the uncertain and variable nature of these generations in terms of reliability and especially providing required balancing reserves. In the current power system structure, balancing reserves (provided by spinning and non-spinning power generation units) usually are provided by conventional fossil-fueled power plants. However, such power plants are not the favorite option for the smart grid because of their low efficiency, high amount of emissions, and expensive capital investments on transmission and distribution facilities, to name a few. Providing regulation services in the presence of variable distributed energy resources would be even more difficult for islanded microgrids. The impact and effectiveness of demand response are still not clear at the distribution and transmission levels. In other words, there is no solid research reported in the literature on the evaluation of the impact of DR on power system dynamic performance. In order to address these issues, a real-time demand response approach along with real-time power management (specifically for microgrids) is proposed in this research. The real-time demand response solution is utilized at the transmission (through load-frequency control model) and distribution level (both in the islanded and grid-tied modes) to provide effective and fast regulation services for the stable operation of the power system. Then, multiple real-time power management algorithms for grid-tied and islanded microgrids are proposed to economically and effectively operate microgrids. Extensive dynamic modeling of generation, storage, and load as well as different controller design are considered and developed throughout this research to provide appropriate models and simulation

  6. Utilizing Multimedia Case Studies to Teach the Professional Side of Project Management

    ERIC Educational Resources Information Center

    Elrod, Cassandra C.; Murray, Susan L.; Flachsbart, Barry B.; Burgher, Karl E.; Foth, Drew M.

    2010-01-01

    This research was conducted to evaluate the effectiveness of using a LITEE multimedia case study to teaching concepts in engineering courses. The LITEE Superstar case study was implemented in an engineering Project Management course. Numerous surveys regarding student expectations, outcomes, and attitudes were collected and results are presented…

  7. Introducing the Human Side of Total Quality Management into Educational Institutions.

    ERIC Educational Resources Information Center

    Thor, Linda M.

    1994-01-01

    Drawing from the experiences of Rio Salado Community College (Arizona) in implementing Total Quality Management, discusses common barriers to change (e.g., time, aversion to change, and pitfalls of change); leadership failure as a cause of failure in TQM implementation; and the importance of constancy of purpose, employee empowerment, and…

  8. Introducing the Human Side of Total Quality Management into Educational Institutions.

    ERIC Educational Resources Information Center

    Thor, Linda M.

    1994-01-01

    Drawing from the experiences of Rio Salado Community College (Arizona) in implementing Total Quality Management, discusses common barriers to change (e.g., time, aversion to change, and pitfalls of change); leadership failure as a cause of failure in TQM implementation; and the importance of constancy of purpose, employee empowerment, and…

  9. Predictive Factors and Management of Rectal Bleeding Side Effects Following Prostate Cancer Brachytherapy

    SciTech Connect

    Price, Jeremy G.; Stone, Nelson N.; Stock, Richard G.

    2013-08-01

    Purpose: To report on the incidence, nature, and management of rectal toxicities following individual or combination brachytherapy following treatment for prostate cancer over a 17-year period. We also report the patient and treatment factors predisposing to acute ≥grade 2 proctitis. Methods and Materials: A total of 2752 patients were treated for prostate cancer between October 1990 and April 2007 with either low-dose-rate brachytherapy alone or in combination with androgen depletion therapy (ADT) or external beam radiation therapy (EBRT) and were followed for a median of 5.86 years (minimum 1.0 years; maximum 19.19 years). We investigated the 10-year incidence, nature, and treatment of acute and chronic rectal toxicities following BT. Using univariate, and multivariate analyses, we determined the treatment and comorbidity factors predisposing to rectal toxicities. We also outline the most common and effective management for these toxicities. Results: Actuarial risk of ≥grade 2 rectal bleeding was 6.4%, though notably only 0.9% of all patients required medical intervention to manage this toxicity. The majority of rectal bleeding episodes (72%) occurred within the first 3 years following placement of BT seeds. Of the 27 patients requiring management for their rectal bleeding, 18 underwent formalin treatment and nine underwent cauterization. Post-hoc univariate statistical analysis revealed that coronary artery disease (CAD), biologically effective dose, rectal volume receiving 100% of the prescription dose (RV100), and treatment modality predict the likelihood of grade ≥2 rectal bleeding. Only CAD, treatment type, and RV100 fit a Cox regression multivariate model. Conclusions: Low-dose-rate prostate brachytherapy is very well tolerated and rectal bleeding toxicities are either self-resolving or effectively managed by medical intervention. Treatment planning incorporating adjuvant ADT while minimizing RV100 has yielded the best toxicity-free survival following

  10. Predictive factors and management of rectal bleeding side effects following prostate cancer brachytherapy.

    PubMed

    Price, Jeremy G; Stone, Nelson N; Stock, Richard G

    2013-08-01

    To report on the incidence, nature, and management of rectal toxicities following individual or combination brachytherapy following treatment for prostate cancer over a 17-year period. We also report the patient and treatment factors predisposing to acute ≥ grade 2 proctitis. A total of 2752 patients were treated for prostate cancer between October 1990 and April 2007 with either low-dose-rate brachytherapy alone or in combination with androgen depletion therapy (ADT) or external beam radiation therapy (EBRT) and were followed for a median of 5.86 years (minimum 1.0 years; maximum 19.19 years). We investigated the 10-year incidence, nature, and treatment of acute and chronic rectal toxicities following BT. Using univariate, and multivariate analyses, we determined the treatment and comorbidity factors predisposing to rectal toxicities. We also outline the most common and effective management for these toxicities. Actuarial risk of ≥ grade 2 rectal bleeding was 6.4%, though notably only 0.9% of all patients required medical intervention to manage this toxicity. The majority of rectal bleeding episodes (72%) occurred within the first 3 years following placement of BT seeds. Of the 27 patients requiring management for their rectal bleeding, 18 underwent formalin treatment and nine underwent cauterization. Post-hoc univariate statistical analysis revealed that coronary artery disease (CAD), biologically effective dose, rectal volume receiving 100% of the prescription dose (RV100), and treatment modality predict the likelihood of grade ≥2 rectal bleeding. Only CAD, treatment type, and RV100 fit a Cox regression multivariate model. Low-dose-rate prostate brachytherapy is very well tolerated and rectal bleeding toxicities are either self-resolving or effectively managed by medical intervention. Treatment planning incorporating adjuvant ADT while minimizing RV100 has yielded the best toxicity-free survival following BT. Copyright © 2013 Elsevier Inc. All rights

  11. An inexact double-sided chance-constrained model for air quality management in Nanshan District, Shengzhen, China

    NASA Astrophysics Data System (ADS)

    Shao, Liguo; Xu, Ye; Huang, Guohe

    2014-12-01

    In this study, an inexact double-sided fuzzy-random-chance-constrained programming (IDSFRCCP) model was developed for supporting air quality management of the Nanshan District of Shenzhen, China, under uncertainty. IDSFRCCP is an integrated model incorporating interval linear programming and double-sided fuzzy-random-chance-constrained programming models. It can express uncertain information as both fuzzy random variables and discrete intervals. The proposed model was solved based on the stochastic and fuzzy chance-constrained programming techniques and an interactive two-step algorithm. The air quality management system of Nanshan District, including one pollutant, six emission sources, six treatment technologies and four receptor sites, was used to demonstrate the applicability of the proposed method. The results indicated that the IDSFRCCP was capable of helping decision makers to analyse trade-offs between system cost and risk of constraint violation. The mid-range solutions tending to lower bounds with moderate αh and qi values were recommended as decision alternatives owing to their robust characteristics.

  12. [Analysis on long-term compliance of anticoagulation treatment and demands of disease management in patients with atrial fibrillation].

    PubMed

    Zuo, Hui-juan; Su, Jiang-lian; Lin, Yun; Zeng, Zhe-chun; Wang, Jin-wen

    2010-08-24

    To analyze the long-term compliance of oral anticoagulant therapy and the demands of disease management in patient with atrial fibrillation (AF). Inpatients with AF taking warfarin were collected from Department of Internal Medicine from January 1 to December 31, 2008. Inpatients from departments of surgery, ophthalmology, otorhinolaryngology, dermatology and pediatrics and those on a previous warfarin therapy were excluded. The data of patient profiles, medical history and anticoagulant treatment were collected from electronic medical record. And the status of anticoagulant treatment one year later and demands of disease management were inquired by telephone. A total of 268 AF patients received a telephone survey. Among them, 145 patients (54.1%) continued taking warfarin. Gender, age, type of AF, duration of AF and history of ischemic stroke was not significantly associated with the compliance of anticoagulant treatment. The odds ratio was 1.74 (95%CI: 0.67-4.47), 0.87 (95%CI: 0.30-2.53), 1.59 (95%CI: 0.35-1.09), 1.09 (95%CI: 0.61-1.93) and 0.44 (95%CI: 0.12-1.60) respectively. Among patients on warfarin, INR was monitored monthly in 88 patients (60.7%) and 70 patients (48.3%) had an INR value of 2.0-3.0. Among 123 withdrawal patients, 88 patients (71.5%) terminated treatment within 6 month. The common reasons included patient ignorance about long-term anticoagulant treatment (35.0%) and switching to aspirin because of a poor effect (24.4%). About 80% of patients wished to obtain instructions about INR monitoring and adjustment of drug dosage. Among them, 196/268 patients (73.1%) wished for a regular follow-up. And 176/196 patients (89.8%) opted for a telephone follow-up and 150/176 patients (85.2%) wanted to receive monthly instructions. The compliance of anticoagulation treatment and the target-meeting proportion of INR value are relative low. And the common reasons of withdrawal are patient ignorance about long-term anticoagulant treatment and switching to

  13. Emergency Response and Long Term Planning: Two sides of the Coin for Managing Water Resources

    NASA Astrophysics Data System (ADS)

    Metchis, K.; Beller-Simms, N.

    2014-12-01

    As projected by the US National Climate Assessment and the IPCC, extreme climate and weather events are occurring more frequently and with more intensity across the nation. Communities - and the water resource managers that serve them - are facing difficult choices to increase emergency preparedness, recover from costly impacts, and increase long term resilience. The presentation is based on a recent set of case studies about what happened in six communities that experienced one or more extreme events, focusing on water resource management. Two of the case studies will be presented, revealing that building climate resilience is not just about long term planning - it is also about taking the steps to be prepared for - and to be able to recover from - emergency events. The results of this study have implications for educating local officials on ways to think about resilience to balance both long-term and short-term preparedness.

  14. Reducing domestic heating demand: Managing the impact of behavior-changing feedback devices via marketing.

    PubMed

    Jensen, Thorben; Chappin, Émile J L

    2017-07-15

    Feedback devices can be used to inform households about their energy-consumption behavior. This may persuade them to practice energy conservation. The use of feedback devices can also-via word of mouth-spread among households and thereby support the spread of the incentivized behavior, e.g. energy-efficient heating behavior. This study investigates how to manage the impact of these environmental innovations via marketing. Marketing activities can support the diffusion of devices. This study aims to identify the most effective strategies of marketing feedback devices. We did this by adapting an agent-based model to simulate the roll-out of a novel feedback technology and heating behavior within households in a virtual city. The most promising marketing strategies were simulated and their impacts were analyzed. We found it particularly effective to lend out feedback devices to consumers, followed by leveraging the social influence of well-connected individuals, and giving away the first few feedback devices for free. Making households aware of the possibility of purchasing feedback devices was found to be least effective. However, making households aware proved to be most cost-efficient. This study shows that actively managing the roll-out of feedback devices can increase their impacts on energy-conservation both effectively and cost-efficiently. Copyright © 2017 Elsevier Ltd. All rights reserved.

  15. From all Sides: Water Resource Management in an Era of Extreme Variability

    NASA Astrophysics Data System (ADS)

    Metchis, K.; Beller-Simms, N.

    2014-12-01

    Extreme climate and weather events are occurring more frequently and with more intensity across the nation as projected by both the IPCC and the US National Climate Assessment. But these are abstract concepts until the consequences of such events are examined at the local level. Further, helping communities come to grips with what this means for building their climate resilience is better understood when multiple factors are considered. This presentation is based on a recent set of case studies about what happened in six communities that experienced one or more extreme events. Multiple interactions affect the outcome of actions taken by a variety of water-related jurisdictions, including those managing drinking water and wastewater utilities, water supply and flood control, and ecosystem and endangered species protection. Two of the case studies will be presented, showing the interdependent and cascading impacts challenging drinking water, wastewater, and stormwater utility managers and others within the watershed. Despite the unique attributes of each region, several common themes emerged from the case studies including how decisions are made, what information was used to inform decisions, what institutional dynamics helped or hindered, and how water resource managers (and their communities) are planning to deal with extreme events in the future.

  16. Municipal solid waste management: Identification and analysis of engineering indexes representing demand and costs generated in virtuous Italian communities

    SciTech Connect

    Gamberini, R. Del Buono, D.; Lolli, F.; Rimini, B.

    2013-11-15

    Highlights: • Collection and analysis of real life data in the field of Municipal Solid Waste (MSW) generation and costs for management. • Study of 92 virtuous Italian communities. • Elaboration of trends of engineering indexes useful during design and evaluation of MSWM systems. - Abstract: The definition and utilisation of engineering indexes in the field of Municipal Solid Waste Management (MSWM) is an issue of interest for technicians and scientists, which is widely discussed in literature. Specifically, the availability of consolidated engineering indexes is useful when new waste collection services are designed, along with when their performance is evaluated after a warm-up period. However, most published works in the field of MSWM complete their study with an analysis of isolated case studies. Conversely, decision makers require tools for information collection and exchange in order to trace the trends of these engineering indexes in large experiments. In this paper, common engineering indexes are presented and their values analysed in virtuous Italian communities, with the aim of contributing to the creation of a useful database whose data could be used during experiments, by indicating examples of MSWM demand profiles and the costs required to manage them.

  17. Strategy, demand, management, and costs of an international cholera vaccine stockpile.

    PubMed

    Maskery, Brian; DeRoeck, Denise; Levin, Ann; Kim, Young Eun; Wierzba, Thomas F; Clemens, John D

    2013-11-01

    In this article, we review the feasibility of mass vaccination against cholera and estimate the global population at risk for epidemic cholera. We then examine the cost of establishing and managing a cholera vaccine stockpile and summarize published mathematical models of the estimated impact of reactive vaccination campaigns developed for the current Haitian outbreak and a recent outbreak in Zimbabwe. On the basis of these evaluations, we recommend a stockpile that starts at 2 million doses, with an estimated annual cost of $5.5-$13.9 million in 2013, and grows to 10 million doses per year by 2017, with an annual cost of $27-$51 million. We believe that the stockpile can enhance efforts to mitigate future cholera outbreaks by guaranteeing the availability of cholera vaccines and, through use of the stockpile, by revealing knowledge about the efficient use of cholera vaccines during and after crises.

  18. Skills, knowledge, aptitudes, and interests for veterinary practice management: fitting personal characteristics to situational demands.

    PubMed

    Ilgen, Daniel R

    2002-01-01

    Recent studies of veterinary practices and services have suggested that more attention must be focused on business practices and on the skills, knowledge, and abilities (SKAs) of veterinarians related to veterinary practice management (VPM). Responses to these concerns have been directed at the selection and education of veterinarians in veterinary school. While this position is supported in the present article, it is argued that the values and interests of persons who are likely to enter the field, as well as the nature of the experiences encountered across the career of veterinarians, will moderate the potential effectiveness of veterinary school practices and experiences regarding SKAs in VPM. The paper explores some potential implications of these moderators on the effectiveness of selection and education for increasing SKAs in VPM.

