Designing Effective Safety Signs, Based on a Study of Recall for Safety Signs.

ERIC Educational Resources Information Center

Berry, Dennis W.

Aside from direct supervision at a recreational facility, safety signs, if designed properly, are the most effective approach to facility safety. This study was conducted to investigate the effectiveness of various sign designs: (l) multiple concepts with text; (2) single concept with text; and (3) single concept with graphics. A discussion of…

Mobile HIV screening in Cape Town, South Africa: clinical impact, cost and cost-effectiveness.

PubMed

Bassett, Ingrid V; Govindasamy, Darshini; Erlwanger, Alison S; Hyle, Emily P; Kranzer, Katharina; van Schaik, Nienke; Noubary, Farzad; Paltiel, A David; Wood, Robin; Walensky, Rochelle P; Losina, Elena; Bekker, Linda-Gail; Freedberg, Kenneth A

2014-01-01

Mobile HIV screening may facilitate early HIV diagnosis. Our objective was to examine the cost-effectiveness of adding a mobile screening unit to current medical facility-based HIV testing in Cape Town, South Africa. We used the Cost Effectiveness of Preventing AIDS Complications International (CEPAC-I) computer simulation model to evaluate two HIV screening strategies in Cape Town: 1) medical facility-based testing (the current standard of care) and 2) addition of a mobile HIV-testing unit intervention in the same community. Baseline input parameters were derived from a Cape Town-based mobile unit that tested 18,870 individuals over 2 years: prevalence of previously undiagnosed HIV (6.6%), mean CD4 count at diagnosis (males 423/µL, females 516/µL), CD4 count-dependent linkage to care rates (males 31%-58%, females 49%-58%), mobile unit intervention cost (includes acquisition, operation and HIV test costs, $29.30 per negative result and $31.30 per positive result). We conducted extensive sensitivity analyses to evaluate input uncertainty. Model outcomes included site of HIV diagnosis, life expectancy, medical costs, and the incremental cost-effectiveness ratio (ICER) of the intervention compared to medical facility-based testing. We considered the intervention to be "very cost-effective" when the ICER was less than South Africa's annual per capita Gross Domestic Product (GDP) ($8,200 in 2012). We projected that, with medical facility-based testing, the discounted (undiscounted) HIV-infected population life expectancy was 132.2 (197.7) months; this increased to 140.7 (211.7) months with the addition of the mobile unit. The ICER for the mobile unit was $2,400/year of life saved (YLS). Results were most sensitive to the previously undiagnosed HIV prevalence, linkage to care rates, and frequency of HIV testing at medical facilities. The addition of mobile HIV screening to current testing programs can improve survival and be very cost-effective in South Africa and other resource-limited settings, and should be a priority.

Metrics for Success: Strategies for Enabling Core Facility Performance and Assessing Outcomes

PubMed Central

Hockberger, Philip E.; Meyn, Susan M.; Nicklin, Connie; Tabarini, Diane; Auger, Julie A.

2016-01-01

Core Facilities are key elements in the research portfolio of academic and private research institutions. Administrators overseeing core facilities (core administrators) require assessment tools for evaluating the need and effectiveness of these facilities at their institutions. This article discusses ways to promote best practices in core facilities as well as ways to evaluate their performance across 8 of the following categories: general management, research and technical staff, financial management, customer base and satisfaction, resource management, communications, institutional impact, and strategic planning. For each category, we provide lessons learned that we believe contribute to the effective and efficient overall management of core facilities. If done well, we believe that encouraging best practices and evaluating performance in core facilities will demonstrate and reinforce the importance of core facilities in the research and educational mission of institutions. It will also increase job satisfaction of those working in core facilities and improve the likelihood of sustainability of both facilities and personnel. PMID:26848284

Metrics for Success: Strategies for Enabling Core Facility Performance and Assessing Outcomes.

PubMed

Turpen, Paula B; Hockberger, Philip E; Meyn, Susan M; Nicklin, Connie; Tabarini, Diane; Auger, Julie A

2016-04-01

Core Facilities are key elements in the research portfolio of academic and private research institutions. Administrators overseeing core facilities (core administrators) require assessment tools for evaluating the need and effectiveness of these facilities at their institutions. This article discusses ways to promote best practices in core facilities as well as ways to evaluate their performance across 8 of the following categories: general management, research and technical staff, financial management, customer base and satisfaction, resource management, communications, institutional impact, and strategic planning. For each category, we provide lessons learned that we believe contribute to the effective and efficient overall management of core facilities. If done well, we believe that encouraging best practices and evaluating performance in core facilities will demonstrate and reinforce the importance of core facilities in the research and educational mission of institutions. It will also increase job satisfaction of those working in core facilities and improve the likelihood of sustainability of both facilities and personnel.

MADM-based smart parking guidance algorithm

PubMed Central

Li, Bo; Pei, Yijian; Wu, Hao; Huang, Dijiang

2017-01-01

In smart parking environments, how to choose suitable parking facilities with various attributes to satisfy certain criteria is an important decision issue. Based on the multiple attributes decision making (MADM) theory, this study proposed a smart parking guidance algorithm by considering three representative decision factors (i.e., walk duration, parking fee, and the number of vacant parking spaces) and various preferences of drivers. In this paper, the expected number of vacant parking spaces is regarded as an important attribute to reflect the difficulty degree of finding available parking spaces, and a queueing theory-based theoretical method was proposed to estimate this expected number for candidate parking facilities with different capacities, arrival rates, and service rates. The effectiveness of the MADM-based parking guidance algorithm was investigated and compared with a blind search-based approach in comprehensive scenarios with various distributions of parking facilities, traffic intensities, and user preferences. Experimental results show that the proposed MADM-based algorithm is effective to choose suitable parking resources to satisfy users’ preferences. Furthermore, it has also been observed that this newly proposed Markov Chain-based availability attribute is more effective to represent the availability of parking spaces than the arrival rate-based availability attribute proposed in existing research. PMID:29236698

Observation of Neutron Skyshine from an Accelerator Based Neutron Source

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

Franklyn, C. B.

2011-12-13

A key feature of neutron based interrogation systems is the need for adequate provision of shielding around the facility. Accelerator facilities adapted for fast neutron generation are not necessarily suitably equipped to ensure complete containment of the vast quantity of neutrons generated, typically >10{sup 11} n{center_dot}s{sup -1}. Simulating the neutron leakage from a facility is not a simple exercise since the energy and directional distribution can only be approximated. Although adequate horizontal, planar shielding provision is made for a neutron generator facility, it is sometimes the case that vertical shielding is minimized, due to structural and economic constraints. It ismore » further justified by assuming the atmosphere above a facility functions as an adequate radiation shield. It has become apparent that multiple neutron scattering within the atmosphere can result in a measurable dose of neutrons reaching ground level some distance from a facility, an effect commonly known as skyshine. This paper describes a neutron detection system developed to monitor neutrons detected several hundred metres from a neutron source due to the effect of skyshine.« less

Assessing healthcare quality using routine data: evaluating the performance of the national tuberculosis programme in South Africa.

PubMed

McLaren, Zoë M; Sharp, Alana R; Zhou, Jifang; Wasserman, Sean; Nanoo, Ananta

2017-02-01

To assess the performance of healthcare facilities by means of indicators based on guidelines for clinical care of TB, which is likely a good measure of overall facility quality. We assessed quality of care in all public health facilities in South Africa using graphical, correlation and locally weighted kernel regression analysis of routine TB test data. Facility performance falls short of national standards of care. Only 74% of patients with TB provided a second specimen for testing, 18% received follow-up testing and 14% received drug resistance testing. Only resistance testing rates improved over time, tripling between 2004 and 2011. National awareness campaigns and changes in clinical guidelines had only a transient impact on testing rates. The poorest performing facilities remained at the bottom of the rankings over the period of study. The optimal policy strategy requires both broad-based policies and targeted resources to poor performers. This approach to assessing facility quality of care can be adapted to other contexts and also provides a low-cost method for evaluating the effectiveness of proposed interventions. Devising targeted policies based on routine data is a cost-effective way to improve the quality of public health care provided. © 2016 John Wiley & Sons Ltd.

Implementation research to improve quality of maternal and newborn health care, Malawi

PubMed Central

Wilhelm, Danielle; Lohmann, Julia; Kambala, Christabel; Chinkhumba, Jobiba; Muula, Adamson S; De Allegri, Manuela

2017-01-01

Abstract Objective To evaluate the impact of a performance-based financing scheme on maternal and neonatal health service quality in Malawi. Methods We conducted a non-randomized controlled before and after study to evaluate the effects of district- and facility-level performance incentives for health workers and management teams. We assessed changes in the facilities’ essential drug stocks, equipment maintenance and clinical obstetric care processes. Difference-in-difference regression models were used to analyse effects of the scheme on adherence to obstetric care treatment protocols and provision of essential drugs, supplies and equipment. Findings We observed 33 health facilities, 23 intervention facilities and 10 control facilities and 401 pregnant women across four districts. The scheme improved the availability of both functional equipment and essential drug stocks in the intervention facilities. We observed positive effects in respect to drug procurement and clinical care activities at non-intervention facilities, likely in response to improved district management performance. Birth assistants’ adherence to clinical protocols improved across all studied facilities as district health managers supervised and coached clinical staff more actively. Conclusion Despite nation-wide stock-outs and extreme health worker shortages, facilities in the study districts managed to improve maternal and neonatal health service quality by overcoming bottlenecks related to supply procurement, equipment maintenance and clinical performance. To strengthen and reform health management structures, performance-based financing may be a promising approach to sustainable improvements in quality of health care. PMID:28670014

A case series study on the effect of Ebola on facility-based deliveries in rural Liberia.

PubMed

Lori, Jody R; Rominski, Sarah Danielson; Perosky, Joseph E; Munro, Michelle L; Williams, Garfee; Bell, Sue Anne; Nyanplu, Aloysius B; Amarah, Patricia N M; Boyd, Carol J

2015-10-12

As communities' fears of Ebola virus disease (EVD) in West Africa exacerbate and their trust in healthcare providers diminishes, EVD has the potential to reverse the recent progress made in promoting facility-based delivery. Using retrospective data from a study focused on maternal and newborn health, this analysis examined the influence of EVD on the use of facility-based maternity care in Bong Country, Liberia, which shares a boarder with Sierra Leone - near the epicenter of the outbreak. Using a case series design, retrospective data from logbooks were collected at 12 study sites in one county. These data were then analyzed to determine women's use of facility-based maternity care between January 2012 and October 2014. The primary outcome was the number of facility-based deliveries over time. The first suspected case of EVD in Bong County was reported on June 30, 2014. Heat maps were generated and the number of deliveries was normalized to the average number of deliveries during the full 12 months before the EVD outbreak (March 2013 - February 2014). Prior to the EVD outbreak, facility-based deliveries steadily increased in Bong County reaching an all-time high of over 500 per month at study sites in the first half of 2014 - indicating Liberia was making inroads in normalizing institutional maternal healthcare. However, as reports of EVD escalated, facility-based deliveries decreased to a low of 113 in August 2014. Ebola virus disease has negatively impacted the use of facility-based maternity services, placing childbearing women at increased risk for morbidity and death.

A standards-based approach to quality improvement for HIV services at Zambia Defence Force facilities: results and lessons learned.

PubMed

Kols, Adrienne; Kim, Young-Mi; Bazant, Eva; Necochea, Edgar; Banda, Joseph; Stender, Stacie

2015-07-01

The Zambia Defence Force adopted the Standards-Based Management and Recognition approach to improve the quality of the HIV-related services at its health facilities. This quality improvement intervention relies on comprehensive, detailed assessment tools to communicate and verify adherence to national standards of care, and to test and implement changes to improve performance. A quasi-experimental evaluation of the intervention was conducted at eight Zambia Defence Force primary health facilities (four facilities implemented the intervention and four did not). Data from three previous analyses are combined to assess the effect of Standards-Based Management and Recognition on three domains: facility readiness to provide services; observed provider performance during antiretroviral therapy (ART) and antenatal care consultations; and provider perceptions of the work environment. Facility readiness scores for ART improved on four of the eight standards at intervention sites, and one standard at comparison sites. Facility readiness scores for prevention of mother-to-child transmission (PMTCT) of HIV increased by 15 percentage points at intervention sites and 7 percentage points at comparison sites. Provider performance improved significantly at intervention sites for both ART services (from 58 to 84%; P < 0.01) and PMTCT services (from 58 to 73%; P = 0.003); there was no significant change at comparison sites. Providers' perceptions of the work environment generally improved at intervention sites and declined at comparison sites; differences in trends between study groups were significant for eight items. A standards-based approach to quality improvement proved effective in supporting healthcare managers and providers to deliver ART and PMTCT services in accordance with evidence-based standards in a health system suffering from staff shortages.

Maternal and perinatal mortality by place of delivery in sub-Saharan Africa: a meta-analysis of population-based cohort studies.

PubMed

Chinkhumba, Jobiba; De Allegri, Manuela; Muula, Adamson S; Robberstad, Bjarne

2014-09-28

Facility-based delivery has gained traction as a key strategy for reducing maternal and perinatal mortality in developing countries. However, robust evidence of impact of place of delivery on maternal and perinatal mortality is lacking. We aimed to estimate the risk of maternal and perinatal mortality by place of delivery in sub-Saharan Africa. We conducted a systematic review of population-based cohort studies reporting on risk of maternal or perinatal mortality at the individual level by place of delivery in sub-Saharan Africa. Newcastle-Ottawa Scale was used to assess study quality. Outcomes were summarized in pooled analyses using fixed and random effects models. We calculated attributable risk percentage reduction in mortality to estimate exposure effect. We report mortality ratios, crude odds ratios and associated 95% confidence intervals. We found 9 population-based cohort studies: 6 reporting on perinatal and 3 on maternal mortality. The mean study quality score was 10 out of 15 points. Control for confounders varied between the studies. A total of 36,772 pregnancy episodes were included in the analyses. Overall, perinatal mortality is 21% higher for home compared to facility-based deliveries, but the difference is only significant when produced with a fixed effects model (OR 1.21, 95% CI: 1.02-1.46) and not when produced by a random effects model (OR 1.21, 95% CI: 0.79-1.84). Under best settings, up to 14 perinatal deaths might be averted per 1000 births if the women delivered at facilities instead of homes. We found significantly increased risk of maternal mortality for facility-based compared to home deliveries (OR 2.29, 95% CI: 1.58-3.31), precluding estimates of attributable risk fraction. Evaluating the impact of facility-based delivery strategy on maternal and perinatal mortality using population-based studies is complicated by selection bias and poor control of confounders. Studies that pool data at an individual level may overcome some of these problems and provide better estimates of relative effectiveness of place of delivery in the region.

Impact of Performance-Based Financing in a Low-Resource Setting: A Decade of Experience in Cambodia.

PubMed

Van de Poel, Ellen; Flores, Gabriela; Ir, Por; O'Donnell, Owen

2016-06-01

This paper exploits the geographic expansion of performance-based financing (PBF) in Cambodia over a decade to estimate its effect on the utilization of maternal and child health services. PBF is estimated to raise the proportion of births occurring in incentivized public health facilities by 7.5 percentage points (25%). A substantial part of this effect arises from switching the location of institutional births from private to public facilities; there is no significant impact on deliveries supervised by a skilled birth attendant, nor is there any significant effect on neonatal mortality, antenatal care and vaccination rates. The impact on births in public facilities is much greater if PBF is accompanied by maternity vouchers that cover user fees, but there is no significant effect among the poorest women. Heterogeneous effects across schemes differing in design suggest that maintaining management authority within a health district while giving explicit service targets to facilities is more effective in raising utilization than contracting management to a non-governmental organization while denying it full autonomy and leaving financial penalties vague. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

A geographical assessment of vegetation carbon stocks and greenhouse gas emissions on potential microalgae-based biofuel facilities in the United States.

PubMed

Quiroz Arita, Carlos; Yilmaz, Özge; Barlak, Semin; Catton, Kimberly B; Quinn, Jason C; Bradley, Thomas H

2016-12-01

The microalgae biofuels life cycle assessments (LCA) present in the literature have excluded the effects of direct land use change (DLUC) from facility construction under the assumption that DLUC effects are negligible. This study seeks to model the greenhouse gas (GHG) emissions of microalgae biofuels including DLUC by quantifying the CO 2 equivalence of carbon released to the atmosphere through the construction of microalgae facilities. The locations and types of biomass and Soil Organic Carbon that are disturbed through microalgae cultivation facility construction are quantified using geographical models of microalgae productivity potential including consideration of land availability. The results of this study demonstrate that previous LCA of microalgae to biofuel processes have overestimated GHG benefits of microalgae-based biofuels production by failing to include the effect of DLUC. Previous estimations of microalgae biofuel production potential have correspondingly overestimated the volume of biofuels that can be produced in compliance with U.S. environmental goals. Copyright © 2016 Elsevier Ltd. All rights reserved.

The effectiveness of empowering in-service training programs for foreign nurse aides in community-based long-term care facilities.

PubMed

Wu, Li-yu; Yin, Teresa J C; Li, I-chuan

2005-01-01

The objective of the study was to examine the effectiveness of empowering in-service training programs for foreign nurse aides working in community-based long-term care (LTC) facilities. The design was a pretest and post-test design with experiment and control groups. The sample consisted of purposeful sampling from 10 LTC facilities in the Shihlin and Peitou areas of Taipei. A total of 35 foreign nurse aides participated in this study; 16 in the experimental group and 19 in the control group. The experimental group attended the training program for a 3-month period, whereas the control group did not receive any training. The research findings reveal that the training program was effective in increasing the work stress of workload/scheduling (Z = 2.01, p

A method for studying the development pattern of urban commercial service facilities based on customer reviews from social media

NASA Astrophysics Data System (ADS)

Wang, Y. D.; Jiang, B. T.; Ye, X. Y.

2016-06-01

Urbanization is one of the most important human social activities in the 21st century (Chaolin et al., 2012). With an increasing number of people visiting cities, the provision of adequate urban service facilities, including public and commercial service facilities, in locations where people live has become an important guarantee of the success of urbanization. Exploring the commercial service facilities in a specific area of a city can help us understand the progress and trends of urban renewal in the area, provide a quantitative basis for evaluating the rationality of planning implementation, and facilitate an analysis of the effects of different factors on the regional development of a city (Schor et al. 2003). In this paper, we proposed a data processing and analysis method for studying the distribution and development pattern of urban commercial facilities based on customer reviews. In addition, based on road network constraints, we explored the patterns contained in customer reviews data, including patterns for the spatial distribution and spatial-temporal evolution of facilities as well as the number of facilities and degree of satisfaction.

42 CFR 482.66 - Special requirements for hospital providers of long-term care services (“swing-beds”).

Code of Federal Regulations, 2013 CFR

2013-10-01

..., based on the most recent census. (3) The hospital does not have in effect a 24-hour nursing waiver... within the two years previous to application. (b) Skilled nursing facility services. The facility is substantially in compliance with the following skilled nursing facility requirements contained in subpart B of...

42 CFR 482.66 - Special requirements for hospital providers of long-term care services (“swing-beds”).

Code of Federal Regulations, 2010 CFR

2010-10-01

..., based on the most recent census. (3) The hospital does not have in effect a 24-hour nursing waiver... within the two years previous to application. (b) Skilled nursing facility services. The facility is substantially in compliance with the following skilled nursing facility requirements contained in subpart B of...

42 CFR 482.66 - Special requirements for hospital providers of long-term care services (“swing-beds”).

Code of Federal Regulations, 2011 CFR

2011-10-01

..., based on the most recent census. (3) The hospital does not have in effect a 24-hour nursing waiver... within the two years previous to application. (b) Skilled nursing facility services. The facility is substantially in compliance with the following skilled nursing facility requirements contained in subpart B of...

42 CFR 482.66 - Special requirements for hospital providers of long-term care services (“swing-beds”).

Code of Federal Regulations, 2012 CFR

2012-10-01

..., based on the most recent census. (3) The hospital does not have in effect a 24-hour nursing waiver... within the two years previous to application. (b) Skilled nursing facility services. The facility is substantially in compliance with the following skilled nursing facility requirements contained in subpart B of...

An assessment of the effect of user fee policy reform on facility-based deliveries in rural Zambia.

PubMed

Chama-Chiliba, Chitalu Miriam; Koch, Steven Fredric

2016-12-07

Improving maternal health outcomes by reducing barriers to accessing maternal health services is a key goal for most developing countries. This paper analyses the effect of user fee removal, which was announced for rural areas of Zambia in April 2006, on the use of public health facilities for childbirth. Data from the 2007 Zambia Demographic and Health Survey, including birth histories for the five years preceding the survey, is linked to administrative data and geo-referenced health facility census data. We exploit a difference-in-differences design, due to a differential change in user fees at the district level; fees were removed in 54 rural districts, but not in the 18 remaining urban districts. We use multilevel modelling to estimate the effect of this policy change, based on 4018 births from May 2002 to September 2007, covering a period before and after the policy announcement in April 2006. The difference-in-difference estimates point to statistically insignificant changes in the proportion of women giving birth at home and in public facilities, but significant changes are found for deliveries in private (faith-based) facilities. Thus, the abolition of delivery fees is found to have some effect on where Zambian mothers choose to have their children born. The removal of user fees has not overcome barriers to the utilisation of delivery services at public facilities. User fee removal may also yield unintended consequences deterring the utilisation of delivery services. Therefore, abolishing user fees, alone, may not be sufficient to affect changes in utilisation; instead, other efforts, such as improving service quality, may have a greater impact.

Towards a Strength-Based Juvenile Correctional Facility: Sustainability and Effects of an Institutional Transformation

ERIC Educational Resources Information Center

Barton, William H.; Mackin, Juliette R.

2012-01-01

In 2006, the administration of a state-run, secure juvenile correctional facility initiated an attempt to transform its institutional culture using a strength-based approach to assessment and case planning. This resulted in a rapid improvement in institutional climate. The current study revisits this setting several years later to see if those…

Towards ion beam therapy based on laser plasma accelerators.

PubMed

Karsch, Leonhard; Beyreuther, Elke; Enghardt, Wolfgang; Gotz, Malte; Masood, Umar; Schramm, Ulrich; Zeil, Karl; Pawelke, Jörg

2017-11-01

Only few ten radiotherapy facilities worldwide provide ion beams, in spite of their physical advantage of better achievable tumor conformity of the dose compared to conventional photon beams. Since, mainly the large size and high costs hinder their wider spread, great efforts are ongoing to develop more compact ion therapy facilities. One promising approach for smaller facilities is the acceleration of ions on micrometre scale by high intensity lasers. Laser accelerators deliver pulsed beams with a low pulse repetition rate, but a high number of ions per pulse, broad energy spectra and high divergences. A clinical use of a laser based ion beam facility requires not only a laser accelerator providing beams of therapeutic quality, but also new approaches for beam transport, dosimetric control and tumor conformal dose delivery procedure together with the knowledge of the radiobiological effectiveness of laser-driven beams. Over the last decade research was mainly focused on protons and progress was achieved in all important challenges. Although currently the maximum proton energy is not yet high enough for patient irradiation, suggestions and solutions have been reported for compact beam transport and dose delivery procedures, respectively, as well as for precise dosimetric control. Radiobiological in vitro and in vivo studies show no indications of an altered biological effectiveness of laser-driven beams. Laser based facilities will hardly improve the availability of ion beams for patient treatment in the next decade. Nevertheless, there are possibilities for a need of laser based therapy facilities in future.

Cost-effectiveness of a quality improvement collaborative for obstetric and newborn care in Niger.

PubMed

Broughton, Edward; Saley, Zakari; Boucar, Maina; Alagane, Dondi; Hill, Kathleen; Marafa, Aicha; Asma, Yaroh; Sani, Karimou

2013-01-01

The purpose of this paper is to describe a quality improvement collaborative conducted in 33 Nigerian facilities to improve maternal and newborn care outcomes by increasing compliance with high-impact, evidence-based care standards. Intervention costs and cost-effectiveness were examined and costs to the Niger Health Ministry (MoH) were estimated if they were to scale-up the intervention to additional sites. Facility-based maternal care outcomes and costs from pre-quality improvement collaborative baseline monitoring data in participating facilities from January to May 2006 were compared with outcomes and costs from the same facilities from June 2008 to September 2008. Cost data were collected from project accounting records. The MoH costs were determined from interviews with clinic managers and quality improvement teams. Effectiveness data were obtained from facilities' records. The average delivery-cost decreased from $35 before to $28 after the collaborative. The USAID/HCI project's incremental cost was $2.43/delivery. The collaborative incremental cost-effectiveness was $147/disability-adjusted life year averted. If the MoH spread the intervention to other facilities, substantive cost-savings and improved health outcomes can be predicted. The intervention achieved significant positive health benefits for a low cost. The Niger MoH can expect approximately 50 per cent return on its investment if it implements the collaborative in new facilities. The improvement collaborative approach can improve health and save health care resources. This is one of the first studies known to examine collaborative quality improvement and economic efficiency in a developing country.

A novel method for designing and optimizing the layout of facilities in bathroom for the elderly in home-based rehabilitation.

PubMed

Wang, Duojin; Wu, Jing; Lin, Qinglian

2018-05-01

The home-based rehabilitation of elderly patients improves their autonomy, independence and reintegration into society. Hence, a suitable environment plays an important role in rehabilitation, as do different assistance technologies. The majority of accidents at home involving elderly people occur in the bathroom. Therefore, the planning of the layout of facilities is important in this potentially dangerous area. This paper proposes an approach towards designing and optimizing the layout of facilities in the bathroom, based on logistical and nonlogistical relationships. A fuzzy-based analytical hierarchical process (fuzzy-AHP) is then proposed for a comprehensive evaluation of the alternatives for this layout plan. This approach was applied to the home of a 71 years old female patient, who was experiencing home-based rehabilitation. After the initial designing and optimizing of the layout of the facilities in her bathroom, a plan could then be created for her particular needs. The results of this research could then enable the home-based rehabilitation of elderly patients to be more effective. Value: This paper develops a new approach to design and optimize the layout of facilities in bathroom for the elderly. Implications for Rehabilitation Develop a new approach to design and optimize the layout of facilities in bathroom. Provide a mathematical and more scientific approach to home layout design for home-based rehabilitation. Provide new opportunities for research, for both the therapist and the patient to analyse the home facility layout.

The effects of ownership and ownership change on nursing home industry costs.

PubMed

Holmes, J S

1996-08-01

This study examines the effects of ownership type and ownership change on nursing home cost structures, differentiating patient care costs from plant costs. Administrative data from the Michigan Department of Social Services, Medical Services Administration (Medicaid), and the Michigan Department of Public Health are used. Cost data are based on audited cost reports for 393 nursing care facilities in Michigan in 1989. Other facility characteristics are based on data from the 1989 annual licensing and certification survey conducted by the Michigan Department of Public Health. A series of ordinary least squares regressions is estimated, in which the dependent variable is either per diem patient costs or per diem plant costs. Ownership types are defined as chain, proprietary non-chain, freestanding non-profit, government-owned, and hospital-based facilities. Pooled estimation techniques, as well as separate regressions by ownership type, are presented to test for interaction effects. Key variables include whether a facility changed ownership in the preceding five years and whether chain facilities are in-state- or out-of-state-owned, in addition to size, payer mix, and case mix. Behavioral differences among nursing home ownership types in respect to patient care costs tended to distinguish government-owned and hospital-based facilities from the freestanding homes rather than the usual distinction between for-profit and not-for-profit classes. Variables traditionally included in nursing home cost studies, such as size, occupancy, payer mix and case mix, were found to have similar effects on per diem patient care costs for freestanding non-profit homes as well as for chain proprietary facilities. With regard to the effects of ownership change on per diem plant and per diem patient costs, however, there are few differences among ownership types. Chain and non-chain for-profit facilities, non-profit homes, and hospital long-term care units that had changed ownership reported significantly higher per diem plant costs than facilities without a change of ownership, but did not spend more on patient-related costs. Michigan Medicaid plant reimbursement system policy changes instituted in 1985 to promote continued ownership of facilities were not entirely successful. Non-profit homes look increasingly like their for-profit counterparts with respect to spending on patient care costs. Increased competition for the more lucrative private-pay patients, coupled with declining state Medicaid reimbursement to nursing homes, may have blurred the historical distinctions between the non-profit and for-profit sectors in the nursing home industry. An exception to increasing homogeneity within the nursing home industry is the tendency of proprietary homes to experience more frequent changes of ownership, which results in higher capital costs passed on to state Medicaid programs. Findings from this study indicate that while facility sales increase per diem plant costs, they do not result in increased spending for direct patient care, suggesting that state Medicaid programs may be indirectly subsidizing facility sales with no accompanying increase in expenditures for patient care. To discourage frequent facility sales, state Medicaid programs may need to consider alternative methods of reimbursing nursing home owners for capital costs.

Community-Based Interventions to Improve and Sustain Antiretroviral Therapy Adherence, Retention in HIV Care and Clinical Outcomes in Low- and Middle-Income Countries for Achieving the UNAIDS 90-90-90 Targets

PubMed Central

Adetokunboh, Olatunji; Uthman, Olalekan A.; Knowlton, Amy W.; Altice, Frederick L.; Schechter, Mauro; Galárraga, Omar; Geng, Elvin; Peltzer, Karl; Chang, Larry W.; Van Cutsem, Gilles; Jaffar, Shabbar S.; Ford, Nathan; Mellins, Claude A.; Remien, Robert H.; Mills, Edward J.

2017-01-01

Little is known about the effect of community versus health facility-based interventions to improve and sustain antiretroviral therapy (ART) adherence, virologic suppression, and retention in care among HIV-infected individuals in low-and middle-income countries (LMICs). We systematically searched four electronic databases for all available randomized controlled trials (RCTs) and comparative cohort studies in LMICs comparing community versus health facility-based interventions. Relative risks (RRs) for pre-defined adherence, treatment engagement (linkage and retention in care), and relevant clinical outcomes were pooled using random effect models. Eleven cohort studies and eleven RCTs (N = 97,657) were included. Meta-analysis of the included RCTs comparing community- versus health facility-based interventions found comparable outcomes in terms of ART adherence (RR = 1.02, 95 % CI 0.99 to 1.04), virologic suppression (RR = 1.00, 95 % CI 0.98 to 1.03), and all-cause mortality (RR = 0.93, 95 % CI 0.73 to 1.18). The result of pooled analysis from the RCTs (RR = 1.03, 95 % CI 1.01 to 1.06) and cohort studies (RR = 1.09, 95 % CI 1.03 to 1.15) found that participants assigned to community-based interventions had statistically significantly higher rates of treatment engagement. Two studies found community-based ART delivery model either cost-saving or cost-effective. Community- versus facility-based models of ART delivery resulted in at least comparable outcomes for clinically stable HIV-infected patients on treatment in LMICs and are likely to be cost-effective. PMID:27475643

Cost-effectiveness of the treatment of uncomplicated severe acute malnutrition by community health workers compared to treatment provided at an outpatient facility in rural Mali.

PubMed

Rogers, Eleanor; Martínez, Karen; Morán, Jose Luis Alvarez; Alé, Franck G B; Charle, Pilar; Guerrero, Saul; Puett, Chloe

2018-02-20

The Malian Nutrition Division of the Ministry of Health and Action Against Hunger tested the feasibility of integrating treatment of severe acute malnutrition (SAM) into the existing Integrated Community Case Management package delivered by community health workers (CHWs). This study assessed costs and cost-effectiveness of CHW-delivered care compared to outpatient facility-based care. Activity-based costing methods were used, and a societal perspective employed to include all relevant costs incurred by institutions, beneficiaries and communities. The intervention and control arm enrolled different numbers of children so a modelled scenario sensitivity analysis was conducted to assess the cost-effectiveness of the two arms, assuming equal numbers of children enrolled. In the base case, with unequal numbers of children in each arm, for CHW-delivered care, the cost per child treated was 244 USD and cost per child recovered was 259 USD. Outpatient facility-based care was less cost-effective at 442 USD per child and 501 USD per child recovered. The conclusions of the analysis changed in the modelled scenario sensitivity analysis, with outpatient facility-based care being marginally more cost-effective (cost per child treated is 188 USD, cost per child recovered is 214 USD), compared to CHW-delivered care. This suggests that achieving good coverage is a key factor influencing cost-effectiveness of CHWs delivering treatment for SAM in this setting. Per week of treatment, households receiving CHW-delivered care spent half of the time receiving treatment and three times less money compared with those receiving treatment from the outpatient facility. This study supports existing evidence that the delivery of treatment by CHWs is a cost-effective intervention, provided that good coverage is achieved. A major benefit of this strategy was the lower cost incurred by the beneficiary household when treatment is available in the community. Further research is needed on the implementation costs that would be incurred by the government to increase the operability of these results.

Cryogenic Fluid Management Facility

NASA Technical Reports Server (NTRS)

Eberhardt, R. N.; Bailey, W. J.; Symons, E. P.; Kroeger, E. W.

1984-01-01

The Cryogenic Fluid Management Facility (CFMF) is a reusable test bed which is designed to be carried into space in the Shuttle cargo bay to investigate systems and technologies required to efficiently and effectively manage cryogens in space. The facility hardware is configured to provide low-g verification of fluid and thermal models of cryogenic storage, transfer concepts and processes. Significant design data and criteria for future subcritical cryogenic storage and transfer systems will be obtained. Future applications include space-based and ground-based orbit transfer vehicles (OTV), space station life support, attitude control, power and fuel depot supply, resupply tankers, external tank (ET) propellant scavenging, space-based weapon systems and space-based orbit maneuvering vehicles (OMV). This paper describes the facility and discusses the cryogenic fluid management technology to be investigated. A brief discussion of the integration issues involved in loading and transporting liquid hydrogen within the Shuttle cargo bay is also included.

Community-based screening for obstetric fistula in Nigeria: a novel approach

PubMed Central

2014-01-01

Background Obstetric fistula continues to have devastating effects on the physical, social, and economic lives of thousands of women in many low-resource settings. Governments require credible estimates of the backlog of existing cases requiring care to effectively plan for the treatment of fistula cases. Our study aims to quantify the backlog of obstetric fistula cases within two states via community-based screenings and to assess the questions in the Demographic Health Survey (DHS) fistula module. Methods The screening sites, all lower level health facilities, were selected based on their geographic coverage, prior relationships with the communities and availability of fistula surgery facilities in the state. This cross-sectional study included women who presented for fistula screenings at study facilities based on their perceived fistula-like symptoms. Research assistants administered the pre-screening questionnaire. Nurse-midwives then conducted a medical exam. Univariate and bivariate analyses are presented. Results A total of 268 women attended the screenings. Based on the pre-screening interview, the backlog of fistula cases reported was 75 (28% of women screened). The backlog identified after the medical exam was 26 fistula cases (29.5% of women screened) in Kebbi State sites and 12 cases in Cross River State sites (6.7%). Verification assessment showed that the DHS questionnaire had 92% sensitivity, 83% specificity with 47% positive predictive value and 98% negative predictive value for identifying women afflicted by fistula among women who came for the screenings. Conclusions This methodology, involving effective, locally appropriate messaging and community outreach followed up with medical examination by nurse-midwives at lower level facilities, is challenging, but represents a promising approach to identify the backlog of women needing surgery and to link them with surgical facilities. PMID:24456506

Communities Putting Prevention to Work: Results of an Obesity Prevention Initiative in Child Care Facilities

ERIC Educational Resources Information Center

Natale, Ruby; Camejo, Stephanie; Sanders, Lee M.

2016-01-01

Obesity is a significant public health issue affecting even our youngest children. Given that a significant amount of young children are enrolled in child care, the goal of this project was to evaluate the effectiveness of a child care facility-based obesity prevention program. Over 1,000 facilities participated in the study. The intervention…

The PIRATE Facility: at the crossroads of research and teaching

NASA Astrophysics Data System (ADS)

Kolb, U.

2014-12-01

I describe the Open University-owned 0.43m robotic observatory PIRATE, based in Mallorca. PIRATE is a cost-effective facility contributing to topical astrophysical research and an inspiring platform for distance education students to learn practical science.

Research on the effect of rainfall flood regulation and control of wetland park based on SWMM model—a case study of wetland park in Yuanjia village, Qishan county, Shaanxi province

NASA Astrophysics Data System (ADS)

Xu, Da; Liu, Yijie

2018-02-01

Taking the wetland park of Yuan Village in Qishan County of Shaanxi Province as the research object, this paper makes a reasonable generalization of the study area, and establishes two models of low impact development (LID) and traditional development in the park. Meantime, rainwater in the surrounding built up area is introduced to into the park for digestion. SWMM model is used to simulate the variation of the total runoff, peak flow and peak time of two development models in Wetland Park under one-hour rainfall at different recurrence periods.The runoff control effect in each single LID facility in the one-hour rainfall once during five years in the built-up area is simulated. The simulation results show that the SWMM model can not only quantify the runoff reduction effect of different LID facilities, but also provide theoretical basis and data support for the urban rainfall flood problem. LID facilities have effects on runoff reduction and peak delay. However, the combined LID facility has obvious advantages for the peak time delay and peak flow control. A single LID facility is more efficient in a single runoff volume control. The order of runoff reduction by various LID facilities is as follows: Rain garden>combined LID facility> vegetative swale> bio-retention cell > permeable pavement. The order of peak time delay effect by the LID facilities is as follows: combined LID facility> Rain garden> vegetative swale> bio-retention cell > permeable pavement. The order of peak flow reduction efficiency by various LID facilities is: combined LID facility> Rain garden> bio-retention cell > vegetative swale> permeable pavement.

Developing mobile- and BIM-based integrated visual facility maintenance management system.

PubMed

Lin, Yu-Cheng; Su, Yu-Chih

2013-01-01

Facility maintenance management (FMM) has become an important topic for research on the operation phase of the construction life cycle. Managing FMM effectively is extremely difficult owing to various factors and environments. One of the difficulties is the performance of 2D graphics when depicting maintenance service. Building information modeling (BIM) uses precise geometry and relevant data to support the maintenance service of facilities depicted in 3D object-oriented CAD. This paper proposes a new and practical methodology with application to FMM using BIM technology. Using BIM technology, this study proposes a BIM-based facility maintenance management (BIMFMM) system for maintenance staff in the operation and maintenance phase. The BIMFMM system is then applied in selected case study of a commercial building project in Taiwan to verify the proposed methodology and demonstrate its effectiveness in FMM practice. Using the BIMFMM system, maintenance staff can access and review 3D BIM models for updating related maintenance records in a digital format. Moreover, this study presents a generic system architecture and its implementation. The combined results demonstrate that a BIMFMM-like system can be an effective visual FMM tool.

Development of experimental facilities for processing metallic crystals in orbit

NASA Technical Reports Server (NTRS)

Duncan, Bill J.

1990-01-01

This paper discusses the evolution, current status, and planning for facilities to exploit the microgravity environment of earth orbit in applied metallic materials science. Space-Shuttle based facilities and some precursor flight programs are reviewed. Current facility development programs and planned Space Station furnace capabilities are described. The reduced gravity levels available in earth orbit allow the processing of metallic materials without the disturbing influence of gravitationally induced thermal convection, stratification due to density differences in sample components, or the effects of hydrostatic pressure.

Institutional environmental impact statement, Michoud Assembly Facility, New Orleans, Louisiana

NASA Technical Reports Server (NTRS)

1978-01-01

A description and analysis of Michoud Assembly Facility as an operational base for both NASA and NASA-related programs and various government tenant-agencies and their contractors is given. Tenant-agencies are governmental agencies or governmental agency contractors which are not involved in a NASA program, but utilize office or manufacturing space at the Michoud Assembly Facility. The statements represent the full description of the likely environmental effects of the facility and are used in the process of making program and project decisions.

Legal requirements for human-health based appeals of wind energy projects in ontario.

PubMed

Engel, Albert M

2014-01-01

In 2009, the government of the province of Ontario, Canada passed new legislation to promote the development of renewable energy facilities, including wind energy facilities in the province. Throughout the legislative process, concerns were raised with respect to the effect of wind energy facilities on human health. Ultimately, the government established setbacks and sound level limits for wind energy facilities and provided Ontario residents with the right to appeal the approval of a wind energy facility on the ground that engaging in the facility in accordance with its approval will cause serious harm to human health. The first approval of a wind facility under the new legislation was issued in 2010 and since then, Ontario's Environmental Review Tribunal as well as Ontario's courts has been considering evidence proffered by appellants seeking revocation of approvals on the basis of serious harm to human health. To date, the evidence has been insufficient to support the revocation of a wind facility approval. This article reviews the legal basis for the dismissal of human-health based appeals.