  19. Coordination of a supply chain with consumer return under vendor-managed consignment inventory and stochastic demand

    NASA Astrophysics Data System (ADS)

    Wu, Zhihui; Chen, Dongyan; Yu, Hui

    2016-07-01

    In this paper, the problem of the coordination policy is investigated for vendor-managed consignment inventory supply chain subject to consumer return. Here, the market demand is assumed to be affected by promotional effort and consumer return policy. The optimal consignment inventory and the optimal promotional effort level are proposed under the decentralized and centralized decisions. Based on the optimal decision conditions, the markdown allowance-promotional cost-sharing contract is investigated to coordinate the supply chain. Subsequently, the comparison between the two extreme policies shows that full-refund policy dominates the no-return policy when the returning cost and the positive effect of return policy are satisfied certain conditions. Finally, a numerical example is provided to illustrate the impacts of consumer return policy on the coordination contract and optimal profit as well as the effectiveness of the proposed supply chain decision.

  20. Demand management by electronic gatekeeping of test requests does not influence requesting behaviour or save costs dramatically.

    PubMed

    Pema, Aarti K; Kiabilua, Olivia; Pillay, Tahir S

    2017-01-01

    Background Healthcare budgets face constraints, and laboratories have developed strategies to adapt to the concomitant increase in workload. Some of the tests (7.4%) may be attributed to unnecessary repeat testing. Electronic gatekeeping has been implemented at selected laboratories in South Africa to limit unnecessary repeat testing. We performed a study of chemistry tests subjected to electronic gatekeeping to determine its effectiveness as a sustainable demand management tool. Methods A 22-month retrospective study of chemistry test requests at a Pretoria hospital was performed. Tests violating electronic gatekeeping rules were rejected upon registration before analysis, and cost-savings were estimated from electronic gatekeeping-held tests. The impact of electronic gatekeeping on the test requesting pattern of clinicians was derived from the percentage cost of electronic gatekeeping-held tests. Results The total savings generated from electronic gatekeeping test rejections amounted to $84,380. Greatest savings were generated from high-cost tests: glycated haemoglobin ($14,139), urea ($8661) and thyroid-stimulating hormone ($7514). The average number of electronic gatekeeping-held tests as a percentage of their total requested number over 22 months was 3.18%. Discussion The savings from electronic gatekeeping-held tests were not as dramatic as anticipated, but were modest and may have some impact in a cost-constrained setting. Electronic gatekeeping was concluded not to have a substantial effect on the clinician test requesting pattern, demonstrated by the largely unchanged monthly percentage of electronic gatekeeping-held tests. As a solitary demand management strategy, electronic gatekeeping does not appear to be as effective as anticipated or as demonstrated in other studies.

  1. Managing an imaging department with a business perspective. A view from the other side.

    PubMed

    Merriam, J

    1999-01-01

    I came to the position of director of radiology at Winchester Hospital with two advanced degrees, in business administration and in health-care administration, to replace a director of 35 years, who had come from a technical background. That this community hospital outside Boston nourishes the entrepreneurial spirit is one of the premises underlying its success. I was supported from the beginning both by the radiologists, who supported the concept of a business-person running the department, and by the manager, whose acceptance of my role helped set the tone for the department. My goal was to create a vision for the department, which I could do only by establishing a relationship with the supervisory staff. Communication became my greatest challenge: to listen and learn from my staff and to articulate how we could move to a new level of performance. My management philosophy included giving budget responsibility to the supervisors, to teach how revenue and expense directly impact the department's business. We learned together the importance of customer service and how it, too, could impact our business. Finally, I helped supervisors offer their own ideas to solve department problems. Joining the AHRA, reading its publications and attending its conferences have helped me gain a broader perspective of the industry. Now, I see my role as a facilitator who sets a vision for the department and provides the proper support, tools and guidance for the staff to achieve results. Together, we have created a successful balance between the business and the patient care components.

  2. Convergence of Vehicle and Infrastructure Data for Traffic and Demand Management

    SciTech Connect

    Young, Stanley E.

    2015-11-16

    measurement of the quality of progression along a corridor. Though still requiring an investment in equipment and communications, these data sources are transforming traffic signal management to a data driven, performance management basis. Ever increasing availability of granular GPS trace data from automobiles may allow for assessment of traffic signal performance, allowing for signal optimization while minimizing the investment in additional sensors and communication infrastructure.

  3. Generating demand for pharmacist-provided medication therapy management: identifying patient-preferred marketing strategies.

    PubMed

    Garcia, Gladys M; Snyder, Margie E; McGrath, Stephanie Harriman; Smith, Randall B; McGivney, Melissa Somma

    2009-01-01

    To identify effective strategies for marketing pharmacist-provided medication therapy management (MTM) services to patients in a self-insured employer setting. Qualitative study. University of Pittsburgh during March through May 2008. 26 university employees taking at least one chronic medication. Three focus group sessions were conducted using a semistructured topic guide to facilitate the discussion. Employees' perceived medication-related needs, perceived benefits of pharmacist-provided MTM, potential barriers for employee participation in MTM, and effective strategies for marketing MTM. Participants reported concerns with timing of doses, medication costs, access, and ensuring adherence. Participants generally felt positively toward pharmacists; however, the level of reported patient contact with pharmacists varied among participants. Some participants questioned pharmacists' education and qualifications for this enhanced role in patient care. Perceived benefits of MTM noted by participants included the opportunity to obtain personalized information about their medications and the potential for improved communication among their health providers. Barriers to patient participation were out-of-pocket costs and lack of time for MTM visits. Participants suggested use of alternative words to describe MTM and marketing approaches that involve personal contact. Pharmacists should emphasize parts of MTM that patients feel are most beneficial (i.e., provision of a personal medication record) and use patient-friendly language to describe MTM when marketing their practice. Patients will need greater exposure to the concept of MTM and the pharmacists' role in order to correctly describe and assign value to this type of pharmacist patient care practice.

  4. The ecological side of an ethnobotanical coin: legacies in historically managed trees.

    PubMed

    Ross, Nanci J; Stevens, M Henry H; Rupiper, Andrew W; Harkreader, Ian; Leben, Laura A

    2014-10-01

    • A growing body of literature now documents how ancient human management of the landscape echoes through to extant environments in eastern North America. Plant domestication is a major theme in the study of human-nature interactions. Long-term ecological impacts of human selection may last for centuries after management ends, yet little work has focused on legacies in the evolution of historically used trees. Ecological data will be valuable in teasing apart myriad variables that confound questions of land-use legacies. We discuss the potential for legacies of ancient human selection and present a preliminary case study for the approach of integrating ecological and historical data for Diospyros virginiana, the American persimmon.• Herbarium samples of D. virginiana (28 male and 40 female) from across the species range provided specimen localities for edaphic analysis. Soil and environmental data were analyzed using nonparametric ordination, Wilcoxon summed rank test, and permutational MANOVA.• Edaphic data demonstrated substantial variation among sites, but revealed no significant differences between sexes. Permutational MANOVA showed no difference in environmental preferences for the tested variables between male and female trees (R(2) < 0.01, P = 0.8).• Extending our understanding of landscape history to the long-term impacts of artificial selection at the species or population level would be valuable in both theoretical and applied botanical research. Multidisciplinary approaches integrating ecological data will be essential for investigation of the evolutionary implications of historical human selection in economic species and the potential for adaptive flexibility in reproductive systems of long-lived perennials. © 2014 Botanical Society of America, Inc.

  5. Managing major data of genetically modified mice: from scientific demands to legal obligations.

    PubMed

    Staudt, Michael; Trauth, Jürgen; Hindi, Iris El; Galuschka, Claudia; Sitek, Dagmar; Schenkel, Johannes

    2012-10-01

    The number of genetically modified mice is increasing rapidly. Several limitations when working with these animals are to be considered: small colonies, the continued danger of loss, often a limited breeding-success, the need to keep those mutants in stock, difficult and costly import-procedures, and also a major (scientific) value of those mutants often available only with major restrictions. To gather relevant information about all active and archived genetically modified mouse lines available in-house (>1.500) and to deal with a unique resource for several, quite different purposes, a data base was developed enabling optimum knowledge management and easy access. The data base covers also legal restraints and is being linked with the institutional publication repository. To identify the lines available detailed information is provided for each line, as the international designation, a short name, the characterization/description, and the genetic modification including the technique used therefore. The origin of the mutation (gene-ID# and donor organism), the origin of regulatory elements and their donors are listed as well as the genetic background, back-cross generation, phenotype, possible publications, keywords, and some in-house information. Also aspects of animal welfare, obligations to record genetically modified organisms, and technology transfer are displayed; the latter to make licenses possible (if legally permitted). Material transfer agreements, patents, or legal restrictions are listed. This data base helps to avoid double-imports, saves animals and costs since a redundant generation or import can be omitted. However, this is a contribution to the 3R principles developed by Russell and Burch.

  6. Demand Response Analysis Tool

    SciTech Connect

    2012-03-01

    Demand Response Analysis Tool is a software developed at the Lawrence Berkeley National Laboratory. It is initially funded by Southern California Edison. Our goal in developing this tool is to provide an online, useable, with standardized methods, an analysis tool to evaluate demand and demand response performance of commercial and industrial facilities. The tool provides load variability and weather sensitivity analysis capabilities as well as development of various types of baselines. It can be used by researchers, real estate management firms, utilities, or any individuals who are interested in analyzing their demand and demand response capabilities.

  7. Risk management algorithm for rear-side collision avoidance using a combined steering torque overlay and differential braking

    NASA Astrophysics Data System (ADS)

    Lee, Junyung; Yi, Kyongsu; Yoo, Hyunjae; Chong, Hyokjin; Ko, Bongchul

    2015-06-01

    This paper describes a risk management algorithm for rear-side collision avoidance. The proposed risk management algorithm consists of a supervisor and a coordinator. The supervisor is designed to monitor collision risks between the subject vehicle and approaching vehicle in the adjacent lane. An appropriate criterion of intervention, which satisfies high acceptance to drivers through the consideration of a realistic traffic, has been determined based on the analysis of the kinematics of the vehicles in longitudinal and lateral directions. In order to assist the driver actively and increase driver's safety, a coordinator is designed to combine lateral control using a steering torque overlay by motor-driven power steering and differential braking by vehicle stability control. In order to prevent the collision while limiting actuator's control inputs and vehicle dynamics to safe values for the assurance of the driver's comfort, the Lyapunov theory and linear matrix inequalities based optimisation methods have been used. The proposed risk management algorithm has been evaluated via simulation using CarSim and MATLAB/Simulink.

  8. Beech vs. Pine - how different tree species manage their water demands

    NASA Astrophysics Data System (ADS)

    Heidbüchel, Ingo; Dreibrodt, Janek; Simard, Sonia; Güntner, Andreas; Blume, Theresa

    2016-04-01

    this as an indication that pine had access to a second water source - possibly the groundwater reached by its deep tap roots. These differences in how tree species organize and optimize their water use and adapt to potential changes in trends in precipitation patterns and amounts have important ramifications for groundwater recharge and we should continue considering them when making decisions on future forest management.

  9. Managing the Personal Side of Health: How Patient Expertise Differs from the Expertise of Clinicians

    PubMed Central

    Pratt, Wanda

    2011-01-01

    Background When patients need health information to manage their personal health, they turn to both health professionals and other patients. Yet, we know little about how the information exchanged among patients (ie, patient expertise) contrasts with the information offered by health professionals (ie, clinician expertise). Understanding how patients’ experiential expertise contrasts with the medical expertise of health professionals is necessary to inform the design of peer-support tools that meet patients’ needs, particularly with the growing prevalence of largely unguided advice sharing through Internet-based social software. Objective The objective of our study was to enhance our understanding of patient expertise and to inform the design of peer-support tools. We compared the characteristics of patient expertise with that of clinician expertise for breast cancer. Methods Through a comparative content analysis of topics discussed and recommendations offered in Internet message boards and books, we contrasted the topic, form, and style of expertise shared in sources of patient expertise with sources of clinician expertise. Results Patient expertise focused on strategies for coping with day-to-day personal health issues gained through trial and error of the lived experience; thus, it was predominately personal in topic. It offered a wealth of actionable advice that was frequently expressed through the narrative style of personal stories about managing responsibilities and activities associated with family, friends, work, and the home during illness. In contrast, clinician expertise was carried through a prescriptive style and focused on explicit facts and opinions that tied closely to the health care delivery system, biomedical research, and health professionals’ work. These differences were significant between sources of patient expertise and sources of clinician expertise in topic (P < .001), form (P < .001), and style (P < .001). Conclusion Patients

  10. Mechanism-based management for mucositis: option for treating side effects without compromising the efficacy of cancer therapy

    PubMed Central

    Kwon, Youngjoo

    2016-01-01

    Mucositis is a major side effect induced by chemotherapy and radiotherapy. Although mucositis is a leading cause of morbidity and mortality in cancer patients, management is largely limited to controlling symptoms, and few therapeutic agents are available for treatment. Since mucositis could be inhibited by the modulation of radiotherapy- or chemotherapy-induced pathways independently of cancer treatment, there is an opportunity for the development of more targeted therapies and interventions. This article examined potential therapeutic agents that have been investigated for the prevention and/or inhibition of mucositis induced by conventional chemotherapy and radiotherapy. They can be classified according to their mechanisms of action: scavenging reactive oxygen species, inhibition of specific cytokine production or inflammation, and inhibition of apoptosis. These early events may be good target pathways for preventing the pathogenesis of mucositis. Considering that both cancer therapy and therapeutic agents for mucositis act on both normal and cancer cells, agents that inhibit mucositis should act through mechanisms that selectively protect normal cells without compromising cancer treatment. Therefore, mechanism-based guidance for the treatment of mucositis is critical to prevent risky treatments for cancer patients and to relieve detrimental side effects effectively from cancer therapy. PMID:27103826

  11. Managing hypertriglyceridemia in children with systemic lupus erythematosus: Two sides of the same coin.

    PubMed

    Basu, Biswanath; Babu, Binu George; Bhattacharyya, Suman

    2016-10-04

    Hypertriglyceridemia is common in children with systemic lupus erythematosus (SLE). A retrospective analysis of the baseline clinical-pathological presentation and treatment outcome (status of lipid profiles) was performed in two children with SLE, who presented with extreme hypertriglyceridemia over a follow-up period of four weeks. The children were treated with prednisolone, mycophenolate mofetil (MMF), hydroxychloroquine and hypolipidemic agents, depending on their disease status. On serial follow-up, the first child showed a significantly raised serum triglyceride level after receiving one week of oral prednisolone therapy. Anti-lipoprotein-lipase (LPL) autoantibody was absent. Lipid profile levels of this child gradually improved after replacing oral prednisolone with another immunosuppressant, namely MMF. The second child presented with extreme hypertriglyceridemia with positive anti-LPL autoantibody. She responded to plasmapheresis followed by increasing the dose of immunosuppressant. So, extreme hypertriglyceridemia in children with SLE may be steroid induced or due to presence of anti-LPL auto antibody. Management should be individualized depending on the etiology.