Keratin-based products for effective wound care management in superficial and partial thickness burns injuries.

PubMed

Loan, Fiona; Cassidy, Sharon; Marsh, Clive; Simcock, Jeremy

2016-05-01

This n=40 cohort study on superficial and partial thickness burns compares novel keratin-based products with the standard products used at our facility. The keratin products are found to facilitate healing with minimal scarring, be well tolerated with minimal pain and itch, be easy to use for the health professional and be cost effective for the health care provider. For these reasons they are being adopted into use at our facility. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Technology for subsystems of space-based plant growth facilities

NASA Technical Reports Server (NTRS)

Bula, R. J.; Morrow, R. C.; Tibbitts, T. W.; Corey, R. B.

1990-01-01

Technologies for different subsystems of space-based plant growth facilities are being developed at the Wisconsin Center for Space Automation and Robotics, a NASA Center for the Commercial Development of Space. The technologies include concepts for water and nutrient delivery, for nutrient composition control, and for irradiation. Effort is being concentrated on these subsystems because available technologies cannot be effectively utilized for space applications.

Developing Mobile BIM/2D Barcode-Based Automated Facility Management System

PubMed Central

Chen, Yen-Pei

2014-01-01

Facility management (FM) has become an important topic in research on the operation and maintenance phase. Managing the work of FM effectively is extremely difficult owing to the variety of environments. One of the difficulties is the performance of two-dimensional (2D) graphics when depicting facilities. Building information modeling (BIM) uses precise geometry and relevant data to support the facilities depicted in three-dimensional (3D) object-oriented computer-aided design (CAD). This paper proposes a new and practical methodology with application to FM that uses an integrated 2D barcode and the BIM approach. Using 2D barcode and BIM technologies, this study proposes a mobile automated BIM-based facility management (BIMFM) system for FM staff in the operation and maintenance phase. The mobile automated BIMFM system is then applied in a selected case study of a commercial building project in Taiwan to verify the proposed methodology and demonstrate its effectiveness in FM practice. The combined results demonstrate that a BIMFM-like system can be an effective mobile automated FM tool. The advantage of the mobile automated BIMFM system lies not only in improving FM work efficiency for the FM staff but also in facilitating FM updates and transfers in the BIM environment. PMID:25250373

Developing mobile BIM/2D barcode-based automated facility management system.

PubMed

Lin, Yu-Cheng; Su, Yu-Chih; Chen, Yen-Pei

2014-01-01

Facility management (FM) has become an important topic in research on the operation and maintenance phase. Managing the work of FM effectively is extremely difficult owing to the variety of environments. One of the difficulties is the performance of two-dimensional (2D) graphics when depicting facilities. Building information modeling (BIM) uses precise geometry and relevant data to support the facilities depicted in three-dimensional (3D) object-oriented computer-aided design (CAD). This paper proposes a new and practical methodology with application to FM that uses an integrated 2D barcode and the BIM approach. Using 2D barcode and BIM technologies, this study proposes a mobile automated BIM-based facility management (BIMFM) system for FM staff in the operation and maintenance phase. The mobile automated BIMFM system is then applied in a selected case study of a commercial building project in Taiwan to verify the proposed methodology and demonstrate its effectiveness in FM practice. The combined results demonstrate that a BIMFM-like system can be an effective mobile automated FM tool. The advantage of the mobile automated BIMFM system lies not only in improving FM work efficiency for the FM staff but also in facilitating FM updates and transfers in the BIM environment.

Effects of physician-owned specialized facilities in health care: a systematic review.

PubMed

Trybou, Jeroen; De Regge, Melissa; Gemmel, Paul; Duyck, Philippe; Annemans, Lieven

2014-12-01

Multiple studies have investigated physician-owned specialized facilities (specialized hospitals and ambulatory surgery centres). However, the evidence is fragmented and the literature lacks cohesion. To provide a comprehensive overview of the effects of physician-owned specialized facilities by synthesizing the findings of published empirical studies. Two reviewers independently researched relevant studies using a standardized search strategy. The Institute of Medicine's quality framework (safe, effective, equitable, efficient, patient-centred, and accessible care) was applied in order to evaluate the performance of such facilities. In addition, the impact on the performance of full-service general hospitals was assessed. Forty-six studies were included in the systematic review. Overall, the quality of the included studies was satisfactory. Our results show that little evidence exists to confirm the advantages attributed to physician-owned specialized facilities, and their impact on full-service general hospitals remains limited. Although data is available on a wide variety of effects, the evidence base is surprisingly thin. There is no compelling evidence available demonstrating the added value of physician-owned specialized facilities in terms of quality or cost of the delivered care. More research is necessary on the relative merits of physician-owned specialized facilities. In addition, their corresponding impact on full-service general hospitals remains unclear. The development of physician-owned specialized facilities should thus be monitored carefully. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

A facility specialist model for improving retention of nursing home staff: results from a randomized, controlled study.

PubMed

Pillemer, Karl; Meador, Rhoda; Henderson, Charles; Robison, Julie; Hegeman, Carol; Graham, Edwin; Schultz, Leslie

2008-07-01

This article reports on a randomized, controlled intervention study designed to reduce employee turnover by creating a retention specialist position in nursing homes. We collected data three times over a 1-year period in 30 nursing homes, sampled in stratified random manner from facilities in New York State and Connecticut and randomly assigned to treatment and control conditions. Staff outcomes were measured through certified nursing assistant interviews, and turnover rates were measured over the course of the year. In the intervention condition, a staff member was selected to be the facility retention specialist, who would advocate for and implement programs to improve staff retention and commitment throughout the facility. Retention specialists received an intensive 3-day training in retention leadership and in a number of evidence-based retention programs. Ongoing support was provided throughout the project. Treatment facilities experienced significant declines in turnover rates compared to control facilities. As predicted, we found positive effects on certified nursing assistant assessments of the quality of retention efforts and of care provided in the facility; we did not find effects for job satisfaction or stress. The study provides evidence for the effectiveness of the retention specialist model. Findings from a detailed process evaluation suggest modifications of the program that may increase program effects.

LLE Review 120 (July-September 2009)

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

Edgell, D.H., editor

2001-02-19

This issue has the following articles: (1) The Omega Laser Facility Users Group Workshop; (2) The Effect of Condensates and Inner Coatings on the Performance of Vacuum Hohlraum Targets; (3) Zirconia-Coated-Carbonyl-Iron-Particle-Based Magnetorheological Fluid for Polishing Optical Glasses and Ceramics; (4) All-Fiber Optical Magnetic Field Sensor Based on Faraday Rotation in Highly Terbium Doped Fiber; (5) Femtosecond Optical Pump-Probe Characterization of High-Pressure-Grown Al{sub 0.86}Ga{sub 0.14}N Single Crystals; (6) LLE's Summer High School Research Program; (7) Laser Facility Report; and (8) National Laser Users Facility and External Users Programs.

Modular Extended-Stay HyperGravity Facility Design Concept: An Artificial-Gravity Space-Settlement Ground Analogue

NASA Technical Reports Server (NTRS)

Dorais, Gregory A.

2015-01-01

This document defines the design concept for a ground-based, extended-stay hypergravity facility as a precursor for space-based artificial-gravity facilities that extend the permanent presence of both human and non-human life beyond Earth in artificial-gravity settlements. Since the Earth's current human population is stressing the environment and the resources off-Earth are relatively unlimited, by as soon as 2040 more than one thousand people could be living in Earthorbiting artificial-gravity habitats. Eventually, the majority of humanity may live in artificialgravity habitats throughout this solar system as well as others, but little is known about the longterm (multi-generational) effects of artificial-gravity habitats on people, animals, and plants. In order to extend life permanently beyond Earth, it would be useful to create an orbiting space facility that generates 1g as well as other gravity levels to rigorously address the numerous challenges of such an endeavor. Before doing so, developing a ground-based artificial-gravity facility is a reasonable next step. Just as the International Space Station is a microgravity research facility, at a small fraction of the cost and risk a ground-based artificial-gravity facility can begin to address a wide-variety of the artificial-gravity life-science questions and engineering challenges requiring long-term research to enable people, animals, and plants to live off-Earth indefinitely.

Facility and market factors affecting transitions from nursing home to community.

PubMed

Arling, Greg; Abrahamson, Kathleen A; Cooke, Valerie; Kane, Robert L; Lewis, Teresa

2011-09-01

Research into nursing home transitions has given limited attention to the facility or community contexts. To identify facility and market factors affecting transitions of nursing home residents back to the community. Multilevel models were used to estimate effects of facility and market factors on facility-level community discharge rates after controlling for resident demographic, health, and functional conditions. Facility discharge rates were adjusted using Empirical Bayes estimation. Annual cohort of first-time admissions (N=24,648) to 378 Minnesota nursing facilities in 75 nursing home markets from July 2005 to June 2006. Community discharge within 90 days of admission; facility occupancy, payer mix, ownership, case-mix acuity, size, admissions from hospitals, nurse staffing level, and proportion of admissions preferring or having support to return to the community; and nursing market population size, average occupancy, market concentration, and availability of home and community-based services. Rates of community discharge (Empirical Bayes residual) were highest in facilities with more residents preferring community discharge, more Medicare days, higher nurse staffing levels, and higher occupancy. In addition, facilities had higher community discharge rates if they were located in markets with a greater ratio of home and community-based services recipients to nursing home residents and with larger populations. State Medicaid programs should undertake system-level interventions that encourage nursing facilities to reduce unused bed capacity, balance the mix of payers, invest in nurse staffing, and take other steps to promote community discharges. In addition, states should increase home and community-based services, particularly in markets with low community discharge rates.

Effect on maternal and child health services in Rwanda of payment to primary health-care providers for performance: an impact evaluation.

PubMed

Basinga, Paulin; Gertler, Paul J; Binagwaho, Agnes; Soucat, Agnes L B; Sturdy, Jennifer; Vermeersch, Christel M J

2011-04-23

Evidence about the best methods with which to accelerate progress towards achieving the Millennium Development Goals is urgently needed. We assessed the effect of performance-based payment of health-care providers (payment for performance; P4P) on use and quality of child and maternal care services in health-care facilities in Rwanda. 166 facilities were randomly assigned at the district level either to begin P4P funding between June, 2006, and October, 2006 (intervention group; n=80), or to continue with the traditional input-based funding until 23 months after study baseline (control group; n=86). Randomisation was done by coin toss. We surveyed facilities and 2158 households at baseline and after 23 months. The main outcome measures were prenatal care visits and institutional deliveries, quality of prenatal care, and child preventive care visits and immunisation. We isolated the incentive effect from the resource effect by increasing comparison facilities' input-based budgets by the average P4P payments made to the treatment facilities. We estimated a multivariate regression specification of the difference-in-difference model in which an individual's outcome is regressed against a dummy variable, indicating whether the facility received P4P that year, a facility-fixed effect, a year indicator, and a series of individual and household characteristics. Our model estimated that facilities in the intervention group had a 23% increase in the number of institutional deliveries and increases in the number of preventive care visits by children aged 23 months or younger (56%) and aged between 24 months and 59 months (132%). No improvements were seen in the number of women completing four prenatal care visits or of children receiving full immunisation schedules. We also estimate an increase of 0·157 standard deviations (95% CI 0·026-0·289) in prenatal quality as measured by compliance with Rwandan prenatal care clinical practice guidelines. The P4P scheme in Rwanda had the greatest effect on those services that had the highest payment rates and needed the least effort from the service provider. P4P financial performance incentives can improve both the use and quality of maternal and child health services, and could be a useful intervention to accelerate progress towards Millennium Development Goals for maternal and child health. World Bank's Bank-Netherlands Partnership Program and Spanish Impact Evaluation Fund, the British Economic and Social Research Council, Government of Rwanda, and Global Development Network. Copyright © 2011 Elsevier Ltd. All rights reserved.

Linking data sources for measurement of effective coverage in maternal and newborn health: what do we learn from individual- vs ecological-linking methods?

PubMed

Willey, Barbara; Waiswa, Peter; Kajjo, Darious; Munos, Melinda; Akuze, Joseph; Allen, Elizabeth; Marchant, Tanya

2018-06-01

Improving maternal and newborn health requires improvements in the quality of facility-based care. This is challenging to measure: routine data may be unreliable; respondents in population surveys may be unable to accurately report on quality indicators; and facility assessments lack population level denominators. We explored methods for linking access to skilled birth attendance (SBA) from household surveys to data on provision of care from facility surveys with the aim of estimating population level effective coverage reflecting access to quality care. We used data from Mayuge District, Uganda. Data from household surveys on access to SBA were linked to health facility assessment census data on readiness to provide basic emergency obstetric and newborn care (BEmONC) in the same district. One individual- and two ecological-linking methods were applied. All methods used household survey reports on where care at birth was accessed. The individual-linking method linked this to data about facility readiness from the specific facility where each woman delivered. The first ecological-linking approach used a district-wide mean estimate of facility readiness. The second used an estimate of facility readiness adjusted by level of health facility accessed. Absolute differences between estimates derived from the different linking methods were calculated, and agreement examined using Lin's concordance correlation coefficient. A total of 1177 women resident in Mayuge reported a birth during 2012-13. Of these, 664 took place in facilities within Mayuge, and were eligible for linking to the census of the district's 38 facilities. 55% were assisted by a SBA in a facility. Using the individual-linking method, effective coverage of births that took place with an SBA in a facility ready to provide BEmONC was just 10% (95% confidence interval CI 3-17). The absolute difference between the individual- and ecological-level linking method adjusting for facility level was one percentage point (11%), and tests suggested good agreement. The ecological method using the district-wide estimate demonstrated poor agreement. The proportion of women accessing appropriately equipped facilities for care at birth is far lower than the coverage of facility delivery. To realise the life-saving potential of health services, countries need evidence to inform actions that address gaps in the provision of quality care. Linking household and facility-based information provides a simple but innovative method for estimating quality of care at the population level. These encouraging findings suggest that linking data sets can result in meaningful evidence even when the exact location of care seeking is not known.

38 CFR 21.146 - Independent instructor course.

Code of Federal Regulations, 2013 CFR

2013-07-01

... reasonable commuting distance from the veteran's home; or (2) The veteran's condition or other circumstances do not permit the veteran to attend an otherwise suitable facility within commuting distance. See... at an otherwise suitable facility because of the effects of his or her disability; (2) Based on...

38 CFR 21.146 - Independent instructor course.

Code of Federal Regulations, 2012 CFR

2012-07-01

... reasonable commuting distance from the veteran's home; or (2) The veteran's condition or other circumstances do not permit the veteran to attend an otherwise suitable facility within commuting distance. See... at an otherwise suitable facility because of the effects of his or her disability; (2) Based on...

38 CFR 21.146 - Independent instructor course.

Code of Federal Regulations, 2014 CFR

2014-07-01

... reasonable commuting distance from the veteran's home; or (2) The veteran's condition or other circumstances do not permit the veteran to attend an otherwise suitable facility within commuting distance. See... at an otherwise suitable facility because of the effects of his or her disability; (2) Based on...

38 CFR 21.146 - Independent instructor course.

Code of Federal Regulations, 2010 CFR

2010-07-01

... reasonable commuting distance from the veteran's home; or (2) The veteran's condition or other circumstances do not permit the veteran to attend an otherwise suitable facility within commuting distance. See... at an otherwise suitable facility because of the effects of his or her disability; (2) Based on...

38 CFR 21.146 - Independent instructor course.

Code of Federal Regulations, 2011 CFR

2011-07-01

... reasonable commuting distance from the veteran's home; or (2) The veteran's condition or other circumstances do not permit the veteran to attend an otherwise suitable facility within commuting distance. See... at an otherwise suitable facility because of the effects of his or her disability; (2) Based on...

Texas Tech & University of Arizona Win APPA's 2013 Award for Excellence

ERIC Educational Resources Information Center

Clendenning, Joanie; Kopach, Christopher M.

2013-01-01

APPA's highest institutional honor, the "Award for Excellence in Facilities Management (AFE)," recognizes those educational institutions whose facilities management organizations demonstrate quality in overall operations and effectiveness. The Award for Excellence is based on a set of criteria that include: Leadership; Strategic and…

Neonatal resuscitation and immediate newborn assessment and stimulation for the prevention of neonatal deaths: a systematic review, meta-analysis and Delphi estimation of mortality effect

PubMed Central

2011-01-01

Background Of 136 million babies born annually, around 10 million require assistance to breathe. Each year 814,000 neonatal deaths result from intrapartum-related events in term babies (previously “birth asphyxia”) and 1.03 million from complications of prematurity. No systematic assessment of mortality reduction from tactile stimulation or resuscitation has been published. Objective To estimate the mortality effect of immediate newborn assessment and stimulation, and basic resuscitation on neonatal deaths due to term intrapartum-related events or preterm birth, for facility and home births. Methods We conducted systematic reviews for studies reporting relevant mortality or morbidity outcomes. Evidence was assessed using GRADE criteria adapted to provide a systematic approach to mortality effect estimates for the Lives Saved Tool (LiST). Meta-analysis was performed if appropriate. For interventions with low quality evidence but strong recommendation for implementation, a Delphi panel was convened to estimate effect size. Results We identified 24 studies of neonatal resuscitation reporting mortality outcomes (20 observational, 2 quasi-experimental, 2 cluster randomized controlled trials), but none of immediate newborn assessment and stimulation alone. A meta-analysis of three facility-based studies examined the effect of resuscitation training on intrapartum-related neonatal deaths (RR= 0.70, 95%CI 0.59-0.84); this estimate was used for the effect of facility-based basic neonatal resuscitation (additional to stimulation). The evidence for preterm mortality effect was low quality and thus expert opinion was sought. In community-based studies, resuscitation training was part of packages with multiple concurrent interventions, and/or studies did not distinguish term intrapartum-related from preterm deaths, hence no meta-analysis was conducted. Our Delphi panel of 18 experts estimated that immediate newborn assessment and stimulation would reduce both intrapartum-related and preterm deaths by 10%, facility-based resuscitation would prevent a further 10% of preterm deaths, and community-based resuscitation would prevent further 20% of intrapartum-related and 5% of preterm deaths. Conclusion Neonatal resuscitation training in facilities reduces term intrapartum-related deaths by 30%. Yet, coverage of this intervention remains low in countries where most neonatal deaths occur and is a missed opportunity to save lives. Expert opinion supports smaller effects of neonatal resuscitation on preterm mortality in facilities and of basic resuscitation and newborn assessment and stimulation at community level. Further evaluation is required for impact, cost and implementation strategies in various contexts. Funding This work was supported by the Bill & Melinda Gates Foundation through a grant to the US Fund for UNICEF, and to the Saving Newborn Lives program of Save the Children, through Save the Children US. PMID:21501429

Effective coverage of essential inpatient care for small and sick newborns in a high mortality urban setting: a cross-sectional study in Nairobi City County, Kenya.

PubMed

Murphy, Georgina A V; Gathara, David; Mwachiro, Jacintah; Abuya, Nancy; Aluvaala, Jalemba; English, Mike

2018-05-22

Effective coverage requires that those in need can access skilled care supported by adequate resources. There are, however, few studies of effective coverage of facility-based neonatal care in low-income settings, despite the recognition that improving newborn survival is a global priority. We used a detailed retrospective review of medical records for neonatal admissions to public, private not-for-profit (mission) and private-for-profit (private) sector facilities providing 24×7 inpatient neonatal care in Nairobi City County to estimate the proportion of small and sick newborns receiving nationally recommended care across six process domains. We used our findings to explore the relationship between facility measures of structure and process and estimate effective coverage. Of 33 eligible facilities, 28 (four public, six mission and 18 private), providing an estimated 98.7% of inpatient neonatal care in the county, agreed to partake. Data from 1184 admission episodes were collected. Overall performance was lowest (weighted mean score 0.35 [95% confidence interval or CI: 0.22-0.48] out of 1) for correct prescription of fluid and feed volumes and best (0.86 [95% CI: 0.80-0.93]) for documentation of demographic characteristics. Doses of gentamicin, when prescribed, were at least 20% higher than recommended in 11.7% cases. Larger (often public) facilities tended to have higher process and structural quality scores compared with smaller, predominantly private, facilities. We estimate effective coverage to be 25% (estimate range: 21-31%). These newborns received high-quality inpatient care, while almost half (44.5%) of newborns needed care but did not receive it and a further 30.4% of newborns received an inadequate service. Failure to receive services and gaps in quality of care both contribute to a shortfall in effective coverage in Nairobi City County. Three-quarters of small and sick newborns do not have access to high-quality facility-based care. Substantial improvements in effective coverage will be required to tackle high neonatal mortality in this urban setting with high levels of poverty.

Nursing home prices and market structure: the effect of assisted living industry expansion.

PubMed

Bowblis, John R

2014-01-01

Since the 1990s, there has been substantial expansion of facility-based alternatives to nursing home care, such as assisted living facilities. This paper analyzes the relationship between expansion of the assisted living industry, nursing home market structure and nursing home private pay prices using a two-year panel of nursing homes in the State of Ohio. Fixed effect regressions suggest that the expansion of assisted living facilities are associated with increased nursing home concentration, but find no effect on private pay nursing home prices. This would be consistent with assisted livings reducing demand for nursing homes by delaying entry into a nursing home, though assisted livings are not direct competitors of nursing homes.

The Increased Effectiveness of HIV Preventive Intervention among Men Who Have Sex with Men and of Follow-Up Care for People Living with HIV after ‘Task-Shifting’ to Community-Based Organizations: A ‘Cash on Service Delivery’ Model in China

PubMed Central

Yan, Hongjing; Zhang, Min; Zhao, Jinkou; Huan, Xiping; Ding, Jianping; Wu, Susu; Wang, Chenchen; Xu, Yuanyuan; Liu, Li; Xu, Fei; Yang, Haitao

2014-01-01

Background A large number of men who have sex with men (MSM) and people living with HIV/AIDS (PLHA) are underserved despite increased service availability from government facilities while many community based organizations (CBOs) are not involved. We aimed to assess the feasibility and effectiveness of the task shifting from government facilities to CBOs in China. Methods HIV preventive intervention for MSM and follow-up care for PLHA were shifted from government facilities to CBOs. Based on ‘cash on service delivery’ model, 10 USD per MSM tested for HIV with results notified, 82 USD per newly HIV cases diagnosed, and 50 USD per PLHA received a defined package of follow-up care services, were paid to the CBOs. Cash payments were made biannually based on the verified results in the national web-based HIV/AIDS information system. Findings After task shifting, CBOs gradually assumed preventive intervention for MSM and follow-up care for PLHA from 2008 to 2012. HIV testing coverage among MSM increased from 4.1% in 2008 to 22.7% in 2012. The baseline median CD4 counts of newly diagnosed HIV positive MSM increased from 309 to 397 cells/µL. HIV tests among MSM by CBOs accounted for less than 1% of the total HIV tests in Nanjing but the share of HIV cases detected by CBOs was 12.4% in 2008 and 43.6% in 2012. Unit cost per HIV case detected by CBOs was 47 times lower than that by government facilities. The coverage of CD4 tests and antiretroviral therapy increased from 71.1% and 78.6% in 2008 to 86.0% and 90.1% in 2012, respectively. Conclusion It is feasible to shift essential HIV services from government facilities to CBOs, and to verify independently service results to adopt ‘cash on service delivery’ model. Services provided by CBOs are cost-effective, as compared with that by government facilities. PMID:25050797

A comparison of absolute calibrations of a radiation thermometer based on a monochromator and a tunable source

NASA Astrophysics Data System (ADS)

Keawprasert, T.; Anhalt, K.; Taubert, D. R.; Sperling, A.; Schuster, M.; Nevas, S.

2013-09-01

An LP3 radiation thermometer was absolutely calibrated at a newly developed monochromator-based set-up and the TUneable Lasers in Photometry (TULIP) facility of PTB in the wavelength range from 400 nm to 1100 nm. At both facilities, the spectral radiation of the respective sources irradiates an integrating sphere, thus generating uniform radiance across its precision aperture. The spectral irradiance of the integrating sphere is determined via an effective area of a precision aperture and a Si trap detector, traceable to the primary cryogenic radiometer of PTB. Due to the limited output power from the monochromator, the absolute calibration was performed with the measurement uncertainty of 0.17 % (k = 1), while the respective uncertainty at the TULIP facility is 0.14 %. Calibration results obtained by the two facilities were compared in terms of spectral radiance responsivity, effective wavelength and integral responsivity. It was found that the measurement results in integral responsivity at the both facilities are in agreement within the expanded uncertainty (k = 2). To verify the calibration accuracy, the absolutely calibrated radiation thermometer was used to measure the thermodynamic freezing temperatures of the PTB gold fixed-point blackbody.

Organizational transformation: a model for joint optimization of culture change and evidence-based design.

PubMed

Hamilton, D Kirk; Orr, Robin Diane; Raboin, W Ellen

2008-01-01

Healthcare organizations face continuous and accelerating external change and thus must be prepared to manage their own change initiatives proactively. Given that many believe that the U.S. healthcare system is broken and most healthcare organizations are dealing with pervasive problems, some organizations may choose to seek transformational change to achieve the six aims identified by the Institute of Medicine: healthcare that is safe, effective, patient-centered, timely, efficient, and equitable. Transformational change will almost certainly involve organizational culture. Culture change may be most effective when linked to other organizational change initiatives such as organizational strategy, structure, policies, procedures, and recruiting. Significant organizational change often requires accompanying facility change. There is an interdependent relationship between facility design and organizational culture. They affect each other and both impact organizational performance. Sociotechnical theory promotes joint optimization of the social (culture) and technical (facilities) aspects of an organization to achieve sustained positive change. To achieve organizational transformation and to sustain positive change, organizations must be prepared to adopt collaborative efforts in culture change and facility design. The authors propose a model for accomplishing joint optimization of culture change and evidence-based facility design.

Why are hospital-based nursing homes so costly? Relative importance of acuity and treatment setting.

PubMed

Pizer, Steven D; White, Alan J; White, Chapin

2002-05-01

To determine the extent to which higher costs in hospital-based skilled nursing facilities (HBSNF) can be explained by observable resident characteristics and unobservable selection effects, implying a design shortcoming of the skilled nursing facility prospective payment system (SNF PPS) implemented for Medicare-covered stays by the Balanced Budget Act of 1997 (BBA 1997). Data on resident characteristics from the Minimum Data Set (MDS) are combined with staff time costs from the Centers for Medicare and Medicaid Services' (CMS, formerly HCFA) 1995 and 1997 SNF Staff Time Measurement (STM) studies and nontherapy ancillary claim costs extracted from CMS SNF claim records. An endogenous switching model was estimated to measure the effect on costs of the relatively high acuity of HBSNF residents, net of differences purely attributable to the treatment setting. It was found that virtually the entire HBSNF differential is attributable to setting effects with resident characteristics and selection effects playing a negligible role. In addition, it was found that marginal costs associated with particular services and conditions are often lower in hospital-based than in freestanding facilities. HBSNFs incur high costs regardless of the characteristics of their residents. Their high fixed costs accompany relatively low marginal costs associated with admitting high-acuity residents. Consequently, a PPS casemix system that depends on resident characteristics and excludes consideration of facility characteristics (as mandated by BBA 1997) need not unfairly penalize HBSNFs, provided a powerful casemix system is used and HBSNFs specialize in the care of high-acuity residents.

Women's Preferences for Place of Delivery in Rural Tanzania: A Population-Based Discrete Choice Experiment

PubMed Central

Paczkowski, Magdalena; Mbaruku, Godfrey; de Pinho, Helen; Galea, Sandro

2009-01-01

Objectives. We fielded a population-based discrete choice experiment (DCE) in rural western Tanzania, where only one third of women deliver children in a health facility, to evaluate health-system factors that influence women's delivery decisions. Methods. Women were shown choice cards that described 2 hypothetical health centers by means of 6 attributes (distance, cost, type of provider, attitude of provider, drugs and equipment, free transport). The women were then asked to indicate which of the 2 facilities they would prefer to use for a future delivery. We used a hierarchical Bayes procedure to estimate individual and mean utility parameters. Results. A total of 1203 women completed the DCE. The model showed good predictive validity for actual facility choice. The most important facility attributes were a respectful provider attitude and availability of drugs and medical equipment. Policy simulations suggested that if these attributes were improved at existing facilities, the proportion of women preferring facility delivery would rise from 43% to 88%. Conclusions. In regions in which attended delivery rates are low despite availability of primary care facilities, policy experiments should test the effect of targeted quality improvements on facility use. PMID:19608959

Strategic Decisions & Staff Collaboration Highlight the 2009 Award for Excellence Winners

ERIC Educational Resources Information Center

Becker, J. Thomas; Taylor, Matthew M.; Lewis, Dan; Ertzberger, Michelle

2009-01-01

APPA's highest institutional honor, the Award for Excellence (AFE) in Facilities Management, recognizes those educational institutions whose facilities management organizations demonstrate quality in overall operations and effectiveness. Fewer than 40 institutions have received this distinct honor. The Award for Excellence is based on a set of…

Integrating Sustainability Programs into the Facilities Capital Planning Process

ERIC Educational Resources Information Center

Buchanan, Susan

2011-01-01

With detailed information about the costs and benefits of potential green investments, educational facilities can effectively evaluate which initiatives will ultimately provide the greatest results over the short and long term. Based on its overall goals, every school, college, or university will have different values and therefore different…

23 CFR 500.111 - IMS.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 23 Highways 1 2011-04-01 2011-04-01 false IMS. 500.111 Section 500.111 Highways FEDERAL HIGHWAY... SYSTEMS Management Systems § 500.111 IMS. An effective IMS for intermodal facilities and systems provides... the various land-based transportation facilities and systems. An IMS should include, at a minimum: (a...

Utilisation of health services and the poor: deconstructing wealth-based differences in facility-based delivery in the Philippines.

PubMed

Hodge, Andrew; Firth, Sonja; Bermejo, Raoul; Zeck, Willibald; Jimenez-Soto, Eliana

2016-07-06

Despite achieving some success, wealth-related disparities in the utilisation of maternal and child health services persist in the Philippines. The aim of this study is to decompose the principal factors driving the wealth-based utilisation gap. Using national representative data from the 2013 Philippines Demographic and Health Survey, we examine the extent overall differences in the utilisation of maternal health services can be explained by observable factors. We apply nonlinear Blinder-Oaxaca-type decomposition methods to quantify the effect of differences in measurable characteristics on the wealth-based coverage gap in facility-based delivery. The mean coverage of facility-based deliveries was respectively 41.1 % and 74.6 % for poor and non-poor households. Between 67 and 69 % of the wealth-based coverage gap was explained by differences in observed characteristics. After controlling for factors characterising the socioeconomic status of the household (i.e. the mothers' and her partners' education and occupation), the birth order of the child was the major factor contributing to the disparity. Mothers' religion and the subjective distance to the health facility were also noteworthy. This study has found moderate wealth-based disparities in the utilisation of institutional delivery in the Philippines. The results confirm the importance of recent efforts made by the Philippine government to implement equitable, pro-poor focused health programs in the most deprived geographic areas of the country. The importance of addressing the social determinants of health, particularly education, as well as developing and implementing effective strategies to encourage institutional delivery for higher order births, should be prioritised.

Developing Mobile- and BIM-Based Integrated Visual Facility Maintenance Management System

PubMed Central

Su, Yu-Chih

2013-01-01

Facility maintenance management (FMM) has become an important topic for research on the operation phase of the construction life cycle. Managing FMM effectively is extremely difficult owing to various factors and environments. One of the difficulties is the performance of 2D graphics when depicting maintenance service. Building information modeling (BIM) uses precise geometry and relevant data to support the maintenance service of facilities depicted in 3D object-oriented CAD. This paper proposes a new and practical methodology with application to FMM using BIM technology. Using BIM technology, this study proposes a BIM-based facility maintenance management (BIMFMM) system for maintenance staff in the operation and maintenance phase. The BIMFMM system is then applied in selected case study of a commercial building project in Taiwan to verify the proposed methodology and demonstrate its effectiveness in FMM practice. Using the BIMFMM system, maintenance staff can access and review 3D BIM models for updating related maintenance records in a digital format. Moreover, this study presents a generic system architecture and its implementation. The combined results demonstrate that a BIMFMM-like system can be an effective visual FMM tool. PMID:24227995

Data management integration for biomedical core facilities

NASA Astrophysics Data System (ADS)

Zhang, Guo-Qiang; Szymanski, Jacek; Wilson, David

2007-03-01

We present the design, development, and pilot-deployment experiences of MIMI, a web-based, Multi-modality Multi-Resource Information Integration environment for biomedical core facilities. This is an easily customizable, web-based software tool that integrates scientific and administrative support for a biomedical core facility involving a common set of entities: researchers; projects; equipments and devices; support staff; services; samples and materials; experimental workflow; large and complex data. With this software, one can: register users; manage projects; schedule resources; bill services; perform site-wide search; archive, back-up, and share data. With its customizable, expandable, and scalable characteristics, MIMI not only provides a cost-effective solution to the overarching data management problem of biomedical core facilities unavailable in the market place, but also lays a foundation for data federation to facilitate and support discovery-driven research.

Distributed architecture and distributed processing mode in urban sewage treatment

NASA Astrophysics Data System (ADS)

Zhou, Ruipeng; Yang, Yuanming

2017-05-01

Decentralized rural sewage treatment facility over the broad area, a larger operation and management difficult, based on the analysis of rural sewage treatment model based on the response to these challenges, we describe the principle, structure and function in networking technology and network communications technology as the core of distributed remote monitoring system, through the application of case analysis to explore remote monitoring system features in a decentralized rural sewage treatment facilities in the daily operation and management. Practice shows that the remote monitoring system to provide technical support for the long-term operation and effective supervision of the facilities, and reduced operating, maintenance and supervision costs for development.

Wind Energy Facilities and Residential Properties: The Effect of Proximity and View on Sales Prices

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

Hoen, Ben; Wiser, Ryan; Cappers, Peter

2010-04-01

With wind energy expanding rapidly in the U.S. and abroad, and with an increasing number of communities considering nearby wind power developments, there is a need to empirically investigate community concerns about wind project development. One such concern is that property values may be adversely affected by wind energy facilities, and relatively little existing research exists on the subject. The present research is based on almost 7,500 sales of single-family homes situated within ten miles of 24 existing wind facilities in nine different U.S. states. The conclusions of the study are drawn from four different hedonic pricing models. The modelmore » results are consistent in that neither the view of the wind facilities nor the distance of the home to those facilities is found to have a statistically significant effect on home sales prices.« less

Boosting facility deliveries with results-based financing: a mixed-methods evaluation of the government midwifery incentive scheme in Cambodia.

PubMed

Ir, Por; Korachais, Catherine; Chheng, Kannarath; Horemans, Dirk; Van Damme, Wim; Meessen, Bruno

2015-08-15

Increasing the coverage of skilled attendance at births in a health facility (facility delivery) is crucial for saving the lives of mothers and achieving Millennium Development Goal five. Cambodia has significantly increased the coverage of facility deliveries and reduced the maternal mortality ratio in the last decade. The introduction of a nationwide government implemented and funded results-based financing initiative, known as the Government Midwifery Incentive Scheme (GMIS), is considered one of the most important contributors to this. We evaluated GMIS to explore its effects on facility deliveries and the health system. We used a mixed-methods design. An interrupted time series model was applied, using routine longitudinal data on reported deliveries between 2006 and 2011 that were extracted from the health information system. In addition, we interviewed 56 key informants and performed 12 focus group discussions with 124 women who had given birth (once or more) since 2006. Findings from the quantitative data were carefully interpreted and triangulated with those from qualitative data. We found that facility deliveries have tripled from 19% of the estimated number of births in 2006 to 57% in 2011 and this increase was more substantial at health centres as compared to hospitals. Segmented linear regressions showed that the introduction of GMIS in October 2007 made the increase in facility deliveries and deliveries with skilled attendants significantly jump by 18 and 10% respectively. Results from qualitative data also suggest that the introduction of GMIS together with other interventions that aimed to improve access to essential maternal health services led to considerable improvements in public health facilities and a steep increase in facility deliveries. Home deliveries attended by traditional birth attendants decreased concomitantly. We also outline several operational issues and limitations of GMIS. The available evidence strongly suggests that GMIS is an effective mechanism to complement other interventions to improve health system performance and boost facility deliveries as well as skilled birth attendance; thereby contributing to the reduction of maternal mortality. Our findings provide useful lessons for Cambodia to further improve GMIS and for other low-income countries to implement similar results-based financing mechanisms.

The effect of referral and transfer patients on hospital funding in a capitated health care delivery system.

PubMed

Pietz, Kenneth; Byrne, Margaret M; Daw, Christina; Petersen, Laura A

2007-10-01

(1) To investigate whether inpatients referred or transferred between facilities result in increased financial loss compared with those admitted directly, in a health care delivery system funded by capitation methods. (2) To determine whether the higher cost of those patients transferred or referred is fairly compensated by a diagnosis-based risk adjustment system, and whether tertiary care facilities bear an unfair financial burden for such patients in a capitated financing environment. The study cohort included all Veterans Affairs (VA) beneficiaries who received inpatient care during fiscal year (FY) 2004. Referral was defined as an outpatient visit to 1 facility followed by an admission to another facility. Transfers were consecutive inpatient stays at different hospitals. We defined loss as cost minus the share of budget determined by a Diagnostic Cost Group-based allocation. Both t tests and linear regression were used to compare the effect on cost and loss for patients transferred or not and referred or not. Mean loss to a facility for patients transferred in was 1231 dollars more than for those not transferred. Mean loss for referred patients was 3341 dollars more than for those not referred, controlling for disease burden. For tertiary hospitals, the difference in losses for transfer patients was less than for other hospitals but greater for referral patients. Patients referred or transferred from other facilities are more costly than those who are not. The difference may not be compensated by a diagnosis-based allocation system. A capitated health care system may consider additional funding to cover the cost of such patients.

Accelerator Facilities for Radiation Research

NASA Technical Reports Server (NTRS)

Cucinotta, Francis A.

1999-01-01

HSRP Goals in Accelerator Use and Development are: 1.Need for ground-based heavy ion and proton facility to understand space radiation effects discussed most recently by NAS/NRC Report (1996). 2. Strategic Program Goals in facility usage and development: -(1) operation of AGS for approximately 600 beam hours/year; (2) operation of Loma Linda University (LLU) proton facility for approximately 400 beam hours/year; (3) construction of BAF facility; and (4) collaborative research at HIMAC in Japan and with other existing or potential international facilities. 3. MOA with LLU has been established to provide proton beams with energies of 40-250 important for trapped protons and solar proton events. 4. Limited number of beam hours available at Brookhaven National Laboratory's (BNL) Alternating Gradient Synchrotron (AGS).

Effective strategies to provide adolescent sexual and reproductive health services and to increase demand and community support.

PubMed

Denno, Donna M; Hoopes, Andrea J; Chandra-Mouli, Venkatraman

2015-01-01

Access to youth friendly health services is vital for ensuring sexual and reproductive health (SRH) and well-being of adolescents. This study is a descriptive review of the effectiveness of initiatives to improve adolescent access to and utilization of sexual and reproductive health services (SRHS) in low- and middle-income countries. We examined four SRHS intervention types: (1) facility based, (2) out-of-facility based, (3) interventions to reach marginalized or vulnerable populations, (4) interventions to generate demand and/or community acceptance. Outcomes assessed across the four questions included uptake of SRHS or sexual and reproductive health commodities and sexual and reproductive health biologic outcomes. There is limited evidence to support the effectiveness of initiatives that simply provide adolescent friendliness training for health workers. Data are most ample (10 initiatives demonstrating weak but positive effects and one randomized controlled trial demonstrating strong positive results on some outcome measures) for approaches that use a combination of health worker training, adolescent-friendly facility improvements, and broad information dissemination via the community, schools, and mass media. We found a paucity of evidence on out-of-facility-based strategies, except for those delivered through mixed-use youth centers that demonstrated that SRHS in these centers are neither well used nor effective at improving SRH outcomes. There was an absence of studies or evaluations examining outcomes among vulnerable or marginalized adolescents. Findings from 17 of 21 initiatives assessing demand-generation activities demonstrated at least some association with adolescent SRHS use. Of 15 studies on parental and other community gatekeepers' approval of SRHS for adolescents, which assessed SRHS/commodity uptake and/or biologic outcomes, 11 showed positive results. Packages of interventions that train health workers, improve facility adolescent friendliness, and endeavor to generate demand through multiple channels are ready for large-scale implementation. However, further evaluation of these initiatives is needed to clarify mechanisms and impact, especially of specific program components. Quality research is needed to determine effective means to deliver services outside the facilities, to reach marginalized or vulnerable adolescents, and to determine effective approaches to increase community acceptance of adolescent SRHS. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

The effectiveness of community-based loan funds for transport during obstetric emergencies in developing countries: a systematic review.

PubMed

Nwolise, Chidiebere Hope; Hussein, Julia; Kanguru, Lovney; Bell, Jacqueline; Patel, Purvi

2015-09-01

Scarcity and costs of transport have been implicated as key barriers to accessing care when obstetric emergencies occur in community settings. Community-based loans have been used to increase utilization of health facilities and potentially reduce maternal mortality by providing funding at community level to provide emergency transport. This review aimed to provide evidence of the effect of community-based loan funds on utilization of health facilities and reduction of maternal mortality in developing countries. Electronic databases of published literature and websites were searched for relevant literature using a pre-defined set of search terms, inclusion and exclusion criteria. Screening of titles, abstracts and full-text articles were done by at least two reviewers independently. Quality assessment was carried out on the selected papers. Data related to deliveries and obstetric complications attended at facilities, maternal deaths and live births were extracted to measure and compare the effects of community-based loan funds using odds ratios (ORs) and reductions in maternal mortality ratio. Forest plots are presented where possible. The results of the review show that groups where community-based loan funds were implemented (alongside other interventions) generally recorded increases in utilization of health facilities for deliveries, with ORs of 3.5 (0.97-15.48) and 3.55 (1.56-8.05); and an increase in utilization of emergency obstetric care with ORs of 2.22 (0.51-10.38) and 3.37 (1.78-6.37). Intervention groups also experienced a positive effect on met need for complications and a reduction in maternal mortality. There is some evidence to suggest that community-based loan funds as part of a multifaceted intervention have positive effects. Conclusions are limited by challenges of study design and bias. Further studies which strengthen the evidence of the effects of loan funds, and mechanism for their functionality, are recommended. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

The importance of public sector health facility-level data for monitoring changes in maternal mortality risks among communities: the case of pakistan.

PubMed

Jain, Anrudh K; Sathar, Zeba; Salim, Momina; Shah, Zakir Hussain

2013-09-01

This paper illustrates the importance of monitoring health facility-level information to monitor changes in maternal mortality risks. The annual facility-level maternal mortality ratios (MMRs), complications to live births ratios and case fatality ratios (CFRs) were computed from data recorded during 2007 and 2009 in 31 upgraded public sector health facilities across Pakistan. The facility-level MMR declined by about 18%; both the number of Caesarean sections and the episodes of complications as a percentage of live births increased; and CFR based on Caesarean sections and episodes of complications declined by 29% and 37%, respectively. The observed increases in the proportion of women with complications among those who come to these facilities point to a reduction in the delay in reaching facilities (first and second delays; Thaddeus & Maine, 1994); the decrease in CFRs points to improvements in treating obstetric complications and a reduction in the delay in receiving treatment once at facilities (the third delay). These findings point to a decline in maternal mortality risks among communities served by these facilities. A system of woman-level data collection instituted at health facilities with comprehensive emergency obstetric care is essential to monitor changes in the effects of any reduction in the three delays and any improvement in quality of care or the effectiveness of treating pregnancy-related complications among women reaching these facilities. Such a system of information gathering at these health facilities would also help policymakers and programme mangers to measure and improve the effectiveness of safe-motherhood initiatives and to monitor progress being made toward achieving the fifth Millennium Development Goal.

The impact of targeted subsidies for facility-based delivery on access to care and equity - evidence from a population-based study in rural Burkina Faso.

PubMed

De Allegri, Manuela; Ridde, Valéry; Louis, Valérie R; Sarker, Malabika; Tiendrebéogo, Justin; Yé, Maurice; Müller, Olaf; Jahn, Albrecht

2012-11-01

We conducted the first population-based impact assessment of a financing policy introduced in Burkina Faso in 2007 on women's access to delivery services. The policy offers an 80 per cent subsidy for facility-based delivery. We collected information on delivery in five repeated cross-sectional surveys carried out from 2006 to 2010 on a representative sample of 1050 households in rural Nouna Health District. Over the 5 years, the proportion of facility-based deliveries increased from 49 to 84 per cent (P<0.001). The utilization gap across socio-economic quintiles, however, remained unchanged. The amount received for all services associated with births decreased by 67 per cent (P<0.001), but women continued to pay on average 1423 CFA (\\[euro]1=655 CFA), about 500 CFA more than the set tariff of 900 CFA. Our findings indicate the operational effectiveness of the policy in increasing the use of facility-based delivery services for women. The potential to reduce maternal mortality substantially has not yet been assessed by health outcome measures of neonatal and maternal mortality.

Team Modelling: Survey of Experimental Platforms (Modelisation d’equipes : Examen de plate-formes experimentales)

DTIC Science & Technology

2006-09-01

Control Force Agility Shared Situational Awareness Attentional Demand Interoperability Network Based Operations Effect Based Operations Speed of...Command Self Synchronization Reach Back Reach Forward Information Superiority Increased Mission Effectiveness Humansystems® Team Modelling...communication effectiveness and Distributed Mission Training (DMT) effectiveness . The NASA Ames Centre - Distributed Research Facilities platform could

Universal opt-out screening for hepatitis C virus (HCV) within correctional facilities is an effective intervention to improve public health.

PubMed

Morris, Meghan D; Brown, Brandon; Allen, Scott A

2017-09-11

Purpose Worldwide efforts to identify individuals infected with the hepatitis C virus (HCV) focus almost exclusively on community healthcare systems, thereby failing to reach high-risk populations and those with poor access to primary care. In the USA, community-based HCV testing policies and guidelines overlook correctional facilities, where HCV rates are believed to be as high as 40 percent. This is a missed opportunity: more than ten million Americans move through correctional facilities each year. Herein, the purpose of this paper is to examine HCV testing practices in the US correctional system, California and describe how universal opt-out HCV testing could expand early HCV detection, improve public health in correctional facilities and communities, and prove cost-effective over time. Design/methodology/approach A commentary on the value of standardizing screening programs across facilities by mandating all facilities (universal) to implement opt-out testing policies for all prisoners upon entry to the correctional facilities. Findings Current variability in facility-level testing programs results in inconsistent testing levels across correctional facilities, and therefore makes estimating the actual number of HCV-infected adults in the USA difficult. The authors argue that universal opt-out testing policies ensure earlier diagnosis of HCV among a population most affected by the disease and is more cost-effective than selective testing policies. Originality/value The commentary explores the current limitations of selective testing policies in correctional systems and provides recommendations and implications for public health and correctional organizations.

The effects of recycling loops in food waste management in Japan: based on the environmental and economic evaluation of food recycling.

PubMed

Takata, Miki; Fukushima, Kazuyo; Kino-Kimata, Noriko; Nagao, Norio; Niwa, Chiaki; Toda, Tatsuki

2012-08-15

In Japan, a revised Food Recycling Law went into effect in 2007 to promote a "recycling loop" that requires food industries to purchase farm products that are grown using food waste-derived compost/animal feed. To realize and expand food recycling, it is necessary to evaluate how the recycling facilities work in the recycling loop. The purpose of this study is to assess the environmental and economic efficiency of the food recycling facilities that are involved in the recycling loop, which are also known as looped facilities. The global warming potential and running cost of five looped facilities were evaluated by LCA (life cycle assessment) and LCC (life cycle cost) approaches: machine integrated compost, windrow compost, liquid feed, dry feed, and bio-gasification. The LCA results showed low total GHG (greenhouse gas) emissions of -126 and -49 kg-CO(2)/t-waste, respectively, for dry feed and bio-gasification facilities, due to a high substitution effect. The LCC study showed a low running cost for composting facilities of -15,648 and -18,955 yen/t-waste, respectively, due to high revenue from the food waste collection. It was found that the mandatory reporting of food waste emitters to the government increased collection fees; however, the collection fee in animal feed facilities was relatively low because food waste was collected at a low price or nutritious food waste was purchased to produce quality feed. In the characterisation survey of various treatment methods, the composting facilities showed a relatively low environmental impact and a high economic efficiency. Animal feed facilities had a wide distribution of the total GHG emissions, depending on both the energy usage during the drying process and the substitution effect, which were related to the water content of the food waste and the number of recycled products. In comparison with incineration, the majority of the food recycling facilities showed low GHG emissions and economic effectiveness. This paper also reported on the effects of recycling loops by comparing looped and non-looped animal feed facilities, and confirmed that the looped facilities were economically effective, due to an increased amount of food waste collection. Copyright © 2012 Elsevier B.V. All rights reserved.

Determinants of environmental audit frequency: the role of firm organizational structure.

PubMed

Earnhart, Dietrich; Leonard, J Mark

2013-10-15

This study empirically examines the extent of environmental management practiced by US chemical manufacturing facilities, as reflected in the number of environmental internal audits conducted annually. As its focus, this study analyzes the effects of firm-level organizational structure on facility-level environmental management practices. For this empirical analysis, the study exploits unique data from a survey distributed to all U.S. chemical manufacturing permitted to discharge wastewater in 2001; the data reflect internal audits conducted during the years 1999-2001. Empirical results reveal differences in auditing behavior based on whether facilities are owned by publicly held or non-publicly held firms, owned by U.S.-based or non-U.S.-based firms, and owned by larger or smaller firms. Copyright © 2013 Elsevier Ltd. All rights reserved.

Technology transfer package on seismic base isolation - Volume II

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

NONE

1995-02-14

This Technology Transfer Package provides some detailed information for the U.S. Department of Energy (DOE) and its contractors about seismic base isolation. Intended users of this three-volume package are DOE Design and Safety Engineers as well as DOE Facility Managers who are responsible for reducing the effects of natural phenomena hazards (NPH), specifically earthquakes, on their facilities. The package was developed as part of DOE's efforts to study and implement techniques for protecting lives and property from the effects of natural phenomena and to support the International Decade for Natural Disaster Reduction. Volume II contains the proceedings for the Shortmore » Course on Seismic Base Isolation held in Berkeley, California, August 10-14, 1992.« less

Correspondence regarding 'Assefa Y, et al., BMC Health Services Research. 2011; 11 (1):81 and 2014; 14(1):45': The Positive-Deviance approach for translating evidence into practice to improve patient retention in HIV care.

PubMed

Assefa, Yibeltal; Hill, Peter S; Kloos, Helmut; Ooms, Gorik; Van Damme, Wim

2018-03-21

The purpose of this correspondence is to describe how the positive-deviance approach can be used to translate evidence into practice, based on successive studies conducted in Ethiopia. In earlier studies, it was identified that retention in antiretroviral treatment care was variable across health facilities; and, seeking compliance across facilities, a framework was developed based on the practices of those positive-deviant health facilities, where performance was noted to be markedly better. It was found that the positive deviance approach was effective in facilitating the transfer of innovative practices (using different mechanisms) from positive-deviant health facilities to negative-deviant health facilities. As a result, the variability in retention in care across health facilities narrowed over time, increasing from 83 to 96% in 2007/8 to 95-97% in 2013/14. In conclusion, the positive-deviance approach is a valuable tool to translate evidence into practice, spread good practices, and help achieving universal health coverage.

Effectiveness of a community-based intervention for people with schizophrenia and their caregivers in India (COPSI): a randomised controlled trial.

PubMed

Chatterjee, Sudipto; Naik, Smita; John, Sujit; Dabholkar, Hamid; Balaji, Madhumitha; Koschorke, Mirja; Varghese, Mathew; Thara, Rangaswamy; Weiss, Helen A; Williams, Paul; McCrone, Paul; Patel, Vikram; Thornicroft, Graham

2014-04-19

Observational evidence suggests that community-based services for people with schizophrenia can be successfully provided by community health workers, when supervised by specialists, in low-income and middle-income countries. We did the COmmunity care for People with Schizophrenia in India (COPSI) trial to compare the effectiveness of a collaborative community-based care intervention with standard facility-based care. We did a multicentre, parallel-group, randomised controlled trial at three sites in India between Jan 1, 2009 and Dec 31, 2010. Patients aged 16-60 years with a primary diagnosis of schizophrenia according to the tenth edition of the International Classification of Diseases, Diagnostic Criteria for Research (ICD-10-DCR) were randomly assigned (2:1), via a computer-generated randomisation list with block sizes of three, six, or nine, to receive either collaborative community-based care plus facility-based care or facility-based care alone. Randomisation was stratified by study site. Outcome assessors were masked to group allocation. The primary outcome was a change in symptoms and disabilities over 12 months, as measured by the positive and negative syndrome scale (PANSS) and the Indian disability evaluation and assessment scale (IDEAS). Analysis was by modified intention to treat. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN 56877013. 187 participants were randomised to the collaborative community-based care plus facility-based care group and 95 were randomised to the facility-based care alone group; 253 (90%) participants completed follow-up to month 12. At 12 months, total PANSS and IDEAS scores were lower in patients in the intervention group than in those in the control group (PANSS adjusted mean difference -3.75, 95% CI -7.92 to 0.42; p=0.08; IDEAS -0.95, -1.68 to -0.23; p=0.01). However, no difference was shown in the proportion of participants who had a reduction of more than 20% in overall symptoms (PANSS 85 [51%] in the intervention group vs 44 [51%] in the control group; p=0.89; IDEAS 75 [48%] vs 28 [35%]). We noted a significant reduction in symptom and disability outcomes at the rural Tamil Nadu site (-9.29, -15.41 to -3.17; p=0.003). Two patients (one in each group) died by suicide during the study, and two patients died because of complications of a road traffic accident and pre-existing cardiac disease. 18 (73%) patients (17 in the intervention group) were admitted to hospital during the course of the trial, of whom seven were admitted because of physical health problems, such as acute gastritis and vomiting, road accident, high fever, or cardiovascular disease. The collaborative community-based care plus facility-based care intervention is modestly more effective than facility-based care, especially for reducing disability and symptoms of psychosis. Our results show that the study intervention is best implemented as an initial service in settings where services are scarce, for example in rural areas. Wellcome Trust. Copyright © 2014 Chatterjee et al. Open Access article distributed under the terms of CC BY-NC-ND. Published by Elsevier Ltd. All rights reserved.

A case study of potential human health impacts from petroleum coke transfer facilities.

PubMed

Dourson, Michael L; Chinkin, Lyle R; MacIntosh, David L; Finn, Jennifer A; Brown, Kathleen W; Reid, Stephen B; Martinez, Jeanelle M

2016-11-01

Petroleum coke or "petcoke" is a solid material created during petroleum refinement and is distributed via transfer facilities that may be located in densely populated areas. The health impacts from petcoke exposure to residents living in proximity to such facilities were evaluated for a petcoke transfer facilities located in Chicago, Illinois. Site-specific, margin of safety (MOS) and margin of exposure (MOE) analyses were conducted using estimated airborne and dermal exposures. The exposure assessment was based on a combined measurement and modeling program that included multiyear on-site air monitoring, air dispersion modeling, and analyses of soil and surfaces in residential areas adjacent to two petcoke transfer facilities located in industrial areas. Airborne particulate matter less than 10 microns (PM 10 ) were used as a marker for petcoke. Based on daily fence line monitoring, the average daily PM 10 concentration at the KCBX Terminals measured on-site was 32 μg/m 3 , with 89% of 24-hr average PM 10 concentrations below 50 μg/m 3 and 99% below 100 μg/m 3 . A dispersion model estimated that the emission sources at the KCBX Terminals produced peak PM 10 levels attributed to the petcoke facility at the most highly impacted residence of 11 μg/m 3 on an annual average basis and 54 μg/m 3 on 24-hr average basis. Chemical indicators of petcoke in soil and surface samples collected from residential neighborhoods adjacent to the facilities were equivalent to levels in corresponding samples collected at reference locations elsewhere in Chicago, a finding that is consistent with limited potential for off-site exposure indicated by the fence line monitoring and air dispersion modeling. The MOE based upon dispersion model estimates ranged from 800 to 900 for potential inhalation, the primary route of concern for particulate matter. This indicates a low likelihood of adverse health effects in the surrounding community. Implications: Handling of petroleum coke at bulk material transfer facilities has been identified as a concern for the public health of surrounding populations. The current assessment, based on measurements and modeling of two facilities located in a densely populated urban area, indicates that petcoke transport and accumulation in off-site locations is minimal. In addition, estimated human exposures, if any, are well below levels that could be anticipated to produce adverse health effects in the general population.

Understanding the relationship between access to care and facility-based delivery through analysis of the 2008 Ghana Demographic Health Survey.

PubMed

Moyer, Cheryl A; McLaren, Zoë M; Adanu, Richard M; Lantz, Paula M

2013-09-01

To determine the types of access to care most strongly associated with facility-based delivery among women in Ghana. Data relating to the "5 As of Access" framework were extracted from the 2008 Ghana Demographic Health Survey and analyzed using multivariate logistic regression. In all, 55.5% of a weighted sample of 1102 women delivered in a healthcare facility, whereas 45.5% delivered at home. Affordability was the strongest access factor associated with delivery location, with health insurance coverage tripling the odds of facility delivery. Availability, accessibility (except urban residence), acceptability, and social access variables were not significant factors in the final models. Social access variables, including needing permission to seek healthcare and not being involved in decisions regarding healthcare, were associated with a reduced likelihood of facility-based delivery when examined individually. Multivariate analysis suggested that these variables reflected maternal literacy, health insurance coverage, and household wealth, all of which attenuated the effects of social access. Affordability was an important determinant of facility delivery in Ghana-even among women with health insurance-but social access variables had a mediating role. Copyright © 2013 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Effects of user fee exemptions on the provision and use of maternal health services: a review of literature.

PubMed

Hatt, Laurel E; Makinen, Marty; Madhavan, Supriya; Conlon, Claudia M

2013-12-01

User fee removal has been put forward as an approach to increasing priority health service utilization, reducing impoverishment, and ultimately reducing maternal and neonatal mortality. However, user fees are a source of facility revenue in many low-income countries, often used for purchasing drugs and supplies and paying incentives to health workers. This paper reviews evidence on the effects of user fee exemptions on maternal health service utilization, service provision, and outcomes, including both supply-side and demand-side effects. We reviewed 19 peer-reviewed research articles addressing user fee exemptions and maternal health services or outcomes published since 1990. Studies were identified through a USAID-commissioned call for evidence, key word search, and screening process. Teams of reviewers assigned criteria-based quality scores to each paper and prepared structured narrative reviews. The grade of the evidence was found to be relatively weak, mainly from short-term, non-controlled studies. The introduction of user fee exemptions appears to have resulted in increased rates of facility-based deliveries and caesarean sections in some contexts. Impacts on maternal and neonatal mortality have not been conclusively demonstrated; exemptions for delivery care may contribute to modest reductions in institutional maternal mortality but the evidence is very weak. User fee exemptions were found to have negative, neutral, or inconclusive effects on availability of inputs, provider motivation, and quality of services. The extent to which user fee revenue lost by facilities is replaced can directly affect service provision and may have unintended consequences for provider motivation. Few studies have looked at the equity effects of fee removal, despite clear evidence that fees disproportionately burden the poor. This review highlights potential and documented benefits (increased use of maternity services) as well as risks (decreased provider motivation and quality) of user fee exemption policies for maternal health services. Governments should link user fee exemption policies with the replacement of lost revenue for facilities as well as broader health system improvements, including facility upgrades, ensured supply of needed inputs, and improved human resources for health. Removing user fees may increase uptake but will not reduce mortality proportionally if the quality of facility-based care is poor. More rigorous evaluations of both demand- and supply-side effects of mature fee exemption programmes are needed.

Effect of prospective reimbursement on nursing home costs.

PubMed Central

Coburn, A F; Fortinsky, R; McGuire, C; McDonald, T P

1993-01-01

OBJECTIVE. This study evaluates the effect of Maine's Medicaid nursing home prospective payment system on nursing home costs and access to care for public patients. DATA SOURCES/STUDY SETTING. The implementation of a facility-specific prospective payment system for nursing homes provided the opportunity for longitudinal study of the effect of that system. Data sources included audited Medicaid nursing home cost reports, quality-of-care data from state facility survey and licensure files, and facility case-mix information from random, stratified samples of homes and residents. Data were obtained for six years (1979-1985) covering the three-year period before and after implementation of the prospective payment system. STUDY DESIGN. This study used a pre-post, longitudinal analytical design in which interrupted, time-series regression models were estimated to test the effects of prospective payment and other factors, e.g., facility characteristics, nursing home market factors, facility case mix, and quality of care, on nursing home costs. PRINCIPAL FINDINGS. Prospective payment contributed to an estimated $3.03 decrease in total variable costs in the third year from what would have been expected under the previous retrospective cost-based payment system. Responsiveness to payment system efficiency incentives declined over the study period, however, indicating a growing problem in achieving further cost reductions. Some evidence suggested that cost reductions might have reduced access for public patients. CONCLUSIONS. Study findings are consistent with the results of other studies that have demonstrated the effectiveness of prospective payment systems in restraining nursing home costs. Potential policy trade-offs among cost containment, access, and quality assurance deserve further consideration, particularly by researchers and policymakers designing the new generation of case mix-based and other nursing home payment systems. PMID:8463109

Effect of prospective reimbursement on nursing home costs.

PubMed

Coburn, A F; Fortinsky, R; McGuire, C; McDonald, T P

1993-04-01

This study evaluates the effect of Maine's Medicaid nursing home prospective payment system on nursing home costs and access to care for public patients. The implementation of a facility-specific prospective payment system for nursing homes provided the opportunity for longitudinal study of the effect of that system. Data sources included audited Medicaid nursing home cost reports, quality-of-care data from state facility survey and licensure files, and facility case-mix information from random, stratified samples of homes and residents. Data were obtained for six years (1979-1985) covering the three-year period before and after implementation of the prospective payment system. This study used a pre-post, longitudinal analytical design in which interrupted, time-series regression models were estimated to test the effects of prospective payment and other factors, e.g., facility characteristics, nursing home market factors, facility case mix, and quality of care, on nursing home costs. Prospective payment contributed to an estimated $3.03 decrease in total variable costs in the third year from what would have been expected under the previous retrospective cost-based payment system. Responsiveness to payment system efficiency incentives declined over the study period, however, indicating a growing problem in achieving further cost reductions. Some evidence suggested that cost reductions might have reduced access for public patients. Study findings are consistent with the results of other studies that have demonstrated the effectiveness of prospective payment systems in restraining nursing home costs. Potential policy trade-offs among cost containment, access, and quality assurance deserve further consideration, particularly by researchers and policymakers designing the new generation of case mix-based and other nursing home payment systems.

Life-Cycle Assessments of Selected NASA Ground-Based Test Facilities

NASA Technical Reports Server (NTRS)

Sydnor, George Honeycutt

2012-01-01

In the past two years, two separate facility-specific life cycle assessments (LCAs) have been performed as summer student projects. The first project focused on 13 facilities managed by NASA s Aeronautics Test Program (ATP), an organization responsible for large, high-energy ground test facilities that accomplish the nation s most advanced aerospace research. A facility inventory was created for each facility, and the operational-phase carbon footprint and environmental impact were calculated. The largest impacts stemmed from electricity and natural gas used directly at the facility and to generate support processes such as compressed air and steam. However, in specialized facilities that use unique inputs like R-134a, R-14, jet fuels, or nitrogen gas, these sometimes had a considerable effect on the facility s overall environmental impact. The second LCA project was conducted on the NASA Ames Arc Jet Complex and also involved creating a facility inventory and calculating the carbon footprint and environmental impact. In addition, operational alternatives were analyzed for their effectiveness at reducing impact. Overall, the Arc Jet Complex impact is dominated by the natural-gas fired boiler producing steam on-site, but alternatives were provided that could reduce the impact of the boiler operation, some of which are already being implemented. The data and results provided by these LCA projects are beneficial to both the individual facilities and NASA as a whole; the results have already been used in a proposal to reduce carbon footprint at Ames Research Center. To help future life cycle projects, several lessons learned have been recommended as simple and effective infrastructure improvements to NASA, including better utility metering and data recording and standardization of modeling choices and methods. These studies also increased sensitivity to and appreciation for quantifying the impact of NASA s activities.

The Effect of Performance-Based Financial Incentives on Improving Health Care Provision in Burundi: A Controlled Cohort Study

PubMed Central

Rudasingwa, Martin; Soeters, Robert; Bossuyt, Michel

2015-01-01

To strengthen the health care delivery, the Burundian Government in collaboration with international NGOs piloted performance-based financing (PBF) in 2006. The health facilities were assigned - by using a simple matching method - to begin PBF scheme or to continue with the traditional input-based funding. Our objective was to analyse the effect of that PBF scheme on the quality of health services between 2006 and 2008. We conducted the analysis in 16 health facilities with PBF scheme and 13 health facilities without PBF scheme. We analysed the PBF effect by using 58 composite quality indicators of eight health services: Care management, outpatient care, maternity care, prenatal care, family planning, laboratory services, medicines management and materials management. The differences in quality improvement in the two groups of health facilities were performed applying descriptive statistics, a paired non-parametric Wilcoxon Signed Ranks test and a simple difference-in-difference approach at a significance level of 5%. We found an improvement of the quality of care in the PBF group and a significant deterioration in the non-PBF group in the same four health services: care management, outpatient care, maternity care, and prenatal care. The findings suggest a PBF effect of between 38 and 66 percentage points (p<0.001) in the quality scores of care management, outpatient care, prenatal care, and maternal care. We found no PBF effect on clinical support services: laboratory services, medicines management, and material management. The PBF scheme in Burundi contributed to the improvement of the health services that were strongly under the control of medical personnel (physicians and nurses) in a short time of two years. The clinical support services that did not significantly improved were strongly under the control of laboratory technicians, pharmacists and non-medical personnel. PMID:25948432

FFRRO Program Information

EPA Pesticide Factsheets

This asset includes information related to Cleanups at Federal Facilities. Information is provided about contaminated federal facility sites in specific communities, with access to technical fact sheets and tools and resources to help government agencies and their contractors fulfill cleanup obligations. EPA's federal facility information is easily accessible to ensure effective stakeholder involvement and accountability at federal facilities.Multiple federal statutes establish requirements for EPA and other federal agencies to protect health and the human environment through cleanups at Federal Facilities, including the Comprehensive Environmental Response, Compensation and Liability Act (CERCLA) of 1980, which was amended by the Superfund Amendments and Reauthorization Act (SARA) in 1986; the Defense Authorization Amendments and Base Realignment and Closure Acts (BRAC) of 1998 and the Defense Base Closure and Realignment Act of 1990; and the Resource Conservation and Recovery Act (RCRA), as amended by the Hazardous and Solid Waste Amendments of 1984 (HS WA) including Subtitle C (hazardous waste), Subtitle D (solid waste), Subtitle I (underground storage tanks), and Subtitle J (Medical Waste Tracking Act of 1988).

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

Bentz, L.K.; Bender, D.S.

This report contains socioeconomic information on the Plainsboro, New Jersey, area, the proposed location of the Compact Ignition Tokamak (CIT) facility. It was prepared as supplemental information for an environmental assessment for the CIT at Princeton Plasma Physics Laboratory (PPPL). The report contains descriptions of the demographic, economic, and community resource characteristics, and, based on information available in early 1987, considers the socioeconomic effect of the proposed facility. In all areas examined, the anticipated socioeconomic impacts of the proposed CIT facility at PPPL are negligible or minimal. 29 refs., 8 figs., 24 tabs.

Consensus-based approach to develop a measurement framework and identify a core set of indicators to track implementation and progress towards effective coverage of facility-based Kangaroo Mother Care.

PubMed

Guenther, Tanya; Moxon, Sarah; Valsangkar, Bina; Wetzel, Greta; Ruiz, Juan; Kerber, Kate; Blencowe, Hannah; Dube, Queen; Vani, Shashi N; Vivio, Donna; Magge, Hema; De Leon-Mendoza, Socorro; Patterson, Janna; Mazia, Goldy

2017-12-01

As efforts to scale up the delivery of Kangaroo Mother Care (KMC) in facilities are increasing, a standardized approach to measure implementation and progress towards effective coverage is needed. Here, we describe a consensus-based approach to develop a measurement framework and identify a core set of indicators for monitoring facility-based KMC that would be feasible to measure within existing systems. The KMC measurement framework and core list of indicators were developed through: 1) scoping exercise to identify potential indicators through literature review and requests from researchers and program implementers; and 2) face-to-face consultations with KMC and measurement experts working at country and global levels to review candidate indicators and finalize selection and definitions. The KMC measurement framework includes two main components: 1) service readiness, based on the WHO building blocks framework; and 2) service delivery action sequence covering identification, service initiation, continuation to discharge, and follow-up to graduation. Consensus was reached on 10 core indicators for KMC, which were organized according to the measurement framework. We identified 4 service readiness indicators, capturing national level policy for KMC, availability of KMC indicators in HMIS, costed operational plans for KMC and availability of KMC services at health facilities with inpatient maternity services. Six indicators were defined for service delivery, including weighing of babies at birth, identification of those ≤2000 g, initiation of facility-based KMC, monitoring the quality of KMC, status of babies at discharge from the facility and levels of follow-up (according to country-specific protocol). These core KMC indicators, identified with input from a wide range of global and country-level KMC and measurement experts, can aid efforts to strengthen monitoring systems and facilitate global tracking of KMC implementation. As data collection systems advance, we encourage program managers and evaluators to document their experiences using this framework to measure progress and allow indicator refinement, with the overall aim of working towards sustainable, country-led data systems.

Who benefits from removing user fees for facility-based delivery services? Evidence on socioeconomic differences from Ghana, Senegal and Sierra Leone.

PubMed

McKinnon, Britt; Harper, Sam; Kaufman, Jay S

2015-06-01

Coverage of skilled delivery care has been increasing across most low-income countries; however, it remains far from universal and is very unequally distributed according to socioeconomic position. In an effort to increase coverage of skilled delivery care and reduce socioeconomic inequalities, governments of several countries in sub-Saharan Africa have recently adopted policies that remove user fees for facility-based delivery services. There is little rigorous evidence of the impact of these policies and few studies have examined effects on socioeconomic inequalities. This study investigates the impact of recent delivery fee exemption policies in Ghana, Senegal, and Sierra Leone on socioeconomic differences in the use of facility-based delivery services. Using Demographic and Health Survey data from nine sub-Saharan African countries, we evaluated the user fee policy changes using a difference-in-differences approach that accounts for underlying common secular trends and time invariant differences among countries, and allows for differential effects of the policy by socioeconomic position. Removing user fees was consistent with meaningful increases in facility deliveries across all categories of household wealth and maternal education. We found little evidence of differential effects of removing user fees across quartiles of household wealth, with increases of 5.4 facility deliveries per hundred live births (95% CI: 2.1, 8.8) among women in the poorest quartile and 6.8 per hundred live births (95% CI: 4.0, 9.7) for women in the richest quartile. However, our results suggest that educated women benefited more from removing user fees compared to women with no education. For women with at least some secondary education, the estimated effect was 8.6 facility deliveries per hundred live births (95% CI: 5.4, 11.9), but only 4.6 per hundred live births (95% CI: 2.2, 7.0) for women with no education (heterogeneity p-value = 0.04). Thus, while removing fees at the point of service increased facility deliveries across the socioeconomic gradient, it did not reduce inequalities defined by household wealth and may have contributed to a widening of educational inequalities. These findings emphasize the need for concerted efforts to address financial and other barriers that contribute to large and persistent socioeconomic inequalities in delivery care. Copyright © 2015 Elsevier Ltd. All rights reserved.

Management of adenolymphangitis and lymphoedema due to lymphatic filariasis in resource-limited North-eastern Nigeria.

PubMed

Akogun, O B; Badaki, J A

2011-09-01

Procedures for health facility-based management of lymphoedema and adenolymphangitis (ADL) have proved very effective in some countries. Unfortunately, in resource-poor communities of Africa where health facilities are few, overburdened and inaccessible, an alternative approach is required. Community-based care (CC), patient care (PC) and health facility care (HC) approaches were compared. In the CC arm, communities were required to select one of their members for care-giving to its affected members, while in the PC, participants were allocated to groups under a leader with responsibility for care giving to group members. In HC, care was given by the nearest health facility. Caregivers from the three arms were trained and supplies were kept at the local government health office. At the sixth month of intervention, 325 lymphoedema and adenolymphangitis patients had been recruited into the study as participants. Within 12 months, compliance with hygiene practices increased from 29.4% to 62.6% and ADL episodes declined from 43.1% to 4.4% in the community designs arm and the cost on the health system was minimal. However, in the patient and health care arms, compliance and accessibility to supplies was severely affected by poor coordination, delay in resource collection leading to very minimal effect on lesions, odour, ADL frequency and duration. Participants abandoned the health facilities after the second visit. Community care approach was more culturally acceptable and effective for the management lymphoedema and ADL than other approaches. Copyright © 2010 Elsevier B.V. All rights reserved.

Analysis of Student Satisfaction Toward Quality of Service Facility

NASA Astrophysics Data System (ADS)

Napitupulu, D.; Rahim, R.; Abdullah, D.; Setiawan, MI; Abdillah, LA; Ahmar, AS; Simarmata, J.; Hidayat, R.; Nurdiyanto, H.; Pranolo, A.

2018-01-01

The development of higher education is very rapid rise to the tight competition both public universities and private colleges. XYZ University realized to win the competition, required continuous quality improvement, including the quality of existing service facilities. Amenities quality services is believed to support the success of the learning activities and improve user satisfaction. This study aims to determine the extent to which the quality of the services effect on user satisfaction. The research method used is survey-based questionnaire that measure perception and expectation. The results showed a gap between perception and expectations of the respondents have a negative value for each item. This means XYZ service facility at the university is not currently meet the expectations of society members. Three service facility that has the lowest index is based on the perception of respondents is a laboratory (2.56), computer and multimedia (2.63) as well as wifi network (2.99). The magnitude of the correlation between satisfaction with the quality of service facilities is 0.725 which means a strong and positive relationship. The influence of the quality of service facilities to the satisfaction of the students is 0.525 meaning that the variable quality of the services facility can explain 52.5% of the variable satisfaction. The study provided recommendations for improvements to enhance the quality of services facility at the XYZ university facilities.

Comparing effectiveness of two client follow-up approaches in sustaining the use of Long Acting Reversible Contraceptives (LARC) among the underserved in rural Punjab, Pakistan: a study protocol and participants' profile.

PubMed

Azmat, Syed Khurram; Hameed, Waqas; Ali, Moazzam; Ishaque, Muhammad; Mustafa, Ghulam; Khan, Omar Farooq; Abbas, Ghazunfer; Munroe, Erik

2015-03-18

Pakistan observes a very high i.e. 37 percent modern contraceptive method related discontinuation rates within 12 months of their initiation. And almost 10 percent of these episodes of discontinuation happened due to the side effects or health concerns experienced by the women. Most importantly, it was noted that more than 12,000 first-level care facilities are located in the rural areas, including rural health centers, basic health units, and family welfare centers, but more than 30% of these facilities are nonfunctional. This paper presents a study protocol and participants' profiling of a prospective cohort follow-up to compare the effectiveness of household based and telephonic approaches in sustaining the use of Long Acting Reversible Contraceptives (LARC) whilst to facilitate lowering method related discontinuation and increasing switching amongst the contraceptive users. A 12-month multi-centre, non-inferiority prospective user follow-up is employed using three different study categories: a) household based follow-up; b) telephonic follow-up; and c) passive or need-based follow-up along with the hypothetical assumption that the telephonic client follow-up is not inferior to the household based follow-up by continuation rate of LARC and the telephonic follow-up is less-costly than the household based client follow-up. This follow-up will be conducted in 22 health facilities - (16 rural and 6 urban based facilities) in district Chakwal. The first two study categories will receive scheduled but different follow-up from the field workers at 1, 3, 6, 9, and 12 month while the third one i.e. the 'passive or need-based follow-up' will serve as a control group. Using sampling software PASS 11, it was estimated to have 414 clients in each study category and around 1366 clients will be recruited to account for 10% attrition rate. The study will help us to examine a more convenient method of effective follow-up for managing side effects, decreasing method discontinuation and increasing switching amongst users. The study information will also facilitate to develop a robust, effective and efficient mechanism for client follow-up to promote the continuation rates of LARC methods. The follow-up results and lessons learnt will be widely shared with stakeholders for their implementation and streamlining in health system.

An Environmental Audit Management Plan for the Royal Australian Air Force

DTIC Science & Technology

1992-09-01

the auditors and the management of this facility at the exit meeting. SA A UO D SO NA 16. Audit report was unduly concerned with trivia . SA A UO 0 SO NA...Welfare Facilities - rubbish, putrescible matter and animal wastes. 12. Swimming Pool - filter backwash. 13. Base Recycling Centre - check for any...concerned with trivia : SA A UD D SD NA 13. The audit report was useful to base management: SA A UD D SD NA 14. The audit process was effective and of

Design and Evaluation of Wood Processing Facilities Using Object-Oriented Simulation

Treesearch

D. Earl Kline; Philip A. Araman

1992-01-01

Managers of hardwood processing facilities need timely information on which to base important decisions such as when to add costly equipment or how to improve profitability subject to time-varying demands. The overall purpose of this paper is to introduce a tool that can effectively provide such timely information. A simulation/animation modeling procedure is described...

Final Environmental Assessment: For Immediate Storm Surge Protection for Santa Rosa Island Facilities, Eglin Air Force Base, FL

DTIC Science & Technology

2006-06-01

ALTERNATIVES .............................................................. 2-1 2.1 Proposed Action ( Preferred Alternative...effects for all alternatives. This section also identifies the preferred alternative and discusses regulatory requirements and/or best management... Preferred Alternative) 06/23/06 Environmental Assessment Page 2-1 for Immediate Storm Surge Protection for Santa Rosa Island Facilities

Shared Use of School Facilities with Community Organizations and Afterschool Physical Activity Program Participation: A Cost-Benefit Assessment

ERIC Educational Resources Information Center

Kanters, Michael A.; Bocarro, Jason N.; Filardo, Mary; Edwards, Michael B.; McKenzie, Thomas L.; Floyd, Myron F.

2014-01-01

Background: Partnerships between school districts and community-based organizations to share school facilities during afterschool hours can be an effective strategy for increasing physical activity. However, the perceived cost of shared use has been noted as an important reason for restricting community access to schools. This study examined…

The effects of small-scale, homelike facilities for older people with dementia on residents, family caregivers and staff: design of a longitudinal, quasi-experimental study.

PubMed

Verbeek, Hilde; van Rossum, Erik; Zwakhalen, Sandra M G; Ambergen, Ton; Kempen, Gertrudis I J M; Hamers, Jan P H

2009-01-20

Small-scale and homelike facilities for older people with dementia are rising in current dementia care. In these facilities, a small number of residents live together and form a household with staff. Normal, daily life and social participation are emphasized. It is expected that these facilities improve residents' quality of life. Moreover, it may have a positive influence on staff's job satisfaction and families involvement and satisfaction with care. However, effects of these small-scale and homelike facilities have hardly been investigated. Since the number of people with dementia increases, and institutional long-term care is more and more organized in small-scale and homelike facilities, more research into effects is necessary. This paper presents the design of a study investigating effects of small-scale living facilities in the Netherlands on residents, family caregivers and nursing staff. A longitudinal, quasi-experimental study is carried out, in which 2 dementia care settings are compared: small-scale living facilities and regular psychogeriatric wards in traditional nursing homes. Data is collected from residents, their family caregivers and nursing staff at baseline and after 6 and 12 months of follow-up. Approximately 2 weeks prior to baseline measurement, residents are screened on cognition and activities of daily living (ADL). Based on this screening profile, residents in psychogeriatric wards are matched to residents living in small-scale living facilities. The primary outcome measure for residents is quality of life. In addition, neuropsychiatric symptoms, depressive symptoms and social engagement are assessed. Involvement with care, perceived burden and satisfaction with care provision are primary outcome variables for family caregivers. The primary outcomes for nursing staff are job satisfaction and motivation. Furthermore, job characteristics social support, autonomy and workload are measured. A process evaluation is performed to investigate to what extent small-scale living facilities and psychogeriatric wards are designed as they were intended. In addition, participants' satisfaction and experiences with small-scale living facilities are investigated. A longitudinal, quasi-experimental study is presented to investigate effects of small-scale living facilities. Although some challenges concerning this design exist, it is currently the most feasible method to assess effects of this relatively new dementia care setting.

How reliable are odour assessments?