  12. Smart Buildings and Demand Response

    NASA Astrophysics Data System (ADS)

    Kiliccote, Sila; Piette, Mary Ann; Ghatikar, Girish

    2011-11-01

    Advances in communications and control technology, the strengthening of the Internet, and the growing appreciation of the urgency to reduce demand side energy use are motivating the development of improvements in both energy efficiency and demand response (DR) systems in buildings. This paper provides a framework linking continuous energy management and continuous communications for automated demand response (Auto-DR) in various times scales. We provide a set of concepts for monitoring and controls linked to standards and procedures such as Open Automation Demand Response Communication Standards (OpenADR). Basic building energy science and control issues in this approach begin with key building components, systems, end-uses and whole building energy performance metrics. The paper presents a framework about when energy is used, levels of services by energy using systems, granularity of control, and speed of telemetry. DR, when defined as a discrete event, requires a different set of building service levels than daily operations. We provide examples of lessons from DR case studies and links to energy efficiency.

  13. The Real Supply-Side Economics. Occasional Paper No. 80.

    ERIC Educational Resources Information Center

    Carnevale, Anthony P.

    Economic policy today is often stated in the terms of "demand managers" and "simple supply-siders" who look upon economic policy simply as a matter of stimulus or restraint. It matters little what programs are cut as long as overall spending is reduced to cool inflation. On the other hand, the real supply-side economists…

  14. Analysis of the attitudes and needs/demands of dental practitioners in the field of patient safety and risk management.

    PubMed

    Yamalik, Nermin; Van Dijk, Ward

    2013-12-01

    Patient safety is a relatively new discipline aimed at improving the quality of care, minimising treatment errors and improving the safety of patients. Although health professions always have a specific concern for patient safety, few practitioners have a clear understanding of the broad context and not all health-care providers practice it. This might well be because of limited availability of information and materials as well as a lack of national or international laws and regulations. Thus, through member National Dental Associations (NDAs) of FDI (World Dental Federation), the present study aimed at analysing the attitudes of dental practitioners to the issues of patient safety and risk management, and the availability of materials and laws and regulations. Determination of their specific needs and demands in these fields was also attempted. For this purpose, an online questionnaire was developed for the member NDAs to respond. Questions mainly focused on the awareness regarding patient safety, availability of materials and regulations and the particular topics for which dentists needed further knowledge and information. A total of 40 responses were received. While some countries lack any documents, patient safety documents and materials were available in some countries but they were mostly limited to infection control and radiation protection and did not address other important aspects of patient safety. The NDAs clearly demanded more information. A significant number of countries also lacked national laws and/or regulations regarding patient safety. Although dentistry always has a genuine concern for patient safety, the findings of the survey suggest that yet more efforts are needed to improve the knowledge, understanding and awareness of dental practitioners regarding its broad context and the relatively 'new' patient safety culture. NDAs, dental educators, national, regional and international dental organisations and health authorities all can play

  15. Effects of postoperative background PCA morphine infusion on pain management and related side effects in patients undergoing abdominal hysterectomy.

    PubMed

    Chen, Wei-Hung; Liu, Kang; Tan, Peng-Heng; Chia, Yuan-Yi

    2011-03-01

    To examine the effects of background morphine infusion via patient-controlled intravenous analgesia (PCA) device. Randomized, controlled, double-blinded study. University-affiliated hospital. 60 ASA physical status 1 and 2 patients scheduled for abdominal hysterectomy. Patients were randomly allocated to either the PCA group without continuous background morphine infusion (Group 1; n = 30) or the PCA group with continuous background morphine infusion (Group 2; n = 30). Pain intensity during movement and at rest, morphine consumption at indicated time intervals, and related side effects were evaluated and recorded for three postoperative days at 12-hour intervals. The degree of patient satisfaction with PCA pain management was elicited and recorded. Pain intensity during movement (VASC) at 12 and 36 hours postoperatively and pain intensity at rest from 12 to 60 hours were significantly higher in Group 2 than Group 1. PCA morphine consumption for three days postoperatively in Group 2 was significantly higher. The frequency of vomiting, nausea, and dizziness were higher in Group 2. The frequency of pruritus, urinary retention, and allodynia was similar for both groups. The degree of patient satisfaction with pain management was generally equivalent between the groups. A continuous background morphine infusion of 0.5 mg/hr did not lower pain intensity during movement or at rest, but induced higher pain intensity, higher opioid usage, and more complications such as vomiting, nausea, and dizziness. Copyright © 2011 Elsevier Inc. All rights reserved.

  16. Consumer Demand Management

    SciTech Connect

    Borlase, Stuart; Chassin, David P.; Horst, Gale R.; Mohagheghi, Salman; Woychik, Eric; Zheng, Alex

    2012-10-24

    The title of the book is: Smart Grids: Infrastructure, Technology, and Solutions. The publisher is CRC Press (an imprint of Taylor & Francis Group). The book will be marketed, distributed and sold by CRC Press. The intended audiences for the book are utilities, vendors, regulators, consumers, educators and other parties interested in learning more about the drivers and technologies of smart grid initiatives in the electric utility industry. The book is based on author contributions. Authors contributing to the book will be doing so on a volunteer basis and will not be financially compensated for their contributions. Contributing authors will be recognized in each chapter of the book, but only my name will be listed as the editor of the book. The responsibility of the editor of the book is to include a broad cross-section of material from vendors, utilities and other industry partners and organizations while providing as much of an unbiased and global perspective on Smart Grid as possible. The editor works for General Electric, but the book is an independent publication and does not belong to, nor is represented, affiliated with, or sponsored by, GE, in any form or fashion. This is a book chapter that Dave Chassin is required to send to the publisher by the end of the April 2011. The ERICA submission should indicate that it is copyrighted material and will be distributed by the publisher (CRC). It is getting an external editorial review, which should be done by tomorrow.

  17. Model-based optimal design of active cool thermal energy storage for maximal life-cycle cost saving from demand management in commercial buildings

    SciTech Connect

    Cui, Borui; Gao, Dian-ce; Xiao, Fu; Wang, Shengwei

    2016-12-23

    This article provides a method in comprehensive evaluation of cost-saving potential of active cool thermal energy storage (CTES) integrated with HVAC system for demand management in non-residential building. The active storage is beneficial by shifting peak demand for peak load management (PLM) as well as providing longer duration and larger capacity of demand response (DR). In this research, a model-based optimal design method using genetic algorithm is developed to optimize the capacity of active CTES aiming for maximizing the life-cycle cost saving concerning capital cost associated with storage capacity as well as incentives from both fast DR and PLM. In the method, the active CTES operates under a fast DR control strategy during DR events while under the storage-priority operation mode to shift peak demand during normal days. The optimal storage capacities, maximum annual net cost saving and corresponding power reduction set-points during DR event are obtained by using the proposed optimal design method. Lastly, this research provides guidance in comprehensive evaluation of cost-saving potential of CTES integrated with HVAC system for building demand management including both fast DR and PLM.

  18. Model-based optimal design of active cool thermal energy storage for maximal life-cycle cost saving from demand management in commercial buildings

    DOE PAGES

    Cui, Borui; Gao, Dian-ce; Xiao, Fu; ...

    2016-12-23

    This article provides a method in comprehensive evaluation of cost-saving potential of active cool thermal energy storage (CTES) integrated with HVAC system for demand management in non-residential building. The active storage is beneficial by shifting peak demand for peak load management (PLM) as well as providing longer duration and larger capacity of demand response (DR). In this research, a model-based optimal design method using genetic algorithm is developed to optimize the capacity of active CTES aiming for maximizing the life-cycle cost saving concerning capital cost associated with storage capacity as well as incentives from both fast DR and PLM. Inmore » the method, the active CTES operates under a fast DR control strategy during DR events while under the storage-priority operation mode to shift peak demand during normal days. The optimal storage capacities, maximum annual net cost saving and corresponding power reduction set-points during DR event are obtained by using the proposed optimal design method. Lastly, this research provides guidance in comprehensive evaluation of cost-saving potential of CTES integrated with HVAC system for building demand management including both fast DR and PLM.« less

  19. Joint Real-Time Energy and Demand-Response Management using a Hybrid Coalitional-Noncooperative Game

    SciTech Connect

    He, Fulin; Gu, Yi; Hao, Jun; Zhang, Jun Jason; Wei, Jiaolong; Zhang, Yingchen

    2015-11-11

    In order to model the interactions among utility companies, building demands and renewable energy generators (REGs), a hybrid coalitional-noncooperative game framework has been proposed. We formulate a dynamic non-cooperative game to study the energy dispatch within multiple utility companies, while we take a coalitional perspective on REGs and buildings demands through a hedonic coalition formation game approach. In this case, building demands request different power supply from REGs, then the building demands can be organized into an ultimate coalition structure through a distributed hedonic shift algorithm. At the same time, utility companies can also obtain a stable power generation profile. In addition, the interactive progress among the utility companies and building demands which cannot be supplied by REGs is implemented by distributed game theoretic algorithms. Numerical results illustrate that the proposed hybrid coalitional-noncooperative game scheme reduces the cost of both building demands and utility companies compared with the initial scene.

  20. Notification: Follow-Up on OIG Report 12-P-0417, Weaknesses in EPA’s Management of the Radiation Network System Demand Attention

    EPA Pesticide Factsheets

    Project #OPE-FY14-0010, January 2, 2014. The EPA OIG is beginning preliminary research on the EPA's actions to address the recommendations in the Apr 19, 2012, OIG Report, Weaknesses in EPA's Management of the Radiation Network System Demand Attention.

  1. Addressing Energy Demand through Demand Response. International Experiences and Practices

    SciTech Connect

    Shen, Bo; Ghatikar, Girish; Ni, Chun Chun; Dudley, Junqiao; Martin, Phil; Wikler, Greg

    2012-06-01

    Demand response (DR) is a load management tool which provides a cost-effective alternative to traditional supply-side solutions to address the growing demand during times of peak electrical load. According to the US Department of Energy (DOE), demand response reflects “changes in electric usage by end-use customers from their normal consumption patterns in response to changes in the price of electricity over time, or to incentive payments designed to induce lower electricity use at times of high wholesale market prices or when system reliability is jeopardized.” 1 The California Energy Commission (CEC) defines DR as “a reduction in customers’ electricity consumption over a given time interval relative to what would otherwise occur in response to a price signal, other financial incentives, or a reliability signal.” 2 This latter definition is perhaps most reflective of how DR is understood and implemented today in countries such as the US, Canada, and Australia where DR is primarily a dispatchable resource responding to signals from utilities, grid operators, and/or load aggregators (or DR providers).

  2. A Framework for an Adaptive Seasonal Water Resources Management Tool: Developing Regional Water Shortage Triggers Incorporating Probabilistic Supply and Demand Outlooks

    NASA Astrophysics Data System (ADS)

    Wang, H.; Asefa, T.; Bracciano, D.; Adams, A.

    2016-12-01

    Defining appropriate water shortage triggers is important as water managers use them to initiate specific mitigation strategies, e.g., supply increases or demand reduction, to guide through water shortage situations. Such triggers used by most water utilities often recognize past hydrologic conditions and current systems state, e.g., reservoir storage. Seasonal supply and demand outlooks are, however, rarely used in defining water shortage triggers primary due to the skill of forecasted in both streamflow and expected demand needs at seasonal scale is limited. With recent advancement in seasonal flow forecasting from hydrologic models and/or advanced statistical models, such limitation should not be a barrier in its application in water resources management. This work demonstrates an application of three-month ahead forward looking water shortage trigger development scheme for Tampa Bay Water, a utility that has three different supply sources to meet demand. A stochastic flow generation model that maintains spatial and temporal correlation at multiple streamflow gauges was used to generate three-month ahead streamflow forecasting. A system operation model that optimizes source allocation from surface water harvesting, groundwater production and a desalination plant was used to minimize operation costs, while meeting a probabilistic regional demand that is imposed on the system. Forecasted median reservoir elevation at the end of the 3-month was used to define different water shortage phases. Different adaptation management actions were implemented as the system moves to a severe water shortage phase. Retrospective analysis using observed flow and demand in the past decade 2005-2015 was used to demonstrates the as well as benefits from implementing shortage mitigation actions. Other potential use of such water shortage trigger development is also discussed.

  3. A potential role for adjunctive vitamin D therapy in the management of weight gain and metabolic side effects of second-generation antipsychotics.

    PubMed

    Nwosu, Benjamin U; Meltzer, Bruce; Maranda, Louise; Ciccarelli, Carol; Reynolds, Daniel; Curtis, Laura; King, Jean; Frazier, Jean A; Lee, Mary M

    2011-01-01

    Second-generation antipsychotic (SGA) medications introduced about 20 years ago are increasingly used to treat psychiatric illnesses in children and adolescents. There has been a five-fold increase in the use of these medications in U.S. children and adolescents in the past decade. However, there has also been a parallel rise in the incidence of side effects associated with these medications, such as obesity, dyslipidemia, insulin resistance, and diabetes mellitus. Despite the severity of these complications and their financial impact on the national healthcare budget, there is neither a clear understanding of the mechanisms contributing to these side effects nor the best ways to address them. Studies that examined lifestyle modification and pharmaceutical agents have yielded mixed results. Therefore, clinical studies using agents, such as vitamin D, which are inexpensive, readily available, with low side effects profile, and have mechanisms to counteract the metabolic side effects of SGA agents, are warranted. Vitamin D is a prohormone with skeletal and extraskeletal properties that could potentially reduce the severity of these metabolic side effects. Its role as an adjunctive therapy for the management of metabolic side effects of SGA agents has not been adequately studied. Effective strategies to curb these side effects will improve the overall health of youths with psychiatric illnesses who receive SGAs. Herein we present a pilot study on the use of vitamin D in patients on treatment with SGAs.

  4. A potential role for adjunctive vitamin D therapy in the management of weight gain and metabolic side effects of second-generation antipsychotics

    PubMed Central

    Nwosu, Benjamin U.; Meltzer, Bruce; Maranda, Louise; Ciccarelli, Carol; Reynolds, Daniel; Curtis, Laura; King, Jean; Frazier, Jean A.; Lee, Mary M.