PubMed

Bokowa, A; Beukes, J A

2012-01-01

This paper will demonstrate the differences found in odour test results, when odour sampling is performed at the same sources by two different consultants. By examining two case studies, this paper will highlight that the difference between the results can be significant. Both studies are based on odour sampling programs determining the odour removal efficiency of odour control units installed at two different facilities: a pet food facility and an oil/grease recycling facility. The first study is based on odour measurements at the inlet and outlet of the unit installed by Applied Plasma Physics AS at the pet food facility. Odour assessments were performed by two separate consultants at the same time. The second study is based on testing of the odour removal effectiveness of two units: a scrubber and a biofilter at an oil/grease recycling facility. During this study two odour sampling programs were performed by two consultants at different times, but under the same process conditions. This paper will show how varying results can play a role in choosing the adequate odour control technologies. The final results suggest that although, an odour control unit may appear to be insufficient, it actually is successful at removing the odours.

Autonomous rendezvous and capture development infrastructure

NASA Technical Reports Server (NTRS)

Bryan, Thomas C.; Roe, Fred; Coker, Cindy; Nelson, Pam; Johnson, B.

1991-01-01

In the development of the technology for autonomous rendezvous and docking, key infrastructure capabilities must be used for effective and economical development. This involves facility capabilities, both equipment and personnel, to devise, develop, qualify, and integrate ARD elements and subsystems into flight programs. One effective way of reducing technical risks in developing ARD technology is the use of the ultimate test facility, using a Shuttle-based reusable free-flying testbed to perform a Technology Demonstration Test Flight which can be structured to include a variety of additional sensors, control schemes, and operational approaches. This conceptual testbed and flight demonstration will be used to illustrate how technologies and facilities at MSFC can be used to develop and prove an ARD system.

Contextual factors as a key to understanding the heterogeneity of effects of a maternal health policy in Burkina Faso?

PubMed Central

Belaid, Loubna; Ridde, Valéry

2015-01-01

Burkina Faso implemented a national subsidy for emergency obstetric and neonatal care (EmONC) covering 80% of the cost of normal childbirth in public health facilities. The objective was to increase coverage of facility-based deliveries. After implementation of the EmONC policy, coverage increased across the country, but disparities were observed between districts and between primary healthcare centres (PHC). To understand the variation in coverage, we assessed the contextual factors and the implementation of EmONC in six PHCs in a district. We conducted a contrasted multiple case study. We interviewed women (n = 71), traditional birth attendants (n = 7), clinic management committees (n = 11), and health workers and district health managers (n = 26). Focus groups (n = 62) were conducted within communities. Observations were carried out in the six PHCs. Implementation was nearly homogeneous in the six PHCs but the contexts and human factors appeared to explain the variations observed on the coverage of facility-based deliveries. In the PHCs of Nogo and Tara, the immediate increase in coverage was attributed to health workers’ leadership in creatively promoting facility-based deliveries and strengthening relationships of trust with communities, users’ positive perceptions of quality of care and the arrival of female professional staff. The change of healthcare team at Iata’s PHC and a penalty fee imposed for home births in Belem may have caused the delayed effects there. Finally, the unchanged coverage in the PHCs of Fati and Mata was likely due to lack of promotion of facility-based deliveries, users’ negative perceptions of quality of care, and conflicts between health workers and users. Before implementation, decision-makers should perform pilot studies to adapt policies according to contexts and human factors. PMID:24633914

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

PubMed

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

2015-04-18

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

Measuring effective coverage of curative child health services in rural Burkina Faso: a cross-sectional study

PubMed Central

Koulidiati, Jean-Louis; Nesbitt, Robin C; Ouedraogo, Nobila; Hien, Hervé; Robyn, Paul Jacob; Compaoré, Philippe; Souares, Aurélia; Brenner, Stephan

2018-01-01

Objective To estimate both crude and effective curative health services coverage provided by rural health facilities to under 5-year-old (U5YO) children in Burkina Faso. Methods We surveyed 1298 child health providers and 1681 clinical cases across 494 primary-level health facilities, as well as 12 497 U5YO children across 7347households in the facilities’ catchment areas. Facilities were scored based on a set of indicators along three quality-of-care dimensions: management of common childhood diseases, management of severe childhood diseases and general service readiness. Linking service quality to service utilisation, we estimated both crude and effective coverage of U5YO children by these selected curative services. Results Measured performance quality among facilities was generally low with only 12.7% of facilities surveyed reaching our definition of high and 57.1% our definition of intermediate quality of care. The crude coverage was 69.5% while the effective coverages indicated that 5.3% and 44.6% of children reporting an illness episode received services of only high or high and intermediate quality, respectively. Conclusion Our study showed that the quality of U5YO child health services provided by primary-level health facilities in Burkina Faso was low, resulting in relatively ineffective population coverage. Poor adherence to clinical treatment guidelines combined with the lack of equipment and qualified clinical staff that performed U5YO consultations seemed to be contributors to the gap between crude and effective coverage. PMID:29858415

Cost and quality of life analysis of HIV self-testing and facility-based HIV testing and counselling in Blantyre, Malawi.

PubMed

Maheswaran, Hendramoorthy; Petrou, Stavros; MacPherson, Peter; Choko, Augustine T; Kumwenda, Felistas; Lalloo, David G; Clarke, Aileen; Corbett, Elizabeth L

2016-02-19

HIV self-testing (HIVST) has been found to be highly effective, but no cost analysis has been undertaken to guide the design of affordable and scalable implementation strategies. Consecutive HIV self-testers and facility-based testers were recruited from participants in a community cluster-randomised trial ( ISRCTN02004005 ) investigating the impact of offering HIVST in addition to facility-based HIV testing and counselling (HTC). Primary costing studies were undertaken of the HIVST service and of health facilities providing HTC to the trial population. Costs were adjusted to 2014 US$ and INT$. Recruited participants were asked about direct non-medical and indirect costs associated with accessing either modality of HIV testing, and additionally their health-related quality of life was measured using the EuroQol EQ-5D. A total of 1,241 participants underwent either HIVST (n = 775) or facility-based HTC (n = 446). The mean societal cost per participant tested through HIVST (US$9.23; 95 % CI: US$9.14-US$9.32) was lower than through facility-based HTC (US$11.84; 95 % CI: US$10.81-12.86). Although the mean health provider cost per participant tested through HIVST (US$8.78) was comparable to facility-based HTC (range: US$7.53-US$10.57), the associated mean direct non-medical and indirect cost was lower (US$2.93; 95 % CI: US$1.90-US$3.96). The mean health provider cost per HIV positive participant identified through HIVST was higher (US$97.50) than for health facilities (range: US$25.18-US$76.14), as was the mean cost per HIV positive individual assessed for anti-retroviral treatment (ART) eligibility and the mean cost per HIV positive individual initiated onto ART. In comparison to the facility-testing group, the adjusted mean EQ-5D utility score was 0.046 (95 % CI: 0.022-0.070) higher in the HIVST group. HIVST reduces the economic burden on clients, but is a costlier strategy for the health provider aiming to identify HIV positive individuals for treatment. The provider cost of HIVST could be substantially lower under less restrictive distribution models, or if costs of oral fluid HIV test kits become comparable to finger-prick kits used in health facilities.

Factors influencing adverse events reporting within the health care system: the case of artemisinin-based combination treatments in northern Ghana.

PubMed

Chatio, Samuel; Aborigo, Raymond; Adongo, Philip Baba; Anyorigiya, Thomas; Dalinjong, Philip Ayizem; Akweongo, Patricia; Oduro, Abraham

2016-02-27

The use of artemisinin-based combination therapy (ACT) as first-line treatment for uncomplicated malaria was a policy recommended by World Health Organization. In 2004, Ghana changed her first-line anti-malarial drug policy to use ACT. This study examined factors affecting adverse events reporting in northern Ghana after the introduction of ACT. This was a qualitative study based on sixty in-depth interviews with health workers, chemical shop owners and patients with malaria who were given ACT at the health facilities. Purposive sampling method was used to select study participants. The interviews were transcribed, coded into themes using Nvivo 9 software. The thematic analysis framework was used to analyse the data. Study respondents reported body weakness and dizziness as the most frequent side effects they had experienced from the used of ACT. Other side effects they reported were swollen testes, abdominal pain and shivering. These side effects were mostly associated with the use of artesunate-amodiaquine compared to other artemisinin-based combinations. Patients were not provided information about the side effects of the drugs and so did not report when they experienced them. Also long queues at health facilities and unfriendly health worker attitude were the main factors affecting adverse events reporting. Other factors such as wrong use of ACT at home, farming and commercial activities also affected effective adverse events reporting in the study area. Patients' lack of knowledge and health sector drawbacks affected side effect reporting on ACT. Intensive health education on likely side effects of ACT should be provided to patients by health workers. Also, improving health worker attitude toward clients will encourage patients to visit the health facilities when they react negatively to ACT and, subsequently, will improve on adverse events reporting.

[Interventions based on exercise and physical environment for preventing falls in cognitively impaired older people living in long-term care facilities: A systematic review and meta-analysis].

PubMed

González-Román, Loreto; Bagur-Calafat, Caritat; Urrútia-Cuchí, Gerard; Garrido-Pedrosa, Jèssica

2016-01-01

This systematic review aims to report the effectiveness of interventions based on exercise and/or physical environment for reducing falls in cognitively impaired older adults living in long-term care facilities. In July 2014, a literature search was conducted using main databases and specialised sources. Randomised controlled trials assessing the effectiveness of fall prevention interventions, which used exercise or physical environment among elderly people with cognitive impairment living in long-term care facilities, were selected. Two independent reviewers checked the eligibility of the studies, and evaluated their methodological quality. If it was adequate, data were gathered. Fourteen studies with 3,539 participants using exercise and/or physical environment by a single or combined approach were included. The data gathered from studies that used both interventions showed a significant reduction in fall rate. Further research is needed to demonstrate the effectiveness of those interventions for preventing falls in the elderly with cognitive impairment living in long-term care establishments. Copyright © 2015 SEGG. Published by Elsevier Espana. All rights reserved.

Development of computer-based analytical tool for assessing physical protection system

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

Mardhi, Alim, E-mail: alim-m@batan.go.id; Chulalongkorn University, Faculty of Engineering, Nuclear Engineering Department, 254 Phayathai Road, Pathumwan, Bangkok Thailand. 10330; Pengvanich, Phongphaeth, E-mail: ppengvan@gmail.com

Assessment of physical protection system effectiveness is the priority for ensuring the optimum protection caused by unlawful acts against a nuclear facility, such as unauthorized removal of nuclear materials and sabotage of the facility itself. Since an assessment based on real exercise scenarios is costly and time-consuming, the computer-based analytical tool can offer the solution for approaching the likelihood threat scenario. There are several currently available tools that can be used instantly such as EASI and SAPE, however for our research purpose it is more suitable to have the tool that can be customized and enhanced further. In this work,more » we have developed a computer–based analytical tool by utilizing the network methodological approach for modelling the adversary paths. The inputs are multi-elements in security used for evaluate the effectiveness of the system’s detection, delay, and response. The tool has capability to analyze the most critical path and quantify the probability of effectiveness of the system as performance measure.« less

Development of computer-based analytical tool for assessing physical protection system

NASA Astrophysics Data System (ADS)

Mardhi, Alim; Pengvanich, Phongphaeth

2016-01-01

Assessment of physical protection system effectiveness is the priority for ensuring the optimum protection caused by unlawful acts against a nuclear facility, such as unauthorized removal of nuclear materials and sabotage of the facility itself. Since an assessment based on real exercise scenarios is costly and time-consuming, the computer-based analytical tool can offer the solution for approaching the likelihood threat scenario. There are several currently available tools that can be used instantly such as EASI and SAPE, however for our research purpose it is more suitable to have the tool that can be customized and enhanced further. In this work, we have developed a computer-based analytical tool by utilizing the network methodological approach for modelling the adversary paths. The inputs are multi-elements in security used for evaluate the effectiveness of the system's detection, delay, and response. The tool has capability to analyze the most critical path and quantify the probability of effectiveness of the system as performance measure.

Quality Management in Astronomical Software and Data Systems

NASA Astrophysics Data System (ADS)

Radziwill, N. M.

2007-10-01

As the demand for more sophisticated facilities increases, the complexity of the technical and organizational challenges faced by operational space- and ground-based telescopes also increases. In many organizations, funding tends not to be proportional to this trend, and steps must be taken to cultivate a lean environment in both development and operations to consistently do more with less. To facilitate this transition, an organization must be aware of how it can meet quality-related goals, such as reducing variation, improving productivity of people and systems, streamlining processes, ensuring compliance with requirements (scientific, organizational, project, or regulatory), and increasing user satisfaction. Several organizations are already on this path. Quality-based techniques for the efficient, effective development of new telescope facilities and maintenance of existing facilities are described.

Provision of mouth-care in long-term care facilities: an educational trial.

PubMed

MacEntee, M I; Wyatt, C C L; Beattie, B L; Paterson, B; Levy-Milne, R; McCandless, L; Kazanjian, A

2007-02-01

This randomized clinical trial aimed to assess the effectiveness of a pyramid-based education for improving the oral health of elders in long-term care (LTC) facilities. Fourteen facilities matched for size were assigned randomly to an active or control group. At baseline in each facility, care-aides in the active group participated with a full-time nurse educator in a seminar about oral health care, and had unlimited access to the educator for oral health-related advice throughout the 3-month trial. Care-aides in the control group participated in a similar seminar with a dental hygienist but they received no additional advice. The residents in the facilities at baseline and after 3 months were examined clinically to measure their oral hygiene, gingival health, masticatory potential, Body Mass Index and Malnutrition Indicator Score, and asked to report on chewing difficulties. Clinical measures after 3 months were not significantly different from baseline in either group, indicating that education neither influenced the oral health nor the dental hygiene of the residents. A pyramid-based educational scheme with nurses and care-aides did not improve the oral health of frail elders in this urban sample of LTC facilities.

The relationship between the availability of the supporting elements of pedestrian with pedestrian crossing facility usage based on user preferences (Case Study corridor of Sumbersari Street, Gajayana Street, MT. Haryono Street, Malang City)

NASA Astrophysics Data System (ADS)

Soetrisno, D. P.

2017-06-01

Pedestrian crossing facilities are effective enough to avoid pedestrians with vehicles, but its utilization is still quite low. It indicated that safety is not the only factor that influences a person to utilize the pedestrian crossing facilities. In addition, the availability of supporting elements of the pedestrian is still not quite attention, which is also became a factor that causes the pedestrians doesn’t utilize the pedestrian crossing facilities. Therefore, this research was structured to examine the relationship between the availability of the supporting elements of the pedestrian with pedestrian crossing facility usage based on user preferences. Data collection method used is primary survey consist of observation and the questionnaire. Sampling techniques used is purposive sampling with the number of respondents as many as 211 respondents by using questionnaire with ordinal scales to identify respondents’ consideration level of supporting elements pedestrian and crossing facility utilization factors. The survey is done on 15 crossing facilities area in 3 different locations with the same characteristics of land use in the form of higher education area (university area) and trades and services activities area. The analysis technique used is frequency distribution analysis in order to identify preference pedestrian on the availability of supporting elements of pedestrian and pedestrian crossing facility utilization factors, and chi square analysis is used to analyze the relationship between the availability of the supporting elements of the pedestrian with pedestrian crossing facility utilization. Based on the chi square analysis results with significance 5 % obtained the result that there are six supporting elements of pedestrian having correlation to the factors of pedestrian crossing facility utilization consist of the availability of sidewalk, pedestrian lights, Street Lighting Lamps, Pedestrian Crossing Markings Facilities, Sign Crossings Facilities, vegetation, and dustbin. So the result of this research can be considered for the government as main stakehoder especially the local government in preparing policy to provide supporting elements of pedestrian that should be on the area of pedestrian crossing facilities.

An Analysis of the Effects Housing Improvements Have on the Retention of Air Force Personnel

DTIC Science & Technology

1990-09-01

facilities for preteens 3. Avaiablrity of recreational facilities for preteens 03. ionvenience of residence to playyards/playgrounds 4> Convenience of...t, but insulazion wou%, definitely save 3n c.ergy costs. No oiaygroundE c- preteen activity center is avai’a"’ -. se to base housing. ’..uui_ ’ r m...recreational facilities for preteens Cumulative Cumulative HSAT25 Frequency Percent Frequency Percent 17 5.1 17 5 a9 14.7 66 19. 3 40 12.0 106 31.3 69 20.7

U.S. Air Force Environmental Assessment, Add To and Alter Type III Hydrant Fueling System, Tinker Air Force Base, Oklahoma

DTIC Science & Technology

2011-12-01

burning of fossil fuels (e.g., oil , natural gas , coal), solid waste decay, and trees and wood products and also as a result of chemical reactions...to negative GHG effects. Methane. CH4 is a GHG that is emitted during the production and transport of coal, natural gas , and oil . Methane...the pump station (Facility 486); Control Room (Facility 487); and the oil -water separator (Facility 488). • Construction of a new Type III pump house

An economic analysis of midwifery training programmes in South Kalimantan, Indonesia.

PubMed

Walker, Damian; McDermott, Jeanne M; Fox-Rushby, Julia; Tanjung, Marwan; Nadjib, Mardiati; Widiatmoko, Dono; Achadi, Endang

2002-01-01

In order to improve the knowledge and skills of midwives at health facilities and those based in villages in South Kalimantan, Indonesia, three in-service training programmes were carried out during 1995-98. A scheme used for both facility and village midwives included training at training centres, peer review and continuing education. One restricted to village midwives involved an internship programme in district hospitals. The incremental cost-effectiveness of these programmes was assessed from the standpoint of the health care provider. It was estimated that the first scheme could be expanded to increase the number of competent midwives based in facilities and villages in South Kalimantan by 1% at incremental costs of US$ 764.6 and US$ 1175.7 respectively, and that replication beyond South Kalimantan could increase the number of competent midwives based in facilities and villages by 1% at incremental costs of US$ 1225.5 and US$ 1786.4 per midwife respectively. It was also estimated that the number of competent village midwives could be increased by 1% at an incremental cost of US$ 898.1 per intern if replicated elsewhere, and at a cost of US$ 146.2 per intern for expanding the scheme in South Kalimantan. It was not clear whether the training programmes were more or less cost-effective than other safe motherhood interventions because the nature of the outcome measures hindered comparison.

"For whom was it effective?" Moderators of the effect of a school-based intervention on potential physical activity determinants among Brazilian students.

PubMed

Barbosa Filho, Valter Cordeiro; da Silva, Kelly Samara; Mota, Jorge; Vieira, Neiva Francenely Cunha; Gubert, Fabiane do Amaral; Lopes, Adair da Silva

2017-04-01

Knowledge about the effects of school-based interventions on modifiable physical activity (PA) determinants (e.g., social support), and whether the intervention effect differs according to students' characteristics (e.g., age and gender) are relevant PA promotion topics. This study aims to answer these topics among Brazilian students. This cluster-randomized controlled trial was conducted with 548 students in the intervention group and 537 in the control group (51.5% of boys; aged 11-18years). The four-month intervention included strategies focused on training teachers, opportunities for PA in the school environment, and health education. Potential PA determinants (attitude, self-efficacy, support of friends, parents, and teachers, perceived neighborhood environment and PA facilities in school) and moderators (gender, age, socioeconomic status (SES), and PA level at baseline) were assessed using self-reported instrument. Height and weight were measured to estimate the students' body mass index (BMI) status. Generalized linear models were used. In general, there was a significant and positive intervention effect for attitude, support of friends and teachers for PA, as well as PA facilities in school; effect size was 0.29, 0.24, 0.34, and 0.29, respectively (P<0.05). Age (support of friends, parents and teachers, and PA facilities in school), SES (support of friends and PA facilities in school), and BMI status (support of friends) were moderators of the intervention effect on some outcomes. In conclusion, the intervention improved potential PA determinants, but some changes occurred differently according to students' characteristics. These findings should be considered in PA policies in the school context. This study is registered at Clinicaltrials.govNCT02439827. Copyright © 2017 Elsevier Inc. All rights reserved.

CFD-CAA Coupled Calculations of a Tandem Cylinder Configuration to Assess Facility Installation Effects

NASA Technical Reports Server (NTRS)

Redonnet, Stephane; Lockard, David P.; Khorrami, Mehdi R.; Choudhari, Meelan M.

2011-01-01

This paper presents a numerical assessment of acoustic installation effects in the tandem cylinder (TC) experiments conducted in the NASA Langley Quiet Flow Facility (QFF), an open-jet, anechoic wind tunnel. Calculations that couple the Computational Fluid Dynamics (CFD) and Computational Aeroacoustics (CAA) of the TC configuration within the QFF are conducted using the CFD simulation results previously obtained at NASA LaRC. The coupled simulations enable the assessment of installation effects associated with several specific features in the QFF facility that may have impacted the measured acoustic signature during the experiment. The CFD-CAA coupling is based on CFD data along a suitably chosen surface, and employs a technique that was recently improved to account for installed configurations involving acoustic backscatter into the CFD domain. First, a CFD-CAA calculation is conducted for an isolated TC configuration to assess the coupling approach, as well as to generate a reference solution for subsequent assessments of QFF installation effects. Direct comparisons between the CFD-CAA calculations associated with the various installed configurations allow the assessment of the effects of each component (nozzle, collector, etc.) or feature (confined vs. free jet flow, etc.) characterizing the NASA LaRC QFF facility.

Single-Event Effect Testing of the Vishay Si7414DN n-Type TrenchFET(Registered Trademark) Power MOSFET

NASA Technical Reports Server (NTRS)

Lauenstein, J.-M.; Casey, M. C.; Campola, M. A.; Phan, A. M.; Wilcox, E. P.; Topper, A. D.; Ladbury, R. L.

2017-01-01

This study was being undertaken to determine the single event effect susceptibility of the commercial Vishay 60-V TrenchFET power MOSFET. Heavy-ion testing was conducted at the Texas AM University Cyclotron Single Event Effects Test Facility (TAMU) and the Lawrence Berkeley National Laboratory BASE Cyclotron Facility (LBNL). In addition, initial 200-MeV proton testing was conducted at Massachusetts General Hospital (MGH) Francis H. Burr Proton Beam Therapy Center. Testing was performed to evaluate this device for single-event effects from lower-LET, lighter ions relevant to higher risk tolerant space missions.

Computational investigations of low-emission burner facilities for char gas burning in a power boiler

NASA Astrophysics Data System (ADS)

Roslyakov, P. V.; Morozov, I. V.; Zaychenko, M. N.; Sidorkin, V. T.

2016-04-01

Various variants for the structure of low-emission burner facilities, which are meant for char gas burning in an operating TP-101 boiler of the Estonia power plant, are considered. The planned increase in volumes of shale reprocessing and, correspondingly, a rise in char gas volumes cause the necessity in their cocombustion. In this connection, there was a need to develop a burner facility with a given capacity, which yields effective char gas burning with the fulfillment of reliability and environmental requirements. For this purpose, the burner structure base was based on the staging burning of fuel with the gas recirculation. As a result of the preliminary analysis of possible structure variants, three types of early well-operated burner facilities were chosen: vortex burner with the supply of recirculation gases into the secondary air, vortex burner with the baffle supply of recirculation gases between flows of the primary and secondary air, and burner facility with the vortex pilot burner. Optimum structural characteristics and operation parameters were determined using numerical experiments. These experiments using ANSYS CFX bundled software of computational hydrodynamics were carried out with simulation of mixing, ignition, and burning of char gas. Numerical experiments determined the structural and operation parameters, which gave effective char gas burning and corresponded to required environmental standard on nitrogen oxide emission, for every type of the burner facility. The burner facility for char gas burning with the pilot diffusion burner in the central part was developed and made subject to computation results. Preliminary verification nature tests on the TP-101 boiler showed that the actual content of nitrogen oxides in burner flames of char gas did not exceed a claimed concentration of 150 ppm (200 mg/m3).

A User's Guide for the Spacecraft Fire Safety Facility

NASA Technical Reports Server (NTRS)

Goldmeer, Jeffrey S.

2000-01-01

The Spacecraft Fire Safety Facility (SFSF) is a test facility that can be flown on NASA's reduced gravity aircraft to perform various types of combustion experiments under a variety of experimental conditions. To date, this facility has flown numerous times on the aircraft and has been used to perform experiments ranging from an examination of the effects transient depressurization on combustion, to ignition and flame spread. A list of pubfications/presentations based on experiments performed in the SFSF is included in the reference section. This facility consists of five main subsystems: combustion chamber, sample holders, gas flow system, imaging system, and the data acquisition/control system. Each of these subsystems will be reviewed in more detail. These subsystems provide the experiment operator with the ability to monitor and/or control numerous experimental parameters.

A comparison of metrics to evaluate the effects of hydro-facility passage stressors on fish

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

Colotelo, Alison H.; Goldman, Amy E.; Wagner, Katie A.

Hydropower is the most common form of renewable energy, and countries worldwide are considering expanding hydropower to new areas. One of the challenges of hydropower deployment is mitigation of the environmental impacts including water quality, habitat alterations, and ecosystem connectivity. For fish species that inhabit river systems with hydropower facilities, passage through the facility to access spawning and rearing habitats can be particularly challenging. Fish moving downstream through a hydro-facility can be exposed to a number of stressors (e.g., rapid decompression, shear forces, blade strike and collision, and turbulence), which can all affect fish survival in direct and indirect ways.more » Many studies have investigated the effects of hydro-turbine passage on fish; however, the comparability among studies is limited by variation in the metrics and biological endpoints used. Future studies investigating the effects of hydro-turbine passage should focus on using metrics and endpoints that are easily comparable. This review summarizes four categories of metrics that are used in fisheries research and have application to hydro-turbine passage (i.e., mortality, injury, molecular metrics, behavior) and evaluates them based on several criteria (i.e., resources needed, invasiveness, comparability among stressors and species, and diagnostic properties). Additionally, these comparisons are put into context of study setting (i.e., laboratory vs. field). Overall, injury and molecular metrics are ideal for studies in which there is a need to understand the mechanisms of effect, whereas behavior and mortality metrics provide information on the whole body response of the fish. The study setting strongly influences the comparability among studies. In laboratory-based studies, stressors can be controlled by both type and magnitude, allowing for easy comparisons among studies. In contrast, field studies expose fish to realistic passage environments but the comparability is limited. Based on these results, future studies, whether lab or field-based, should focus on metrics that relate to mortality for ease of comparison.« less

Does courtesy bias affect how clients report on objective and subjective measures of family planning service quality? A comparison between facility- and home-based interviews.

PubMed

Hameed, Waqas; Ishaque, Muhammad; Gul, Xaher; Siddiqui, Junaid-Ur-Rehman; Hussain, Sharmeen; Hussain, Wajahat; Ahmed, Aftab; Balal, Asma

2017-01-01

Despite a general understanding that exit interviews being conducted at service providers' facilities may influence clients' responses favorably to health professionals, there is very little evidence available that demonstrates the extent to which this problem exists. This study aimed at assessing and comparing clients' perceptions of the quality of family planning services and their satisfaction levels between facility- and home-based interviews. A cross-sectional survey was conducted among clients receiving family planning services across three service delivery channels - nongovernmental organization (NGO) clinics, social franchise (SF) centers, and outreach camps. The survey took place from December 2015 to January 2016 in 70 districts across all four provinces of Pakistan. A total of 2,807 clients were interviewed, of whom 1,404 clients were interviewed at health facilities after receiving services and 1,403 were interviewed at their homes within 3 days of method uptake. Overall, we found no significant differences between the characteristics of study participants interviewed at health facilities or at home. The findings suggested that experiences reported in exit surveys at facilities were strongly biased positively. This was true for both experiential (service quality) and perception-based (satisfaction) questions in the context of SF centers, while at NGO clinics the interview location only affected clients' responses regarding service quality. However, in outreach settings, clients are more likely to share bad experiences in exit interviews than in home-based interviews on objectively asked questions (service quality). Our study indicates signs of courtesy bias and possibly the Hawthorne effect in exit interviews. Program implementers could opt for home-based interviews for women receiving services at NGO clinics or SF center, whereas exit interviews could be used in outreach settings.

Does courtesy bias affect how clients report on objective and subjective measures of family planning service quality? A comparison between facility- and home-based interviews

PubMed Central

Hameed, Waqas; Ishaque, Muhammad; Gul, Xaher; Siddiqui, Junaid-ur-Rehman; Hussain, Sharmeen; Hussain, Wajahat; Ahmed, Aftab; Balal, Asma

2017-01-01

Purpose Despite a general understanding that exit interviews being conducted at service providers’ facilities may influence clients’ responses favorably to health professionals, there is very little evidence available that demonstrates the extent to which this problem exists. This study aimed at assessing and comparing clients’ perceptions of the quality of family planning services and their satisfaction levels between facility- and home-based interviews. Methods A cross-sectional survey was conducted among clients receiving family planning services across three service delivery channels – nongovernmental organization (NGO) clinics, social franchise (SF) centers, and outreach camps. The survey took place from December 2015 to January 2016 in 70 districts across all four provinces of Pakistan. A total of 2,807 clients were interviewed, of whom 1,404 clients were interviewed at health facilities after receiving services and 1,403 were interviewed at their homes within 3 days of method uptake. Results Overall, we found no significant differences between the characteristics of study participants interviewed at health facilities or at home. The findings suggested that experiences reported in exit surveys at facilities were strongly biased positively. This was true for both experiential (service quality) and perception-based (satisfaction) questions in the context of SF centers, while at NGO clinics the interview location only affected clients’ responses regarding service quality. However, in outreach settings, clients are more likely to share bad experiences in exit interviews than in home-based interviews on objectively asked questions (service quality). Conclusion Our study indicates signs of courtesy bias and possibly the Hawthorne effect in exit interviews. Program implementers could opt for home-based interviews for women receiving services at NGO clinics or SF center, whereas exit interviews could be used in outreach settings. PMID:29760573

Marketing in the long-term care continuum.

PubMed

Laurence, J Nathan; Kash, Bita A

2010-04-01

Today, long-term care facilities are composed of independent, assisted living, and skilled nursing facilities along with many variations of those themes in between. The clientele for these various types of facilities differ because of the level of care the facility provides as well as the amenities long-term care consumers are looking for. However, there many similarities and common approaches to how reaching the target audience through effective marketing activities. Knowing who the target audience is, how to reach them, and how to communicate with them will serve any facility well in this competitive market. Developing marketing strategies for long-term care settings is as important as understanding what elements of care can be marketed individually as a niche market. Determining the market base for a facility is equally crucial since the target populations differ among the three types of facilities. By reviewing current marketing articles and applying marketing practices, we have crafted some general principles for which each facility type can learn from. Finally, we will discuss the types of marketing and how they related to the spectrum of long-term care facilities.

Effects of a psycho-educational intervention on direct care workers' communicative behaviors with residents with dementia.

PubMed

Barbosa, Ana; Marques, Alda; Sousa, Liliana; Nolan, Mike; Figueiredo, Daniela

2016-01-01

This study assessed the effects of a person-centered care-based psycho-educational intervention on direct care workers' communicative behaviors with people with dementia living in aged-care facilities. An experimental study with a pretest-posttest control-group design was conducted in four aged-care facilities. Two experimental facilities received an 8-week psycho-educational intervention aiming to develop workers' knowledge about dementia, person-centered care competences, and tools for stress management. Control facilities received education only, with no support to deal with stress. In total, 332 morning care sessions, involving 56 direct care workers (female, mean age 44.72 ± 9.02 years), were video-recorded before and 2 weeks after the intervention. The frequency and duration of a list of verbal and nonverbal communicative behaviors were analyzed. Within the experimental group there was a positive change from pre- to posttest on the frequency of all workers' communicative behaviors. Significant treatment effects in favor of the experimental group were obtained for the frequency of inform (p < .01, η(2)partial = 0.09) and laugh (p < .01, η(2)partial = 0.18). Differences between groups emerged mainly in nonverbal communicative behaviors. The findings suggest that a person-centered care-based psycho-educational intervention can positively affect direct care workers' communicative behaviors with residents with dementia. Further research is required to determine the extent of the benefits of this approach.

Best demonstrated control technology for graphic arts

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

Friedman, B.; Vaught, C.

The Graphic Arts Industry is a source of volatile organic compound (VOC) emissions. The study was conducted to document the reported overall control efficiency for VOC at a number of rotogravure and flexographic printing facilities. The primary conclusions from the study are: (1) the use of capture and control systems and the use of water-based ink systems have been demonstrated to be effective and reliable in achieving greater than 90 percent overall VOC reduction rotogravure and flexographic printing facilities; (2) facilities can be retrofitted to achieve 90 percent VOC reductions; and (3) permanent total enclosures meeting EPA criteria have beenmore » successfully installed and operated at rotogravure and flexographic printing facilities.« less

National facilities study. Volume 4: Space operations facilities task group

NASA Technical Reports Server (NTRS)

1994-01-01

The principal objectives of the National Facilities Study (NFS) were to: (1) determine where U.S. facilities do not meet national aerospace needs; (2) define new facilities required to make U.S. capabilities 'world class' where such improvements are in the national interest; (3) define where consolidation and phase-out of existing facilities is appropriate; and (4) develop a long-term national plan for world-class facility acquisition and shared usage. The Space Operations Facilities Task Group defined discrete tasks to accomplish the above objectives within the scope of the study. An assessment of national space operations facilities was conducted to determine the nation's capability to meet the requirements of space operations during the next 30 years. The mission model used in the study to define facility requirements is described in Volume 3. Based on this model, the major focus of the Task Group was to identify any substantive overlap or underutilization of space operations facilities and to identify any facility shortfalls that would necessitate facility upgrades or new facilities. The focus of this initial study was directed toward facility recommendations related to consolidations, closures, enhancements, and upgrades considered necessary to efficiently and effectively support the baseline requirements model. Activities related to identifying facility needs or recommendations for enhancing U.S. international competitiveness and achieving world-class capability, where appropriate, were deferred to a subsequent study phase.

MIMI: multimodality, multiresource, information integration environment for biomedical core facilities.

PubMed

Szymanski, Jacek; Wilson, David L; Zhang, Guo-Qiang

2009-10-01

The rapid expansion of biomedical research has brought substantial scientific and administrative data management challenges to modern core facilities. Scientifically, a core facility must be able to manage experimental workflow and the corresponding set of large and complex scientific data. It must also disseminate experimental data to relevant researchers in a secure and expedient manner that facilitates collaboration and provides support for data interpretation and analysis. Administratively, a core facility must be able to manage the scheduling of its equipment and to maintain a flexible and effective billing system to track material, resource, and personnel costs and charge for services to sustain its operation. It must also have the ability to regularly monitor the usage and performance of its equipment and to provide summary statistics on resources spent on different categories of research. To address these informatics challenges, we introduce a comprehensive system called MIMI (multimodality, multiresource, information integration environment) that integrates the administrative and scientific support of a core facility into a single web-based environment. We report the design, development, and deployment experience of a baseline MIMI system at an imaging core facility and discuss the general applicability of such a system in other types of core facilities. These initial results suggest that MIMI will be a unique, cost-effective approach to addressing the informatics infrastructure needs of core facilities and similar research laboratories.

Supply-side barriers to maternity-care in India: a facility-based analysis.

PubMed

Kumar, Santosh; Dansereau, Emily

2014-01-01

Health facilities in many low- and middle-income countries face several types of barriers in delivering quality health services. Availability of resources at the facility may significantly affect the volume and quality of services provided. This study investigates the effect of supply-side determinants of maternity-care provision in India. Health facility data from the District-Level Household Survey collected in 2007-2008 were analyzed to explore the effects of supply-side factors on the volume of delivery care provided at Indian health facilities. A negative binomial regression model was applied to the data due to the count and over-dispersion property of the outcome variable (number of deliveries performed at the facility). Availability of a labor room (Incidence Rate Ratio [IRR]: 1.81; 95% Confidence Interval [CI]: 1.68-1.95) and facility opening hours (IRR: 1.43; CI: 1.35-1.51) were the most significant predictors of the volume of delivery care at the health facilities. Medical and paramedical staff were found to be positively associated with institutional deliveries. The volume of deliveries was also higher if adequate beds, essential obstetric drugs, medical equipment, electricity, and communication infrastructures were available at the facility. Findings were robust to the inclusion of facility's catchment area population and district-level education, health insurance coverage, religion, wealth, and fertility. Separate analyses were performed for facilities with and without a labor room and results were qualitatively similar across these two types of facilities. Our study highlights the importance of supply-side barriers to maternity-care India. To meet Millennium Development Goals 4 and 5, policymakers should make additional investments in improving the availability of medical drugs and equipment at primary health centers (PHCs) in India.

Supply-Side Barriers to Maternity-Care in India: A Facility-Based Analysis

PubMed Central

Kumar, Santosh; Dansereau, Emily

2014-01-01

Background Health facilities in many low- and middle-income countries face several types of barriers in delivering quality health services. Availability of resources at the facility may significantly affect the volume and quality of services provided. This study investigates the effect of supply-side determinants of maternity-care provision in India. Methods Health facility data from the District-Level Household Survey collected in 2007–2008 were analyzed to explore the effects of supply-side factors on the volume of delivery care provided at Indian health facilities. A negative binomial regression model was applied to the data due to the count and over-dispersion property of the outcome variable (number of deliveries performed at the facility). Results Availability of a labor room (Incidence Rate Ratio [IRR]: 1.81; 95% Confidence Interval [CI]: 1.68–1.95) and facility opening hours (IRR: 1.43; CI: 1.35–1.51) were the most significant predictors of the volume of delivery care at the health facilities. Medical and paramedical staff were found to be positively associated with institutional deliveries. The volume of deliveries was also higher if adequate beds, essential obstetric drugs, medical equipment, electricity, and communication infrastructures were available at the facility. Findings were robust to the inclusion of facility's catchment area population and district-level education, health insurance coverage, religion, wealth, and fertility. Separate analyses were performed for facilities with and without a labor room and results were qualitatively similar across these two types of facilities. Conclusions Our study highlights the importance of supply-side barriers to maternity-care India. To meet Millennium Development Goals 4 and 5, policymakers should make additional investments in improving the availability of medical drugs and equipment at primary health centers (PHCs) in India. PMID:25093729

Measuring Work Environment and Performance in Nursing Homes

PubMed Central

Temkin-Greener, Helena; Zheng, Nan (Tracy); Katz, Paul; Zhao, Hongwei; Mukamel, Dana B.

2008-01-01

Background Qualitative studies of the nursing home work environment have long suggested that such attributes as leadership and communication may be related to nursing home performance, including residents' outcomes. However, empirical studies examining these relationships have been scant. Objectives This study is designed to: develop an instrument for measuring nursing home work environment and perceived work effectiveness; test the reliability and validity of the instrument; and identify individual and facility-level factors associated with better facility performance. Research Design and Methods The analysis was based on survey responses provided by managers (N=308) and direct care workers (N=7,418) employed in 162 facilities throughout New York State. Exploratory factor analysis, Chronbach's alphas, analysis of variance, and regression models were used to assess instrument reliability and validity. Multivariate regression models, with fixed facility effects, were used to examine factors associated with work effectiveness. Results The reliability and the validity of the survey instrument for measuring work environment and perceived work effectiveness has been demonstrated. Several individual (e.g. occupation, race) and facility characteristics (e.g. management style, workplace conditions, staffing) that are significant predictors of perceived work effectiveness were identified. Conclusions The organizational performance model used in this study recognizes the multidimensionality of the work environment in nursing homes. Our findings suggest that efforts at improving work effectiveness must also be multifaceted. Empirical findings from such a line of research may provide insights for improving the quality of the work environment and ultimately the quality of residents' care. PMID:19330892

Defense Science Board Task Force on SEA BASING

DTIC Science & Technology

2003-08-01

to: Consider the operational requirements, the assets required, the role(s) of new technologies, and the effects of “jointness” Examine the...improve effectiveness , efficiency or economy? Are there other doctrine, organizational, training, materiel, leadership, personnel or facilities aspects...sea of all four Services In effect , sea basing must become a truly joint concept with capabilities that allow for the projection of the full

A Videotape-Based Training Method for Improving the Detection of Depression in Residents of Long-Term Care Facilities

ERIC Educational Resources Information Center

Wood, Stacey; Cummings, Jeffrey L.; Schnelle, Betha; Stephens, Mary

2002-01-01

Purpose: This article reviews the effectiveness of a new training program for improving nursing staffs' detection of depression within long-term care facilities. The course was designed to increase recognition of the Minimal Data Set (MDS) Mood Trigger items, to be brief, and to rely on images rather than didactics. Design and Methods: This study…

Evaluating the impact of the community-based health planning and services initiative on uptake of skilled birth care in Ghana.

PubMed

Johnson, Fiifi Amoako; Frempong-Ainguah, Faustina; Matthews, Zoe; Harfoot, Andrew J P; Nyarko, Philomena; Baschieri, Angela; Gething, Peter W; Falkingham, Jane; Atkinson, Peter M

2015-01-01

The Community-based Health Planning and Services (CHPS) initiative is a major government policy to improve maternal and child health and accelerate progress in the reduction of maternal mortality in Ghana. However, strategic intelligence on the impact of the initiative is lacking, given the persistant problems of patchy geographical access to care for rural women. This study investigates the impact of proximity to CHPS on facilitating uptake of skilled birth care in rural areas. Data from the 2003 and 2008 Demographic and Health Survey, on 4,349 births from 463 rural communities were linked to georeferenced data on health facilities, CHPS and topographic data on national road-networks. Distance to nearest health facility and CHPS was computed using the closest facility functionality in ArcGIS 10.1. Multilevel logistic regression was used to examine the effect of proximity to health facilities and CHPS on use of skilled care at birth, adjusting for relevant predictors and clustering within communities. The results show that a substantial proportion of births continue to occur in communities more than 8 km from both health facilities and CHPS. Increases in uptake of skilled birth care are more pronounced where both health facilities and CHPS compounds are within 8 km, but not in communities within 8 km of CHPS but lack access to health facilities. Where both health facilities and CHPS are within 8 km, the odds of skilled birth care is 16% higher than where there is only a health facility within 8km. Where CHPS compounds are set up near health facilities, there is improved access to care, demonstrating the facilitatory role of CHPS in stimulating access to better care at birth, in areas where health facilities are accessible.

Evaluating the Impact of the Community-Based Health Planning and Services Initiative on Uptake of Skilled Birth Care in Ghana

PubMed Central

Johnson, Fiifi Amoako; Frempong-Ainguah, Faustina; Matthews, Zoe; Harfoot, Andrew J. P.; Nyarko, Philomena; Baschieri, Angela; Gething, Peter W.; Falkingham, Jane; Atkinson, Peter M.

2015-01-01

Background The Community-based Health Planning and Services (CHPS) initiative is a major government policy to improve maternal and child health and accelerate progress in the reduction of maternal mortality in Ghana. However, strategic intelligence on the impact of the initiative is lacking, given the persistant problems of patchy geographical access to care for rural women. This study investigates the impact of proximity to CHPS on facilitating uptake of skilled birth care in rural areas. Methods and Findings Data from the 2003 and 2008 Demographic and Health Survey, on 4,349 births from 463 rural communities were linked to georeferenced data on health facilities, CHPS and topographic data on national road-networks. Distance to nearest health facility and CHPS was computed using the closest facility functionality in ArcGIS 10.1. Multilevel logistic regression was used to examine the effect of proximity to health facilities and CHPS on use of skilled care at birth, adjusting for relevant predictors and clustering within communities. The results show that a substantial proportion of births continue to occur in communities more than 8 km from both health facilities and CHPS. Increases in uptake of skilled birth care are more pronounced where both health facilities and CHPS compounds are within 8 km, but not in communities within 8 km of CHPS but lack access to health facilities. Where both health facilities and CHPS are within 8 km, the odds of skilled birth care is 16% higher than where there is only a health facility within 8km. Conclusion Where CHPS compounds are set up near health facilities, there is improved access to care, demonstrating the facilitatory role of CHPS in stimulating access to better care at birth, in areas where health facilities are accessible. PMID:25789874

Preparedness of elderly long-term care facilities in HSE East for influenza outbreaks.

PubMed

O'Connor, L; Boland, M; Murphy, H

2015-01-01

Abstract We assessed preparedness of HSE East elderly long-term care facilities for an influenza outbreak, and identified Public Health Department support needs. We surveyed 166 facilities based on the HSE checklist document for influenza outbreaks, with 58% response rate. Client flu vaccination rates were > 75%; leading barriers were client anxiety and consent issues. Target flu vaccine uptake of 40% in staff occurred in 43% of facilities and was associated with staff vaccine administration by afacility-attached GP (p = 0.035), having a facility outbreak plan (p = 0.013) and being anon-HSE run facility (p = 0.013). Leading barriers were staff personal anxiety (94%) and lack of awareness of the protective effect on clients (21%). Eighty-nine percent found Public Health helpful, and requested further educational support and advocacy. Staff vaccine uptake focus, organisational leadership, optimal vaccine provision models, outbreak plans and Public Health support are central to the influenza campaign in elderly long-term care facilities.

[Potential vulnerability to flooding at public health facilities in four northern regions of Peru].

PubMed

Hernández-Vásquez, Akram; Arroyo-Hernández, Hugo; Bendezú-Quispe, Guido; Díaz-Seijas, Deysi; Vilcarromero, Stalin; Rubilar-González, Juan; Gutierrez-Lagos, Edith

2016-03-01

In order to determine the potential vulnerability of public health facilities in four northern regions of Peru to the possible effects of El Niño-Southern Oscillation (ENSO) phenomenon. An exploratory spatial analysis was performed using the geo-referenced points for at-risk areas based on the activation of gullies that were reported by the National Water Authority, and the location of the four regional public health facilities of the Ministry of Health. Concentric areas of influence were simulate from the points of risk towards the public health facilities using radii of 200, 1000 and 1500 meters. The Tumbes region would be the most affected with 37.2% of its health facilities being affected by floods and landslides. The I-2 and I-3 categories of health facilities appeared to be the most affected with 28.9% and 31.6% respectively. Therefore, public health facilities near the risk zones may be affected by the ENSO.

Community-based pulmonary rehabilitation in a non-healthcare facility is feasible and effective.

PubMed

Cecins, Nola; Landers, Holly; Jenkins, Sue

2017-02-01

Pulmonary rehabilitation programs (PRPs) are most commonly provided in hospital settings which present barriers to attendance such as long distances or travel times. Community-based settings have been used in an attempt to alleviate the travel burden. This study evaluated the feasibility and outcomes of a network of community-based PRPs provided in non-healthcare facilities (CPRPs). The CPRPs were established in five venues and comprised two supervised group sessions each week for 8 weeks. Participant inclusion criteria and guidelines for exercise testing and training were developed to reduce the risk of adverse events. Outcome measures included 6-min walk distance (6MWD) and health-related quality of life (chronic respiratory questionnaire (CRQ)). Respiratory-related hospital admission data were collected in the 12 months prior to and following the program. Two hundred and fifty-one participants (79% with chronic obstructive pulmonary disease: mean ± SD FEV 1 49 ± 21%predicted) entered a CPRP of which 166 (66%) completed. Improvements were demonstrated in 6MWD (mean difference (95% CI) 44 m (37-52)) and total CRQ score (0.5 points per item (0.4-0.7)). Fewer participants had a respiratory-related hospital admission following the program (12% vs. 37%, p < 0.0001). Pulmonary rehabilitation is safe, feasible and effective when conducted in community-based non-healthcare facilities.

Orbital transfer vehicle launch operations study: Manpower summary and facility requirements, volume 5

NASA Technical Reports Server (NTRS)

1986-01-01

All manpower numbers, number of heads (by skill), serial time and manhours have been accumulated and compiled on a per subtask basis in spreadsheet format for both the ground based and the space based data flows. To aid in identifying the facility resources required to process the Ground Based Orbital Transfer Vehicle (GBOTV) and/or the space based orbital transfer vehicle (SBOTV) through the ground facilities at Kennedy Space Center (KSC), a software application package was developed using a general purpose data base management system known as Data Flex. The facility requirements are used as the basic input to this software application. The resources of the KSC facility that could be used by orbital transfer vehicle program were digitized in the same format used to identify facility requirements. The facility capabilities were digitized in this format for subsequent, automated comparative analyses. Composite facility requirements are compared to each of the baseline facility capabilities and the system generates a relative score that indicates how each facility weighs against the composite requirements in relation to the other facilities in the set.

Practice patterns, case mix, Medicare payment policy, and dialysis facility costs.

PubMed Central

Hirth, R A; Held, P J; Orzol, S M; Dor, A

1999-01-01

OBJECTIVE: To evaluate the effects of case mix, practice patterns, features of the payment system, and facility characteristics on the cost of dialysis. DATA SOURCES/STUDY SETTING: The nationally representative sample of dialysis units in the 1991 U.S. Renal Data System's Case Mix Adequacy (CMA) Study. The CMA data were merged with data from Medicare Cost Reports, HCFA facility surveys, and HCFA's end-stage renal disease patient registry. STUDY DESIGN: We estimated a statistical cost function to examine the determinants of costs at the dialysis unit level. PRINCIPAL FINDINGS: The relationship between case mix and costs was generally weak. However, dialysis practices (type of dialysis membrane, membrane reuse policy, and treatment duration) did have a significant effect on costs. Further, facilities whose payment was constrained by HCFA's ceiling on the adjustment for area wage rates incurred higher costs than unconstrained facilities. The costs of hospital-based units were considerably higher than those of freestanding units. Among chain units, only members of one of the largest national chains exhibited significant cost savings relative to independent facilities. CONCLUSIONS: Little evidence showed that adjusting dialysis payment to account for differences in case mix across facilities would be necessary to ensure access to care for high-cost patients or to reimburse facilities equitably for their costs. However, current efforts to increase dose of dialysis may require higher payments. Longer treatments appear to be the most economical method of increasing the dose of dialysis. Switching to more expensive types of dialysis membranes was a more costly means of increasing dose and hence must be justified by benefits beyond those of higher dose. Reusing membranes saved money, but the savings were insufficient to offset the costs associated with using more expensive membranes. Most, but not all, of the higher costs observed in hospital-based units appear to reflect overhead cost allocation rather than a difference in real resources devoted to treatment. The economies experienced by the largest chains may provide an explanation for their recent growth in market share. The heterogeneity of results by chain size implies that characterizing units using a simple chain status indicator variable is inadequate. Cost differences by facility type and the effects of the ongoing growth of large chains are worthy of continued monitoring to inform both payment policy and antitrust enforcement. PMID:10029498

Practice patterns, case mix, Medicare payment policy, and dialysis facility costs.

PubMed

Hirth, R A; Held, P J; Orzol, S M; Dor, A

1999-02-01

To evaluate the effects of case mix, practice patterns, features of the payment system, and facility characteristics on the cost of dialysis. The nationally representative sample of dialysis units in the 1991 U.S. Renal Data System's Case Mix Adequacy (CMA) Study. The CMA data were merged with data from Medicare Cost Reports, HCFA facility surveys, and HCFA's end-stage renal disease patient registry. We estimated a statistical cost function to examine the determinants of costs at the dialysis unit level. The relationship between case mix and costs was generally weak. However, dialysis practices (type of dialysis membrane, membrane reuse policy, and treatment duration) did have a significant effect on costs. Further, facilities whose payment was constrained by HCFA's ceiling on the adjustment for area wage rates incurred higher costs than unconstrained facilities. The costs of hospital-based units were considerably higher than those of freestanding units. Among chain units, only members of one of the largest national chains exhibited significant cost savings relative to independent facilities. Little evidence showed that adjusting dialysis payment to account for differences in case mix across facilities would be necessary to ensure access to care for high-cost patients or to reimburse facilities equitably for their costs. However, current efforts to increase dose of dialysis may require higher payments. Longer treatments appear to be the most economical method of increasing the dose of dialysis. Switching to more expensive types of dialysis membranes was a more costly means of increasing dose and hence must be justified by benefits beyond those of higher dose. Reusing membranes saved money, but the savings were insufficient to offset the costs associated with using more expensive membranes. Most, but not all, of the higher costs observed in hospital-based units appear to reflect overhead cost allocation rather than a difference in real resources devoted to treatment. The economies experienced by the largest chains may provide an explanation for their recent growth in market share. The heterogeneity of results by chain size implies that characterizing units using a simple chain status indicator variable is inadequate. Cost differences by facility type and the effects of the ongoing growth of large chains are worthy of continued monitoring to inform both payment policy and antitrust enforcement.

Resident's concerns and attitudes towards Solid Waste Management facilities

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

Rahardyan, B.; Matsuto, T.; Kakuta, Y.

2004-07-01

Because of limited space, the siting and construction of a new SWM facility is a big challenge in Japan. An SWM facility should be socially accepted as well as environmentally and economically sound. This study aimed to investigate people's concerns about SWM facilities and their attitudes towards such facilities. A questionnaire was designed based on literature reviews and was sent to residents in three municipalities with different backgrounds. The questions covered concerns on the impact of an SWM facility, management aspects, unfairness of facility siting, and attitudes to facility construction. Of the many concerns, 'pollution and health effect' had themore » highest rating, followed by 'reliability', 'damage to nature' and 'cost'. The rating was different between municipalities, reflecting their geographic and social backgrounds. Using factor analysis, correlations among concerns were analyzed, and five principal components were extracted, namely 'pollution', 'nuisance', 'facility management', 'planning of facility', and 'merit/demerit'. Although obvious correlations were not found between individual items of concern and attitudes to construction of a facility, the discriminant analysis indicated dominant concerns of attitudes, but the disagreement between actual impact and citizens were found. As for attributes, the 'opposed' attitude decreased for residents who had visited an SWM facility, even if they had only seen it from outside.« less

[Cost-effectiveness research in elderly residents in long-term care: prevention is better than cure, but not always cheaper].

PubMed

Achterberg, Wilco P; Gussekloo, Jacobijn; van den Hout, Wilbert B

2015-01-01

Cost-effectiveness research in elderly residents in long-term care facilities is based on general principals of cost-effectiveness research; these have been developed primarily from the perspective of relatively healthy adults in curative medicine. These principals are, however, inadequate when evaluating interventions for the fragile elderly in long-term care, both in terms of the value attached to the health of patients and to the specific decision-making context of the institution. Here we discuss the pitfalls of cost-effectiveness research in long-term care facilities, illustrated by two prevention interventions for prevalent conditions in nursing homes: pressure ulcers and urinary tract infections. These turned out to be effective, but not cost-effective.

Development of large-aperture electro-optical switch for high power laser at CAEP

NASA Astrophysics Data System (ADS)

Zhang, Xiongjun; Wu, Dengsheng; Zhang, Jun; Lin, Donghui; Zheng, Jiangang; Zheng, Kuixing

2015-02-01

Large-aperture electro-optical switch based on plasma Pockels cell (PPC) is one of important components for inertial confinement fusion (ICF) laser facility. We have demonstrated a single-pulse driven 4×1 PPC with 400mm×400mm aperture for SGIII laser facility. And four 2×1 PPCs modules with 350mm×350mm aperture have been operated in SGII update laser facility. It is different to the PPC of NIF and LMJ for its simple operation to perform Pockels effect. With optimized operation parameters, the PPCs meet the SGII-U laser requirement of four-pass amplification control. Only driven by one high voltage pulser, the simplified PPC system would be provided with less associated diagnostics, and higher reliability. To farther reduce the insert loss of the PPC, research on the large-aperture PPC based on DKDP crystal driven by one pulse is developed. And several single-pulse driven PPCs with 80mm×80mm DKDP crystal have been manufactured and operated in laser facilities.

A cross sectional comparison of postnatal care quality in facilities participating in a maternal health voucher program versus non-voucher facilities in Kenya.

PubMed

Warren, Charlotte E; Abuya, Timothy; Kanya, Lucy; Obare, Francis; Njuki, Rebecca; Temmerman, Marleen; Bellows, Ben

2015-07-24

Health service fees constitute substantial barriers for women seeking childbirth and postnatal care. In an effort to reduce health inequities, the government of Kenya in 2006 introduced the output-based approach (OBA), or voucher programme, to increase poor women's access to quality Safe Motherhood services including postnatal care. To help improve service quality, OBA programmes purchase services on behalf of the poor and marginalised, with provider reimbursements for verified services. Kenya's programme accredited health facilities in three districts as well as in two informal Nairobi settlements. Postnatal care quality in voucher health facilities (n = 21) accredited in 2006 and in similar non-voucher health facilities (n = 20) are compared with cross sectional data collected in 2010. Summary scores for quality were calculated as additive sums of specific aspects of each attribute (structure, process, outcome). Measures of effect were assessed in a linear regression model accounting for clustering at facility level. Data were analysed using Stata 11.0. The overall quality of postnatal care is poor in voucher and non-voucher facilities, but many facilities demonstrated 'readiness' for postnatal care (structural attributes: infrastructure, equipment, supplies, staffing, training) indicated by high scores (83/111), with public voucher facilities scoring higher than public non-voucher facilities. The two groups of facilities evinced no significant differences in postnatal care mean process scores: 14.2/55 in voucher facilities versus 16.4/55 in non-voucher facilities; coefficient: -1.70 (-4.9, 1.5), p = 0.294. Significantly more newborns were seen within 48 hours (83.5% versus 72.1%: p = 0.001) and received Bacillus Calmette-Guerin (BCG) (82.5% versus 76.5%: p < 0.001) at voucher facilities than at non-voucher facilities. Four years after facility accreditation in Kenya, scores for postnatal care quality are low in all facilities, even those with Safe Motherhood vouchers. We recommend the Kenya OBA programme review its Safe Motherhood reimbursement package and draw lessons from supply side results-based financing initiatives, to improve postnatal care quality.

Prevalence and correlates of hospital-based autologous blood programs: a statewide survey.

PubMed

Hull, A L; Neuhauser, D V; Goodnough, L T

1992-05-01

To identify potential barriers to use of autologous blood procurement to minimize homologous blood transfusion needs during elective surgery, the authors conducted a telephone survey of 120 blood bank directors, representing 138 Ohio hospitals. The prevalence of autologous blood procurement facilities, estimated volume of autologous blood, and attitudes and perceptions of the directors toward autologous blood predeposit programs were assessed. Analysis of the data indicated that 30% of Ohio hospitals have autologous blood procurement facilities; larger hospitals were more likely to have this facility. Overall, 5.5% of transfusions involve predeposited autologous blood. No significant differences were found according to hospital bed size or whether the hospital had a procurement facility. Blood bank directors perceived surgeons to be knowledgeable about autologous predeposit; patient demand and surgical practice were felt to be more effective in promoting the use of autologous blood at the hospital than were blood bank efforts. Directors who had autologous predeposit procurement facilities perceived that the facility provided a marketing advantage. Respondents from larger hospitals were more likely to perceive that these programs could be financially self-sufficient. The authors conclude that an economic cost-benefit analysis of hospital-based autologous blood procurement programs is important. Positive findings may influence transfusion services to adopt autologous blood procurement programs, whereas negative findings may convince hospitals that community blood donor facilities can provide better autologous blood procurement.

Dual indices for prioritizing investment in decentralized HIV services at Nigerian primary health care facilities.

PubMed

Fronczak, Nancy; Oyediran, Kola' A; Mullen, Stephanie; Kolapo, Usman M

2016-04-01

Decentralizing health services, including those for HIV prevention and treatment, is one strategy for maximizing the use of limited resources and expanding treatment options; yet few methods exist for systematically identifying where investments for service expansion might be most effective, in terms of meeting needs and rapid availability of improved services. The Nigerian Government, the United States Government under the President's Emergency Plan for AIDS Relief (PEPFAR) program and other donors are expanding services for prevention of mother-to-child transmission (PMTCT) of HIV to primary health care facilities in Nigeria. Nigerian primary care facilities vary greatly in their readiness to deliver HIV/AIDS services. In 2012, MEASURE Evaluation assessed 268 PEPFAR-supported primary health care facilities in Nigeria and developed a systematic method for prioritizing these facilities for expansion of PMTCT services. Each assessed facility was scored based on two indices with multiple, weighted variables: one measured facility readiness to provide PMTCT services, the other measured local need for the services and feasibility of expansion. These two scores were compiled and the summary score used as the basis for prioritizing facilities for PMTCT service expansion. The rationale was that using need and readiness to identify where to expand PMTCT services would result in more efficient allocation of resources. A review of the results showed that the indices achieved the desired effect-that is prioritizing facilities with high need even when readiness was problematic and also prioritizing facilities where rapid scale-up was feasible. This article describes the development of the two-part index and discusses advantages of using this approach when planning service expansion. The authors' objective is to contribute to development of methodologies for prioritizing investments in HIV, as well as other public health arenas, that should improve cost-effectiveness and strengthen services and systems in resource-limited countries. © The Author 2015. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Seasonal influenza vaccination of healthcare employees: results of a 4-year campaign.

PubMed

Hirsch, Pamela; Hodgson, Michael; Davey, Victoria

2011-05-01

To document successful substantial increases in healthcare worker influenza vaccination rates and to identify reasons for success and failure. (1) Four-year longitudinal characterization of facility vaccination rates, (2) Web-based facility-level questionnaire for influenza coordinators to identify success factors in year 3, and (3) semistructured telephone interviews of influenza coordinators at facilities with substantial increases or declines in year 4. National single-payer hospital (healthcare) system with 153 hospitals in 5 levels of complexity. Facility leadership staff. (1) Vaccination data collected from management sources (doses from pharmacies, denominator data from payrolls); (2) a Web-based survey aligned with a previously administered instrument (Wisconsin Health Department), piloted in-house, modified to reflect national strategies and improvements; and (3) semistructured telephone interviews with influenza coordinators at facilities that improved or worsened by more than 20% between the 2007-2008 and 2008-2009 influenza seasons. Vaccination acceptance rates improved from 45% of healthcare workers in 2005-2006 to 66.5% in 2008-2009. Facilities with lower complexity had higher vaccination rates. No individual factors were associated with improved performance. Sustained management attention can lead to improvements in healthcare worker influenza vaccination rates. Wavering of attention, though, may lead to rapid loss of effectiveness. Declination statements in this system did not contribute to vaccine acceptance.

An Evidence-Based Cue-Selection Guide and Logic Model to Improve Pressure Ulcer Prevention in Long-term Care.

PubMed

Yap, Tracey L; Kennerly, Susan M; Bergstrom, Nancy; Hudak, Sandra L; Horn, Susan D

2016-01-01

Pressure ulcers have consistently resisted prevention efforts in long-term care facilities nationwide. Recent research has described cueing innovations that-when selected according to the assumptions and resources of particular facilities-support best practices of pressure ulcer prevention. This article synthesizes that research into a unified, dynamic logic model to facilitate effective staff implementation of a pressure ulcer prevention program.

Does Information Matter? Competition, Quality, and the Impact of Nursing Home Report Cards

PubMed Central

Grabowski, David C; Town, Robert J

2011-01-01

Objective We evaluate the effects of the Nursing Home Quality Initiative (NHQI), which introduced quality measures to the Centers for Medicare and Medicaid Services' Nursing Home Compare website, on facility performance and consumer demand for services. Data Sources The nursing home Minimum Data Set facility reports from 1999 to 2005 merged with facility-level data from the On-Line Survey, Certification, and Reporting System. Study Design We rely on the staggered rollout of the report cards across pilot and nonpilot states to examine the effect of report cards on market share and quality of care. We also exploit differences in nursing home market competition at baseline to identify the impacts of the new information on nursing home quality. Results The introduction of the NHQI was generally unrelated to facility quality and consumer demand. However, nursing homes facing greater competition improved their quality more than facilities in less competitive markets. Conclusions The lack of competition in many nursing home markets may help to explain why the NHQI report card effort had a minimal effect on nursing home quality. With the introduction of market-based reforms such as report cards, this result suggests policy makers must also consider market structure in efforts to improve nursing home performance. PMID:21790590

Does information matter? Competition, quality, and the impact of nursing home report cards.

PubMed

Grabowski, David C; Town, Robert J

2011-12-01

We evaluate the effects of the Nursing Home Quality Initiative (NHQI), which introduced quality measures to the Centers for Medicare and Medicaid Services' Nursing Home Compare website, on facility performance and consumer demand for services. The nursing home Minimum Data Set facility reports from 1999 to 2005 merged with facility-level data from the On-Line Survey, Certification, and Reporting System. We rely on the staggered rollout of the report cards across pilot and nonpilot states to examine the effect of report cards on market share and quality of care. We also exploit differences in nursing home market competition at baseline to identify the impacts of the new information on nursing home quality. The introduction of the NHQI was generally unrelated to facility quality and consumer demand. However, nursing homes facing greater competition improved their quality more than facilities in less competitive markets. The lack of competition in many nursing home markets may help to explain why the NHQI report card effort had a minimal effect on nursing home quality. With the introduction of market-based reforms such as report cards, this result suggests policy makers must also consider market structure in efforts to improve nursing home performance. © Health Research and Educational Trust.

Effect of a package of integrated demand- and supply-side interventions on facility delivery rates in rural Bangladesh: Implications for large-scale programs

PubMed Central

Choudhury, Aziz Ahmed; Khanam, Rasheda; Moin, Syed Mamun Ibne; Ahmed, Salahuddin; Begum, Nazma; Shoma, Nurun Naher; Quaiyum, Md Abdul; Baqui, Abdullah H.

2017-01-01

Background According to the Bangladesh Demographic and Health Survey 2014, only approximately 37 percent of women deliver in a health facility. Among the eight administrative divisions of Bangladesh, the facility delivery rate is lowest in the Sylhet division (22.6 percent) where we assessed the effect of integrated supply- and demand-side interventions on the facility-based delivery rate. Methods Population-based cohort data of pregnant women from an ongoing maternal and newborn health improvement study being conducted in a population of ~120,000 in Sylhet district were used. The study required collection and processing of biological samples immediately after delivery. Therefore, the project assembled various strategies to increase institutional delivery rates. The supply-side intervention included capacity expansion of the health facilities through service provider refresher training, 24/7 service coverage, additions of drugs and supplies, and incentives to the providers. The demand-side component involved financial incentives to cover expenses, a provision of emergency transport, and referral support to a tertiary-level hospital. We conducted a before-and-after observational study to assess the impact of the intervention in a total of 1,861 deliveries between December 2014 and November 2016. Results Overall, implementation of the intervention package was associated with 52.6 percentage point increase in the proportions of facility-based deliveries from a baseline rate of 25.0 percent to 77.6 percent in 24 months. We observed lower rates of institutional deliveries when only supply-side interventions were implemented. The proportion rose to 47.1 percent and continued increasing when the project emphasized addressing the financial barriers to accessing obstetric care in a health facility. Conclusions An integrated supply- and demand-side intervention was associated with a substantial increase in institutional delivery. The package can be tailored to identify which combination of interventions may produce the optimum result and be scaled. Rigorous implementation research studies are needed to draw confident conclusions and to provide information about the costs, feasibility for scale-up and sustainability. PMID:29073229

Impact and economic evaluation of a novel HIV service delivery model in rural Malawi.

PubMed

McBain, Ryan K; Petersen, Elizabeth; Tophof, Nora; Dunbar, Elizabeth L; Kalanga, Noel; Nazimera, Lawrence; Mganga, Andrew; Dullie, Luckson; Mukherjee, Joia; Wroe, Emily B

2017-09-10

We performed an impact and cost-effectiveness analysis of a novel HIV service delivery model in a high prevalence, remote district of Malawi with a population of 143 800 people. A population-based retrospective analysis of 1-year survival rates among newly enrolled HIV-positive patients at 682 health facilities throughout Malawi, comparing facilities implementing the service delivery model (n = 13) and those implementing care-as-usual (n = 669). Through district-level health surveillance data, we evaluated 1-year survival rates among HIV patients newly enrolled between July 2013 and June 2014 - representing 129 938 patients in care across 682 health facilities - using a multilevel modeling framework. The model, focused on social determinants of health, was implemented throughout Neno District at 13 facilities and compared with facilities in all other districts. Activity-based costing was used to annualize financial and economic costs from a societal perspective. Incremental cost-effectiveness ratios were expressed as quality-adjusted life-years gained. The national average 1-year survival rate for newly enrolled antiretroviral therapy clients was 78.9%: this rate was 87.9% in Neno District, compared with 78.8% across all other districts in Malawi (P < 0.001; 95% confidence interval: 0.079-0.104). The economic cost of receiving care in Neno district (n = 6541 patients) was $317/patient/year, compared with an estimated $219/patient in other districts. This translated to $906 per quality-adjusted life-year gained. Neno District's comprehensive model of care, featuring a strong focus on the community, is $98 more expensive per capita per annum but demonstrates superior 1-year survival rates, despite its remote location. Moreover, it should be considered cost-effective by traditional international standards.

Improving the effectiveness of traffic monitoring based on wireless location technology.

DOT National Transportation Integrated Search

2004-01-01

A fundamental requirement for effectively monitoring and operating transportation facilities is reliable, accurate data on traffic flow. The current state of the practice is to use networks of point detectors to gather information on traffic flow at ...

Ground and pavement effects using FHWA's Traffic Noise Model 2.5

DOT National Transportation Integrated Search

2010-04-30

The Volpe Center Acoustics Facility, in support of the Federal Highway Administration (FHWA) has been conducting a study to investigate the effects of using different ground types based on an improved understanding of the characteristics of the groun...

Development and perceived effects of an educational programme on quality and safety in medication handling in residential facilities.

PubMed

Mygind, Anna; El-Souri, Mira; Rossing, Charlotte; Thomsen, Linda Aagaard

2018-04-01

To develop and test an educational programme on quality and safety in medication handling for staff in residential facilities for the disabled. The continuing pharmacy education instructional design model was used to develop the programme with 22 learning objectives on disease and medicines, quality and safety, communication and coordination. The programme was a flexible, modular seven + two days' course addressing quality and safety in medication handling, disease and medicines, and medication supervision and reconciliation. The programme was tested in five Danish municipalities. Municipalities were selected based on their application for participation; each independently selected a facility for residents with mental and intellectual disabilities, and a facility for residents with severe mental illnesses. Perceived effects were measured based on a questionnaire completed by participants before and after the programme. Effects on motivation and confidence as well as perceived effects on knowledge, skills and competences related to medication handling, patient empowerment, communication, role clarification and safety culture were analysed conducting bivariate, stratified analyses and test for independence. Of the 114 participants completing the programme, 75 participants returned both questionnaires (response rate = 66%). Motivation and confidence regarding quality and safety in medication handling significantly improved, as did perceived knowledge, skills and competences on 20 learning objectives on role clarification, safety culture, medication handling, patient empowerment and communication. The programme improved staffs' motivation and confidence and their perceived ability to handle residents' medication safely through improved role clarification, safety culture, medication handling and patient empowerment and communication skills. © 2017 Royal Pharmaceutical Society.

Restructuring in response to case mix reimbursement in nursing homes: A contingency approach

PubMed Central

Zinn, Jacqueline; Feng, Zhanlian; Mor, Vincent; Intrator, Orna; Grabowski, David

2013-01-01

Background Resident-based case mix reimbursement has become the dominant mechanism for publicly funded nursing home care. In 1998 skilled nursing facility reimbursement changed from cost-based to case mix adjusted payments under the Medicare Prospective Payment System for the costs of all skilled nursing facility care provided to Medicare recipients. In addition, as of 2004, 35 state Medicaid programs had implemented some form of case mix reimbursement. Purpose The purpose of the study is to determine if the implementation of Medicare and Medicaid case mix reimbursement increased the administrative burden on nursing homes, as evidenced by increased levels of nurses in administrative functions. Methodology/Approach The primary data for this study come from the Centers for Medicare and Medicaid Services Online Survey Certification and Reporting database from 1997 through 2004, a national nursing home database containing aggregated facility-level information, including staffing, organizational characteristics and resident conditions, on all Medicare/Medicaid certified nursing facilities in the country. We conducted multivariate regression analyses using a facility fixed-effects model to examine the effects of the implementation of Medicaid case mix reimbursement and Medicare Prospective Payment System on changes in the level of total administrative nurse staffing in nursing homes. Findings Both Medicaid case mix reimbursement and Medicare Prospective Payment System increased the level of administrative nurse staffing, on average by 5.5% and 4.0% respectively. However, lack of evidence for a substitution effect suggests that any decline in direct care staffing after the introduction of case mix reimbursement is not attributable to a shift from clinical nursing resources to administrative functions. Practice Implications Our findings indicate that the administrative burden posed by case mix reimbursement has resource implications for all freestanding facilities. At the margin, the increased administrative burden imposed by case mix may become a factor influencing a range of decisions, including resident admission and staff hiring. PMID:18360162

Restructuring in response to case mix reimbursement in nursing homes: a contingency approach.

PubMed

Zinn, Jacqueline; Feng, Zhanlian; Mor, Vincent; Intrator, Orna; Grabowski, David

2008-01-01

Resident-based case mix reimbursement has become the dominant mechanism for publicly funded nursing home care. In 1998 skilled nursing facility reimbursement changed from cost-based to case mix adjusted payments under the Medicare Prospective Payment System for the costs of all skilled nursing facility care provided to Medicare recipients. In addition, as of 2004, 35 state Medicaid programs had implemented some form of case mix reimbursement. The purpose of the study is to determine if the implementation of Medicare and Medicaid case mix reimbursement increased the administrative burden on nursing homes, as evidenced by increased levels of nurses in administrative functions. The primary data for this study come from the Centers for Medicare and Medicaid Services Online Survey Certification and Reporting database from 1997 through 2004, a national nursing home database containing aggregated facility-level information, including staffing, organizational characteristics and resident conditions, on all Medicare/Medicaid certified nursing facilities in the country. We conducted multivariate regression analyses using a facility fixed-effects model to examine the effects of the implementation of Medicaid case mix reimbursement and Medicare Prospective Payment System on changes in the level of total administrative nurse staffing in nursing homes. Both Medicaid case mix reimbursement and Medicare Prospective Payment System increased the level of administrative nurse staffing, on average by 5.5% and 4.0% respectively. However, lack of evidence for a substitution effect suggests that any decline in direct care staffing after the introduction of case mix reimbursement is not attributable to a shift from clinical nursing resources to administrative functions. Our findings indicate that the administrative burden posed by case mix reimbursement has resource implications for all freestanding facilities. At the margin, the increased administrative burden imposed by case mix may become a factor influencing a range of decisions, including resident admission and staff hiring.

Rapid prototyping facility for flight research in artificial-intelligence-based flight systems concepts

NASA Technical Reports Server (NTRS)

Duke, E. L.; Regenie, V. A.; Deets, D. A.

1986-01-01

The Dryden Flight Research Facility of the NASA Ames Research Facility of the NASA Ames Research Center is developing a rapid prototyping facility for flight research in flight systems concepts that are based on artificial intelligence (AI). The facility will include real-time high-fidelity aircraft simulators, conventional and symbolic processors, and a high-performance research aircraft specially modified to accept commands from the ground-based AI computers. This facility is being developed as part of the NASA-DARPA automated wingman program. This document discusses the need for flight research and for a national flight research facility for the rapid prototyping of AI-based avionics systems and the NASA response to those needs.

Teaching ergonomics to nursing facility managers using computer-based instruction.

PubMed

Harrington, Susan S; Walker, Bonnie L

2006-01-01

This study offers evidence that computer-based training is an effective tool for teaching nursing facility managers about ergonomics and increasing their awareness of potential problems. Study participants (N = 45) were randomly assigned into a treatment or control group. The treatment group completed the ergonomics training and a pre- and posttest. The control group completed the pre- and posttests without training. Treatment group participants improved significantly from 67% on the pretest to 91% on the posttest, a gain of 24%. Differences between mean scores for the control group were not significant for the total score or for any of the subtests.

Are environmental risk estimations linked to the actual environmental impact? Application to an oil handling facility (NE Spain).

PubMed

Valdor, Paloma F; Puente, Araceli; Gómez, Aina G; Ondiviela, Bárbara; Juanes, José A

2017-01-30

The environmental risk analysis of aquatic systems includes the evaluation of the likelihood that adverse ecological effects may occur as a result of exposure to one or more stressors. In harbor areas, pollution is provided by a complex mixture of substances with different levels of toxicity, persistence and bioaccumulation, which complicates the hazards characterization and their multiple effects. A study of the relationship between the environmental impact and the environmental risk assessment at a specific isolated oil handling facility was undertaken. The environmental risk of the oil handling facility, considering the consequences of specific pollutants, was estimated and the associated environmental impact was quantified based on a 'weights of evidence' approach. The contamination quantified at the potentially affected area around the monobuoy of Tarragona has proved to be related with environmental risk estimations but the lines of evidence obtained do not allow us to assert that the activity developed at this facility has an associated environmental impact. Copyright © 2016 Elsevier Ltd. All rights reserved.

Environmental Health Practice: Statistically Based Performance Measurement

PubMed Central

Enander, Richard T.; Gagnon, Ronald N.; Hanumara, R. Choudary; Park, Eugene; Armstrong, Thomas; Gute, David M.

2007-01-01

Objectives. State environmental and health protection agencies have traditionally relied on a facility-by-facility inspection-enforcement paradigm to achieve compliance with government regulations. We evaluated the effectiveness of a new approach that uses a self-certification random sampling design. Methods. Comprehensive environmental and occupational health data from a 3-year statewide industry self-certification initiative were collected from representative automotive refinishing facilities located in Rhode Island. Statistical comparisons between baseline and postintervention data facilitated a quantitative evaluation of statewide performance. Results. The analysis of field data collected from 82 randomly selected automotive refinishing facilities showed statistically significant improvements (P<.05, Fisher exact test) in 4 major performance categories: occupational health and safety, air pollution control, hazardous waste management, and wastewater discharge. Statistical significance was also shown when a modified Bonferroni adjustment for multiple comparisons was performed. Conclusions. Our findings suggest that the new self-certification approach to environmental and worker protection is effective and can be used as an adjunct to further enhance state and federal enforcement programs. PMID:17267709

The impact of community health worker-led home delivery of antiretroviral therapy on virological suppression: a non-inferiority cluster-randomized health systems trial in Dar es Salaam, Tanzania.

PubMed

Geldsetzer, Pascal; Francis, Joel M; Ulenga, Nzovu; Sando, David; Lema, Irene A; Mboggo, Eric; Vaikath, Maria; Koda, Happiness; Lwezaula, Sharon; Hu, Janice; Noor, Ramadhani A; Olofin, Ibironke; Larson, Elysia; Fawzi, Wafaie; Bärnighausen, Till

2017-02-22

Home delivery of antiretroviral therapy (ART) by community health workers (CHWs) may improve ART retention by reducing the time burden and out-of-pocket expenditures to regularly attend an ART clinic. In addition, ART home delivery may shorten waiting times and improve quality of care for those in facility-based care by decongesting ART clinics. This trial aims to determine whether ART home delivery for patients who are clinically stable on ART combined with facility-based care for those who are not stable on ART is non-inferior to the standard of care (facility-based care for all ART patients) in achieving and maintaining virological suppression. This is a non-inferiority cluster-randomized trial set in Dar es Salaam, Tanzania. A cluster is one of 48 healthcare facilities with its surrounding catchment area. 24 clusters were randomized to ART home delivery and 24 to the standard of care. The intervention consists of home visits by CHWs to provide counseling and deliver ART to patients who are stable on ART, while the control is the standard of care (facility-based ART and CHW home visits without ART home delivery). In addition, half of the healthcare facilities in each study arm were randomized to standard counseling during home visits (covering family planning, prevention of HIV transmission, and ART adherence), and half to standard plus nutrition counseling (covering food production and dietary advice). The non-inferiority design applies to the endpoints of the ART home delivery trial; the primary endpoint is the proportion of ART patients at a healthcare facility who are virally suppressed at the end of the study period. The margin of non-inferiority for this primary endpoint was set at nine percentage points. As the number of ART patients in sub-Saharan Africa is expected to rise, this trial provides causal evidence on the effectiveness of a home-based care model that could decongest ART clinics and reduce patients' healthcare expenditures. More broadly, this trial will inform the increasing policy interest in task-shifting of chronic disease care from facility- to community-based healthcare workers. ClinicalTrials.gov: NCT02711293 . Registration date: 16 March 2016.

The effect of physical rehabilitation on activities of daily living in older residents of long-term care facilities: systematic review with meta-analysis.