    2014-01-01

    Second-generation antipsychotic (SGA) medications introduced about 20 years ago are increasingly used to treat psychiatric illnesses in children and adolescents. There has been a five-fold increase in the use of these medications in U.S. children and adolescents in the past decade. However, there has also been a parallel rise in the incidence of side effects associated with these medications, such as obesity, dyslipidemia, insulin resistance, and diabetes mellitus. Despite the severity of these complications and their financial impact on the national healthcare budget, there is neither a clear understanding of the mechanisms contributing to these side effects nor the best ways to address them. Studies that examined lifestyle modification and pharmaceutical agents have yielded mixed results. Therefore, clinical studies using agents, such as vitamin D, which are inexpensive, readily available, with low side effects profile, and have mechanisms to counteract the metabolic side effects of SGA agents, are warranted. Vitamin D is a prohormone with skeletal and extraskeletal properties that could potentially reduce the severity of these metabolic side effects. Its role as an adjunctive therapy for the management of metabolic side effects of SGA agents has not been adequately studied. Effective strategies to curb these side effects will improve the overall health of youths with psychiatric illnesses who receive SGAs. Herein we present a pilot study on the use of vitamin D in patients on treatment with SGAs. PMID:22145446

  5. Uptake of meningococcal conjugate vaccine among adolescents in large managed care organizations, United States, 2005: Demand, supply and seasonality

    PubMed Central

    2009-01-01

    Background In February 2005, the US Advisory Committee on Immunization Practices recommended the new meningococcal conjugate vaccine (MCV4) for routine use among 11- to 12-year-olds (at the preadolescent health-care visit), 14- to 15-year-olds (before high-school entry), and groups at increased risk. Vaccine distribution started in March; however, in July, the manufacturer reported inability to meet demand and widespread MCV4 shortages were reported. Our objectives were to determine early uptake patterns among target (11-12 and 14-15 year olds) and non-target (13- plus 16-year-olds) age groups. A post hoc analysis was conducted to compare seasonal uptake patterns of MCV4 with polysaccharide meningococcal (MPSV4) and tetanus diphtheria (Td) vaccines. Methods We analyzed data for adolescents 11-16 years from five managed care organizations participating in the Vaccine Safety Datalink (VSD). For MCV4, we estimated monthly and cumulative coverage during 2005 and calculated risk ratios. For MPSV4 and Td, we combined 2003 and 2004 data and compared their seasonal uptake patterns with MCV4. Results Coverage for MCV4 during 2005 among the 623,889 11-16 years olds was 10%. Coverage for 11-12 and 14-15 year olds was 12% and 11%, respectively, compared with 8% for 13- plus 16-year-olds (p < 0.001). Of the 64,272 MCV4 doses administered from March-December 2005, 73% were administered June-August. Fifty-nine percent of all MPSV4 doses and 38% of all Td doses were administered during June-August. Conclusion A surge in vaccine uptake between June and August was observed among adolescents for MCV4, MPSV4 and Td vaccines. The increase in summer-time vaccinations and vaccination of non-targeted adolescents coupled with supply limitations likely contributed to the reported shortages of MCV4 in 2005. PMID:19887009

  6. Informing management on the future structure of hospital care: an extrapolation of trends in demand and costs in lung diseases.

    PubMed

    Vogl, Matthias; Leidl, Reiner

    2016-05-01

    The planning of health care management benefits from understanding future trends in demand and costs. In the case of lung diseases in the national German hospital market, we therefore analyze the current structure of care, and forecast future trends in key process indicators. We use standardized, patient-level, activity-based costing from a national cost calculation data set of respiratory cases, representing 11.9-14.1 % of all cases in the major diagnostic category "respiratory system" from 2006 to 2012. To forecast hospital admissions, length of stay (LOS), and costs, the best adjusted models out of possible autoregressive integrated moving average models and exponential smoothing models are used. The number of cases is predicted to increase substantially, from 1.1 million in 2006 to 1.5 million in 2018 (+2.7 % each year). LOS is expected to decrease from 7.9 to 6.1 days, and overall costs to increase from 2.7 to 4.5 billion euros (+4.3 % each year). Except for lung cancer (-2.3 % each year), costs for all respiratory disease areas increase: surgical interventions +9.2 % each year, COPD +3.9 %, bronchitis and asthma +1.7 %, infections +2.0 %, respiratory failure +2.6 %, and other diagnoses +8.5 % each year. The share of costs of surgical interventions in all costs of respiratory cases increases from 17.8 % in 2006 to 30.8 % in 2018. Overall costs are expected to increase particularly because of an increasing share of expensive surgical interventions and rare diseases, and because of higher intensive care, operating room, and diagnostics and therapy costs.

  7. Managing Demand and Capacity Using Multi-Sector Planning and Flexible Airspace: Human-in-the-Loop Evaluation of NextGen

    NASA Technical Reports Server (NTRS)

    Lee, Paul U.; Smith, Nancy M.; Prevot, Thomas; Homola, Jeffrey R.

    2010-01-01

    When demand for an airspace sector exceeds capacity, the balance can be re-established by reducing the demand, increasing the capacity, or both. The Multi-Sector Planner (MSP) concept has been proposed to better manage traffic demand by modifying trajectories across multiple sectors. A complementary approach to MSP, called Flexible Airspace Management (FAM), reconfigures the airspace such that capacity can be reallocated dynamically to balance the traffic demand across multiple sectors, resulting in fewer traffic management initiatives. The two concepts have been evaluated with a series of human-in-the-loop simulations at the Airspace Operations Laboratory to examine and refine the roles of the human operators in these concepts, as well as their tools and procedural requirements. So far MSP and FAM functions have been evaluated individually but the integration of the two functions is desirable since there are significant overlaps in their goals, geographic/temporal scope of the problem space, and the implementation timeframe. Ongoing research is planned to refine the humans roles in the integrated concept.

  8. Development of a Demand Sensitive Drought Index and Its Forecasting for Climate Adaptation and Water Management over the Continental United States

    NASA Astrophysics Data System (ADS)

    Etienne, E.; Khanbilvardi, R.; Devineni, N.

    2014-12-01

    Drought has cascading effects on the environment, economy and society. Seasonal water deficits resulting from natural variability in rainfall coupled with increased demands have severe implications for the adequacy of water storage in both surface and groundwater stores. Managers need better estimates of potential shortfalls in supply due to droughts of varying severity and duration. While global and national drought indicators exist, none directly connect existing or projected water demand to the potential deficit during the drought. They are essentially supply based. However, the temporal patterns of both demand and supply ultimately determine the stress or impact. Consequently, assessment of risk for various sectorial operations could be much better informed if appropriate stress indices were developed for drought conditions relative to current and projected demands, and their likelihood assessed for future climate scenarios. The present research addresses this methodological gap by (1) developing new drought indices that consider both water supply and current or projected sectorial demands, and (2) developing insights into the large-scale climatic drivers for forecasting drought onset, duration and severity up to one season ahead for climate informed adaptive risk assessment and long-term planning. We present an application at a county level for the conterminous United States considering more than 60 years of rainfall data as the renewable supply, and water demand patterns for 3 sectors (agricultural, industrial, and domestic use). The demand data are available at the county level. Consequently, we use the county rather than river basins as the unit of analysis. The county is also a spatial resolution consistent with political decision making. The index is useful for indicating whether small or large surface storage will suffice, or whether the extent of groundwater storage or external transfers, or changes in demand are needed to achieve a sustainable solution.

  9. Side Effects: Fatigue

    Cancer.gov

    Fatigue is a common side effect of many cancer treatments such as chemotherapy, radiation therapy, immunotherapy, and surgery. Anemia and pain can also cause fatigue. Learn about symptoms and way to manage fatigue.

  10. Side Effects: Diarrhea

    Cancer.gov

    Diarrhea, a side effect of cancer treatment, may cause symptoms such as loose, watery stools. Diarrhea can lead to dehydration and malnutrition in cancer patients. Learn about ways to treat and manage diarrhea during cancer treatment.

  11. Side Effects: Sleep Problems

    Cancer.gov

    Sleep problems are a common side effect during cancer treatment. Find out how a polysomnogram can assess sleep problems. Learn about the benefits of managing sleep disorders in men and women with cancer.

  12. Evaluating the comparative effectiveness of different demand side interventions to increase maternal health service utilization and practice of birth spacing in South Kivu, Democratic Republic of Congo: an innovative, mixed methods approach.

    PubMed

    Dumbaugh, Mari; Bapolisi, Wyvine; van de Weerd, Jennie; Zabiti, Michel; Mommers, Paula; Balaluka, Ghislain Bisimwa; Merten, Sonja

    2017-07-03

    In this protocol we describe a mixed methods study in the province of South Kivu, Democratic Republic of Congo evaluating the effectiveness of different demand side strategies to increase maternal health service utilization and the practice of birth spacing. Conditional service subsidization, conditional cash transfers and non-monetary incentives aim to encourage women to use maternal health services and practice birth spacing in two different health districts. Our methodology will comparatively evaluate the effectiveness of different approaches against each other and no intervention. This study comprises four main research activities: 1) Formative qualitative research to determine feasibility of planned activities and inform development of the quantitative survey; 2) A community-based, longitudinal survey; 3) A retrospective review of health facility records; 4) Qualitative exploration of intervention acceptability and emergent themes through in-depth interviews with program participants, non-participants, their partners and health providers. Female community health workers are engaged as core members of the research team, working in tandem with female survey teams to identify women in the community who meet eligibility criteria. Female community health workers also act as key informants and community entry points during methods design and qualitative exploration. Main study outcomes are completion of antenatal care, institutional delivery, practice of birth spacing, family planning uptake and intervention acceptability in the communities. Qualitative methods also explore decision making around maternal health service use, fertility preference and perceptions of family planning. The innovative mixed methods design allows quantitative data to inform the relationships and phenomena to be explored in qualitative collection. In turn, qualitative findings will be triangulated with quantitative findings. Inspired by the principles of grounded theory, qualitative

  13. The accuracy and reproducibility of video assessment in the pitch-side management of concussion in elite rugby.

    PubMed

    Fuller, G W; Kemp, S P T; Raftery, M

    2017-03-01

    To investigate the accuracy and reliability of side-line video review of head impact events to aid identification of concussion in elite sport. Diagnostic accuracy and inter-rater agreement study. Immediate care, match day and team doctors involved in the 2015 Rugby Union World Cup viewed 20 video clips showing broadcaster's footage of head impact events occurring during elite Rugby matches. Subjects subsequently recorded whether any criteria warranting permanent removal from play or medical room head injury assessment were present. The accuracy of these ratings were compared to consensus expert opinion by calculating mean sensitivity and specificity across raters. The reproducibility of doctor's decisions was additionally assessed using raw agreement and Gwets AC1 chance corrected agreement coefficient. Forty rugby medicine doctors were included in the study. Compared to the expert reference standard overall sensitivity and specificity of doctors decisions were 77.5% (95% CI 73.1-81.5%) and 53.3% (95% CI 48.2-58.2%) respectively. Overall there was raw agreement of 67.8% (95% CI 57.9-77.7%) between doctors across all video clips. Chance corrected Gwets AC1 agreement coefficient was 0.39 (95% CI 0.17-0.62), indicating fair agreement. Rugby World Cup doctors' demonstrated moderate accuracy and fair reproducibility in head injury event decision making when assessing video clips of head impact events. The use of real-time video may improve the identification, decision making and management of concussion in elite sports. Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  14. Simulating long-term past changes in the balance between water demand and availability and assessing their main drivers at the river basin management scale

    NASA Astrophysics Data System (ADS)

    Fabre, J.; Ruelland, D.; Dezetter, A.; Grouillet, B.

    2014-11-01

    The aim of this study was to assess the balance between water demand and availability and its spatial and temporal variability from 1971 to 2009 in the Herault (2500 km2, France) and the Ebro (85 000 km2, Spain) catchments. Natural streamflow was evaluated using a conceptual hydrological model. The regulation of river flow was accounted for through a widely applicable demand-driven reservoir management model applied to the largest dam in the Herault basin and to 11 major dams in the Ebro basin. Urban water demand was estimated from population and monthly unit water consumption data. Water demand for irrigation was computed from irrigated area, crop and soil data, and climatic forcing. Finally, a series of indicators comparing water supply and water demand at strategic resource and demand nodes were computed at a 10 day time step. Variations in water stress in each catchment over the past 40 years were successfully modeled, taking into account climatic and anthropogenic pressures and changes in water management strategies over time. Observed changes in discharge were explained by separating human and hydro-climatic pressures on water resources: respectively 20 and 3% of the decrease in the Ebro and the Herault discharges were linked to human-induced changes. Although key areas of the Herault basin were shown to be highly sensitive to hydro-climatic variability, the balance between water uses and availability in the Ebro basin appears to be more critical, owing to high agricultural pressure on water resources. The proposed modeling framework is currently being used to assess water stress under climatic and socio-economic prospective scenarios. Further research will investigate the effectiveness of adaptation policies aimed at maintaining the balance between water use and availability.

  15. New drugs, new toxicities: severe side effects of modern targeted and immunotherapy of cancer and their management.

    PubMed

    Kroschinsky, Frank; Stölzel, Friedrich; von Bonin, Simone; Beutel, Gernot; Kochanek, Matthias; Kiehl, Michael; Schellongowski, Peter

    2017-04-14

    is also essential for regeneration and tissue repair. Therefore, severe vascular side effects, including thromboembolic events, gastrointestinal bleeding or perforation, hypertension, and congestive heart failure, compromise antitumor efficacy.The limited knowledge of the pathophysiology and management of life-threatening complications relating to new cancer drugs presents a need to provide ICU staff, oncologists, and organ specialists with evidence-based algorithms.

  16. The impact of demand management strategies on parents' decision-making for out-of-hours primary care: findings from a survey in The Netherlands.

    PubMed

    Giesen, Marie-Jeanne; Keizer, Ellen; van de Pol, Julia; Knoben, Joris; Wensing, Michel; Giesen, Paul

    2017-05-09

    To explore the potential impact of demand management strategies on patient decision-making in medically non-urgent and urgent scenarios during out-of-hours for children between the ages of 0 and 4 years. We conducted a cross-sectional survey with paper-based case scenarios. A survey was sent to all 797 parents of children aged between 0 and 4 years from four Dutch general practitioner (GP) practices. Four demand management strategies (copayment, online advice, overview medical cost and GP appointment next morning) were incorporated in two medically non-urgent and two urgent case scenarios. Combining the case scenarios with the demand management strategies resulted in 16 cases (four scenarios each with four demand management strategies). Each parent randomly received a questionnaire with three different case scenarios with three different demand strategies and a baseline case scenario without a demand management strategy. The response rate was 47.4%. The strategy online advice led to more medically appropriate decision-making for both non-urgent case scenarios (OR 0.26; CI 0.11 to 0.58) and urgent case scenarios (OR 0.16; CI 0.08 to 0.32). Overview of medical cost (OR 0.59; CI 0.38 to 0.92) and a GP appointment planned the next morning (OR 0.57; CI 0.34 to 0.97) had some influence on patient decisions for urgent cases, but not for non-urgent cases. Copayment had no influence on patient decisions. Online advice has the highest potential to reduce medically unnecessary use. Furthermore it enhanced safety of parents' decisions on seeking help for their young children during out-of-hours primary care. Valid online information on health symptoms for patients should be promoted. © 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.

  17. [Imatinib plasma levels in the management of cutaneous side effects induced by imatinib (Glivec®): 2 case reports].

    PubMed

    Trabelsi, Sameh; Gaïes, Emna; Sraïri, Samia; Sahnoun, Rim; Daghfous, Riadh; Lakhal, Mohamed; El Aïdli, Sihem; Klouz, Anis

    2013-01-01

    Imatinib, an antineoplastic drug used to treat certain cancers, has many side effects such as hematologic, neurologic or cutaneous toxicity. These toxicities seem to be due to a high imatinib plasmatic concentration and are frequently controlled by a discontinuation or a dosage reduction of the drug. We report here in 2 cases of cutaneous side effects induced by imatinib in order to demonstrate the necessity of drug monitoring in such cases. In our cases, imatinib is responsible in the occurrence of these side effects. Monitoring plasma levels of imatinib allowed us to judge if levels were toxic or not and to avoid discontinuation of imatinib in some cases.