PubMed

Crocker, Tom; Young, John; Forster, Anne; Brown, Lesley; Ozer, Seline; Greenwood, Darren C

2013-11-01

the worldwide population is ageing. One expected consequence of this is an increase in morbidity and an associated increased demand for long-term care. Physical rehabilitation is beneficial in older people, but relatively little is known about effects in residents of long-term care facilities. to examine the effects of physical rehabilitation on activities of daily living (ADL) in elderly residents of long-term care facilities. systematic review with meta-analysis of randomised controlled trials. We included studies that compared the effect of a physical rehabilitation intervention on independence in ADL with either no intervention or an alternative intervention in older people (over 60 years) living in long-term care facilities. We searched 19 databases including the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, AMED, Web of Knowledge and Google Scholar. Two researchers independently screened papers and extracted data. Outcomes of included studies were combined in a standardised mean difference random-effects meta-analysis. thirteen of 14 studies identified were included in the meta-analysis. Independence in ADL was improved by 0.24 standard units (95% CI: 0.11-0.38; P = 0.0005). This is equivalent to 1.3 points on the Barthel Index (0-20 scale). No significant differences in effect were found based on participant or intervention characteristics. Larger sample size and low attrition were associated with smaller estimates of effect. All studies were assessed to be at risk of bias. physical rehabilitation may improve independence for elderly long-term care facility residents, but mean effects are small. It is unclear which interventions are most appropriate.

The Effect of the Removal of User Fees for Delivery at Public Health Facilities on Institutional Delivery in Urban Kenya.

PubMed

Calhoun, Lisa M; Speizer, Ilene S; Guilkey, David; Bukusi, Elizabeth

2018-03-01

Objectives In 2013, Kenya removed delivery fees at public health facilities in an effort to promote equity in access to health services and address high maternal mortality. This study determines the effect of the policy to remove user fees on institutional delivery in a population-based sample of women from urban Kenya. Methods Longitudinal data were collected from a representative sample of 8500 women from five cities in Kenya in 2010 with a follow-up interview in 2014 (response rate 58.9%). Respondents were asked about their most recent birth since 2008 at baseline and 2012 at endline, including the delivery location. Multinomial logistic regression is used, controlling for the temporal time trend and background characteristics, to determine if births which occurred after the national policy change were more likely to occur at a public facility than at home or a private facility. Results Multivariate findings show that women were significantly more likely to deliver at a public facility as compared to a private facility after the policy. Among the poor, the results show that poor women were significantly more likely to deliver in a public facility compared to home or a private facility after policy change. Conclusions for Practice These findings show Kenya's progress towards achieving universal access to delivery services and meeting its national development targets. The removal of delivery fees in the public sector is leading to increased use of facilities for delivery among the urban poor; this is an important first step in reducing maternal death.

Improving performance of Zambia Defence Force antiretroviral therapy providers: evaluation of a standards-based approach

PubMed Central

Kim, Young Mi; Banda, Joseph; Kanjipite, Webby; Sarkar, Supriya; Bazant, Eva; Hiner, Cyndi; Tholandi, Maya; Reinhardt, Stephanie; Njobvu, Panganani Dalisani; Kols, Adrienne; Benavides, Bruno

2013-01-01

ABSTRACT Background: The Zambia Defence Force (ZDF) has applied the Standards-Based Management and Recognition (SBM-R®) approach, which uses detailed performance standards, at some health facilities to improve HIV-related services offered to military personnel and surrounding civilian communities. This study examines the effectiveness of the SBM-R approach in improving facility readiness and provider performance at ZDF facilities. Methods: We collected data on facility readiness and provider performance before and after the 2010–2012 intervention at 4 intervention sites selected for their relatively poor performance and 4 comparison sites. Assessors observed whether each facility met 16 readiness standards and whether providers met 9 performance standards during consultations with 354 returning antiretroviral therapy (ART) clients. We then calculated the percentages of criteria achieved for each readiness and performance standard and conducted bivariate and multivariate analyses of provider performance data. Results: Facilities' ART readiness scores exceeded 80% before the intervention at both intervention and comparison sites. At endline, scores improved on 4 facility readiness standards in the intervention group but on only 1 standard in the comparison group. Multivariate analysis found that the overall provider performance score increased significantly in the intervention group (from 58% to 84%; P<.01) but not in the comparison group (from 62% to 70%). The before-and-after improvement in scores was significantly greater among intervention sites than among comparison sites for 2 standards—initial assessment of the client's condition and nutrition counseling. Conclusion: The standards-based approach, which involved intensive and mutually reinforcing intervention activities, showed modest improvements in some aspects of providers' performance during ART consultations. Further research is needed to determine whether improvements in provider performance affect client outcomes such as adherence to ART. PMID:25276534

Facilities Performance Indicators Report, 2008-09

ERIC Educational Resources Information Center

Hills, Christina, Ed.

2010-01-01

This paper features another expanded Web-based Facilities Performance Indicators Report (FPI). The purpose of APPA's Facilities Performance Indicators is to provide a representative set of statistics about facilities in educational institutions. The 2008-09 iteration of the Web-based Facilities Performance Indicators Survey was posted and…

Integrated Urban Flood Analysis considering Optimal Operation of Flood Control Facilities in Urban Drainage Networks

NASA Astrophysics Data System (ADS)

Moon, Y. I.; Kim, M. S.; Choi, J. H.; Yuk, G. M.

2017-12-01

eavy rainfall has become a recent major cause of urban area flooding due to the climate change and urbanization. To prevent property damage along with casualties, a system which can alert and forecast urban flooding must be developed. Optimal performance of reducing flood damage can be expected of urban drainage facilities when operated in smaller rainfall events over extreme ones. Thus, the purpose of this study is to execute: A) flood forecasting system using runoff analysis based on short term rainfall; and B) flood warning system which operates based on the data from pump stations and rainwater storage in urban basins. In result of the analysis, it is shown that urban drainage facilities using short term rainfall forecasting data by radar will be more effective to reduce urban flood damage than using only the inflow data of the facility. Keywords: Heavy Rainfall, Urban Flood, Short-term Rainfall Forecasting, Optimal operating of urban drainage facilities. AcknowledgmentsThis research was supported by a grant (17AWMP-B066744-05) from Advanced Water Management Research Program (AWMP) funded by Ministry of Land, Infrastructure and Transport of Korean government.

Toward a fourth-generation x-ray source.

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

Monction, D. E.

1999-05-19

The field of synchrotron radiation research has grown rapidly over the last 25 years due to both the push of the accelerator and magnet technology that produces the x-ray beams and the pull of the extraordinary scientific research that is possible with them. Three successive generations of synchrotrons radiation facilities have resulted in beam brilliances 11 to 12 orders of magnitude greater than the standard laboratory x-ray tube. However, greater advances can be easily imagined given the fact that x-ray beams from present-day facilities do not exhibit the coherence or time structure so familiar with the optical laser. Theoretical workmore » over the last ten years or so has pointed to the possibility of generating hard x-ray beams with laser-like characteristics. The concept is based on self-amplified spontaneous emission (SASE) in flee-electron lasers. A major facility of this type based upon a superconducting linac could produce a cost-effective facility that spans wave-lengths from the ultraviolet to the hard x-ray regime, simultaneously servicing large numbers experimenters from a wide range of disciplines. As with each past generation of synchrotrons facilities, immense new scientific opportunities would result from fourth-generation sources.« less

Evaluating building performance in healthcare facilities: an organizational perspective.

PubMed

Steinke, Claudia; Webster, Lynn; Fontaine, Marie

2010-01-01

Using the environment as a strategic tool is one of the most cost-effective and enduring approaches for improving public health; however, it is one that requires multiple perspectives. The purpose of this article is to highlight an innovative methodology that has been developed for conducting comprehensive performance evaluations in public sector health facilities in Canada. The building performance evaluation methodology described in this paper is a government initiative. The project team developed a comprehensive building evaluation process for all new capital health projects that would respond to the aforementioned need for stakeholders to be more accountable and to better integrate the larger organizational strategy of facilities. The Balanced Scorecard, which is a multiparadigmatic, performance-based business framework, serves as the underlying theoretical framework for this initiative. It was applied in the development of the conceptual model entitled the Building Performance Evaluation Scorecard, which provides the following benefits: (1) It illustrates a process to link facilities more effectively to the overall mission and goals of an organization; (2) It is both a measurement and a management system that has the ability to link regional facilities to measures of success and larger business goals; (3) It provides a standardized methodology that ensures consistency in assessing building performance; and (4) It is more comprehensive than traditional building evaluations. The methodology presented in this paper is both a measurement and management system that integrates the principles of evidence-based design with the practices of pre- and post-occupancy evaluation. It promotes accountability and continues throughout the life cycle of a project. The advantage of applying this framework is that it engages health organizations in clarifying a vision and strategy for their facilities and helps translate those strategies into action and measurable performance outcomes.

New food safety law: effectiveness on the ground.

PubMed

Drew, Christa A; Clydesdale, Fergus M

2015-01-01

The demand for safety in the US food supply from production to consumption necessitates a scientific, risk-based strategy for the management of microbiological, chemical, and physical hazards in food. The key to successful management is an increase in systematic collaboration and communication and in enforceable procedures with all domestic and international stakeholders. The enactment of the Food Safety Modernization Act (FSMA) aims to prevent or reduce large-scale food-borne illness outbreaks through stricter facility registration and records standards, mandatory prevention-based controls, increased facility inspections in the United States and internationally, mandatory recall authority, import controls, and increased consumer communication. The bill provisions are expected to cost $1.4 billion over the next four years. Effective implementation of the FSMA's 50 rules, reports, studies, and guidance documents in addition to an increased inspection burden requires further funding appropriations. Additional full-time inspectors and unprecedented foreign compliance is necessary for the full and effective implementation of the FSMA.

Cervical cancer screening through human papillomavirus testing in community health campaigns versus health facilities in rural western Kenya.

PubMed

Huchko, Megan J; Ibrahim, Saduma; Blat, Cinthia; Cohen, Craig R; Smith, Jennifer S; Hiatt, Robert A; Bukusi, Elizabeth

2018-04-01

To determine the effectiveness of community health campaigns (CHCs) as a strategy for human papillomavirus (HPV)-based cervical cancer screening in rural western Kenya. Between January and November 2016, a cluster-randomized trial was carried out in 12 communities in western Kenya to investigate high-risk HPV testing offered via self-collection to women aged 25-65 years in CHCs versus government health facilities. Outcome measures were the total number of women accessing cervical cancer screening and the proportion of HPV-positive women accessing treatment. In total, 4944 women underwent HPV-based cervical cancer screening in CHCs (n=2898) or health facilities (n=2046). Screening uptake as a proportion of total eligible women in the population was greater in communities assigned to CHCs (60.0% vs 37.0%, P<0.001). Rates of treatment acquisition were low in both arms (CHCs 39.2%; health facilities 31.5%; P=0.408). Cervical cancer screening using HPV testing of self-collected samples reached a larger proportion of women when offered through periodic CHCs compared with health facilities. The community-based model is a promising strategy for cervical cancer prevention. Lessons learned from this trial can be used to identify ways of maximizing the impact of such strategies through greater community participation and improved linkage to treatment. ClinicalTrials.gov registration: NCT02124252. © 2017 International Federation of Gynecology and Obstetrics.

Comprehensive facilities plan

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

NONE

1997-09-01

The Ernest Orlando Lawrence Berkeley National Laboratory`s Comprehensive Facilities Plan (CFP) document provides analysis and policy guidance for the effective use and orderly future development of land and capital assets at the Berkeley Lab site. The CFP directly supports Berkeley Lab`s role as a multiprogram national laboratory operated by the University of California (UC) for the Department of Energy (DOE). The CFP is revised annually on Berkeley Lab`s Facilities Planning Website. Major revisions are consistent with DOE policy and review guidance. Facilities planing is motivated by the need to develop facilities for DOE programmatic needs; to maintain, replace and rehabilitatemore » existing obsolete facilities; to identify sites for anticipated programmatic growth; and to establish a planning framework in recognition of site amenities and the surrounding community. The CFP presents a concise expression of the policy for the future physical development of the Laboratory, based upon anticipated operational needs of research programs and the environmental setting. It is a product of the ongoing planning processes and is a dynamic information source.« less

THE EFFECTS OF COMPUTER-BASED FIRE SAFETY TRAINING ON THE KNOWLEDGE, ATTITUDES, AND PRACTICES OF CAREGIVERS

PubMed Central

Harrington, Susan S.; Walker, Bonnie L.

2010-01-01

Background Older adults in small residential board and care facilities are at a particularly high risk of fire death and injury because of their characteristics and environment. Methods The authors investigated computer-based instruction as a way to teach fire emergency planning to owners, operators, and staff of small residential board and care facilities. Participants (N = 59) were randomly assigned to a treatment or control group. Results Study participants who completed the training significantly improved their scores from pre- to posttest when compared to a control group. Participants indicated on the course evaluation that the computers were easy to use for training (97%) and that they would like to use computers for future training courses (97%). Conclusions This study demonstrates the potential for using interactive computer-based training as a viable alternative to instructor-led training to meet the fire safety training needs of owners, operators, and staff of small board and care facilities for the elderly. PMID:19263929

Environmental Assessment: Proposed Consolidated Transportation Facility, Hill Air Force Base, Utah

DTIC Science & Technology

2011-02-01

environment, establishing a resource baseline against which the effects of the various alternatives can be evaluated. It presents relevant facilities and...regulated include the following waste streams. • Used spray cans (less than one ton per year) are collected. These cans are typically empty or mostly...Civil Engineer Organizations, 75 CEG and 75 CES T 84056 5713 Lahm Lane, Building 593N, Hill AFB U Steven Weed, MILCON Project Programmer, (801

Regulatory approaches for addressing dissolved oxygen concerns at hydropower facilities

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

Peterson, Mark J.; Cada, Glenn F.; Sale, Michael J.

Low dissolved oxygen (DO) concentrations are a common water quality problem downstream of hydropower facilities. At some facilities, structural improvements (e.g. installation of weir dams or aerating turbines) or operational changes (e.g., spilling water over the dam) can be made to improve DO levels. In other cases, structural and operational approaches are too costly for the project to implement or are likely to be of limited effectiveness. Despite improvements in overall water quality below dams in recent years, many hydropower projects are unable to meet state water quality standards for DO. Regulatory agencies in the U.S. are considering or implementingmore » dramatic changes in their approach to protecting the quality of the Nation’s waters. New policies and initiatives have emphasized flexibility, increased collaboration and shared responsibility among all parties, and market-based, economic incentives. The use of new regulatory approaches may now be a viable option for addressing the DO problem at some hydropower facilities. This report summarizes some of the regulatory-related options available to hydropower projects, including negotiation of site-specific water quality criteria, use of biological monitoring, watershed-based strategies for the management of water quality, and watershed-based trading. Key decision points center on the health of the local biological communities and whether there are contributing impacts (i.e., other sources of low DO effluents) in the watershed. If the biological communities downstream of the hydropower project are healthy, negotiation for site-specific water quality standards or biocriteria (discharge performance criteria based on characteristics of the aquatic biota) might be pursued. If there are other effluent dischargers in the watershed that contribute to low DO problems, watershed-scale strategies and effluent trading may be effective. This report examines the value of regulatory approaches by reviewing their use in other« less

Health worker preferences for community-based health insurance payment mechanisms: a discrete choice experiment

PubMed Central

2012-01-01

Background In 2004, a community-based health insurance scheme (CBI) was introduced in Nouna health district, Burkina Faso. Since its inception, coverage has remained low and dropout rates high. One important reason for low coverage and high dropout is that health workers do not support the CBI scheme because they are dissatisfied with the provider payment mechanism of the CBI. Methods A discrete choice experiment (DCE) was used to examine CBI provider payment attributes that influence health workers’ stated preferences for payment mechanisms. The DCE was conducted among 176 health workers employed at one of the 34 primary care facilities or the district hospital in Nouna health district. Conditional logit models with main effects and interactions terms were used for analysis. Results Reimbursement of service fees (adjusted odds ratio (aOR) 1.49, p < 0.001) and CBI contributions for medical supplies and equipment (aOR 1.47, p < 0.001) had the strongest effect on whether the health workers chose a given provider payment mechanism. The odds of selecting a payment mechanism decreased significantly if the mechanism included (i) results-based financing (RBF) payments made through the local health management team (instead of directly to the health workers (aOR 0.86, p < 0.001)) or (ii) RBF payments based on CBI coverage achieved in the health worker’s facility relative to the coverage achieved at other facilities (instead of payments based on the numbers of individuals or households enrolled at the health worker’s facility (aOR 0.86, p < 0.001)). Conclusions Provider payment mechanisms can crucially determine CBI performance. Based on the results from this DCE, revised CBI payment mechanisms were introduced in Nouna health district in January 2011, taking into consideration health worker preferences on how they are paid. PMID:22697498

Determination of Ground-Laboratory to In-Space Effective Atomic Oxygen Fluence for DC 93?500 Silicone

NASA Technical Reports Server (NTRS)

deGroh, Kim K.; Banks, Bruce A.; Ma, David

2004-01-01

The objective of this research was to calibrate the ground-to-space effective atomic oxygen fluence for DC 93-500 silicone in a thermal energy electron cyclotron resonance (ECR) oxygen plasma facility. Silicones, commonly used spacecraft materials, do not chemically erode with atomic oxygen attack like other organic materials but form an oxidized hardened silicate surface layer. Therefore, the effective atomic oxygen fluence in a ground test facility should not be determined based on mass loss measurements, as they are with organic polymers. A technique has been developed at the Glenn Research Center to determine the equivalent amount of atomic oxygen exposure in an ECR ground test facility to produce the same degree of atomic oxygen damage as in space. The approach used was to compare changes in the surface hardness of ground test (ECR) exposed DC 93-500 silicone with DC 93-500 exposed to low Earth orbit (LEO) atomic oxygen as part of a shuttle flight experiment. The ground to in-space effective atomic oxygen fluence correlation was determined based on the fluence in the ECR source that produced the same hardness for the fluence in-space. Nanomechanical hardness versus contact depth measurements were obtained for five ECR exposed DC 93-500 samples (ECR exposed for 18 to 40 hrs, corresponding to Kapton effective fluences of 4.2 x 10(exp 20) to 9.4 x 10(exp 20) atoms/sq cm, respectively) and for space exposed DC 93-500 from the Evaluation of Oxygen Interactions with Materials III (EOIM III) shuttle flight experiment, exposed to LEO atomic oxygen for 2.3 x 10(exp 20) atoms/sq cm. Pristine controls were also evaluated. A ground-to-space correlation value was determined based on correlation values for four contact depths (150, 200, 250, and 300 nm), which represent the near surface depth data. The results indicate that the Kapton effective atomic oxygen fluence in the ECR facility needs to be 2.64 times higher than in LEO to replicate equivalent exposure damage in the ground test silicone as occurred in the space exposed silicone.

Neutron Source Facility Training Simulator Based on EPICS

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

Park, Young Soo; Wei, Thomas Y.; Vilim, Richard B.

A plant operator training simulator is developed for training the plant operators as well as for design verification of plant control system (PCS) and plant protection system (PPS) for the Kharkov Institute of Physics and Technology Neutron Source Facility. The simulator provides the operator interface for the whole plant including the sub-critical assembly coolant loop, target coolant loop, secondary coolant loop, and other facility systems. The operator interface is implemented based on Experimental Physics and Industrial Control System (EPICS), which is a comprehensive software development platform for distributed control systems. Since its development at Argonne National Laboratory, it has beenmore » widely adopted in the experimental physics community, e.g. for control of accelerator facilities. This work is the first implementation for a nuclear facility. The main parts of the operator interface are the plant control panel and plant protection panel. The development involved implementation of process variable database, sequence logic, and graphical user interface (GUI) for the PCS and PPS utilizing EPICS and related software tools, e.g. sequencer for sequence logic, and control system studio (CSS-BOY) for graphical use interface. For functional verification of the PCS and PPS, a plant model is interfaced, which is a physics-based model of the facility coolant loops implemented as a numerical computer code. The training simulator is tested and demonstrated its effectiveness in various plant operation sequences, e.g. start-up, shut-down, maintenance, and refueling. It was also tested for verification of the plant protection system under various trip conditions.« less

A Study To Determine the Effect of Skill-Focused Curriculum & Instruction on Student Achievement as Evidenced by GED & ACT Pre/Post Scores.

ERIC Educational Resources Information Center

Hinterer, Sally A.

This study explored the effect of skill-based curricula (based on Bloom's Taxonomy) on the academic performance of incarcerated youth. It investigated the impact of teaching thinking skills as a model for designing curricula at the West Virginia Industrial Home for Youth's Johnston High School, a maximum-security juvenile facility. The Graduate…

The Role of Health Extension Workers in Linking Pregnant Women With Health Facilities for Delivery in Rural and Pastoralist Areas of Ethiopia.

PubMed

Jackson, Ruth; Hailemariam, Assefa

2016-09-01

Women's preference to give birth at home is deeply embedded in Ethiopian culture. Many women only go to health facilities if they have complications during birth. Health Extension Workers (HEWs) have been deployed to improve the utilization of maternal health services by bridging the gap between communities and health facilities. This study examined the barriers and facilitators for HEWs as they refer women to mid-level health facilities for birth. A qualitative study was conducted in three regions: Afar Region, Southern Nations Nationalities and People's Region and Tigray Region between March to December 2014. Interviews and focus group discussions were conducted with 45 HEWs, 14 women extension workers (employed by Afar Pastoralist Development Association, Afar Region) and 11 other health workers from health centers, hospitals or health offices. Data analysis was done based on collating the data and identifying key themes. Barriers to health facilities included distance, lack of transportation, sociocultural factors and disrespectful care. Facilitators for facility-based deliveries included liaising with Health Development Army (HDA) leaders to refer women before their expected due date or if labour starts at home; the introduction of ambulance services; and, provision of health services that are culturally more acceptable for women. HEWs can effectively refer more women to give birth in health facilities when the HDA is well established, when health staff provide respectful care, and when ambulance is available at any time.

Beam-Dynamics Analysis of Long-Range Wakefield Effects on the SCRF Cavities at the Fast Facility

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

Shin, Young-Min; Bishofberger, Kip; Carlsten, Bruce

Long-range wakefields in superconducting RF (SCRF) cavities create complicated effects on beam dynamics in SCRF-based FEL beamlines. The driving bunch excites effectively an infinite number of structure modes (including HOMs) which oscillate within the SCRF cavity. Couplers with loads are used to damp the HOMs. However, these HOMs can persist for long periods of time in superconducting structures, which leads to long-range wakefields. Clear understanding of the long-range wakefield effects is a critical element for risk mitigation of future SCRF accelerators such as XFEL at DESY, LCLS-II XFEL, and MaRIE XFEL. We are currently developing numerical tools for simulating long-rangemore » wakefields in SCRF accelerators and plan to experimentally verify the tools by measuring these wakefields at the Fermilab Accelerator Science and Technology (FAST) facility. This paper previews the experimental conditions at the FAST 50 MeV beamline based on the simulation results.« less

Direction of rational use of water at livestock facilities

NASA Astrophysics Data System (ADS)

Potseluev, A. A.; Nazarov, I. V.

2017-05-01

The article notes the world water shortage problem. Against this background, Russia’s agricultural production is considered, in particular the livestock sector as the main consumer of water resources. The structure of the main technological processes at livestock facilities is given and possible technological damage is indicated in case of the lack of technological processes for servicing animals and poultry with water. The direction of rational use of water based on the introduction of new technical and technological solutions of water supply systems and means is substantiated. Constructive solutions of systems and facilities that help to reduce water consumption are presented, and as well a possible positive effect.

Medicare payment reform and provider entry and exit in the post-acute care market.

PubMed

Huckfeldt, Peter J; Sood, Neeraj; Romley, John A; Malchiodi, Alessandro; Escarce, José J

2013-10-01

To understand the impacts of Medicare payment reform on the entry and exit of post-acute providers. Medicare Provider of Services data, Cost Reports, and Census data from 1991 through 2010. We examined market-level changes in entry and exit after payment reforms relative to a preexisting time trend. We also compared changes in high Medicare share markets relative to lower Medicare share markets and for freestanding relative to hospital-based facilities. We calculated market-level entry, exit, and total stock of home health agencies, skilled nursing facilities, and inpatient rehabilitation facilities from Provider of Services files between 1992 and 2010. We linked these measures with demographic information from the Census and American Community Survey, information on Certificate of Need laws, and Medicare share of facilities in each market drawn from Cost Report data. Payment reforms reducing average and marginal payments reduced entries and increased exits from the market. Entry effects were larger and more persistent than exit effects. Entry and exit rates fluctuated more for home health agencies than skilled nursing facilities. Effects on number of providers were consistent with entry and exit effects. Payment reform affects market entry and exit, which in turn may affect market structure, access to care, quality and cost of care, and patient outcomes. Policy makers should consider potential impacts of payment reforms on post-acute care market structure when implementing these reforms. © Health Research and Educational Trust.

Medicare Payment Reform and Provider Entry and Exit in the Post-Acute Care Market

PubMed Central

Huckfeldt, Peter J; Sood, Neeraj; Romley, John A; Malchiodi, Alessandro; Escarce, José J

2013-01-01

Objective To understand the impacts of Medicare payment reform on the entry and exit of post-acute providers. Data Sources Medicare Provider of Services data, Cost Reports, and Census data from 1991 through 2010. Study Design We examined market-level changes in entry and exit after payment reforms relative to a preexisting time trend. We also compared changes in high Medicare share markets relative to lower Medicare share markets and for freestanding relative to hospital-based facilities. Data Extraction Methods We calculated market-level entry, exit, and total stock of home health agencies, skilled nursing facilities, and inpatient rehabilitation facilities from Provider of Services files between 1992 and 2010. We linked these measures with demographic information from the Census and American Community Survey, information on Certificate of Need laws, and Medicare share of facilities in each market drawn from Cost Report data. Principal Findings Payment reforms reducing average and marginal payments reduced entries and increased exits from the market. Entry effects were larger and more persistent than exit effects. Entry and exit rates fluctuated more for home health agencies than skilled nursing facilities. Effects on number of providers were consistent with entry and exit effects. Conclusions Payment reform affects market entry and exit, which in turn may affect market structure, access to care, quality and cost of care, and patient outcomes. Policy makers should consider potential impacts of payment reforms on post-acute care market structure when implementing these reforms. PMID:23557215

Approaches to improve the quality of maternal and newborn health care: an overview of the evidence.

PubMed

Austin, Anne; Langer, Ana; Salam, Rehana A; Lassi, Zohra S; Das, Jai K; Bhutta, Zulfiqar A

2014-09-04

Despite progress in recent years, an estimated 273,500 women died as a result of maternal causes in 2010. The burden of these deaths is disproportionately bourne by women who reside in low income countries or belong to the poorest sectors of the population of middle or high income ones, and it is particularly acute in regions where access to and utilization of facility-based services for childbirth and newborn care is lowest. Evidence has shown that poor quality of facility-based care for these women and newborns is one of the major contributing factors for their elevated rates of morbidity and mortality. In addition, women who perceive the quality of facilty-based care to be poor,may choose to avoid facility-based deliveries, where life-saving interventions could be availble. In this context, understanding the underlying factors that impact the quality of facility-based services and assessing the effectiveness of interventions to improve the quality of care represent critical inputs for the improvement of maternal and newborn health. This series of five papers assesses and summarizes information from relevant systematic reviews on the impact of various approaches to improve the quality of care for women and newborns. The first paper outlines the conceptual framework that guided this study and the methodology used for selecting the reviews and for the analysis. The results are described in the following three papers, which highlight the evidence of interventions to improve the quality of maternal and newborn care at the community, district, and facility level. In the fifth and final paper of the series, the overall findings of the review are discussed, research gaps are identified, and recommendations proposed to impove the quality of maternal and newborn health care in resource-poor settings.

76 FR 2897 - Combined Notice of Filings #1

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-18

... Assignment, Contenancy and Common Facilities Agreement with Succession to be effective 10/14/2010. Filed Date... Energy LLC submits tariff filing per 35: Amendment to Market-Based Rate Tariff 01062011 to be effective 1... Succession to be effective 2/9/2011. Filed Date: 01/06/2011. Accession Number: 20110106-5096. Comment Date: 5...

Definition of technology development missions for early space stations orbit transfer vehicle serving. Phase 2, task 1: Space station support of operational OTV servicing

NASA Technical Reports Server (NTRS)

1983-01-01

Representative space based orbital transfer vehicles (OTV), ground based vehicle turnaround assessment, functional operational requirements and facilities, mission turnaround operations, a comparison of ground based versus space based tasks, activation of servicing facilities prior to IOC, fleet operations requirements, maintenance facilities, OTV servicing facilities, space station support requirements, and packaging for delivery are discussed.

Nursing home cost and ownership type: evidence of interaction effects.

PubMed

Arling, G; Nordquist, R H; Capitman, J A

1987-06-01

Due to steadily increasing public expenditures for nursing home care, much research has focused on factors that influence nursing home costs, especially for Medicaid patients. Nursing home cost function studies have typically used a number of predictor variables in a multiple regression analysis to determine the effect of these variables on operating cost. Although several authors have suggested that nursing home ownership types have different goal orientations, not necessarily based on economic factors, little attention has been paid to this issue in empirical research. In this study, data from 150 Virginia nursing homes were used in multiple regression analysis to examine factors accounting for nursing home operating costs. The context of the study was the Virginia Medicaid reimbursement system, which has intermediate care and skilled nursing facility (ICF and SNF) facility-specific per diem rates, set according to facility cost histories. The analysis revealed interaction effects between ownership and other predictor variables (e.g., percentage Medicaid residents, case mix, and region), with predictor variables having different effects on cost depending on ownership type. Conclusions are drawn about the goal orientations and behavior of chain-operated, individual for-profit, and public and nonprofit facilities. The implications of these findings for long-term care reimbursement policies are discussed.

Nursing home cost and ownership type: evidence of interaction effects.

PubMed Central

Arling, G; Nordquist, R H; Capitman, J A

1987-01-01

Due to steadily increasing public expenditures for nursing home care, much research has focused on factors that influence nursing home costs, especially for Medicaid patients. Nursing home cost function studies have typically used a number of predictor variables in a multiple regression analysis to determine the effect of these variables on operating cost. Although several authors have suggested that nursing home ownership types have different goal orientations, not necessarily based on economic factors, little attention has been paid to this issue in empirical research. In this study, data from 150 Virginia nursing homes were used in multiple regression analysis to examine factors accounting for nursing home operating costs. The context of the study was the Virginia Medicaid reimbursement system, which has intermediate care and skilled nursing facility (ICF and SNF) facility-specific per diem rates, set according to facility cost histories. The analysis revealed interaction effects between ownership and other predictor variables (e.g., percentage Medicaid residents, case mix, and region), with predictor variables having different effects on cost depending on ownership type. Conclusions are drawn about the goal orientations and behavior of chain-operated, individual for-profit, and public and nonprofit facilities. The implications of these findings for long-term care reimbursement policies are discussed. PMID:3301746

Community-based intermittent mass testing and treatment for malaria in an area of high transmission intensity, western Kenya: study design and methodology for a cluster randomized controlled trial.

PubMed

Samuels, Aaron M; Awino, Nobert; Odongo, Wycliffe; Abong'o, Benard; Gimnig, John; Otieno, Kephas; Shi, Ya Ping; Were, Vincent; Allen, Denise Roth; Were, Florence; Sang, Tony; Obor, David; Williamson, John; Hamel, Mary J; Patrick Kachur, S; Slutsker, Laurence; Lindblade, Kim A; Kariuki, Simon; Desai, Meghna

2017-06-07

Most human Plasmodium infections in western Kenya are asymptomatic and are believed to contribute importantly to malaria transmission. Elimination of asymptomatic infections requires active treatment approaches, such as mass testing and treatment (MTaT) or mass drug administration (MDA), as infected persons do not seek care for their infection. Evaluations of community-based approaches that are designed to reduce malaria transmission require careful attention to study design to ensure that important effects can be measured accurately. This manuscript describes the study design and methodology of a cluster-randomized controlled trial to evaluate a MTaT approach for malaria transmission reduction in an area of high malaria transmission. Ten health facilities in western Kenya were purposively selected for inclusion. The communities within 3 km of each health facility were divided into three clusters of approximately equal population size. Two clusters around each health facility were randomly assigned to the control arm, and one to the intervention arm. Three times per year for 2 years, after the long and short rains, and again before the long rains, teams of community health volunteers visited every household within the intervention arm, tested all consenting individuals with malaria rapid diagnostic tests, and treated all positive individuals with an effective anti-malarial. The effect of mass testing and treatment on malaria transmission was measured through population-based longitudinal cohorts, outpatient visits for clinical malaria, periodic population-based cross-sectional surveys, and entomological indices.

A systematic review and meta-analysis of the effects of educating parents on the benefits and schedules of childhood vaccinations in low and middle-income countries.

PubMed

Lukusa, Lungeni Auguy; Ndze, Valantine Ngum; Mbeye, Nyanyiwe Masingi; Wiysonge, Charles Shey

2018-03-26

Public health benefits of childhood vaccinations risk being derailed by low vaccination coverage in low and middle-income countries. One reason for the low coverage is poor parental knowledge of the importance of completing vaccination schedules. We therefore assessed the effects on childhood vaccination coverage, of educating parents and other persons assuming the parental role. We prospectively registered the systematic review, published the protocol, and used standard Cochrane methods to collect and synthesise the evidence. We found six eligible randomised trials with 4248 participants. Three trials assessed health-facility based education of mothers on the importance of completing vaccination schedules; immediately after birth and three months later (one study) or during the first vaccination visit (two studies). The other trials assessed community-based education, including information campaigns on the importance of vaccines using audiotaped presentations and leaflet distributions (one study); structured group discussions on benefits and costs of childhood vaccination and local action plans for improving vaccine uptake (one study); and home-based information sessions using graphic cards showing benefits and costs of childhood vaccinations and location of vaccination centres (one study). Combining the data shows that these interventions lead to substantial improvements in childhood vaccination coverage (relative increase 36%, 95% confidence interval 14% to 62%). There was no difference between the effects of community-based and facility-based education. Therefore, education in communities and health facilities on the importance of childhood vaccinations should be integrated into all vaccination programmes in low and middle-income countries; accompanied by robust monitoring of impacts and use of data for action.

Impact of Facility- and Community-Based Peer Support Models on Maternal Uptake and Retention in Malawi's Option B+ HIV Prevention of Mother-to-Child Transmission Program: A 3-Arm Cluster Randomized Controlled Trial (PURE Malawi).

PubMed

Phiri, Sam; Tweya, Hannock; van Lettow, Monique; Rosenberg, Nora E; Trapence, Clement; Kapito-Tembo, Atupele; Kaunda-Khangamwa, Blessings; Kasende, Florence; Kayoyo, Virginia; Cataldo, Fabian; Stanley, Christopher; Gugsa, Salem; Sampathkumar, Veena; Schouten, Erik; Chiwaula, Levison; Eliya, Michael; Chimbwandira, Frank; Hosseinipour, Mina C

2017-06-01

Many sub-Saharan African countries have adopted Option B+, a prevention of mother-to-child transmission approach providing HIV-infected pregnant and lactating women with immediate lifelong antiretroviral therapy. High maternal attrition has been observed in Option B+. Peer-based support may improve retention. A 3-arm stratified cluster randomized controlled trial was conducted in Malawi to assess whether facility- and community-based peer support would improve Option B+ uptake and retention compared with standard of care (SOC). In SOC, no enhancements were made (control). In facility-based and community-based models, peers provided patient education, support groups, and patient tracing. Uptake was defined as attending a second scheduled follow-up visit. Retention was defined as being alive and in-care at 2 years without defaulting. Attrition was defined as death, default, or stopping antiretroviral therapy. Generalized estimating equations were used to estimate risk differences (RDs) in uptake. Cox proportional hazards regression with shared frailties was used to estimate hazard of attrition. Twenty-one facilities were randomized and enrolled 1269 women: 447, 428, and 394 in facilities that implemented SOC, facility-based, and community-based peer support models, respectively. Mean age was 27 years. Uptake was higher in facility-based (86%; RD: 6%, confidence interval [CI]: -3% to 15%) and community-based (90%; RD: 9%, CI: 1% to 18%) models compared with SOC (81%). At 24 months, retention was higher in facility-based (80%; RD: 13%, CI: 1% to 26%) and community-based (83%; RD: 16%, CI: 3% to 30%) models compared with SOC (66%). Facility- and community-based peer support interventions can benefit maternal uptake and retention in Option B+.

INTEGRATION OF FACILITY MODELING CAPABILITIES FOR NUCLEAR NONPROLIFERATION ANALYSIS

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

Gorensek, M.; Hamm, L.; Garcia, H.

2011-07-18

Developing automated methods for data collection and analysis that can facilitate nuclear nonproliferation assessment is an important research area with significant consequences for the effective global deployment of nuclear energy. Facility modeling that can integrate and interpret observations collected from monitored facilities in order to ascertain their functional details will be a critical element of these methods. Although improvements are continually sought, existing facility modeling tools can characterize all aspects of reactor operations and the majority of nuclear fuel cycle processing steps, and include algorithms for data processing and interpretation. Assessing nonproliferation status is challenging because observations can come frommore » many sources, including local and remote sensors that monitor facility operations, as well as open sources that provide specific business information about the monitored facilities, and can be of many different types. Although many current facility models are capable of analyzing large amounts of information, they have not been integrated in an analyst-friendly manner. This paper addresses some of these facility modeling capabilities and illustrates how they could be integrated and utilized for nonproliferation analysis. The inverse problem of inferring facility conditions based on collected observations is described, along with a proposed architecture and computer framework for utilizing facility modeling tools. After considering a representative sampling of key facility modeling capabilities, the proposed integration framework is illustrated with several examples.« less

Simulation and Evaluation of Low Impact Development of Urban Residential District Based on SWMM and GIS

NASA Astrophysics Data System (ADS)

Huang, Tielan; Wang, Yunpeng; Zhang, Jinlan

2017-07-01

In this study, simulation and evaluation of low impact development in resident district was carried out based on Storm Water Management Model (SWMM) and GIS method. In the evaluation model, we added 3 kinds of low impact development facilities, namely permeable pavement, rainwater garden, and green roof. These facilities are used alone or in combination. The model was run under five different rainfall reappearing periods. The simulation results using low impact development facilities were compared with simulation results under the current situation and undeveloped state. The results show that the total amount of runoff was greatly reduced by using various types of low impact development facilities in the urban residential district. The maximum reduction rate was using permeable pavement, reached 29.9%, followed was using rainwater garden, and the worst was using green roof. The lowest cost of reduction of the total amount of runoff was using permeable pavement, the followed was using rainwater garden, and the highest was using green roof. The combination scheme of various low impact development facilities has the highest efficiency of reducing total amount of runoff, and the lowest cost, which considering of the actual situation of the study area. The study indicated that application of low impact development facilities can reduce surface runoff effectively, which should be a useful way for prevention of urban waterlogging.

Quality of medical service, patient satisfaction and loyalty with a focus on interpersonal-based medical service encounters and treatment effectiveness: a cross-sectional multicenter study of complementary and alternative medicine (CAM) hospitals.

PubMed

Kim, Chang Eun; Shin, Joon-Shik; Lee, Jinho; Lee, Yoon Jae; Kim, Me-Riong; Choi, Areum; Park, Ki Byung; Lee, Ho-Joo; Ha, In-Hyuk

2017-03-28

Treatment effectiveness holds considerable importance in the association between service quality and satisfaction in medical service studies. While complementary and alternative medicine (CAM) use grows more prominent, comprehensive evaluations of the quality of medical service at CAM-oriented hospitals are scarce. This study assesses the quality of medical services provided at a CAM-oriented hospital of Korean medicine using the service encounter system approach and analyzes the influence of treatment effectiveness on patient loyalty. A survey study using one-on-one interviews was conducted using a cross-sectional design in outpatients visiting one of fifteen Korean medicine facilities located throughout Korea. A total of 880 surveys were completed from June to July, 2014, and 728 surveys were included in the final analysis after excluding incomplete or incorrect questionnaires. The reliability and validity of the surveys was confirmed using Cronbach's alpha coefficient and confirmatory factor analysis, and a structural equation modeling analysis was performed to verify causality and association between factors (quality of medical service, treatment effectiveness, patient satisfaction, and intent to revisit). The measured factors of physician performance and quality of service procedures had a positive effect on treatment effectiveness. The impression of the facilities and environment directly impacted satisfaction rates for interpersonal-based medical service encounters, while treatment effectiveness positively affected satisfaction regarding quality of medical service. However, treatment effectiveness had a more significant effect on satisfaction compared to facilities and environment, and it indirectly affected satisfaction and directly influenced intent to revisit. Treatment effectiveness and satisfaction both positively influenced intent to revisit. The importance of treatment effectiveness should be recognized when examining quality of medical services, and we hope that these findings may contribute to future studies.

What makes or mars the facility-based childbirth experience: thematic analysis of women's childbirth experiences in western Kenya.