  18. Groundwater demand management at local scale in rural areas of India: a strategy to ensure water well sustainability based on aquifer diffusivity and community participation

    NASA Astrophysics Data System (ADS)

    Kulkarni, Himanshu; Vijay Shankar, P. S.; Deolankar, S. B.; Shah, Mihir

    Watershed development programmes provide an opportunity for sustainable management strategies, although currently, they remain largely `supply-side' mechanisms of water resources development. Hydrogeological conditions, community participation and status of groundwater usage are important in evolving strategies on `demand-side' groundwater management. Neemkheda aquifer is a typical low-storage, low-hydraulic conductivity aquifer from a watershed in the dryland regions of Madhya Pradesh State of central India. A shallow unconfined aquifer, it consists of an upper coarse, calcareous sandstone unit underlain by a fine-grained sandstone unit. A `well commune' of seven wells is poised to test the concept of joint groundwater management, wherein wells are mechanisms of tapping a common water source, the Neemkheda aquifer. The strategy for systematic groundwater management in the Neemkheda well commune is based upon the relationship between Transmissivity (T) and Storage coefficient (S), i.e. aquifer diffusivity, and its variation within the aquifer. Wells within a high diffusivity domain tend to dewater more quickly than wells within a low diffusivity domain. A well-use schedule during the dry season, based upon aquifer diffusivity forms the basis of the groundwater management concept. The distribution of local aquifer diffusivities governs the relationship between local and regional aquifer depletion times and forms the basis of the groundwater management exercise being proposed for the Neemkheda aquifer. Los programas de desarrollo de una cuenca hídrica son una oportunidad para el uso de estrategias de gestión sostenible, aunque hoy en día estas siguen siendo principalmente mecanismos para el desarrollo de recursos hídricos con énfasis en la ``oferta''. Las condiciones hidrogeológicas, la participación comunitaria y la condición de utilización del agua subterránea, son importantes en el desarrollo de estrategias para la gestión del agua subterránea, desde

  19. Aromatase inhibitor associated arthralgia: the importance of oncology provider-patient communication about side effects and potential management through physical activity.

    PubMed

    Nyrop, Kirsten A; Callahan, Leigh F; Rini, Christine; Altpeter, Mary; Hackney, Betsy; DePue, Amy; Wilson, Anne; Schechter, Arielle; Muss, Hyman B

    2016-06-01

    Breast cancer survivors on aromatase inhibitors (AI) often experience side effects of joint pain, stiffness, or achiness (arthralgia). This study presents findings from a qualitative study of survivors on an AI regarding their knowledge of potential joint pain side effects and how both AI side effects and their management through moderate physical activity could be discussed during routine visits with their oncology provider. Qualitative data from semi-structured interviews were content analyzed for emergent themes. Descriptive statistics summarize sample characteristics. Our sample included 36 survivors, mean age of 67 (range 46-87); 86 % Caucasian and 70 % had education beyond high school. AI experience are as follows: 64 % anastrozole/Arimidex, 48 % letrozole/Femara, and 31 % exemestane/Aromasin. Participants expressed interest in having more information about potential joint pain side effects when the AI was prescribed so they could understand their joint symptoms when they appeared or intensified. They were relieved to learn that their joint symptoms were not unusual or "in their head." Participants would have been especially motivated to try walking as a way to manage their joint pain if physical activity had been recommended by their oncologist. Breast cancer survivors who are prescribed an AI as part of their adjuvant treatment want ongoing communication with their oncology provider about the potential for joint pain side effects and how these symptoms may be managed through regular physical activity. The prescription of an AI presents a "teachable moment" for oncologists to recommend and encourage their patients to engage in regular physical activity.

  20. Integrating policies for the management of animal genetic resources with demand for livestock products and environmental sustainability

    USDA-ARS?s Scientific Manuscript database

    Recognition of the need to conserve animal genetic resources comes at a time when the global livestock sector faces significant challenges in meeting the growing demand for livestock products and the mitigation of negative environmental impacts caused by livestock. Outside of the U.S. it would seem ...

  1. Demanding Satisfaction

    ERIC Educational Resources Information Center

    Oguntoyinbo, Lekan

    2010-01-01

    It was the kind of crisis most universities dread. In November 2006, a group of minority student leaders at Indiana University-Purdue University Indianapolis (IUPUI) threatened to sue the university if administrators did not heed demands that included providing more funding for multicultural student groups. This article discusses how this threat…

  2. A Supply and Demand Management Perspective on the Accelerated Global Introductions of Inactivated Poliovirus Vaccine in a Constrained Supply Market.

    PubMed

    Lewis, Ian; Ottosen, Ann; Rubin, Jennifer; Blanc, Diana Chang; Zipursky, Simona; Wootton, Emily

    2017-07-01

    A total of 105 countries have introduced IPV as of September 2016 of which 85 have procured the vaccine through UNICEF. The Global Eradication and Endgame Strategic Plan 2013-2018 called for the rapid introduction of at least one dose of IPV into routine immunization schedules in 126 all OPV-using countries by the end of 2015. At the time of initiating the procurement process, demand was estimated based on global modeling rather than individual country indications. In its capacity as procurement agency for the Global Polio Eradication Initiative and Gavi, the Vaccine Alliance, UNICEF set out to secure access to IPV supply for around 100 countries. Based on offers received, sufficient supply was awarded to two manufacturers to meet projected routine requirements. However, due to technical issues scaling up vaccine production and an unforecasted demand for IPV use in campaigns to interrupt wild polio virus and to control type 2 vaccine derived polio virus outbreaks, IPV supplies are severely constrained. Activities to stretch supplies and to suppress demand have been ongoing since 2014, including delaying IPV introduction in countries where risks of type 2 reintroduction are lower, implementing the multi-dose vial policy, and encouraging the use of fractional dose delivered intradermally. Despite these efforts, there is still insufficient IPV supply to meet demand. The impact of the supply situation on IPV introduction timelines in countries are the focus of this article, and based on lessons learned with the IPV introductions, it is recommended for future health programs with accelerated scale up of programs, to take a cautious approach on supply commitments, putting in place clear allocation criteria in case of shortages or delays and establishing a communication strategy vis a vis beneficiaries. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

  3. 77 FR 3544 - Meeting and Webinar on the Active Traffic and Demand Management and Intelligent Network Flow...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-24

    ... North Capitol Street NW., Washington, DC 20001, (202) 624-5490. Persons planning to attend any part of...-ready technologies and innovative operational approaches for managing traffic congestion within the... transportation network. Issued in Washington, DC, on the 18th day of January 2012. John Augustine, Managing...

  4. Demand management: an audit of chemical pathology test rejections by an electronic gate-keeping system at an academic hospital in Cape Town.

    PubMed

    Smit, Ida; Zemlin, Annalise E; Erasmus, Rajiv T

    2015-07-01

    Demand management is an area of laboratory activity, which is becoming increasingly important. Within the health-care system, demand management can be defined as the use of health resources to maximise its utility. Tygerberg Hospital has introduced an electronic gate-keeping system. Chemistry tests which generate the highest cost are subjected to this system and may be automatically rejected according to a set of rules. This study aimed: (1) to identify the number of chemistry tests rejected by the eGK; (2) to identify which of these rejected tests were subsequently restored and (3) to assess the impact of rejections on clinical outcome and cost-saving. A retrospective audit was conducted to determine the number of chemistry tests rejected and subsequently restored over a 6-month period. The case-notes of patients for whom requested tests previously rejected had been restored were randomly selected and investigated to assess clinical impact. Any cost-saving was calculated. A total of 68,480 tests were subjected to gate-keeping, and 4605 tests (6.7%) were rejected while 679 (14.7%) of these were restored by the requestor phoning the laboratory after obtaining authorisation. After examining a subset of clinical notes it was found that in most cases (80%), patient care was unaffected. The total cost saved was £ 25,387. The majority of the rejected tests were unnecessary and following rejection, real savings were made. Electronic gate-keeping is a simple, effective and sustainable method of demand management. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  5. Advancing Cost-Effective Readiness by Improving the Supply Chain Management of Sparse, Intermittently-Demanded Parts

    DTIC Science & Technology

    2015-03-26

    thank Dr. Brad Silver, Dr. Tovey Bachman, Dr. Dave Peterson, Dr. ‘Doc’ Doug Blazer, and Dr. Dave Fulk . A special thanks to Dr. Fulk /Dr. Bachman...x x x 2006 Zeithaml, et al. x 2005 Campbell, et al. x x 2013 Willemain x 2007 Ketchen & Hult x x 2014 Fulk x x x x x x 2008 Abbas, et al. 2008 Cobb...2007. [44] D. Fulk , Proactive Demand Leveling (PDL): Exec V7.0, Washington, DC: LMI, 2014. [45] K. Nikolopoulos, A. Syntetos, J. Boylan, F

  6. Can we manage demand for allergy testing by restricting requests to a small number of prime target allergens?

    PubMed

    Reynolds, Timothy M; Twomey, Patrick J

    2007-09-01

    Demand for expensive tests such as allergen-specific IgE is expanding far faster than for cheaper tests: at Burton Hospital the annual growth rate is 24%. Different hospitals have different policies on allergen testing. We report a comparison of the effect of requesting policy on diagnostic yield. All results from five years of allergen testing were downloaded from the data warehouse at Burton, and a representative sample of recent results was evaluated from Ipswich Hospital. Statistical analysis by chi(2) test and significance tests for differences of proportions were carried out. Ipswich hospital used a standard four-allergen panel for respiratory patients and demonstrated a statistically significantly lower positivity rate for three of those four allergens. No relationship between the number of allergens tested and the probability of a positive result was shown - the probability of a positive result was approximately 0.3. Number of allergen-specific IgE tests requested/patient have remained roughly constant over 5(1/2) years but total demand has increased. Selective requesting for allergen-specific IgE testing may be more effective than use of a standard panel but this cannot be conclusively proven. It is not appropriate to attempt to limit workload by specifying a maximum number of tests that are allowed for any individual patient.

  7. Supply and demand: negotiating the prescription drug labyrinth to reduce costs.

    PubMed

    DeStefino, Kevin

    2003-01-01

    Prescription drug costs are increasing at a rate of 15% to 17% a year and a look into the future does not bring much better news. Employers can expect to see more numbers like these as doctors more aggressively treat diseases using drug therapy, the population continues to age and pharmaceutical companies continue to spend billions of dollars on direct-to-consumer advertising aimed at consumers who are desensitized to the true costs of their prescriptions. In this environment, it is unlikely that companies can realistically expect to reverse costs of even to avoid cost increases. However, this article provides employers with a prudent approach to managing both the supply and demand sides of the prescription drug equation in order to reduce their level of increase. Supply-side management focuses on negotiations with vendors, while the demand side focuses on managing employee utilization.

  8. Review of current Southern California edison load management programs and proposal for a new market-driven, mass-market, demand-response program

    SciTech Connect

    Weller, G.H.

    2002-01-01

    Utility load management programs, including direct load control and interruptible load programs, constitute a large installed base of controllable loads that are employed by utilities as system reliability resources. In response to energy supply shortfalls expected during the summer of 2001, the California Public Utilities Commission in spring 2001 authorized new utility load management programs as well as revisions to existing programs. This report provides an independent review of the designs of these new programs for a large utility (Southern California Edison) and suggests possible improvements to enhance the price responsiveness of the customer actions influenced by these programs. The report also proposes a new program to elicit a mass-market demand response to utility price signals.

  9. Voluntary Management of Residential Water Demand in Low and Middle-Low Income Households: Case Study of Soacha (colombia)

    NASA Astrophysics Data System (ADS)

    Acosta, R.; Rodriguez, J. P.

    2016-12-01

    Water resources availability is a global concern due to increasing demands, decreasing quality and uncertain spatio-temporal variability (United Nations, 2009). In urban contexts research on efficient water use is a priority to cope with the future vulnerability of water supplies as a result of the impacts of climate change (Bates et al, 2008). Following the proposed methodologies of He and Kua (2013) for implementing programs to promote sustainable energy consumption, we focused on the use of educational strategies to promote a voluntary rationalization of residential water demand. We collaborated with three schools in Soacha (Colombia) where students ranging from 12 to 15 years participated in the project as promoters of educational campaigns inside their families, covering 120 low and middle-low income households. Three intervention or treatment strategies (i.e. e-learning, in-person active learning activities and graphical learning tools) were carried out over a period of 5 months. We analyzed the effects of the treatments strategies in reducing water consumption rates and the dependence of this variable on socio-demographic, economic, environmental, and life quality factors by using personal interviews and self reported water saving technics. The results showed that educational campaigns have a positive effect on reducing consumption in the households. Graphical learning tools accounted for the highest reduction in water consumption. Moreover, the results of the study suggests that socio-economic factors such as type of house, social level, income, and life quality variables significantly affect the variability in water consumption, which is an important fact to consider in similar cases where communities face difficult socio-economic conditions, displacement or high rates of urban growth.

  10. Current management of the hemophilic child: a demanding interlocutor. Quality of life and adequate cost-efficacy analysis.

    PubMed

    Giordano, Paola; Lassandro, Giuseppe; Valente, Michele; Molinari, Angelo Claudio; Ieranò, Paola; Coppola, Antonio

    2014-11-01

    Hemophilias are the most known inherited bleeding disorders. The challenges in the management of hemophilic children are different from those in adults: prophylaxis regimen removed the hallmark of crippling disease with lifelong disabilities; individualized regimens are being implemented in order to overcome venous access problems. Presently, at least in high-income countries, advances in treatment of hemophilia resulted in continuous improvement of the patients' quality of life and life expectancy. Inhibitors remain the most severe complication of hemophilia therapy. The treatment' compliance is the key to achieve a successful management. The patient, his family, the medical and psychological team are the players of a comprehensive care system. The current management of hemophilic children is the example of huge resource investments enabling long-term benefits in particular quality of life as a primary objective of the healthcare process.

  11. The Human Side of Libraries.

    ERIC Educational Resources Information Center

    Surace, Cecily J.

    This paper discusses current trends in personnel management, with emphasis on performance standards and employee evaluation. Advances in personnel management from the scientific management theory to the application of the "human side of enterprise" approach should be reflected in how library managers review personnel and operate their libraries.…

  12. Meeting the Growing Demand for Sustainability-Focused Management Education: A Case Study of a PRME Academic Institution

    ERIC Educational Resources Information Center

    Young, Suzanne; Nagpal, Swati

    2013-01-01

    The current business landscape has created the impetus to develop management graduates with capabilities that foster responsible leadership and sustainability. Through the lens of Gitsham's 3C Model (Complexity, Context and Connection) of graduate capabilities, this paper discusses the experience of implementing the United Nations Principles for…

  13. Consumer demand for green stormwater management technology in an urban setting: The case of Chicago rain barrels

    NASA Astrophysics Data System (ADS)

    Ando, Amy W.; Freitas, Luiz P. C.

    2011-12-01

    Hydrological disruption and water pollution from urbanization can be reduced if households in urban areas adopt decentralized storm water controls. We study a citywide municipal subsidized rain-barrel program in the third biggest city in the United States, Chicago, to explore what factors influence whether households purchase this sort of green storm water management technology in an urban setting. Specifically, we regress census-tract level data on the number of rain barrels adopted in different parts of the city on socioeconomic variables, data on local flood frequency, and features of the housing stock. We find that rain-barrel purchases are not correlated with local levels of flooding, even though city residents were told by program managers that rain barrels could alleviate local flooding. Instead, rain barrels are heavily concentrated in places with high-income attitudinally green populations. We do find more rain barrels were adopted in places close to rain-barrel distribution points and near sites of hydrological information campaigns; thus, policy makers might increase green-technology adoption in areas where they can do the most good by reducing transaction costs and providing education programs to those areas. Finally, our results indicate that owner occupancy is positively correlated with green-technology adoption. Low-rise rental housing may have inefficiently low levels of adoption, such that city managers might want to develop programs to encourage storm water management investments by landlords who do not live in their own properties.

  14. Determining Nutrient Requirements For Intensively Managed Loblolly Pine Stands Using the SSAND (Soil Supply and Nutrient Demand) Model

    Treesearch

    Hector G. Adegbidi; Nicholas B. Comerford; Hua Li; Eric J. Jokela; Nairam F. Barros

    2002-01-01

    Nutrient management represents a central component of intensive silvicultural systems that are designed to increase forest productivity in southern pine stands. Forest soils throughout the South are generally infertile, and fertilizers may be applied one or more times over the course of a rotation. Diagnostic techniques, such as foliar analysis and soil testing are...

  15. Meeting the Growing Demand for Sustainability-Focused Management Education: A Case Study of a PRME Academic Institution

    ERIC Educational Resources Information Center

    Young, Suzanne; Nagpal, Swati

    2013-01-01

    The current business landscape has created the impetus to develop management graduates with capabilities that foster responsible leadership and sustainability. Through the lens of Gitsham's 3C Model (Complexity, Context and Connection) of graduate capabilities, this paper discusses the experience of implementing the United Nations Principles for…

  16. [Development of an instrument for the assessment of demand and monitoring of the health management in a health insurance].

    PubMed

    Burnus, M; Benner, V; Becker, L; Müller, D; Stock, S

    2014-06-01

    To identify and follow up the health relevant effects of change-management-projects and to determine improvements in activities following this change a specific health-controlling instrument with benchmarking options has been developed. This instrument applies scientific quality standards and shows the organisational value in form of an index (BGM-Systemindex). It shows the correlation between the four indices management system, health-related actions, health and absence rate and allows a qualitative view of corporate health promotion on and its long term effects. The initiator for the project was an employee survey, which showed a need for action to improve job satisfaction. The survey was the reason that management initiated an integral change-management-project. The project showed many interfaces with the corporate health promotion (BGM), thus enabling consequent changes to be made and their effects to be evaluated. The aim of the project was to clearly increase employee satisfaction up to the next employee survey. Overall the project can be considered a success as the main aim of the project to increase the employees job satisfaction in the given period of time was clearly accomplished. The BGM-Systemindex also stood the test for comprehensive monitoring of the employees health. The project was able to prove that the health relevant parameters could be optimised and that the quality, acceptance and efficiency of the intervention methods had improved. It also showed a positive development of the early and long term health indicators. This is a positive contrast to available literature, which shows that an insufficient or incorrectly used change management results in a lower employee satisfaction. As a result it was decided to use the tool in future.

  17. Examination of food waste co-digestion to manage the peak in energy demand at wastewater treatment plants.

    PubMed

    Lensch, D; Schaum, C; Cornel, P

    2016-01-01

    Many digesters in Germany are not operated at full capacity; this offers the opportunity for co-digestion. Within this research the potentials and limits of a flexible and adapted sludge treatment are examined with a focus on the digestion process with added food waste as co-substrate. In parallel, energy data from a municipal wastewater treatment plant (WWTP) are analysed and lab-scale semi-continuous and batch digestion tests are conducted. Within the digestion tests, the ratio of sewage sludge to co-substrate was varied. The final methane yields show the high potential of food waste: the higher the amount of food waste the higher the final yield. However, the conversion rates directly after charging demonstrate better results by charging 10% food waste instead of 20%. Finally, these results are merged with the energy data from the WWTP. As an illustration, the load required to cover base loads as well as peak loads for typical daily variations of the plant's energy demand are calculated. It was found that 735 m³ raw sludge and 73 m³ of a mixture of raw sludge and food waste is required to cover 100% of the base load and 95% of the peak load.

  18. Metabolic acidosis due to inhaled salbutamol toxicity: A hazardous side effect complicating management of suspected cases of acute severe asthma

    PubMed Central

    Tomar, R.P.S.; Vasudevan, R.

    2012-01-01

    Metabolic acidosis has seldom been reported during treatment of asthma with use of beta agonist but not with much clinical consequence. We report two cases of metabolic acidosis with hyperventilation as a direct effect of salbutamol that caused difficulty in assessment and management of their respiratory symptoms which resolved with appropriate tapering of beta agonist. PMID:24532877

  19. Management of side effects of immune checkpoint blockade by anti-CTLA-4 and anti-PD-1 antibodies in metastatic melanoma.

    PubMed

    Kähler, Katharina C; Hassel, Jessica C; Heinzerling, Lucie; Loquai, Carmen; Mössner, Rotraut; Ugurel, Selma; Zimmer, Lisa; Gutzmer, Ralf

    2016-07-01

    CTLA-4 and PD-1 are potential targets for tumor-induced downregulation of lymphocytic immune responses. Immune checkpoint-modifying monoclonal antibodies oppose these effects, inducing T cell-mediated immune responses to various tumors including melanoma. Both anti-CTLA-4 and anti-PD-1 antibodies modify the interaction between tumor, antigen-presenting cells, and T lymphocytes. With respect to overall survival, clinical studies have shown a major benefit for the anti-CTLA-4 antibody ipilimumab as well as the two anti-PD-1 antibodies nivolumab and pembrolizumab. Following approval of ipilimumab in 2011, the latter two achieved market authorization in the summer of 2015. Immune responses thus induced and enhanced inevitably entail autoimmune phenomena, affecting various organs to varying degrees. Knowledge of these side effects is crucial with regard to prevention and management by treating physicians. Typically occurring early on and presenting with pronounced and persistent diarrhea, colitis represents a major and severe side effect. Other immune-mediated disorders include dermatitis, hypophysitis, thyroiditis, hepatitis, iridocyclitis as well as other less common autoimmune phenomena. Early recognition and initiation of treatment can reduce risks and sequelae for patients. This review describes the mechanisms of action of immune checkpoint blockade as well as its clinical effects in metastatic melanoma, with a detailed focus on the spectrum of adverse events and their therapeutic management.

  20. Canadian Cardiovascular Society Consensus Conference guidelines on heart failure, update 2009: diagnosis and management of right-sided heart failure, myocarditis, device therapy and recent important clinical trials.

    PubMed

    Howlett, Jonathan G; McKelvie, Robert S; Arnold, J Malcolm O; Costigan, Jeannine; Dorian, Paul; Ducharme, Anique; Estrella-Holder, Estrellita; Ezekowitz, Justin A; Giannetti, Nadia; Haddad, Haissam; Heckman, George A; Herd, Anthony M; Isaac, Debra; Jong, Philip; Kouz, Simon; Liu, Peter; Mann, Elizabeth; Moe, Gordon W; Tsuyuki, Ross T; Ross, Heather J; White, Michel

    2009-02-01

    The Canadian Cardiovascular Society published a comprehensive set of recommendations on the diagnosis and management of heart failure in January 2006. Based on feedback obtained through a national program of heart failure workshops and through active solicitation of stakeholders, several topics were identified because of their importance to the practicing clinician. Topics chosen for the present update include best practices for the diagnosis and management of right-sided heart failure, myocarditis and device therapy, and a review of recent important or landmark clinical trials. These recommendations were developed using the structured approach for the review and assessment of evidence adopted and previously described by the Society. The present update has been written from a clinical perspective to provide a user-friendly and practical approach. Specific clinical questions that are addressed include: What is right-sided heart failure and how should one approach the diagnostic work-up? What other clinical entities may masquerade as this nebulous condition and how can we tell them apart? When should we be concerned about the presence of myocarditis and how quickly should patients with this condition be referred to an experienced centre? Among the myriad of recently published landmark clinical trials, which ones will impact our standards of clinical care? The goals are to aid physicians and other health care providers to optimally treat heart failure patients, resulting in a measurable impact on patient health and clinical outcomes in Canada.

  1. Canadian Cardiovascular Society Consensus Conference guidelines on heart failure, update 2009: Diagnosis and management of right-sided heart failure, myocarditis, device therapy and recent important clinical trials

    PubMed Central

    Howlett, Jonathan G; McKelvie, Robert S; Arnold, J Malcolm O; Costigan, Jeannine; Dorian, Paul; Ducharme, Anique; Estrella-Holder, Estrellita; Ezekowitz, Justin A; Giannetti, Nadia; Haddad, Haissam; Heckman, George A; Herd, Anthony M; Isaac, Debra; Jong, Philip; Kouz, Simon; Liu, Peter; Mann, Elizabeth; Moe, Gordon W; Tsuyuki, Ross T; Ross, Heather J; White, Michel

    2009-01-01

    The Canadian Cardiovascular Society published a comprehensive set of recommendations on the diagnosis and management of heart failure in January 2006. Based on feedback obtained through a national program of heart failure workshops and through active solicitation of stakeholders, several topics were identified because of their importance to the practicing clinician. Topics chosen for the present update include best practices for the diagnosis and management of right-sided heart failure, myocarditis and device therapy, and a review of recent important or landmark clinical trials. These recommendations were developed using the structured approach for the review and assessment of evidence adopted and previously described by the Society. The present update has been written from a clinical perspective to provide a user-friendly and practical approach. Specific clinical questions that are addressed include: What is right-sided heart failure and how should one approach the diagnostic work-up? What other clinical entities may masquerade as this nebulous condition and how can we tell them apart? When should we be concerned about the presence of myocarditis and how quickly should patients with this condition be referred to an experienced centre? Among the myriad of recently published landmark clinical trials, which ones will impact our standards of clinical care? The goals are to aid physicians and other health care providers to optimally treat heart failure patients, resulting in a measurable impact on patient health and clinical outcomes in Canada. PMID:19214293

  2. Energy Demands

    ERIC Educational Resources Information Center

    Wilkinson, Ron

    2010-01-01

    When construction slows and campus operating expenses are under the microscope, it is more important than ever to save energy dollars with the equipment and staff on hand. For the facilities manager who thinks out of the box, significant savings can be found on most school and college campuses. This article provides energy-conservation tips that…

  3. Energy Demands

    ERIC Educational Resources Information Center

    Wilkinson, Ron

    2010-01-01

    When construction slows and campus operating expenses are under the microscope, it is more important than ever to save energy dollars with the equipment and staff on hand. For the facilities manager who thinks out of the box, significant savings can be found on most school and college campuses. This article provides energy-conservation tips that…

  4. Progress towards Managing Residential Electricity Demand: Impacts of Standards and Labeling for Refrigerators and Air Conditioners in India

    SciTech Connect

    McNeil, Michael A.; Iyer, Maithili

    2009-05-30

    The development of Energy Efficiency Standards and Labeling (EES&L) began in earnest in India in 2001 with the Energy Conservation Act and the establishment of the Indian Bureau of Energy Efficiency (BEE). The first main residential appliance to be targeted was refrigerators, soon to be followed by room air conditioners. Both of these appliances are of critical importance to India's residential electricity demand. About 15percent of Indian households own a refrigerator, and sales total about 4 million per year, but are growing. At the same time, the Indian refrigerator market has seen a strong trend towards larger and more consumptive frost-free units. Room air conditioners in India have traditionally been sold to commercial sector customers, but an increasing number are going to the residential sector. Room air conditioner sales growth in India peaked in the last few years at 20percent per year. In this paper, we perform an engineering-based analysis using data specific to Indian appliances. We evaluate costs and benefits to residential and commercial sector consumers from increased equipment costs and utility bill savings. The analysis finds that, while the BEE scheme presents net benefits to consumers, there remain opportunities for efficiency improvement that would optimize consumer benefits, according to Life Cycle Cost analysis. Due to the large and growing market for refrigerators and air conditioners in India, we forecast large impacts from the standards and labeling program as scheduled. By 2030, this program, if fully implemented would reduce Indian residential electricity consumption by 55 TWh. Overall savings through 2030 totals 385 TWh. Finally, while efficiency levels have been set for several years for refrigerators, labels and MEPS for these products remain voluntary. We therefore consider the negative impact of this delay of implementation to energy and financial savings achievable by 2030.

  5. Last-century forest productivity in a managed dry-edge Scots pine population: the two sides of climate warming.

    PubMed

    Marqués, Laura; Madrigal-González, Jaime; Zavala, Miguel A; Julio Camarero, J; Hartig, Florian

    2017-09-25

    Climate change in the Mediterranean, associated with warmer temperatures and more frequent droughts, is expected to impact forest productivity and the functioning of forests ecosystems as carbon reservoirs in the region. Climate warming can positively affect forest growth by extending the growing season, whereas increasing summer drought generally reduces forest productivity and may cause growth decline, trigger dieback, hamper regeneration and increase mortality. Forest management could potentially counteract such negative effects by reducing stand density and thereby competition for water. The effectiveness of such interventions, however, has so far mostly been evaluated for short time periods at the tree and stand levels, which limits our confidence regarding the efficacy of thinning interventions over longer time scales under the complex interplay between climate, stand structure and forest management. In this study, we use a century-long historical dataset to assess the effects of climate and management on forest productivity and regeneration. We consider rear-edge Scots pine (Pinus sylvestris) populations covering continental and Mediterranean conditions along an altitudinal gradient in Central Spain. We use linear mixed-effects models to disentangle the effects of altitude, climate, and stand volume on forest growth and ingrowth (recruitment and young trees'growth). We find that warming tends to benefit these tree populations - warmer winter temperature has a significant positive effect on both forest growth and ingrowth - and the effect is more pronounced at low elevations. However, drought conditions severely reduce growth and ingrowth, in particular when competition (stand volume) is high. We conclude that summer droughts are the main threat to Scots pine populations in the region, and that a reduction of stand volume can partially mitigate the negative impacts of more arid conditions. Mitigation and adaptation measures could therefore manage stand

  6. Perceived control systems, work conditions, and efficiency among Swedish dentists: interaction between two sides of human resource management.

    PubMed

    Bejerot, E; Söderfeldt, B; Aronsson, G; Härenstam, A; Söderfeldt, M

    1999-02-01

    Two aspects of Human Resource Management (HRM), a main trend in modern personnel management, are considered in this study: A 'hard' version stressing performance monitoring and competition, and a 'soft' version stressing communication with employees. The aim of the investigation was to examine whether these two aspects of modern management are reflected in dentists' perceptions of differences in work conditions compared with other professionals. A questionnaire was answered by 312 publicly employed dentists and 3,600 other professionals in Sweden. The response rate was 66-77%. Effects from HRM on work, conditions and perceived efficiency were confirmed. The interaction effects, reflecting the duality of HRM, resulted in poorer work conditions, e.g. worse balance between effort and reward and worse opportunities for developing competence and collaboration in the workplace. This pertains especially in the case of dentists, where the positive effects of 'soft' HRM did not compensate for the negative effects of 'hard' HRM. Dentists in Sweden's Public Dental Health Service appear as a vulnerable group among Swedish professionals.

  7. Evidence of discrete yellowfin tuna (Thunnus albacares) populations demands rethink of management for this globally important resource.

    PubMed

    Grewe, P M; Feutry, P; Hill, P L; Gunasekera, R M; Schaefer, K M; Itano, D G; Fuller, D W; Foster, S D; Davies, C R

    2015-11-23

    Tropical tuna fisheries are central to food security and economic development of many regions of the world. Contemporary population assessment and management generally assume these fisheries exploit a single mixed spawning population, within ocean basins. To date population genetics has lacked the required power to conclusively test this assumption. Here we demonstrate heterogeneous population structure among yellowfin tuna sampled at three locations across the Pacific Ocean (western, central, and eastern) via analysis of double digest restriction-site associated DNA using Next Generation Sequencing technology. The differences among locations are such that individuals sampled from one of the three regions examined can be assigned with close to 100% accuracy demonstrating the power of this approach for providing practical markers for fishery independent verification of catch provenance in a way not achieved by previous techniques. Given these results, an extended pan-tropical survey of yellowfin tuna using this approach will not only help combat the largest threat to sustainable fisheries (i.e. illegal, unreported, and unregulated fishing) but will also provide a basis to transform current monitoring, assessment, and management approaches for this globally significant species.