PubMed

Afulani, Patience A; Kirumbi, Leah; Lyndon, Audrey

2017-12-29

Sub-Saharan Africa accounts for approximately 66% of global maternal deaths. Poor person-centered maternity care, which emphasizes the quality of patient experience, contributes both directly and indirectly to these poor outcomes. Yet, few studies in low resource settings have examined what is important to women during childbirth from their perspective. The aim of this study is to examine women's facility-based childbirth experiences in a rural county in Kenya, to identify aspects of care that contribute to a positive or negative birth experience. Data are from eight focus group discussions conducted in a rural county in western Kenya in October and November 2016, with 58 mothers aged 15 to 49 years who gave birth in the preceding nine weeks. We recorded and transcribed the discussions and used a thematic approach for data analysis. The findings suggest four factors influence women's perceptions of quality of care: responsiveness, supportive care, dignified care, and effective communication. Women had a positive experience when they were received well at the health facility, treated with kindness and respect, and given sufficient information about their care. The reverse led to a negative experience. These experiences were influenced by the behavior of both clinical and support staff and the facility environment. This study extends the literature on person-centered maternity care in low resource settings. To improve person-centered maternity care, interventions need to address the responsiveness of health facilities, ensure women receive supportive and dignified care, and promote effective patient-provider communication.

Primary and secondary sources of formaldehyde in urban atmospheres: Houston Texas region

NASA Astrophysics Data System (ADS)

Parrish, D. D.; Ryerson, T. B.; Mellqvist, J.; Johansson, J.; Fried, A.; Richter, D.; Walega, J. G.; Washenfelder, R. A.; de Gouw, J. A.; Peischl, J.; Aikin, K. C.; McKeen, S. A.; Frost, G. J.; Fehsenfeld, F. C.; Herndon, S. C.

2011-12-01

We evaluate the rates of secondary production and primary emission of formaldehyde (CH2O) from petrochemical industrial facilities and on-road vehicles in the Houston Texas region. This evaluation is based upon ambient measurements collected during field studies in 2000, 2006 and 2009. The predominant CH2O source (92 ± 4% of total) is secondary production formed during the atmospheric oxidation of highly reactive volatile organic compounds (HRVOCs) emitted from the petrochemical facilities. Smaller contributions are primary emissions from these facilities (4 ± 2%), and secondary production (~3%) and primary emissions (~1%) from vehicles. The primary emissions from both sectors are well quantified by current emission inventories. Since secondary production dominates, control efforts directed at primary CH2O emissions cannot address the large majority of CH2O sources in the Houston area, although there may still be a role for such efforts. Ongoing efforts to control alkene emissions from the petrochemical facilities, as well as volatile organic compound emissions from the motor vehicle fleet, will effectively reduce the CH2O concentrations in the Houston region. We have not addressed other emission sectors, such as off-road mobile sources or secondary formation from biogenic hydrocarbons. Previous analyses based on correlations between ambient concentrations of CH2O and various marker species have suggested much larger primary emissions of CH2O, but those results neglect confounding effects of dilution and loss processes, and do not demonstrate the causes of the observed correlations. Similar problems must be suspected in any source apportionment analysis of secondary species based upon correlations of ambient concentrations of pollutants.

Primary and secondary sources of formaldehyde in urban atmospheres: Houston Texas region

NASA Astrophysics Data System (ADS)

Parrish, D. D.; Ryerson, T. B.; Mellqvist, J.; Johansson, J.; Fried, A.; Richter, D.; Walega, J. G.; Washenfelder, R. A.; de Gouw, J. A.; Peischl, J.; Aikin, K. C.; McKeen, S. A.; Frost, G. J.; Fehsenfeld, F. C.; Herndon, S. C.

2012-04-01

We evaluate the rates of secondary production and primary emission of formaldehyde (CH2O) from petrochemical industrial facilities and on-road vehicles in the Houston Texas region. This evaluation is based upon ambient measurements collected during field studies in 2000, 2006 and 2009. The predominant CH2O source (92 ± 4% of total) is secondary production formed during the atmospheric oxidation of highly reactive volatile organic compounds (HRVOCs) emitted from the petrochemical facilities. Smaller contributions are primary emissions from these facilities (4 ± 2%), and secondary production (~3%) and primary emissions (~1%) from vehicles. The primary emissions from both sectors are well quantified by current emission inventories. Since secondary production dominates, control efforts directed at primary CH2O emissions cannot address the large majority of CH2O sources in the Houston area, although there may still be a role for such efforts. Ongoing efforts to control alkene emissions from the petrochemical facilities, as well as volatile organic compound emissions from the motor vehicle fleet, will effectively reduce the CH2O concentrations in the Houston region. We do not address other emission sectors, such as off-road mobile sources or secondary formation from biogenic hydrocarbons. Previous analyses based on correlations between ambient concentrations of CH2O and various marker species have suggested much larger primary emissions of CH2O, but those results neglect confounding effects of dilution and loss processes, and do not demonstrate the causes of the observed correlations. Similar problems must be suspected in any source apportionment analysis of secondary species based upon correlations of ambient concentrations of pollutants.

High Performance Solid Polymer Electrolytes for Rechargeable Batteries: A Self-Catalyzed Strategy toward Facile Synthesis.

PubMed

Cui, Yanyan; Liang, Xinmiao; Chai, Jingchao; Cui, Zili; Wang, Qinglei; He, Weisheng; Liu, Xiaochen; Liu, Zhihong; Cui, Guanglei; Feng, Jiwen

2017-11-01

It is urgent to seek high performance solid polymer electrolytes (SPEs) via a facile chemistry and simple process. The lithium salts are composed of complex anions that are stabilized by a Lewis acid agent. This Lewis acid can initiate the ring opening polymerization. Herein, a self-catalyzed strategy toward facile synthesis of crosslinked poly(ethylene glycol) diglycidyl ether-based solid polymer electrolyte (C-PEGDE) is presented. It is manifested that the poly(ethylene glycol) diglycidyl ether-based solid polymer electrolyte possesses a superior electrochemical stability window up to 4.5 V versus Li/Li + and considerable ionic conductivity of 8.9 × 10 -5 S cm -1 at ambient temperature. Moreover, the LiFePO 4 /C-PEGDE/Li batteries deliver stable charge/discharge profiles and considerable rate capability. It is demonstrated that this self-catalyzed strategy can be a very effective approach for high performance solid polymer electrolytes.

Setting up a Rayleigh Scattering Based Flow Measuring System in a Large Nozzle Testing Facility

NASA Technical Reports Server (NTRS)

Panda, Jayanta; Gomez, Carlos R.

2002-01-01

A molecular Rayleigh scattering based air density measurement system has been built in a large nozzle testing facility at NASA Glenn Research Center. The technique depends on the light scattering by gas molecules present in air; no artificial seeding is required. Light from a single mode, continuous wave laser was transmitted to the nozzle facility by optical fiber, and light scattered by gas molecules, at various points along the laser beam, is collected and measured by photon-counting electronics. By placing the laser beam and collection optics on synchronized traversing units, the point measurement technique is made effective for surveying density variation over a cross-section of the nozzle plume. Various difficulties associated with dust particles, stray light, high noise level and vibration are discussed. Finally, a limited amount of data from an underexpanded jet are presented and compared with expected variations to validate the technique.

Obchs: AN Effective Harmony Search Algorithm with Oppositionbased Chaos-Enhanced Initialization for Solving Uncapacitated Facility Location Problems

NASA Astrophysics Data System (ADS)

Heidari, A. A.; Kazemizade, O.; Abbaspour, R. A.

2015-12-01

In this paper, a continuous harmony search (HS) approach is investigated for tackling the Uncapacitated Facility Location (UFL) task. This article proposes an efficient modified HS-based optimizer to improve the performance of HS on complex spatial tasks like UFL problems. For this aim, opposition-based learning (OBL) and chaotic patterns are utilized. The proposed technique is examined against several UFL benchmark challenges in specialized literature. Then, the modified HS is substantiated in detail and compared to the basic HS and some other methods. The results showed that new opposition-based chaotic HS (OBCHS) algorithm not only can exploit better solutions competently but it is able to outperform HS in solving UFL problems.

Key Factors of e-Learning: A Case Study at a Spanish Bank

ERIC Educational Resources Information Center

Andreu, Rafael; Jauregui, Kety

2005-01-01

Given the evident potential shown by developing new technologies, there are increasingly more companies that develop and implement training programs that use the new-technology-based facilities. Likewise, suppliers developing new-technology-based programs have emerged seeking greater effectiveness and cost reduction as opposed to traditional…

Building Bridges between School-Based Health Clinics and Schools

ERIC Educational Resources Information Center

Richardson, Jeanita W.

2007-01-01

Background: The 2 institutions that hold great promise in mitigating the negative cyclical relationship between poor health and educational readiness are schools and school-based health care facilities (SBHCs). In partnership with schools, SBHCs could have a profound effect on learning outcomes, which include, but are not limited to, poor…

A summary of existing and planned experiment hardware for low-gravity fluids research

NASA Technical Reports Server (NTRS)

Hill, Myron E.; O'Malley, Terence F.

1991-01-01

NASA's ground-based and space-based low-gravity facilities are summarized, and an overview of selected experiments that have been developed for use in these facilities is presented. A variety of ground-based facilities (drop towers and aircraft) used to conduct low-gravity experiments for in-space experimentation are described. Capabilities that are available to the researcher and future on-orbit fluids facilities are addressed. The payload bay facilities range from the completely self-contained, relatively small get-away-special canisters to the Materials Science Laboratory and to the larger Spacelab facilities that require crew interaction.

Reducing drinking water supply chemical contamination: risks from underground storage tanks.

PubMed

Enander, Richard T; Hanumara, R Choudary; Kobayashi, Hisanori; Gagnon, Ronald N; Park, Eugene; Vallot, Christopher; Genovesi, Richard

2012-12-01

Drinking water supplies are at risk of contamination from a variety of physical, chemical, and biological sources. Ranked among these threats are hazardous material releases from leaking or improperly managed underground storage tanks located at municipal, commercial, and industrial facilities. To reduce human health and environmental risks associated with the subsurface storage of hazardous materials, government agencies have taken a variety of legislative and regulatory actions--which date back more than 25 years and include the establishment of rigorous equipment/technology/operational requirements and facility-by-facility inspection and enforcement programs. Given a history of more than 470,000 underground storage tank releases nationwide, the U.S. Environmental Protection Agency continues to report that 7,300 new leaks were found in federal fiscal year 2008, while nearly 103,000 old leaks remain to be cleaned up. In this article, we report on an alternate evidence-based intervention approach for reducing potential releases from the storage of petroleum products (gasoline, diesel, kerosene, heating/fuel oil, and waste oil) in underground tanks at commercial facilities located in Rhode Island. The objective of this study was to evaluate whether a new regulatory model can be used as a cost-effective alternative to traditional facility-by-facility inspection and enforcement programs for underground storage tanks. We conclude that the alternative model, using an emphasis on technical assistance tools, can produce measurable improvements in compliance performance, is a cost-effective adjunct to traditional facility-by-facility inspection and enforcement programs, and has the potential to allow regulatory agencies to decrease their frequency of inspections among low risk facilities without sacrificing compliance performance or increasing public health risks. © 2012 Society for Risk Analysis.

An Evidence-Based Cue-Selection Guide and Logic Model to Improve Pressure Ulcer Prevention in Long Term Care

PubMed Central

Yap, Tracey L.; Kennerly, Susan M.; Bergstrom, Nancy; Hudak, Sandra L.; Horn, Susan D.

2015-01-01

Pressure ulcers (PrUs) have consistently resisted prevention efforts in long term care (LTC) facilities nationwide. Recent research has described cueing innovations that – when selected according to the assumptions and resources of particular facilities – support best practices of PrU prevention. This paper synthesizes that research into a unified, dynamic logic model to facilitate effective staff implementation of a PrU prevention program. PMID:26066791

Surrogate Final Technical Report for "Solar: A Photovoltaic Manufacturing Development Facility"

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

Farrar, Paul

2014-06-27

The project goal to create a first-of-a-kind crystalline Silicon (c-Si) photovoltaic (PV) Manufacturing & Technology Development Facility (MDF) that will support the growth and maturation of a strong domestic PV manufacturing industry, based on innovative and differentiated technology, by ensuring industry participants can, in a timely and cost-effective manner, access cutting-edge manufacturing equipment and production expertise needed to accelerate the transition of innovative technologies from R&D into manufacturing.

Health Habits of Employees in a Large Medical Center: Time Trends and Impact of a Worksite Wellness Facility.

PubMed

Abu Dabrh, Abd Moain; Gorty, Archana; Jenkins, Sarah M; Murad, Mohammad Hassan; Hensrud, Donald D

2016-02-11

Worksite health interventions are not novel but their effect remains subject of debate. We examined employer-based wellness program to determine health habits trends, and compare prevalence estimates to national data. We conducted serial surveys (1996 and 2007-10) to employees of a large medical center that included questions measuring outcomes, including obesity, regular exercise, cardiovascular activity, and smoking status. Logistic regression models were estimated to compare data by membership across years, considering p-values ≤ 0.01 as statistically significant. 3,206 employees responded (Response rates 59-68%). Obesity prevalence increased over time in members and nonmembers of the wellness facility, consistent with national trends. Members had a lower prevalence of cigarette smoking compared to nonmembers (overall year-adjusted odds ratio 0.66, P < 0.001). Further, employees had a lower prevalence of cigarette smoking (9.7 vs. 17.3% in 2010, P < 0.001) compared with national data. Wellness facility membership was associated with increased regular exercise and cardiovascular exercise (P < 0.001) compared to nonmembers. In summary, working in a medical center was associated with a decreased prevalence of cigarette smoking, but not with lower prevalence of obesity. Worksite wellness facility membership was associated with increased exercise and decreased cigarette smoking. Employer-based interventions may be effective in improving some health behaviors.

Health Habits of Employees in a Large Medical Center: Time Trends and Impact of a Worksite Wellness Facility

PubMed Central

Abu Dabrh, Abd Moain; Gorty, Archana; Jenkins, Sarah M.; Murad, Mohammad Hassan; Hensrud, Donald D.

2016-01-01

Worksite health interventions are not novel but their effect remains subject of debate. We examined employer-based wellness program to determine health habits trends, and compare prevalence estimates to national data. We conducted serial surveys (1996 and 2007–10) to employees of a large medical center that included questions measuring outcomes, including obesity, regular exercise, cardiovascular activity, and smoking status. Logistic regression models were estimated to compare data by membership across years, considering p-values ≤ 0.01 as statistically significant. 3,206 employees responded (Response rates 59–68%). Obesity prevalence increased over time in members and nonmembers of the wellness facility, consistent with national trends. Members had a lower prevalence of cigarette smoking compared to nonmembers (overall year-adjusted odds ratio 0.66, P < 0.001). Further, employees had a lower prevalence of cigarette smoking (9.7 vs. 17.3% in 2010, P < 0.001) compared with national data. Wellness facility membership was associated with increased regular exercise and cardiovascular exercise (P < 0.001) compared to nonmembers. In summary, working in a medical center was associated with a decreased prevalence of cigarette smoking, but not with lower prevalence of obesity. Worksite wellness facility membership was associated with increased exercise and decreased cigarette smoking. Employer-based interventions may be effective in improving some health behaviors. PMID:26864205

A rapid prototyping facility for flight research in advanced systems concepts

NASA Technical Reports Server (NTRS)

Duke, Eugene L.; Brumbaugh, Randal W.; Disbrow, James D.

1989-01-01

The Dryden Flight Research Facility of the NASA Ames Research Facility of the NASA Ames Research Center is developing a rapid prototyping facility for flight research in flight systems concepts that are based on artificial intelligence (AI). The facility will include real-time high-fidelity aircraft simulators, conventional and symbolic processors, and a high-performance research aircraft specially modified to accept commands from the ground-based AI computers. This facility is being developed as part of the NASA-DARPA automated wingman program. This document discusses the need for flight research and for a national flight research facility for the rapid prototyping of AI-based avionics systems and the NASA response to those needs.

Atomic oxygen effects on boron nitride and silicon nitride: A comparison of ground based and space flight data

NASA Technical Reports Server (NTRS)

Cross, J. B.; Lan, E. H.; Smith, C. A.; Whatley, W. J.

1990-01-01

The effects of atomic oxygen on boron nitride (BN) and silicon nitride (Si3N4) were evaluated in a low Earth orbit (LEO) flight experiment and in a ground based simulation facility. In both the inflight and ground based experiments, these materials were coated on thin (approx. 250A) silver films, and the electrical resistance of the silver was measured in situ to detect any penetration of atomic oxygen through the BN and Si3N4 materials. In the presence of atomic oxygen, silver oxidizes to form silver oxide, which has a much higher electrical resistance than pure silver. Permeation of atomic oxygen through BN, as indicated by an increase in the electrical resistance of the silver underneath, was observed in both the inflight and ground based experiments. In contrast, no permeation of atomic oxygen through Si3N4 was observed in either the inflight or ground based experiments. The ground based results show good qualitative correlation with the LEO flight results, indicating that ground based facilities such as the one at Los Alamos National Lab can reproduce space flight data from LEO.

SINGLE EVENT EFFECTS TEST FACILITY AT OAK RIDGE NATIONAL LABORATORY

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

Riemer, Bernie; Gallmeier, Franz X; Dominik, Laura J

2015-01-01

Increasing use of microelectronics of ever diminishing feature size in avionics systems has led to a growing Single Event Effects (SEE) susceptibility arising from the highly ionizing interactions of cosmic rays and solar particles. Single event effects caused by atmospheric radiation have been recognized in recent years as a design issue for avionics equipment and systems. To ensure a system meets all its safety and reliability requirements, SEE induced upsets and potential system failures need to be considered, including testing of the components and systems in a neutron beam. Testing of ICs and systems for use in radiation environments requiresmore » the utilization of highly advanced laboratory facilities that can run evaluations on microcircuits for the effects of radiation. This paper provides a background of the atmospheric radiation phenomenon and the resulting single event effects, including single event upset (SEU) and latch up conditions. A study investigating requirements for future single event effect irradiation test facilities and developing options at the Spallation Neutron Source (SNS) is summarized. The relatively new SNS with its 1.0 GeV proton beam, typical operation of 5000 h per year, expertise in spallation neutron sources, user program infrastructure, and decades of useful life ahead is well suited for hosting a world-class SEE test facility in North America. Emphasis was put on testing of large avionics systems while still providing tunable high flux irradiation conditions for component tests. Makers of ground-based systems would also be served well by these facilities. Three options are described; the most capable, flexible, and highest-test-capacity option is a new stand-alone target station using about one kW of proton beam power on a gas-cooled tungsten target, with dual test enclosures. Less expensive options are also described.« less

Single Event Effects Test Facility Options at the Oak Ridge National Laboratory

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

Riemer, Bernie; Gallmeier, Franz X; Dominik, Laura J

2015-01-01

Increasing use of microelectronics of ever diminishing feature size in avionics systems has led to a growing Single Event Effects (SEE) susceptibility arising from the highly ionizing interactions of cosmic rays and solar particles. Single event effects caused by atmospheric radiation have been recognized in recent years as a design issue for avionics equipment and systems. To ensure a system meets all its safety and reliability requirements, SEE induced upsets and potential system failures need to be considered, including testing of the components and systems in a neutron beam. Testing of integrated circuits (ICs) and systems for use in radiationmore » environments requires the utilization of highly advanced laboratory facilities that can run evaluations on microcircuits for the effects of radiation. This paper provides a background of the atmospheric radiation phenomenon and the resulting single event effects, including single event upset (SEU) and latch up conditions. A study investigating requirements for future single event effect irradiation test facilities and developing options at the Spallation Neutron Source (SNS) is summarized. The relatively new SNS with its 1.0 GeV proton beam, typical operation of 5000 h per year, expertise in spallation neutron sources, user program infrastructure, and decades of useful life ahead is well suited for hosting a world-class SEE test facility in North America. Emphasis was put on testing of large avionics systems while still providing tunable high flux irradiation conditions for component tests. Makers of ground-based systems would also be served well by these facilities. Three options are described; the most capable, flexible, and highest-test-capacity option is a new stand-alone target station using about one kW of proton beam power on a gas-cooled tungsten target, with dual test enclosures. Less expensive options are also described.« less

Managing Disruptive Behavior by Patients and Physicians: A Responsibility of the Dialysis Facility Medical Director.

PubMed

Jones, Edward R; Goldman, Richard S

2015-08-07

The Centers for Medicare & Medicaid Services' Conditions for Coverage make the medical director of an ESRD facility responsible for all aspects of care, including high-quality health care delivery (e.g., safe, effective, timely, efficient, and patient centered). Because of the high-pressure environment of the dialysis facility, conflicts are common. Conflict frequently occurs when aberrant behaviors disrupt the dialysis facility. Patients, family members, friends, and, less commonly appreciated, nephrology clinicians (i.e., nephrologists and advanced care practitioners) may manifest disruptive behavior. Disruptive behavior in the dialysis facility impairs the ability to deliver high-quality care. Furthermore, disruptive behavior is the leading cause for involuntary discharge (IVD) or involuntary transfer (IVT) of a patient from a facility. IVD usually results in loss of continuity of care, increased emergency department visits, and increased unscheduled, acute dialysis treatments. A sufficient number of IVDs and IVTs also trigger an extensive review of the facility by the regional ESRD Networks, exposing the facility to possible Medicare-imposed sanctions. Medical directors must be equipped to recognize and correct disruptive behavior. Nephrology-based literature and tools exist to help dialysis facility medical directors successfully address and resolve disruptive behavior before medical directors must involuntarily discharge a patient or terminate an attending clinician. Copyright © 2015 by the American Society of Nephrology.

Advance distribution of misoprostol for prevention of postpartum hemorrhage (PPH) at home births in two districts of Liberia

PubMed Central

2014-01-01

Background A postpartum hemorrhage prevention program to increase uterotonic coverage for home and facility births was introduced in two districts of Liberia. Advance distribution of misoprostol was offered during antenatal care (ANC) and home visits. Feasibility, acceptability, effectiveness of distribution mechanisms and uterotonic coverage were evaluated. Methods Eight facilities were strengthened to provide PPH prevention with oxytocin, PPH management and advance distribution of misoprostol during ANC. Trained traditional midwives (TTMs) as volunteer community health workers (CHWs) provided education to pregnant women, and district reproductive health supervisors (DRHSs) distributed misoprostol during home visits. Data were collected through facility and DRHS registers. Postpartum interviews were conducted with a sample of 550 women who received advance distribution of misoprostol on place of delivery, knowledge, misoprostol use, and satisfaction. Results There were 1826 estimated deliveries during the seven-month implementation period. A total of 980 women (53.7%) were enrolled and provided misoprostol, primarily through ANC (78.2%). Uterotonic coverage rate of all deliveries was 53.5%, based on 97.7% oxytocin use at recorded facility vaginal births and 24.9% misoprostol use at home births. Among 550 women interviewed postpartum, 87.7% of those who received misoprostol and had a home birth took the drug. Sixty-three percent (63.0%) took it at the correct time, and 54.0% experienced at least one minor side effect. No serious adverse events reported among enrolled women. Facility-based deliveries appeared to increase during the program. Conclusions The program was moderately effective at achieving high uterotonic coverage of all births. Coverage of home births was low despite the use of two channels of advance distribution of misoprostol. Although ANC reached a greater proportion of women in late pregnancy than home visits, 46.3% of expected deliveries did not receive education or advance distribution of misoprostol. A revised community-based strategy is needed to increase advance distribution rates and misoprostol coverage rates for home births. Misoprostol for PPH prevention appears acceptable to women in Liberia. Correct timing of misoprostol self-administration needs improved emphasis during counseling and education. PMID:24894566

Advance distribution of misoprostol for prevention of postpartum hemorrhage (PPH) at home births in two districts of Liberia.

PubMed

Smith, Jeffrey Michael; Baawo, Saye Dahn; Subah, Marion; Sirtor-Gbassie, Varwo; Howe, Cuallau Jabbeh; Ishola, Gbenga; Tehoungue, Bentoe Z; Dwivedi, Vikas

2014-06-04

A postpartum hemorrhage prevention program to increase uterotonic coverage for home and facility births was introduced in two districts of Liberia. Advance distribution of misoprostol was offered during antenatal care (ANC) and home visits. Feasibility, acceptability, effectiveness of distribution mechanisms and uterotonic coverage were evaluated. Eight facilities were strengthened to provide PPH prevention with oxytocin, PPH management and advance distribution of misoprostol during ANC. Trained traditional midwives (TTMs) as volunteer community health workers (CHWs) provided education to pregnant women, and district reproductive health supervisors (DRHSs) distributed misoprostol during home visits. Data were collected through facility and DRHS registers. Postpartum interviews were conducted with a sample of 550 women who received advance distribution of misoprostol on place of delivery, knowledge, misoprostol use, and satisfaction. There were 1826 estimated deliveries during the seven-month implementation period. A total of 980 women (53.7%) were enrolled and provided misoprostol, primarily through ANC (78.2%). Uterotonic coverage rate of all deliveries was 53.5%, based on 97.7% oxytocin use at recorded facility vaginal births and 24.9% misoprostol use at home births. Among 550 women interviewed postpartum, 87.7% of those who received misoprostol and had a home birth took the drug. Sixty-three percent (63.0%) took it at the correct time, and 54.0% experienced at least one minor side effect. No serious adverse events reported among enrolled women. Facility-based deliveries appeared to increase during the program. The program was moderately effective at achieving high uterotonic coverage of all births. Coverage of home births was low despite the use of two channels of advance distribution of misoprostol. Although ANC reached a greater proportion of women in late pregnancy than home visits, 46.3% of expected deliveries did not receive education or advance distribution of misoprostol. A revised community-based strategy is needed to increase advance distribution rates and misoprostol coverage rates for home births. Misoprostol for PPH prevention appears acceptable to women in Liberia. Correct timing of misoprostol self-administration needs improved emphasis during counseling and education.

A summary of existing and planned experiment hardware for low-gravity fluids research

NASA Technical Reports Server (NTRS)

Hill, Myron E.; Omalley, Terence F.

1991-01-01

An overview is presented of (1) existing ground-based, low gravity research facilities, with examples of hardware capabilities, and (2) existing and planned space-based research facilities, with examples of current and past flight hardware. Low-gravity, ground-based facilities, such as drop towers and aircraft, provide the experimenter with quick turnaround time, easy access to equipment, gravity levels ranging from 10(exp -2) to 10(exp -6) G, and low-gravity durations ranging from 2 to 30 sec. Currently, the only operational space-based facility is the Space Shuttle. The Shuttle's payload bay and middeck facilities are described. Existing and planned low-gravity fluids research facilities are also described with examples of experiments and hardware capabilities.

Heterogeneity in the effect of public health insurance on catastrophic out-of-pocket health expenditures: the case of Mexico.

PubMed

Grogger, Jeffrey; Arnold, Tamara; León, Ana Sofía; Ome, Alejandro

2015-06-01

Low- and middle-income countries increasingly provide broad-based public health coverage to their residents. One of the goals of such programmes is to reduce the extent to which beneficiaries incur catastrophic out-of-pocket expenditures on health care. A recent field experiment showed that on average Mexico's new public insurance programme reduced such expenditures in rural areas. Our reanalysis of that data, augmented with administrative data on health infrastructure, shows that this effect depends strongly on the type of health facility to which the beneficiary has access. A second analysis, based on data from Mexico's National Household Income and Expenditure Surveys (abbreviated ENIGH for its name in Spanish), substantiates those findings. It shows that catastrophic expenditures have fallen sharply for rural households with access to well-staffed facilities, but that they have fallen little if at all for rural households with access to poorly staffed facilities. Our analysis of the ENIGH also shows that Mexico's public health insurance programme has sharply reduced catastrophic spending among urban households. Considering that most Mexicans live either in urban areas or in rural areas with access to well-staffed facilities, our results show that the public health insurance programme has been largely successful in achieving one of its key goals. At the same time, our results show how difficult it can be to provide effective protection against catastrophic health expenditures for residents of remote rural areas. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

Evaluating the Emergency Notification Systems of the NASA White Sands Test

NASA Technical Reports Server (NTRS)

Chavez, Alfred Paul

2004-01-01

The problem was that the NASA Fire and Emergency Services did not know if the current emergency notification systems on the NASA White Sands Test Facility were appropriate for alerting the employees of an emergency. The purpose of this Applied Research Project was to determine if the current emergency notification systems of the White Sands Test Facility are appropriate for alerting the employees of an emergency. This was a descriptive research project. The research questions were: 1) What are similar facilities using to alert the employees of an emergency?; 2) Are the current emergency notification systems suitable for the community hazards on the NASA White Sands Test Facility?; 3) What is the NASA Fire and Emergency Services currently using to measure the effectiveness of the emergency notification systems?; and 4) What are the current training methods used to train personnel to the emergency notification systems at the NASA White Sands Test Facility? The procedures involved were to research other established facilities, research published material from credible sources, survey the facility to determine the facility perception of the emergency notification systems, and evaluate the operating elements of the established emergency notification systems for the facility. The results were that the current systems are suitable for the type of hazards the facility may endure. The emergency notification systems are tested frequently to ensure effectiveness in the event of an emergency. Personnel are trained and participate in a yearly drill to make certain personnel are educated on the established systems. The recommendations based on the results were to operationally improve the existing systems by developing and implementing one system that can overall notify the facility of a hazard. Existing procedures and training should also be improved to ensure that all personnel are educated on what to do when the emergency notification systems are activated.

Risk-based targeting: A new approach in environmental protection

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

Fox, C.A.

1995-12-31

Risk-based targeting has recently emerged as an effective tool to help prioritize efforts to identify and manage geographic areas, chemicals, facilities, and agricultural activities that cause the most environmental degradation. This paper focuses on how the Environmental Protection Agency (EPA) has recently used risk-based targeting to identify and screen Federal, industrial, commercial and municipal facilities which contribute to probable human health (fish consumption advisories and contaminated fish tissue) and aquatic life (contaminated sediments) impacts. Preliminary results identified several hundred potential contributors of problem chemicals to probable impacts within the same river reach in 1991--93. Analysis by industry sector showed thatmore » the majority of the facilities identified were publicly owned treatment works (POTWs), in addition to industry organic and inorganic chemical manufacturers, petroleum refineries, and electric services, coatings, engravings, and allied services, among others. Both compliant and non-compliant potentially contributing facilities were identified to some extent in all EPA regions. Additional results identifying possible linkages of other pollutant sources to probable impacts, as well as estimation of potential exposure of these contaminants to minority and/or poverty populations are also presented. Out of these analyses, a number of short and long-term strategies are being developed that EPA may use to reduce loadings of problem contaminants to impacted waterbodies.« less

Multidimensional team-based intervention using musical cues to reduce odds of facility-acquired pressure ulcers in long-term care: a paired randomized intervention study.

PubMed

Yap, Tracey L; Kennerly, Susan M; Simmons, Mark R; Buncher, Charles R; Miller, Elaine; Kim, Jay; Yap, Winston Y

2013-09-01

To test the effectiveness of a pressure ulcer (PU) prevention intervention featuring musical cues to remind all long-term care (LTC) staff (nursing and ancillary) to help every resident move or reposition every 2 hours. Twelve-month paired-facility two-arm (with one-arm crossover) randomized intervention trial. Ten midwestern U.S. LTC facilities. Four treatment facilities received intervention during Months 1 to 12, four comparison facilities received intervention during Months 7 to 12, and two pseudo-control facilities received no intervention. LTC facility residents (N = 1,928). All facility staff received in-person education, video, and handouts, and visiting family members received informational pamphlets on PU prevention and an intervention featuring musical cues. Nurse-led multidisciplinary staff teams presented the cues as prompts for staff and family to reposition residents or remind them to move. Musical selections (with and without lyrics) customized to facility preferences were played daily over the facility intercom or public address system every 2 hours for the 12-hour daytime period. Primary outcome measure was the frequency of new facility-acquired PUs divided by the total number of facility Minimum Data Set (MDS) resident assessments conducted during the study period. Odds of a new PU were lower in intervention facilities (P = .08) for MDS 2.0 assessments and were significantly lower (P = .05) for MDS 3.0. Mean odds ratios suggested intervention facility residents were 45% less likely than comparison facility residents to develop a new PU. Customized musical cues that prompt multidisciplinary staff teams to encourage or enable movement of all residents hold promise for reducing facility-acquired PUs in LTC settings. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

An Integrated Assessment of Location-Dependent Scaling for Microalgae Biofuel Production Facilities

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

Coleman, Andre M.; Abodeely, Jared; Skaggs, Richard

Successful development of a large-scale microalgae-based biofuels industry requires comprehensive analysis and understanding of the feedstock supply chain—from facility siting/design through processing/upgrading of the feedstock to a fuel product. The evolution from pilot-scale production facilities to energy-scale operations presents many multi-disciplinary challenges, including a sustainable supply of water and nutrients, operational and infrastructure logistics, and economic competitiveness with petroleum-based fuels. These challenges are addressed in part by applying the Integrated Assessment Framework (IAF)—an integrated multi-scale modeling, analysis, and data management suite—to address key issues in developing and operating an open-pond facility by analyzing how variability and uncertainty in space andmore » time affect algal feedstock production rates, and determining the site-specific “optimum” facility scale to minimize capital and operational expenses. This approach explicitly and systematically assesses the interdependence of biofuel production potential, associated resource requirements, and production system design trade-offs. The IAF was applied to a set of sites previously identified as having the potential to cumulatively produce 5 billion-gallons/year in the southeastern U.S. and results indicate costs can be reduced by selecting the most effective processing technology pathway and scaling downstream processing capabilities to fit site-specific growing conditions, available resources, and algal strains.« less

Pressure ulcer multidisciplinary teams via telemedicine: a pragmatic cluster randomized stepped wedge trial in long term care.

PubMed

Stern, Anita; Mitsakakis, Nicholas; Paulden, Mike; Alibhai, Shabbir; Wong, Josephine; Tomlinson, George; Brooker, Ann-Sylvia; Krahn, Murray; Zwarenstein, Merrick

2014-02-24

The study was conducted to determine the clinical and cost effectiveness of enhanced multi-disciplinary teams (EMDTs) vs. 'usual care' for the treatment of pressure ulcers in long term care (LTC) facilities in Ontario, Canada We conducted a multi-method study: a pragmatic cluster randomized stepped-wedge trial, ethnographic observation and in-depth interviews, and an economic evaluation. Long term care facilities (clusters) were randomly allocated to start dates of the intervention. An advance practice nurse (APN) with expertise in skin and wound care visited intervention facilities to educate staff on pressure ulcer prevention and treatment, supported by an off-site hospital based expert multi-disciplinary wound care team via email, telephone, or video link as needed. The primary outcome was rate of reduction in pressure ulcer surface area (cm2/day) measured on before and after standard photographs by an assessor blinded to facility allocation. Secondary outcomes were time to healing, probability of healing, pressure ulcer incidence, pressure ulcer prevalence, wound pain, hospitalization, emergency department visits, utility, and cost. 12 of 15 eligible LTC facilities were randomly selected to participate and randomized to start date of the intervention following the stepped wedge design. 137 residents with a total of 259 pressure ulcers (stage 2 or greater) were recruited over the 17 month study period. No statistically significant differences were found between control and intervention periods on any of the primary or secondary outcomes. The economic evaluation demonstrated a mean reduction in direct care costs of $650 per resident compared to 'usual care'. The qualitative study suggested that onsite support by APN wound specialists was welcomed, and is responsible for reduced costs through discontinuation of expensive non evidence based treatments. Insufficient allocation of nursing home staff time to wound care may explain the lack of impact on healing. Enhanced multi-disciplinary wound care teams were cost effective, with most benefit through cost reduction initiated by APNs, but did not improve the treatment of pressure ulcers in nursing homes. Policy makers should consider the potential yield of strengthening evidence based primary care within LTC facilities, through outreach by APNs. ClinicalTrials.gov identifier NCT01232764.

Effective Instructional Practices in Juvenile Justice Facilities

ERIC Educational Resources Information Center

Mathur, Sarup R.; Schoenfeld, Naomi

2010-01-01

The majority of youths involved with the juvenile justice system struggle to make academic progress. This article reviews the characteristics of youths in these settings and highlights evidence-based instructional practices that are effective with struggling students, as well as practices that have been documented as successful in secure…

The Effectiveness of an Emergent Literacy Intervention for Teenage Parents

ERIC Educational Resources Information Center

Scott, Amy; van Bysterveldt, Anne; McNeill, Brigid

2016-01-01

This study determined the effectiveness of an experimental emergent literacy intervention, targeting teenage mothers attending an educational facility. Using a pretest/posttest research design, 27 participants completed a 7­-week intervention based in the classroom, targeting a range of emergent literacy skills that they could utilize when reading…

Treatment Study Plan for Nitrate Salt Waste Remediation Revision 1.0

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

Juarez, Catherine L.; Funk, David John; Vigil-Holterman, Luciana R.

2016-03-07

The two stabilization treatment methods that are to be examined for their effectiveness in the treatment of both the unremediated and remediated nitrate salt wastes include (1) the addition of zeolite and (2) cementation. Zeolite addition is proposed based on the results of several studies and analyses that specifically examined the effectiveness of this process for deactivating nitrate salts. Cementation is also being assessed because of its prevalence as an immobilization method used for similar wastes at numerous facilities around the DOE complex, including at Los Alamos. The results of this Treatment Study Plan will be used to provide themore » basis for a Resource Conservation and Recovery Act (RCRA) permit modification request of the LANL Hazardous Waste Facility Permit for approval by the New Mexico Environment Department-Hazardous Waste Bureau (NMED-HWB) of the proposed treatment process and the associated facilities.« less

Availability of essential drugs for managing HIV-related pain and symptoms within 120 PEPFAR-funded health facilities in East Africa: a cross-sectional survey with onsite verification.

PubMed

Harding, Richard; Simms, Victoria; Penfold, Suzanne; Downing, Julia; Powell, Richard A; Mwangi-Powell, Faith; Namisango, Eve; Moreland, Scott; Gikaara, Nancy; Atieno, Mackuline; Kataike, Jennifer; Nsubuga, Clare; Munene, Grace; Banga, Geoffrey; Higginson, Irene J

2014-04-01

World Health Organization's essential drugs list can control the highly prevalent HIV-related pain and symptoms. Availability of essential medicines directly influences clinicians' ability to effectively manage distressing manifestations of HIV. To determine the availability of pain and symptom controlling drugs in East Africa within President's Emergency Plan for AIDS Relief-funded HIV health care facilities. Directly observed quantitative health facilities' pharmacy stock review. We measured availability, expiration and stock-outs of specified drugs required for routine HIV management, including the World Health Organization pain ladder. A stratified random sample in 120 President's Emergency Plan for AIDS Relief-funded HIV care facilities (referral and district hospitals, health posts/centres and home-based care providers) in Kenya and Uganda. Non-opioid analgesics (73%) and co-trimoxazole (64%) were the most commonly available drugs and morphine (7%) the least. Drug availability was higher in hospitals and lower in health centres, health posts and home-based care facilities. Facilities generally did not use minimum stock levels, and stock-outs were frequently reported. The most common drugs had each been out of stock in the past 6 months in 47% of facilities stocking them. When a minimum stock level was defined, probability of a stock-out in the previous 6 months was 32.6%, compared to 45.5% when there was no defined minimum stock level (χ (2) = 5.07, p = 0.024). The data demonstrate poor essential drug availability, particularly analgesia, limited by facility type. The lack of strong opioids, isoniazid and paediatric formulations is concerning. Inadequate drug availability prevents implementation of simple clinical pain and symptom control protocols, causing unnecessary distress. Research is needed to identify supply chain mechanisms that lead to these problems.

Polyurethane-acrylate-based hydrophobic film: Facile fabrication, characterization, and application

NASA Astrophysics Data System (ADS)

Park, Jongsung; Nguyen, Bui Quoc Huy; Kim, Ji-Kwan; Shanmugasundaram, Arunkumar; Lee, Dong-Weon

2018-06-01

Polyurethane-acrylate (PUA) is a versatile UV-curable polymer with a short curing time at room temperature, whose surface structure can be flexibly modified by applying various micropatterns. In this paper, we propose a facile and cost-effective fabrication method for the continuous production of an optically transparent PUA-based superhydrophobic thin film. Poly(dimethylsiloxane) (PDMS) was employed as a soft mold for the fabrication of PUA films through the roll-to-roll technique. In addition, nanosilica was spray-coated onto the PUA surface to further improve the hydrophobicity. The fabricated PUA thin film showed the highest static water contact angle (WCA) of ∼140°. The high durability of the PUA film was also demonstrated through mechanical impacting tests. Furthermore, only ∼2% of voltage loss was observed in the solar panel covered with the PUA-based superhydrophobic film. These obtained results indicate the feasibility of applying the film as a protective layer in applications requiring a high transparency and a self-cleaning effect.