  8. Evidence of discrete yellowfin tuna (Thunnus albacares) populations demands rethink of management for this globally important resource

    NASA Astrophysics Data System (ADS)

    Grewe, P. M.; Feutry, P.; Hill, P. L.; Gunasekera, R. M.; Schaefer, K. M.; Itano, D. G.; Fuller, D. W.; Foster, S. D.; Davies, C. R.

    2015-11-01

    Tropical tuna fisheries are central to food security and economic development of many regions of the world. Contemporary population assessment and management generally assume these fisheries exploit a single mixed spawning population, within ocean basins. To date population genetics has lacked the required power to conclusively test this assumption. Here we demonstrate heterogeneous population structure among yellowfin tuna sampled at three locations across the Pacific Ocean (western, central, and eastern) via analysis of double digest restriction-site associated DNA using Next Generation Sequencing technology. The differences among locations are such that individuals sampled from one of the three regions examined can be assigned with close to 100% accuracy demonstrating the power of this approach for providing practical markers for fishery independent verification of catch provenance in a way not achieved by previous techniques. Given these results, an extended pan-tropical survey of yellowfin tuna using this approach will not only help combat the largest threat to sustainable fisheries (i.e. illegal, unreported, and unregulated fishing) but will also provide a basis to transform current monitoring, assessment, and management approaches for this globally significant species.

  9. Anaerobic side-stream reactor for excess sludge reduction: 5-year management of a full-scale plant.

    PubMed

    Velho, V F; Foladori, P; Andreottola, G; Costa, R H R

    2016-07-15

    The long-term performances of a full-scale anaerobic side-stream reactor (ASSR) aimed at sludge reduction have been monitored for the first time, in comparison with a conventional activated sludge process (CAS). The plant was integrated with an ASSR treatment of 2293-3293 m(3). Operational parameters in the ASSR were: ORP -250 mV, interchange ratio of 7-10%, hydraulic retention time of 7 d. No worsening of effluent quality was observed in the ASSR configuration and removal efficiency of COD and NH4 was above 95%. A slight increase in the Sludge Volume Index did not cause worsening in effluent solids concentration. The observed sludge yield (Yobs) passed from 0.44 kgTSS/kgCOD in the CAS to 0.35 in the ASSR configuration. The reduction of Yobs by 20% is lower than expected from the literature where sythetic wastewater is used, indicating that sludge reduction efficiency is largely affected by inert mass fed with influent real wastewater. An increase by 45% of the ASSR volume did not promote a further reduction of Yobs, because sludge reduction is affected not solely by endogenous decay but also by other factors such as interchange ratio and aerobiosis/anaerobiosis alternation.

  10. Feasibility of Rainwater Harvesting to fulfill potable water demand using quantitative water management in low-lying delta regions of Asia

    NASA Astrophysics Data System (ADS)

    Mahmood, A.; Hossain, F.

    2016-12-01

    Low-lying deltas of Asian region are usually densely populated and located in developing countries situated at the downstream end of major rivers. Extensive dam construction by the upstream countries has now caused water scarcity in large portions of low-lying deltas. Most inhabitants depend on shallow tube well for safe drinking water that tend to suffer from water quality issues (e.g. Arsenic contamination). In addition, people also get infected from water borne diseases like Cholera and Typhoid due to lack of safe drinking water. Developing a centralized piped network based water supply system is often not a feasible option in rural regions. Due to social acceptability, environment friendliness, lower capital and maintenance cost, rainwater harvesting can be the most sustainable option to supply safe drinking water in rural areas. In this study, first we estimate the monthly rainfall variability using long precipitation climatology from satellite precipitation data. The upper and lower bounds of monthly harvestable rainwater were estimated for each satellite precipitation grid. Taking this lower bound of monthly harvestable rainwater as input, we use quantitative water management concept to determine the percent of the time of the year potable water demand can be fulfilled. Analysis indicates that a 6 m³ reservoir tank can fulfill the potable water demand of a 6 person family throughout a year in almost all parts of this region.

  11. Dividends with Demand Response

    SciTech Connect

    Kintner-Meyer, Michael CW; Goldman, Charles; Sezgen, O.; Pratt, D.

    2003-10-31

    To assist facility managers in assessing whether and to what extent they should participate in demand response programs offered by ISOs, we introduce a systematic process by which a curtailment supply curve can be developed that integrates costs and other program provisions and features. This curtailment supply curve functions as bid curve, which allows the facility manager to incrementally offer load to the market under terms and conditions acceptable to the customer. We applied this load curtailment assessment process to a stylized example of an office building, using programs offered by NYISO to provide detail and realism.

  12. A walk on the wild side: Disturbance dynamics and the conservation and management of European mountain forest ecosystems.

    PubMed

    Kulakowski, Dominik; Seidl, Rupert; Holeksa, Jan; Kuuluvainen, Timo; Nagel, Thomas A; Panayotov, Momchil; Svoboda, Miroslav; Thorn, Simon; Vacchiano, Giorgio; Whitlock, Cathy; Wohlgemuth, Thomas; Bebi, Peter

    2017-03-15

    Mountain forests are among the most important ecosystems in Europe as they support numerous ecological, hydrological, climatic, social, and economic functions. They are unique relatively natural ecosystems consisting of long-lived species in an otherwise densely populated human landscape. Despite this, centuries of intensive forest management in many of these forests have eclipsed evidence of natural processes, especially the role of disturbances in long-term forest dynamics. Recent trends of land abandonment and establishment of protected forests have coincided with a growing interest in managing forests in more natural states. At the same time, the importance of past disturbances highlighted in an emerging body of literature, and recent increasing disturbances due to climate change are challenging long-held views of dynamics in these ecosystems. Here, we synthesize aspects of this Special Issue on the ecology of mountain forest ecosystems in Europe in the context of broader discussions in the field, to present a new perspective on these ecosystems and their natural disturbance regimes. Most mountain forests in Europe, for which long-term data are available, show a strong and long-term effect of not only human land use but also of natural disturbances that vary by orders of magnitude in size and frequency. Although these disturbances may kill many trees, the forests themselves have not been threatened. The relative importance of natural disturbances, land use, and climate change for ecosystem dynamics varies across space and time. Across the continent, changing climate and land use are altering forest cover, forest structure, tree demography, and natural disturbances, including fires, insect outbreaks, avalanches, and wind disturbances. Projected continued increases in forest area and biomass along with continued warming are likely to further promote forest disturbances. Episodic disturbances may foster ecosystem adaptation to the effects of ongoing and future

  13. Server Side Applications And Plugins Architecture For The Analysis Of Geospatial Information And The Management Of Water Resources

    NASA Astrophysics Data System (ADS)

    Pierleoni, Arnaldo; Casagrande, Luca; Bellezza, Michele; Casadei, Stefano

    2010-05-01

    The need for increasingly complex geospatial algorithms dedicated to the management of water resources, the fact that many of them require specific knowledge and the need for dedicated computing machines has led to the necessity of centralizing and sharing all the server applications and the plugins developed. For this purpose, a Web Processing Service (WPS) that can make available to users a range of geospatial analysis algorithms, geostatistics, remote sensing procedures and that can be used simply by providing data and input parameters and download the results has been developed. The core of the system infrastructure is a GRASS GIS, which acts as a computational engine, providing more than 350 forms of analysis and the opportunity to create new and ad hoc procedures. The implementation of the WPS was performed using the software PyWPS written in Python that is easily manageable and configurable. All these instruments are managed by a daemon named "Arcibald" specifically created for the purpose of listing the order of the requests that come from the users. In fact, it may happen that there are already ongoing processes so the system will queue the new ones registering the request and running it only when the previous calculations have been completed. However, individual Geoprocessing have an indicator to assess the resources necessary to implement it, enabling you to run geoprocesses that do not require excessive computing time in parallel. This assessment is also made in relation to the size of the input file provided. The WPS standard defines methods for accessing and running Geoprocessing regardless of the client used, however, the project has been developed specifically for a graphical client to access the resources. The client was built as a plugin for the GIS QGis Software which provides the most common tools for the view and the consultation of geographically referenced data. The tool was tested using the data taken during the bathymetric campaign at the

  14. [Tyrosine kinase inhibiting the VEGF pathway and elderly people: Tolerance, pre-treatment assessment and side effects management].

    PubMed

    Bretagne, Marie; Boudou-Rouquette, Pascaline; Huillard, Olivier; Thomas-Schoemann, Audrey; Chahwakilian, Anne; Orvoen, Galdric; Arrondeau, Jennifer; Tlemsani, Camille; Cessot, Anatole; Cabanes, Laure; Blanchet, Benoit; Coriat, Romain; Alexandre, Jérôme; Goldwasser, François

    2016-03-01

    Angiogenesis inhibition is a major antitumor strategy that has emerged during the last decade. Oral tyrosine kinase inhibitors (TKI) targeting the VEGF receptor, including sunitinib, sorafenib, axitinib, regorafenib, pazopanib, and vandetanib reduce tumor growth and metastasis. These agents are approved for the treatment of metastatic diseases in first or second-line. They display a narrow therapeutic index. However, data in the elderly and/or in patients with multiple illnesses remain scarce. This population is classically excluded from clinical trials. The aim of this review is to provide an overview of existing literature regarding antiangiogenic TKI tolerance in the elderly (>70 years old). We also highlight key points of the pre-therapeutic evaluation and summarize the management of common toxicities.

  15. Advanced Controls and Communications for Demand Response andEnergy Efficiency in Commercial Buildings

    SciTech Connect

    Kiliccote, Sila; Piette, Mary Ann; Hansen, David

    2006-01-17

    Commercial buildings account for a large portion of summer peak demand. Research results show that there is significant potential to reduce peak demand in commercial buildings through advanced control technologies and strategies. However, a better understanding of commercial building's contribution to peak demand and the use of energy management and control systems is required to develop this demand response resource to its full potential. This paper discusses recent research results and new opportunities for advanced building control systems to provide demand response (DR) to improve electricity markets and reduce electric grid problems. The main focus of this paper is the role of new and existing control systems for HVAC and lighting in commercial buildings. A demand-side management framework from building operations perspective with three main features: daily energy efficiency, daily peak load management and event driven, dynamic demand response is presented. A general description of DR, its benefits, and nationwide potential in commercial buildings is outlined. Case studies involving energy management and control systems and DR savings opportunities are presented. The paper also describes results from three years of research in California to automate DR in buildings. Case study results and research on advanced buildings systems in New York are also presented.

  16. Efficacy of low-level laser therapy as an auxiliary tool for management of acute side effects of head and neck radiotherapy.

    PubMed

    González-Arriagada, Wilfredo Alejandro; Ramos, Lara Maria Alencar; Andrade, Marco Aurélio Carvalho; Lopes, Marcio Ajudarte

    2017-10-11

    Head and neck radiotherapy (HNRT) is associated with acute and chronic side effects, some of which result in great morbidity. The aim of this study was to determine the efficacy of low-level laser therapy (LLLT) as an oral care tool for the management of these effects. Clinical information was collected from 216 patients undergoing HNRT; these individuals were divided into a control group without laser therapy (n = 108), and a laser group (n = 108). The intervention of the laser group was performed in a different period to the control group and was applied three times weekly. All data were analyzed by a descriptive statistical analysis. The presence and severity of mucositis was similar between the groups. However, the laser group showed a lower frequency of interruption of oncologic therapy related to mucositis (p = 0.030) and the need for parenteral nutrition during the HNRT (p = 0.027). In addition, trismus was less intense in the laser group (p = 0.023). The introduction of laser therapy in the supportive care for patients undergoing HNRT showed benefits for the patient and the medical system, reducing morbidity and costs associated with side-effects.

  17. Side Effects: Hair Loss (Alopecia)

    Cancer.gov

    Hair loss, also called alopecia, is a side effect of cancer treatments, such as chemotherapy and radiation therapy. Learn how to cope with and manage hair loss. Listen to tips from others who have experienced hair loss.

  18. Innovative Soft-Sided Waste Packaging System Implementation at a Small Department of Energy Environmental Restoration/Waste Management (ER/WM) Site

    SciTech Connect

    Wolf, J.

    2002-02-28

    Weiss Associates (WA) performs a broad range of environmental restoration/waste management (ER/WM) activities for the U.S. Department of Energy (DOE) at the former Laboratory for Energy-Related Health Research (LEHR), University of California, Davis (UC Davis). Over the last three years, the LEHR ER/WM program transitioned from a baseline packaging system of steel, 2.7 cubic meter (3.5-cubic yard) B-25 boxes to a 7.0 cubic meter (9.1-cubic yard) soft-sided container (Lift Liner) system. The transition increased efficiencies in processing, packaging, and storage, and when combined with decreased procurement costs, achieved a $402,000 cost savings (Table I). Additional disposal costs between $128,600 and $182,600 were avoided by minimizing void space. Future cost savings by the end of fiscal year 2003 are projected between $250,640 and $1,003,360.

  19. Road and Rail Side Vegetation Management Implications of Habitat Use by Moose Relative to Brush Cutting Season

    NASA Astrophysics Data System (ADS)

    Rea, Roy V.; Child, Kenneth N.; Spata, David P.; MacDonald, Douglas

    2010-07-01

    Plants cut at different times produce resprouts that vary in their nutritional value relative to when they are cut. To determine how vegetation management in transportation (road and rail) corridors at different times of the year could influence browse quality in the years following cutting, and how this could potentially influence encounters between herbivores and vehicles, we undertook a 3-year study. In 2001, at a wildlife viewing area near Prince George, British Columbia, Canada, we established a control area and treatment areas where shrubs and trees that are used as food by moose ( Alces alces) were cut at the beginning of June, July, August, September, and October. In the fall, moose were most often observed browsing the resprouts of plants cut in August (years 1 and 2 post-treatment) and September (year 3). Cumulative winter track counts were highest in the uncut control area in the years following cutting. Spring pellet counts revealed that most pellets were deposited in the uncut (years 1 and 2) and August-cut (year 3) areas during winter. With the exception of the first year after cutting, browse removal by moose was highest for plants cut later in the growing season. Overall, our findings suggest that following cutting, plants cut later in the year are selected more often by moose relative to those cut earlier. To reduce browse use of corridor vegetation in areas where concerns for moose-vehicle collisions exist, we recommend that vegetation maintenance activities be conducted in the early summer months of June and July.

  20. Road and rail side vegetation management implications of habitat use by moose relative to brush cutting season.

    PubMed

    Rea, Roy V; Child, Kenneth N; Spata, David P; Macdonald, Douglas

    2010-07-01

    Plants cut at different times produce resprouts that vary in their nutritional value relative to when they are cut. To determine how vegetation management in transportation (road and rail) corridors at different times of the year could influence browse quality in the years following cutting, and how this could potentially influence encounters between herbivores and vehicles, we undertook a 3-year study. In 2001, at a wildlife viewing area near Prince George, British Columbia, Canada, we established a control area and treatment areas where shrubs and trees that are used as food by moose (Alces alces) were cut at the beginning of June, July, August, September, and October. In the fall, moose were most often observed browsing the resprouts of plants cut in August (years 1 and 2 post-treatment) and September (year 3). Cumulative winter track counts were highest in the uncut control area in the years following cutting. Spring pellet counts revealed that most pellets were deposited in the uncut (years 1 and 2) and August-cut (year 3) areas during winter. With the exception of the first year after cutting, browse removal by moose was highest for plants cut later in the growing season. Overall, our findings suggest that following cutting, plants cut later in the year are selected more often by moose relative to those cut earlier. To reduce browse use of corridor vegetation in areas where concerns for moose-vehicle collisions exist, we recommend that vegetation maintenance activities be conducted in the early summer months of June and July.

  1. Low-level laser therapy/photobiomodulation in the management of side effects of chemoradiation therapy in head and neck cancer: part 2: proposed applications and treatment protocols.

    PubMed

    Zecha, Judith A E M; Raber-Durlacher, Judith E; Nair, Raj G; Epstein, Joel B; Elad, Sharon; Hamblin, Michael R; Barasch, Andrei; Migliorati, Cesar A; Milstein, Dan M J; Genot, Marie-Thérèse; Lansaat, Liset; van der Brink, Ron; Arnabat-Dominguez, Josep; van der Molen, Lisette; Jacobi, Irene; van Diessen, Judi; de Lange, Jan; Smeele, Ludi E; Schubert, Mark M; Bensadoun, René-Jean

    2016-06-01

    There is a large body of evidence supporting the efficacy of low-level laser therapy (LLLT), more recently termed photobiomodulation (PBM) for the management of oral mucositis (OM) in patients undergoing radiotherapy for head and neck cancer (HNC). Recent advances in PBM technology, together with a better understanding of mechanisms involved and dosimetric parameters may lead to the management of a broader range of complications associated with HNC treatment. This could enhance patient adherence to cancer therapy, and improve quality of life and treatment outcomes. The mechanisms of action, dosimetric, and safety considerations for PBM have been reviewed in part 1. Part 2 discusses the head and neck treatment side effects for which PBM may prove to be effective. In addition, PBM parameters for each of these complications are suggested and future research directions are discussed. Narrative review and presentation of PBM parameters are based on current evidence and expert opinion. PBM may have potential applications in the management of a broad range of side effects of (chemo)radiation therapy (CRT) in patients being treated for HNC. For OM management, optimal PBM parameters identified were as follows: wavelength, typically between 633 and 685 nm or 780-830 nm; energy density, laser or light-emitting diode (LED) output between 10 and 150 mW; dose, 2-3 J (J/cm(2)), and no more than 6 J/cm(2) on the tissue surface treated; treatment schedule, two to three times a week up to daily; emission type, pulsed (<100 Hz); and route of delivery, intraorally and/or transcutaneously. To facilitate further studies, we propose potentially effective PBM parameters for prophylactic and therapeutic use in supportive care for dermatitis, dysphagia, dry mouth, dysgeusia, trismus, necrosis, lymphedema, and voice/speech alterations. PBM may have a role in supportive care for a broad range of complications associated with the treatment of HNC with CRT. The suggested PBM irradiation

  2. Low-level laser therapy/photobiomodulation in the management of side effects of chemoradiation therapy in head and neck cancer: part 2: proposed applications and treatment protocols

    PubMed Central

    Zecha, Judith A. E. M.; Raber-Durlacher, Judith E.; Nair, Raj G.; Epstein, Joel B.; Elad, Sharon; Hamblin, Michael R.; Barasch, Andrei; Migliorati, Cesar A.; Milstein, Dan M. J.; Genot, Marie-Thérèse; Lansaat, Liset; van der Brink, Ron; Arnabat-Dominguez, Josep; van der Molen, Lisette; Jacobi, Irene; van Diessen, Judi; de Lange, Jan; Smeele, Ludi E.; Schubert, Mark M.

    2016-01-01

    Purpose There is a large body of evidence supporting the efficacy of low-level laser therapy (LLLT), more recently termed photobiomodulation (PBM) for the management of oral mucositis (OM) in patients undergoing radiotherapy for head and neck cancer (HNC). Recent advances in PBM technology, together with a better understanding of mechanisms involved and dosimetric parameters may lead to the management of a broader range of complications associated with HNC treatment. This could enhance patient adherence to cancer therapy, and improve quality of life and treatment outcomes. The mechanisms of action, dosimetric, and safety considerations for PBM have been reviewed in part 1. Part 2 discusses the head and neck treatment side effects for which PBM may prove to be effective. In addition, PBM parameters for each of these complications are suggested and future research directions are discussed. Methods Narrative review and presentation of PBM parameters are based on current evidence and expert opinion. Results PBM may have potential applications in the management of a broad range of side effects of (chemo)radiation therapy (CRT) in patients being treated for HNC. For OM management, optimal PBM parameters identified were as follows: wavelength, typically between 633 and 685 nm or 780–830 nm; energy density, laser or light-emitting diode (LED) output between 10 and 150 mW; dose, 2–3 J (J/cm2), and no more than 6 J/cm2 on the tissue surface treated; treatment schedule, two to three times a week up to daily; emission type, pulsed (<100 Hz); and route of delivery, intraorally and/or transcutaneously. To facilitate further studies, we propose potentially effective PBM parameters for prophylactic and therapeutic use in supportive care for dermatitis, dysphagia, dry mouth, dysgeusia, trismus, necrosis, lymphedema, and voice/speech alterations. Conclusion PBM may have a role in supportive care for a broad range of complications associated with the treatment of HNC with CRT

  3. A leader-follower-interactive method for regional water resources management with considering multiple water demands and eco-environmental constraints

    NASA Astrophysics Data System (ADS)

    Chen, Yizhong; Lu, Hongwei; Li, Jing; Ren, Lixia; He, Li

    2017-05-01

    This study presents the mathematical formulation and implementations of a synergistic optimization framework based on an understanding of water availability and reliability together with the characteristics of multiple water demands. This framework simultaneously integrates a set of leader-followers-interactive objectives established by different decision makers during the synergistic optimization. The upper-level model (leader's one) determines the optimal pollutants discharge to satisfy the environmental target. The lower-level model (follower's one) accepts the dispatch requirement from the upper-level one and dominates the optimal water-allocation strategy to maximize economic benefits representing the regional authority. The complicated bi-level model significantly improves upon the conventional programming methods through the mutual influence and restriction between the upper- and lower-level decision processes, particularly when limited water resources are available for multiple completing users. To solve the problem, a bi-level interactive solution algorithm based on satisfactory degree is introduced into the decision-making process for measuring to what extent the constraints are met and the objective reaches its optima. The capabilities of the proposed model are illustrated through a real-world case study of water resources management system in the district of Fengtai located in Beijing, China. Feasible decisions in association with water resources allocation, wastewater emission and pollutants discharge would be sequentially generated for balancing the objectives subject to the given water-related constraints, which can enable Stakeholders to grasp the inherent conflicts and trade-offs between the environmental and economic interests. The performance of the developed bi-level model is enhanced by comparing with single-level models. Moreover, in consideration of the uncertainty in water demand and availability, sensitivity analysis and policy analysis are

  4. Home Network Technologies and Automating Demand Response

    SciTech Connect

    McParland, Charles

    2009-12-01

    Over the past several years, interest in large-scale control of peak energy demand and total consumption has increased. While motivated by a number of factors, this interest has primarily been spurred on the demand side by the increasing cost of energy and, on the supply side by the limited ability of utilities to build sufficient electricity generation capacity to meet unrestrained future demand. To address peak electricity use Demand Response (DR) systems are being proposed to motivate reductions in electricity use through the use of price incentives. DR systems are also be design to shift or curtail energy demand at critical times when the generation, transmission, and distribution systems (i.e. the 'grid') are threatened with instabilities. To be effectively deployed on a large-scale, these proposed DR systems need to be automated. Automation will require robust and efficient data communications infrastructures across geographically dispersed markets. The present availability of widespread Internet connectivity and inexpensive, reliable computing hardware combined with the growing confidence in the capabilities of distributed, application-level communications protocols suggests that now is the time for designing and deploying practical systems. Centralized computer systems that are capable of providing continuous signals to automate customers reduction of power demand, are known as Demand Response Automation Servers (DRAS). The deployment of prototype DRAS systems has already begun - with most initial deployments targeting large commercial and industrial (C & I) customers. An examination of the current overall energy consumption by economic sector shows that the C & I market is responsible for roughly half of all energy consumption in the US. On a per customer basis, large C & I customers clearly have the most to offer - and to gain - by participating in DR programs to reduce peak demand. And, by concentrating on a small number of relatively sophisticated

  5. Automated Demand Response and Commissioning

    SciTech Connect

    Piette, Mary Ann; Watson, David S.; Motegi, Naoya; Bourassa, Norman

    2005-04-01

    This paper describes the results from the second season of research to develop and evaluate the performance of new Automated Demand Response (Auto-DR) hardware and software technology in large facilities. Demand Response (DR) is a set of activities to reduce or shift electricity use to improve the electric grid reliability and manage electricity costs. Fully-Automated Demand Response does not involve human intervention, but is initiated at a home, building, or facility through receipt of an external communications signal. We refer to this as Auto-DR. The evaluation of the control and communications must be properly configured and pass through a set of test stages: Readiness, Approval, Price Client/Price Server Communication, Internet Gateway/Internet Relay Communication, Control of Equipment, and DR Shed Effectiveness. New commissioning tests are needed for such systems to improve connecting demand responsive building systems to the electric grid demand response systems.

  6. Characterising Wildlife Trade Market Supply-Demand Dynamics

    PubMed Central

    Rowcliffe, M.; Cowlishaw, G.; Alexander, J. S.; Ntiamoa-Baidu, Y.; Brenya, A.; Milner-Gulland, E. J.

    2016-01-01

    The trade in wildlife products can represent an important source of income for poor people, but also threaten wildlife locally, regionally and internationally. Bushmeat provides livelihoods for hunters, traders and sellers, protein to rural and urban consumers, and has depleted the populations of many tropical forest species. Management interventions can be targeted towards the consumers or suppliers of wildlife products. There has been a general assumption in the bushmeat literature that the urban trade is driven by consumer demand with hunters simply fulfilling this demand. Using the urban bushmeat trade in the city of Kumasi, Ghana, as a case study, we use a range of datasets to explore the processes driving the urban bushmeat trade. We characterise the nature of supply and demand by explicitly considering three market attributes: resource condition, hunter behaviour, and consumer behaviour. Our results suggest that bushmeat resources around Kumasi are becoming increasingly depleted and are unable to meet demand, that hunters move in and out of the trade independently of price signals generated by the market, and that, for the Kumasi bushmeat system, consumption levels are driven not by consumer choice but by shortfalls in supply and consequent price responses. Together, these results indicate that supply-side processes dominate the urban bushmeat trade in Kumasi. This suggests that future management interventions should focus on changing hunter behaviour, although complementary interventions targeting consumer demand are also likely to be necessary in the long term. Our approach represents a structured and repeatable method to assessing market dynamics in information-poor systems. The findings serve as a caution against assuming that wildlife markets are demand driven, and highlight the value of characterising market dynamics to inform appropriate management. PMID:27632169

  7. Characterising Wildlife Trade Market Supply-Demand Dynamics.

    PubMed

    McNamara, J; Rowcliffe, M; Cowlishaw, G; Alexander, J S; Ntiamoa-Baidu, Y; Brenya, A; Milner-Gulland, E J

    2016-01-01

    The trade in wildlife products can represent an important source of income for poor people, but also threaten wildlife locally, regionally and internationally. Bushmeat provides livelihoods for hunters, traders and sellers, protein to rural and urban consumers, and has depleted the populations of many tropical forest species. Management interventions can be targeted towards the consumers or suppliers of wildlife products. There has been a general assumption in the bushmeat literature that the urban trade is driven by consumer demand with hunters simply fulfilling this demand. Using the urban bushmeat trade in the city of Kumasi, Ghana, as a case study, we use a range of datasets to explore the processes driving the urban bushmeat trade. We characterise the nature of supply and demand by explicitly considering three market attributes: resource condition, hunter behaviour, and consumer behaviour. Our results suggest that bushmeat resources around Kumasi are becoming increasingly depleted and are unable to meet demand, that hunters move in and out of the trade independently of price signals generated by the market, and that, for the Kumasi bushmeat system, consumption levels are driven not by consumer choice but by shortfalls in supply and consequent price responses. Together, these results indicate that supply-side processes dominate the urban bushmeat trade in Kumasi. This suggests that future management interventions should focus on changing hunter behaviour, although complementary interventions targeting consumer demand are also likely to be necessary in the long term. Our approach represents a structured and repeatable method to assessing market dynamics in information-poor systems. The findings serve as a caution against assuming that wildlife markets are demand driven, and highlight the value of characterising market dynamics to inform appropriate management.

  8. The alchemy of demand response: turning demand into supply

    SciTech Connect

    Rochlin, Cliff

    2009-11-15

    Paying customers to refrain from purchasing products they want seems to run counter to the normal operation of markets. Demand response should be interpreted not as a supply-side resource but as a secondary market that attempts to correct the misallocation of electricity among electric users caused by regulated average rate tariffs. In a world with costless metering, the DR solution results in inefficiency as measured by deadweight losses. (author)

  9. Future Proofing Water Policy and Catchment Management for a Changing Climate: A Case Study of Competing Demands and Water Scarcity in the River Thames and Catchment

    NASA Astrophysics Data System (ADS)

    Whitehead, P. G.; Crossman, J.; Jin, L.

    2011-12-01

    The River Thames Catchment is the major water supply system in Southern England and supplies all of London's water supply from either the River Lee (a tributary of the Thames) or the main river abstraction site at Teddington (see Figure 1) or from groundwater sources in London. There has been a measurable change in rainfall patterns over the past 250 years with reducing summer rainfall and, hence flows, over the past 40 years. In 1976, following 3 dry winters, the London Reservoirs were more or less empty and the river flow direction was reversed to ensure a supply of water for London. Recent climate change studies in the Thames catchments suggest an increasing threat to water supply and also damage to river water quality and ecology. In addition to a changing climate, population levels in London have risen in recent years and the catchment is increasingly vulnerable to land use change. Since the 1920s changes in land use have increased the levels of nitrogen and phosphorus in the catchment and this trend is predicted to be exacerbated as climate change reduces freshwater dilution. Also land use is predicted to change as agriculture becomes more intensive as farmers react to higher grain and food prices. At the same time rising water temperatures has exposed the river to the potential for toxic algal blooms, such as cyanobacteria. This doom and gloom story is being managed however using a range of policy instruments, led by central government and public and private organisations such as Thames Water and the Environment Agency. Measures such as new reservoirs, a water transfer scheme from Wales and water metering to reduce demand are all being actively pursued, as are land management measures to control diffuse pollution. In order to assess the effects of climate change on the Thames catchment a major modelling study has been undertaken. The Integrated Catchment Model (INCA) has been set up for the Thames to model flow, nitrogen, phosphorus and ecology. Climate

  10. Does the knowledge-to-action (KTA) framework facilitate physical demands analysis development for firefighter injury management and return-to-work planning?

    PubMed

    Sinden, Kathryn; MacDermid, Joy C

    2014-03-01

    Employers are tasked with developing injury management and return-to-work (RTW) programs in response to occupational health and safety policies. Physical demands analyses (PDAs) are the cornerstone of injury management an