47 CFR 63.22 - Facilities-based international common carriers.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 3 2011-10-01 2011-10-01 false Facilities-based international common carriers. 63.22 Section 63.22 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER... Supplements § 63.22 Facilities-based international common carriers. The following conditions apply to...

47 CFR 63.22 - Facilities-based international common carriers.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 47 Telecommunication 3 2012-10-01 2012-10-01 false Facilities-based international common carriers. 63.22 Section 63.22 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER... Supplements § 63.22 Facilities-based international common carriers. The following conditions apply to...

47 CFR 63.22 - Facilities-based international common carriers.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 3 2010-10-01 2010-10-01 false Facilities-based international common carriers. 63.22 Section 63.22 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER... Supplements § 63.22 Facilities-based international common carriers. The following conditions apply to...

Improved accuracy in ground-based facilities - Development of an automated film-reading system for ballistic ranges

NASA Technical Reports Server (NTRS)

Yates, Leslie A.

1992-01-01

Software for an automated film-reading system that uses personal computers and digitized shadowgraphs is described. The software identifies pixels associated with fiducial-line and model images, and least-squares procedures are used to calculate the positions and orientations of the images. Automated position and orientation readings for sphere and cone models are compared to those obtained using a manual film reader. When facility calibration errors are removed from these readings, the accuracy of the automated readings is better than the pixel resolution, and it is equal to, or better than, the manual readings. The effects of film-reading and facility-calibration errors on calculated aerodynamic coefficients is discussed.

Facile Fabrication of Binary Nanoscale Interface for No-Loss Microdroplet Transportation.

PubMed

Liang, Weitao; Zhu, Liqun; Li, Weiping; Xu, Chang; Liu, Huicong

2016-06-07

Binary nanoscale interfacial materials are fundamental issues in many applications for smart surfaces. A binary nanoscale interface with binary surface morphology and binary wetting behaviors has been prepared by a facile wet-chemical method. The prepared surface presents superhydrophobicity and high adhesion with the droplet at the same time. The composition, surface morphology, and wetting behaviors of the prepared surface have been systematic studied. The special wetting behaviors can be contributed to the binary nanoscale effect. The stability of the prepared surface was also investigated. As a primary application, a facile device based on the prepared binary nanoscale interface with superhydrophobicity and high adhesion was constructed for microdroplet transportation.

Effect of Community Engagement Interventions on Patient Safety and Risk Reduction Efforts in Primary Health Facilities: Evidence from Ghana

PubMed Central

Alhassan, Robert Kaba; Nketiah-Amponsah, Edward; Spieker, Nicole; Arhinful, Daniel Kojo; Ogink, Alice; van Ostenberg, Paul; Rinke de Wit, Tobias F.

2015-01-01

Background Patient safety and quality care remain major challenges to Ghana’s healthcare system. Like many health systems in Africa, this is largely because demand for healthcare is outstripping available human and material resource capacity of healthcare facilities and new investment is insufficient. In the light of these demand and supply constraints, systematic community engagement (SCE) in healthcare quality assessment can be a feasible and cost effective option to augment existing quality improvement interventions. SCE entails structured use of existing community groups to assess healthcare quality in health facilities. Identified quality gaps are discussed with healthcare providers, improvements identified and rewards provided if the quality gaps are closed. Purpose This paper evaluates whether or not SCE, through the assessment of health service quality, improves patient safety and risk reduction efforts by staff in healthcare facilities. Methods A randomized control trail was conducted in 64 primary healthcare facilities in the Greater Accra and Western regions of Ghana. Patient risk assessments were conducted in 32 randomly assigned intervention and control facilities. Multivariate multiple regression test was used to determine effect of the SCE interventions on staff efforts towards reducing patient risk. Spearman correlation test was used to ascertain associations between types of community groups engaged and risk assessment scores of healthcare facilities. Findings Clinic staff efforts towards increasing patient safety and reducing risk improved significantly in intervention facilities especially in the areas of leadership/accountability (Coef. = 10.4, p<0.05) and staff competencies (Coef. = 7.1, p<0.05). Improvement in service utilization and health resources could not be attributed to the interventions because these were outside the control of the study and might have been influenced by institutional or national level developments between the baseline and follow-up period. Community groups that were gender balanced, religious/faith-based, and had structured leadership appeared to be better options for effective SCE in healthcare quality assessment. Conclusion Community engagement in healthcare quality assessment is a feasible client-centered quality improvement option that should be discussed for possible scale-up in Ghana and other resource poor countries in Africa. PMID:26619143

Effect of Community Engagement Interventions on Patient Safety and Risk Reduction Efforts in Primary Health Facilities: Evidence from Ghana.

PubMed

Alhassan, Robert Kaba; Nketiah-Amponsah, Edward; Spieker, Nicole; Arhinful, Daniel Kojo; Ogink, Alice; van Ostenberg, Paul; Rinke de Wit, Tobias F

2015-01-01

Patient safety and quality care remain major challenges to Ghana's healthcare system. Like many health systems in Africa, this is largely because demand for healthcare is outstripping available human and material resource capacity of healthcare facilities and new investment is insufficient. In the light of these demand and supply constraints, systematic community engagement (SCE) in healthcare quality assessment can be a feasible and cost effective option to augment existing quality improvement interventions. SCE entails structured use of existing community groups to assess healthcare quality in health facilities. Identified quality gaps are discussed with healthcare providers, improvements identified and rewards provided if the quality gaps are closed. This paper evaluates whether or not SCE, through the assessment of health service quality, improves patient safety and risk reduction efforts by staff in healthcare facilities. A randomized control trail was conducted in 64 primary healthcare facilities in the Greater Accra and Western regions of Ghana. Patient risk assessments were conducted in 32 randomly assigned intervention and control facilities. Multivariate multiple regression test was used to determine effect of the SCE interventions on staff efforts towards reducing patient risk. Spearman correlation test was used to ascertain associations between types of community groups engaged and risk assessment scores of healthcare facilities. Clinic staff efforts towards increasing patient safety and reducing risk improved significantly in intervention facilities especially in the areas of leadership/accountability (Coef. = 10.4, p<0.05) and staff competencies (Coef. = 7.1, p<0.05). Improvement in service utilization and health resources could not be attributed to the interventions because these were outside the control of the study and might have been influenced by institutional or national level developments between the baseline and follow-up period. Community groups that were gender balanced, religious/faith-based, and had structured leadership appeared to be better options for effective SCE in healthcare quality assessment. Community engagement in healthcare quality assessment is a feasible client-centered quality improvement option that should be discussed for possible scale-up in Ghana and other resource poor countries in Africa.

Preliminary results in the NASA Lewis H2-O2 combustion MHD experiment

NASA Technical Reports Server (NTRS)

Smith, J. M.

1979-01-01

MHD (magnetohydrodynamic) power generation experiments were carried out in the NASA Lewis Research Center cesium-seeded H2-O2 combustion facility. This facility uses a neon-cooled cryomagnet capable of producing magnetic fields in excess of 5 tesla. The effects of power takeoff location, generator loading, B-field strength, and electrode breakdown on generator performance are discussed. The experimental data is compared to a theory based on one-dimensional flow with heat transfer, friction, and voltage drops.

Germicidal Activity against Carbapenem/Colistin-Resistant Enterobacteriaceae Using a Quantitative Carrier Test Method.

PubMed

Kanamori, Hajime; Rutala, William A; Gergen, Maria F; Sickbert-Bennett, Emily E; Weber, David J

2018-05-07

Susceptibility to germicides for carbapenem/colistin-resistant Enterobacteriaceae is poorly described. We investigated the efficacy of multiple germicides against these emerging antibiotic-resistant pathogens using the disc-based quantitative carrier test method that can produce results more similar to those encountered in healthcare settings than a suspension test. Our study results demonstrated that germicides commonly used in healthcare facilities likely will be effective against carbapenem/colistin-resistant Enterobacteriaceae when used appropriately in healthcare facilities. Copyright © 2018 American Society for Microbiology.

State Law Approaches to Facility Regulation of Abortion and Other Office Interventions

PubMed Central

Daniel, Sara; Cloud, Lindsay K.

2018-01-01

Objectives. To compare the prevalence and characteristics of facility laws governing abortion provision specifically (targeted regulation of abortion providers [TRAP] laws); office-based surgeries, procedures, sedation or anesthesia (office interventions) generally (OBS laws); and other procedures specifically. Methods. We conducted cross-sectional legal assessments of state facility laws for office interventions in effect as of August 1, 2016. We coded characteristics for each law and compared characteristics across categories of laws. Results. TRAP laws (n = 55; in 34 states) were more prevalent than OBS laws (n = 25; in 25 states) or laws targeting other procedures (n = 1; in 1 state). TRAP laws often regulated facilities that would not be regulated under OBS laws (e.g., all TRAP laws, but only 2 OBS laws, applied regardless of sedation or anesthesia used). TRAP laws imposed more numerous and more stringent requirements than OBS laws. Conclusions. Many states regulate abortion-providing facilities differently, and more stringently, than facilities providing other office interventions. The Supreme Court’s 2016 decision in Whole Woman’s Health v Hellerstedt casts doubt on the legitimacy of that differential treatment. PMID:29470114

Predictors of Use of Monitored Anesthesia Care for Outpatient Gastrointestinal Endoscopy in a Capitated Payment System.

PubMed

Adams, Megan A; Prenovost, Katherine M; Dominitz, Jason A; Holleman, Robert G; Kerr, Eve A; Krein, Sarah L; Saini, Sameer D; Rubenstein, Joel H

2017-12-01

Use of monitored anesthesia care (MAC) for gastrointestinal endoscopy has increased in the Veterans Health Administration (VHA) as in fee-for-service environments, despite the absence of financial incentives. We investigated factors associated with use of MAC in an integrated health care delivery system with a capitated payment model. We performed a retrospective cohort study using multilevel logistic regression, with MAC use modeled as a function of procedure year, patient- and provider-level factors, and facility effects. We collected data from 2,091,590 veterans who underwent outpatient esophagogastroduodenoscopy and/or colonoscopy during fiscal years 2000-2013 at 133 facilities. The adjusted rate of MAC use in the VHA increased 17% per year (odds ratio for increase, 1.17; 95% confidence interval, 1.09-1.27) from fiscal year 2000 through 2013. The most rapid increase occurred starting in 2011. VHA use of MAC was associated with patient-level factors that included obesity, obstructive sleep apnea, higher comorbidity, and use of prescription opioids and/or benzodiazepines, although the magnitude of these effects was small. Provider-level and facility factors were also associated with use of MAC, although again the magnitude of these associations was small. Unmeasured facility-level effects had the greatest effect on the trend of MAC use. In a retrospective study of veterans who underwent outpatient esophagogastroduodenoscopy and/or colonoscopy from fiscal year 2000 through 2013, we found that even in a capitated system, patient factors are only weakly associated with use of MAC. Facility-level effects are the most prominent factor influencing increasing use of MAC. Future studies should focus on better defining the role of MAC and facility and organizational factors that affect choice of endoscopic sedation. It will also be important to align resources and incentives to promote appropriate allocation of MAC based on clinically meaningful patient factors. Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

Impact of the Fit and Strong Intervention on Older Adults with Osteoarthritis

ERIC Educational Resources Information Center

Hughes, Susan L.; Seymour, Rachel B.; Campbell, Richard; Pollak, Naomi; Huber, Gail; Sharma, Leena

2004-01-01

Purpose: This study assessed the impact of a low cost, multicomponent physical activity intervention for older adults with lower extremity osteoarthritis. Design and Methods: A randomized controlled trial compared the effects of a facility-based multiple-component training program followed by home-based adherence (n = 80) to a wait list control…

77 FR 17496 - Fisheries and Habitat Conservation and Migratory Birds Programs; Final Land-Based Wind Energy...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-26

... resulting from construction, operation, and maintenance of land-based wind energy facilities. DATES: These...) established the Wind Turbine Guidelines Advisory Committee (Committee) under the Federal Advisory Committee... concern over certain issues such as the effects of wind turbine noise on wildlife, these issues have not...

Study of a GaAs:Cr-based Timepix detector using synchrotron facility

NASA Astrophysics Data System (ADS)

Smolyanskiy, P.; Kozhevnikov, D.; Bakina, O.; Chelkov, G.; Dedovich, D.; Kuper, K.; Leyva Fabelo, A.; Zhemchugov, A.

2017-11-01

High resistivity gallium arsenide compensated by chromium fabricated by Tomsk State University has demonstrated a good suitability as a sensor material for hybrid pixel detectors used in X-ray imaging systems with photon energies up to 60 keV. The material is available with a thickness up to 1 mm and due to its Z number a high absorption efficiency in this energy region is provided. However, the performance of thick GaAs:Cr-based detectors in spectroscopic applications is limited by readout electronics with relatively small pixels due to the charge sharing effect. In this paper, we present the experimental investigation of the charge sharing effect contribution in the GaAs:Cr-based Timepix detector. By means of scanning the detector with a pencil photon beam generated by the synchrotron facility, the geometrical mapping of pixel sensitivity is obtained, as well as the energy resolution of a single pixel. The experimental results are supported by numerical simulations. The observed limitation of the GaAs:Cr-based Timepix detector for the high flux X-ray imaging is discussed.

Active and passive surveillance for communicable diseases in child care facilities, Seattle-King County, Washington.

PubMed

MacDonald, J K; Boase, J; Stewart, L K; Alexander, E R; Solomon, S L; Cordell, R L

1997-12-01

The purpose of this study was to develop and evaluate models for public health surveillance of illnesses among children in out-of-home child care facilities. Between July 1992 and March 1994, 200 Seattle-King County child care facilities participated in active or enhanced passive surveillance, or both. Reporting was based on easily recognized signs, symptoms, and sentinel events. Published criteria were used in evaluating surveillance effectiveness, and notifiable disease reporting of participating and nonparticipating facilities was compared. Neither surveillance model was well accepted by child care providers. Enhanced passive and active surveillance had comparable sensitivity. Reporting delays and the large amount of time needed for data entry led to problems with timeliness, especially in terms of written reporting during active surveillance. Widespread active public health surveillance in child care facilities is not feasible for most local health departments. Improvements in public health surveillance in child care settings will depend on acceptability to providers.

Palliative Care Matters: Lessons From the Loss of a Facility Dog.

PubMed

Holman, Elizabeth; Levy, Cari; Kennedy, Brenda

2018-01-01

Animal-assisted intervention is gaining attention as a stress reduction modality. Quantitative data demonstrate its effectiveness, as a recent study published in AJHPM supported that a Veterans Affairs (VA) hospital facility dog paired with a palliative care psychologist had a measurable impact on salivary cortisol levels and heart rate in hospitalized veterans. There remains an important role for qualitative insights. The Denver VA palliative care team learned a range of lessons from the sudden loss of their facility dog, many of which relate directly to palliative care. The importance of communication, adjusting to changing teams, and the need for consultation and support based in shared goals and values all became evident in the course of the facility dog's illness. After her death, lessons shifted to grief and loss and how providers, patients, and a community care for each other. People's connection to the facility dog ultimately proved to be a critical factor in helping them connect with one another.

The effect of facility-based antiretroviral therapy programs on outpatient services in Kenya and Uganda.

PubMed

Wollum, Alexandra; Dansereau, Emily; Fullman, Nancy; Achan, Jane; Bannon, Kelsey A; Burstein, Roy; Conner, Ruben O; DeCenso, Brendan; Gasasira, Anne; Haakenstad, Annie; Hanlon, Michael; Ikilezi, Gloria; Kisia, Caroline; Levine, Aubrey J; Masters, Samuel H; Njuguna, Pamela; Okiro, Emelda A; Odeny, Thomas A; Allen Roberts, D; Gakidou, Emmanuela; Duber, Herbert C

2017-08-16

Considerable debate exists concerning the effects of antiretroviral therapy (ART) service scale-up on non-HIV services and overall health system performance in sub-Saharan Africa. In this study, we examined whether ART services affected trends in non-ART outpatient department (OPD) visits in Kenya and Uganda. Using a nationally representative sample of health facilities in Kenya and Uganda, we estimated the effect of ART programs on OPD visits from 2007 to 2012. We modeled the annual percent change in non-ART OPD visits using hierarchical mixed-effects linear regressions, controlling for a range of facility characteristics. We used four different constructs of ART services to capture the different ways in which the presence, growth, overall, and relative size of ART programs may affect non-ART OPD services. Our final sample included 321 health facilities (140 in Kenya and 181 in Uganda). On average, OPD and ART visits increased steadily in Kenya and Uganda between 2007 and 2012. For facilities where ART services were not offered, the average annual increase in OPD visits was 4·2% in Kenya and 13·5% in Uganda. Among facilities that provided ART services, we found average annual OPD volume increases of 7·2% in Kenya and 5·6% in Uganda, with simultaneous annual increases of 13·7% and 12·5% in ART volumes. We did not find a statistically significant relationship between annual changes in OPD services and the presence, growth, overall, or relative size of ART services. However, in a subgroup analysis, we found that Ugandan hospitals that offered ART services had statistically significantly less growth in OPD visits than Ugandan hospitals that did not provide ART services. Our findings suggest that ART services in Kenya and Uganda did not have a statistically significant deleterious effects on OPD services between 2007 and 2012, although subgroup analyses indicate variation by facility type. Our findings are encouraging, particularly given recent recommendations for universal access to ART, demonstrating that expanding ART services is not inherently linked to declines in other health services in sub-Saharan Africa.

Wind-tunnel based definition of the AFE aerothermodynamic environment. [Aeroassist Flight Experiment

NASA Technical Reports Server (NTRS)

Miller, Charles G.; Wells, W. L.

1992-01-01

The Aeroassist Flight Experiment (AFE), scheduled to be performed in 1994, will serve as a precursor for aeroassisted space transfer vehicles (ASTV's) and is representative of entry concepts being considered for missions to Mars. Rationale for the AFE is reviewed briefly as are the various experiments carried aboard the vehicle. The approach used to determine hypersonic aerodynamic and aerothermodynamic characteristics over a wide range of simulation parameters in ground-based facilities is presented. Facilities, instrumentation and test procedures employed in the establishment of the data base are discussed. Measurements illustrating the effects of hypersonic simulation parameters, particularly normal-shock density ratio (an important parameter for hypersonic blunt bodies), and attitude on aerodynamic and aerothermodynamic characteristics are presented, and predictions from computational fluid dynamic (CFD) computer codes are compared with measurement.

Risk-based decision making for terrorism applications.

PubMed

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

2009-03-01

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

Dual indices for prioritizing investment in decentralized HIV services at Nigerian primary health care facilities

PubMed Central

Oyediran, Kola’ A; Mullen, Stephanie; Kolapo, Usman M

2016-01-01

Decentralizing health services, including those for HIV prevention and treatment, is one strategy for maximizing the use of limited resources and expanding treatment options; yet few methods exist for systematically identifying where investments for service expansion might be most effective, in terms of meeting needs and rapid availability of improved services. The Nigerian Government, the United States Government under the President's Emergency Plan for AIDS Relief (PEPFAR) program and other donors are expanding services for prevention of mother-to-child transmission (PMTCT) of HIV to primary health care facilities in Nigeria. Nigerian primary care facilities vary greatly in their readiness to deliver HIV/AIDS services. In 2012, MEASURE Evaluation assessed 268 PEPFAR-supported primary health care facilities in Nigeria and developed a systematic method for prioritizing these facilities for expansion of PMTCT services. Each assessed facility was scored based on two indices with multiple, weighted variables: one measured facility readiness to provide PMTCT services, the other measured local need for the services and feasibility of expansion. These two scores were compiled and the summary score used as the basis for prioritizing facilities for PMTCT service expansion. The rationale was that using need and readiness to identify where to expand PMTCT services would result in more efficient allocation of resources. A review of the results showed that the indices achieved the desired effect—that is prioritizing facilities with high need even when readiness was problematic and also prioritizing facilities where rapid scale-up was feasible. This article describes the development of the two-part index and discusses advantages of using this approach when planning service expansion. The authors' objective is to contribute to development of methodologies for prioritizing investments in HIV, as well as other public health arenas, that should improve cost-effectiveness and strengthen services and systems in resource-limited countries. PMID:26363172

Facility-Based Delivery during the Ebola Virus Disease Epidemic in Rural Liberia: Analysis from a Cross-Sectional, Population-Based Household Survey.

PubMed

Ly, John; Sathananthan, Vidiya; Griffiths, Thomas; Kanjee, Zahir; Kenny, Avi; Gordon, Nicholas; Basu, Gaurab; Battistoli, Dale; Dorr, Lorenzo; Lorenzen, Breeanna; Thomson, Dana R; Waters, Ami; Moore, Uriah G; Roberts, Ruth; Smith, Wilmot L; Siedner, Mark J; Kraemer, John D

2016-08-01

The Ebola virus disease (EVD) epidemic has threatened access to basic health services through facility closures, resource diversion, and decreased demand due to community fear and distrust. While modeling studies have attempted to estimate the impact of these disruptions, no studies have yet utilized population-based survey data. We conducted a two-stage, cluster-sample household survey in Rivercess County, Liberia, in March-April 2015, which included a maternal and reproductive health module. We constructed a retrospective cohort of births beginning 4 y before the first day of survey administration (beginning March 24, 2011). We then fit logistic regression models to estimate associations between our primary outcome, facility-based delivery (FBD), and time period, defined as the pre-EVD period (March 24, 2011-June 14, 2014) or EVD period (June 15, 2014-April 13, 2015). We fit both univariable and multivariable models, adjusted for known predictors of facility delivery, accounting for clustering using linearized standard errors. To strengthen causal inference, we also conducted stratified analyses to assess changes in FBD by whether respondents believed that health facility attendance was an EVD risk factor. A total of 1,298 women from 941 households completed the survey. Median age at the time of survey was 29 y, and over 80% had a primary education or less. There were 686 births reported in the pre-EVD period and 212 in the EVD period. The unadjusted odds ratio of facility-based delivery in the EVD period was 0.66 (95% confidence interval [CI] 0.48-0.90, p-value = 0.010). Adjustment for potential confounders did not change the observed association, either in the principal model (adjusted odds ratio [AOR] = 0.70, 95%CI 0.50-0.98, p = 0.037) or a fully adjusted model (AOR = 0.69, 95%CI 0.50-0.97, p = 0.033). The association was robust in sensitivity analyses. The reduction in FBD during the EVD period was observed among those reporting a belief that health facilities are or may be a source of Ebola transmission (AOR = 0.59, 95%CI 0.36-0.97, p = 0.038), but not those without such a belief (AOR = 0.90, 95%CI 0.59-1.37, p = 0.612). Limitations include the possibility of FBD secular trends coincident with the EVD period, recall errors, and social desirability bias. We detected a 30% decreased odds of FBD after the start of EVD in a rural Liberian county with relatively few cases. Because health facilities never closed in Rivercess County, this estimate may under-approximate the effect seen in the most heavily affected areas. These are the first population-based survey data to show collateral disruptions to facility-based delivery caused by the West African EVD epidemic, and they reinforce the need to consider the full spectrum of implications caused by public health emergencies.

A review of the use of tanning beds as a dermatological treatment.

PubMed

Radack, Kyle P; Farhangian, Michael E; Anderson, Kathryn L; Feldman, Steven R

2015-03-01

In-office phototherapy is an effective treatment for many dermatologic conditions, however, many patients are unable to adhere to the rigorous travel and time commitments sometimes needed. Tanning bed facilities are nearly ubiquitous in modern society and could represent a more convenient means to obtain ultraviolet (UV) exposure when office phototherapy is not feasible. The purpose of this study was to review available evidence on the use of tanning facilities as a treatment for dermatologic conditions. PubMed was searched on February 2015 for "tanning beds" and "phototherapy", and with some dermatologic conditions sensitive to UV light, including "psoriasis", "mycosis fungoides", "acne", "atopic dermatitis" and "eczema". From there, further articles were found using the reference sections of the initial papers. A similar methodology was used with the Google Scholar search engine. Only articles in English and prospective studies were included in this review. We found studies validating the use of tanning facilities for psoriasis treatment. Use as a treatment option for atopic dermatitis, mycosis fungoides, acne, scleroderma, vitiligo, and pruritus, as well as other UV sensitive dermatoses, may also be beneficial. This study is limited by the lack of double-blind, placebo-controlled trials, long-term follow-up studies, and meta-analyses for tanning facility use in dermatologic phototherapy, and by the lack of standardization of both tanning facilities and exposure dosing. Unsupervised sun exposure is a standard recommendation for some patients to obtain phototherapy. Selected use of commercial tanning beds in the treatment of dermatologic conditions may be another useful and effective treatment for those patients with an inability to access office-based or home-based phototherapy.

A sham case-control study of effectiveness of DTP-Hib-hepatitis B vaccine against rotavirus acute gastroenteritis in Kenya

PubMed Central

2014-01-01

Background In many GAVI-eligible countries, effectiveness of new vaccines will be evaluated by case-control methodology. To inform the design and assess selection bias of a future case-control study of rotavirus vaccine effectiveness (VE) in western Kenya, we performed a sham case-control study evaluating VE of pentavalent vaccine (DTP-Hib-HepB) against rotavirus acute gastroenteritis (AGE). Methods From ongoing rotavirus surveillance, we defined cases as children 12 weeks to 23 months old with EIA-confirmed rotavirus AGE. We enrolled one community-based and two hospital-based control groups. We collected vaccination status from cards at enrollment, or later in homes, and evaluated VE by logistic regression. Results We enrolled 91 cases (64 inpatient, 27 outpatient), 252 non-rotavirus AGE facility-based controls (unmatched), 203 non-AGE facility-based controls (age-matched) and 271 community controls (age-matched). Documented receipt of 3 pentavalent doses was 77% among cases and ranged from 81-86% among controls. One percent of cases and 0-2% of controls had no pentavalent doses. The adjusted odds ratio of three versus zero doses for being a case was 3.27 (95% CI 0.01-1010) for community controls and 0.69 (95% CI 0.06-7.75) for non-rotavirus hospital-based AGE controls, translating to VE of -227% and 31%, respectively, with wide confidence intervals. (No facility-based non-AGE controls were unvaccinated.) Similar results were found for ≥2 pentavalent doses and for severe rotavirus AGE. Conclusions The study showed that it is feasible to carry out a real case control in the study area, but this needs to be done as soon as the vaccine is introduced to capture the real impact. Sham case-control or pilot studies before vaccine introduction can be useful in designing case-control VE studies. PMID:24517198

Exposure to oil mist and oil vapour during offshore drilling in norway, 1979-2004.

PubMed

Steinsvåg, Kjersti; Bråtveit, Magne; Moen, Bente E

2006-03-01

To describe personal exposure to airborne hydrocarbon contaminants (oil mist and oil vapour) from 1979 to 2004 in the mud-handling areas of offshore drilling facilities operating on the Norwegian continental shelf when drilling with oil-based muds. Qualitative and quantitative information was gathered during visits to companies involved in offshore oil and gas production in Norway. Monitoring reports on oil mist and oil vapour exposure covered 37 drilling facilities. Exposure data were analysed using descriptive statistics and by constructing linear mixed-effects models. Samples had been taken during the use of three generations of hydrocarbon base oils, namely diesel oils (1979-1984), low-aromatic mineral oils (1985-1997) and non-aromatic mineral oils (1998-2004). Sampling done before 1984 showed high exposure to diesel vapour (arithmetic mean, AM = 1217 mg m(-3)). When low-aromatic mineral oils were used, the exposure to oil mist and oil vapour was 4.3 and 36 mg m(-3), and the respective AMs for non-aromatic mineral oils were reduced to 0.54 and 16 mg m(-3). Downward time trends were indicated for both oil mist (6% per year) and oil vapour (8% per year) when the year of monitoring was introduced as a fixed effect in a linear mixed-effects model analysis. Rig type, technical control measures and mud temperature significantly determined exposure to oil mist. Rig type, type of base oil, viscosity of the base oil, work area, mud temperature and season significantly determined exposure to oil vapour. Major decreases in variability were found for the between-rig components. Exposure to oil mist and oil vapour declined over time in the mud-handling areas of offshore drilling facilities. Exposure levels were associated with rig type, mud temperature, technical control measures, base oil, viscosity of the base oil, work area and season.

A sham case-control study of effectiveness of DTP-Hib-hepatitis B vaccine against rotavirus acute gastroenteritis in Kenya.

PubMed

Khagayi, Sammy; Tate, Jacqueline E; Onkoba, Reuben; Parashar, Umesh; Odhiambo, Frank; Burton, Deron; Laserson, Kayla; Feikin, Daniel R

2014-02-11

In many GAVI-eligible countries, effectiveness of new vaccines will be evaluated by case-control methodology. To inform the design and assess selection bias of a future case-control study of rotavirus vaccine effectiveness (VE) in western Kenya, we performed a sham case-control study evaluating VE of pentavalent vaccine (DTP-Hib-HepB) against rotavirus acute gastroenteritis (AGE). From ongoing rotavirus surveillance, we defined cases as children 12 weeks to 23 months old with EIA-confirmed rotavirus AGE. We enrolled one community-based and two hospital-based control groups. We collected vaccination status from cards at enrollment, or later in homes, and evaluated VE by logistic regression. We enrolled 91 cases (64 inpatient, 27 outpatient), 252 non-rotavirus AGE facility-based controls (unmatched), 203 non-AGE facility-based controls (age-matched) and 271 community controls (age-matched). Documented receipt of 3 pentavalent doses was 77% among cases and ranged from 81-86% among controls. One percent of cases and 0-2% of controls had no pentavalent doses. The adjusted odds ratio of three versus zero doses for being a case was 3.27 (95% CI 0.01-1010) for community controls and 0.69 (95% CI 0.06-7.75) for non-rotavirus hospital-based AGE controls, translating to VE of -227% and 31%, respectively, with wide confidence intervals. (No facility-based non-AGE controls were unvaccinated.) Similar results were found for ≥2 pentavalent doses and for severe rotavirus AGE. The study showed that it is feasible to carry out a real case control in the study area, but this needs to be done as soon as the vaccine is introduced to capture the real impact. Sham case-control or pilot studies before vaccine introduction can be useful in designing case-control VE studies.

Method for siting detectors within a facility

DOEpatents

Gleason, Nathaniel Jeremy Meyer

2007-12-11

A method, system and article of manufacture of siting one or more detectors in a facility represented with zones are provided. Signals S.sub.i,j representing an effect in zone j in response to a release of contaminant in zone i for one or more flow conditions are provided. A candidate architecture has one or more candidate zones. A limiting case signal is determined for each flow condition for multiple candidate architectures. The limiting case signal is a smallest system signal of multiple system signals associated with a release in a zone. Each system signal is a maximum one of the signals representing the effect in the candidate zones from the release in one zone for the flow condition. For each candidate architecture, a robust limiting case signal is determined based on a minimum of the limiting case signals. One candidate architecture is selected based on the robust limiting case signals.

Impact of performance-based financing on primary health care services in Haiti.

PubMed

Zeng, Wu; Cros, Marion; Wright, Katherine D; Shepard, Donald S

2013-09-01

To strengthen Haiti's primary health care (PHC) system, the country first piloted performance-based financing (PBF) in 1999 and subsequently expanded the approach to most internationally funded non-government organizations. PBF complements support (training and technical assistance). This study evaluates (a) the separate impact of PBF and international support on PHC's service delivery; (b) the combined impact of PBF and technical assistance on PHC's service delivery; and (c) the costs of PBF implementation in Haiti. To minimize the risk of facilities neglecting potential non-incentivized services, the incentivized indicators were randomly chosen at the end of each year. We obtained quantities of key services from four departments for 217 health centres (15 with PBF and 202 without) from 2008 through 2010, computed quarterly growth rates and analysed the results using a difference-in-differences approach by comparing the growth of incentivized and non-incentivized services between PBF and non-PBF facilities. To interpret the statistical analyses, we also interviewed staff in four facilities. Whereas international support added 39% to base costs of PHC, incentive payments added only 6%. Support alone increased the quantities of PHC services over 3 years by 35% (2.7%/quarter). However, support plus incentives increased these amounts by 87% over 3 years (5.7%/quarter) compared with facilities with neither input. Incentives alone was associated with a net 39% increase over this period, and more than doubled the growth of services (P < 0.05). Interview findings found no adverse impacts and, in fact, indicated beneficial impacts on quality. Incentives proved to be a relatively inexpensive, well accepted and very effective complement to support, suggesting that a small amount of money, strategically used, can substantially improve PHC. Haiti's experience, after more than a decade of use, indicates that incentives are an effective tool to strengthen PHC.

Parasite-based malaria diagnosis: Are Health Systems in Uganda equipped enough to implement the policy?

PubMed Central

2012-01-01

Background Malaria case management is a key strategy for malaria control. Effective coverage of parasite-based malaria diagnosis (PMD) remains limited in malaria endemic countries. This study assessed the health system's capacity to absorb PMD at primary health care facilities in Uganda. Methods In a cross sectional survey, using multi-stage cluster sampling, lower level health facilities (LLHF) in 11 districts in Uganda were assessed for 1) tools, 2) skills, 3) staff and infrastructure, and 4) structures, systems and roles necessary for the implementing of PMD. Results Tools for PMD (microscopy and/or RDTs) were available at 30 (24%) of the 125 LLHF. All LLHF had patient registers and 15% had functional in-patient facilities. Three months’ long stock-out periods were reported for oral and parenteral quinine at 39% and 47% of LLHF respectively. Out of 131 health workers interviewed, 86 (66%) were nursing assistants; 56 (43%) had received on-job training on malaria case management and 47 (36%) had adequate knowledge in malaria case management. Overall, only 18% (131/730) Ministry of Health approved staff positions were filled by qualified personnel and 12% were recruited or transferred within six months preceding the survey. Of 186 patients that received referrals from LLHF, 130(70%) had received pre-referral anti-malarial drugs, none received pre-referral rectal artesunate and 35% had been referred due to poor response to antimalarial drugs. Conclusion Primary health care facilities had inadequate human and infrastructural capacity to effectively implement universal parasite-based malaria diagnosis. The priority capacity building needs identified were: 1) recruitment and retention of qualified staff, 2) comprehensive training of health workers in fever management, 3) malaria diagnosis quality control systems and 4) strengthening of supply chain, stock management and referral systems. PMID:22920954

The Effect of Seasonal Floods on Health: Analysis of Six Years of National Health Data and Flood Maps

PubMed Central

Saulnier, Dell D.; Hanson, Claudia; Ir, Por; Mölsted Alvesson, Helle; von Schreeb, Johan

2018-01-01

There is limited knowledge on the effect of seasonal flooding on health over time. We quantified the short- and long-term effects of floods on selected health indicators at public healthcare facilities in 11 districts in Cambodia, a flood-prone setting. Counts of inpatient discharge diagnoses and outpatient consultations for diarrhea, acute respiratory infections, skin infections, injuries, noncommunicable diseases and vector-borne diseases were retrieved from public healthcare facilities for each month between January 2008 and December 2013. Flood water was mapped by month, in square kilometers, from satellite data. Poisson regression models with three lag months were constructed for the health problems in each district, controlled for seasonality and long-term trends. During times of flooding and three months after, there were small to moderate increases in visits to healthcare facilities for skin infections, acute respiratory infections, and diarrhea, while no association was seen at one to two months. The associations were small to moderate, and a few of our results were significant. We observed increases in care seeking for diarrhea, skin infections, and acute respiratory infections following floods, but the associations are uncertain. Additional research on previous exposure to flooding, using community- and facility-based data, would help identify expected health risks after floods in flood-prone settings. PMID:29614051

University multi-user facility survey-2010.

PubMed

Riley, Melissa B

2011-12-01

Multi-user facilities serve as a resource for many universities. In 2010, a survey was conducted investigating possible changes and successful characteristics of multi-user facilities, as well as identifying problems in facilities. Over 300 surveys were e-mailed to persons identified from university websites as being involved with multi-user facilities. Complete responses were received from 36 facilities with an average of 20 years of operation. Facilities were associated with specific departments (22%), colleges (22%), and university research centers (8.3%) or were not affiliated with any department or college within the university (47%). The five most important factors to succeed as a multi-user facility were: 1) maintaining an experienced, professional staff in an open atmosphere; 2) university-level support providing partial funding; 3) broad client base; 4) instrument training programs; and 5) an effective leader and engaged strategic advisory group. The most significant problems were: 1) inadequate university financial support and commitment; 2) problems recovering full service costs from university subsidies and user fees; 3) availability of funds to repair and upgrade equipment; 4) inability to retain highly qualified staff; and 5) unqualified users dirtying/damaging equipment. Further information related to these issues and to fee structure was solicited. Overall, there appeared to be a decline in university support for facilities and more emphasis on securing income by serving clients outside of the institution and by obtaining grants from entities outside of the university.

Use of mobile technology-based participatory mapping approaches to geolocate health facility attendees for disease surveillance in low resource settings.

PubMed

Fornace, Kimberly M; Surendra, Henry; Abidin, Tommy Rowel; Reyes, Ralph; Macalinao, Maria L M; Stresman, Gillian; Luchavez, Jennifer; Ahmad, Riris A; Supargiyono, Supargiyono; Espino, Fe; Drakeley, Chris J; Cook, Jackie

2018-06-18

Identifying fine-scale spatial patterns of disease is essential for effective disease control and elimination programmes. In low resource areas without formal addresses, novel strategies are needed to locate residences of individuals attending health facilities in order to efficiently map disease patterns. We aimed to assess the use of Android tablet-based applications containing high resolution maps to geolocate individual residences, whilst comparing the functionality, usability and cost of three software packages designed to collect spatial information. Using Open Data Kit GeoODK, we designed and piloted an electronic questionnaire for rolling cross sectional surveys of health facility attendees as part of a malaria elimination campaign in two predominantly rural sites in the Rizal, Palawan, the Philippines and Kulon Progo Regency, Yogyakarta, Indonesia. The majority of health workers were able to use the tablets effectively, including locating participant households on electronic maps. For all households sampled (n = 603), health facility workers were able to retrospectively find the participant household using the Global Positioning System (GPS) coordinates and data collected by tablet computers. Median distance between actual house locations and points collected on the tablet was 116 m (IQR 42-368) in Rizal and 493 m (IQR 258-886) in Kulon Progo Regency. Accuracy varied between health facilities and decreased in less populated areas with fewer prominent landmarks. Results demonstrate the utility of this approach to develop real-time high-resolution maps of disease in resource-poor environments. This method provides an attractive approach for quickly obtaining spatial information on individuals presenting at health facilities in resource poor areas where formal addresses are unavailable and internet connectivity is limited. Further research is needed on how to integrate these with other health data management systems and implement in a wider operational context.

Breast cancer stage at diagnosis: is travel time important?

PubMed

Henry, Kevin A; Boscoe, Francis P; Johnson, Christopher J; Goldberg, Daniel W; Sherman, Recinda; Cockburn, Myles

2011-12-01

Recent studies have produced inconsistent results in their examination of the potential association between proximity to healthcare or mammography facilities and breast cancer stage at diagnosis. Using a multistate dataset, we re-examine this issue by investigating whether travel time to a patient's diagnosing facility or nearest mammography facility impacts breast cancer stage at diagnosis. We studied 161,619 women 40 years and older diagnosed with invasive breast cancer from ten state population based cancer registries in the United States. For each woman, we calculated travel time to their diagnosing facility and nearest mammography facility. Logistic multilevel models of late versus early stage were fitted, and odds ratios were calculated for travel times, controlling for age, race/ethnicity, census tract poverty, rural/urban residence, health insurance, and state random effects. Seventy-six percent of women in the study lived less than 20 min from their diagnosing facility, and 93 percent lived less than 20 min from the nearest mammography facility. Late stage at diagnosis was not associated with increasing travel time to diagnosing facility or nearest mammography facility. Diagnosis age under 50, Hispanic and Non-Hispanic Black race/ethnicity, high census tract poverty, and no health insurance were all significantly associated with late stage at diagnosis. Travel time to diagnosing facility or nearest mammography facility was not a determinant of late stage of breast cancer at diagnosis, and better geographic proximity did not assure more favorable stage distributions. Other factors beyond geographic proximity that can affect access should be evaluated more closely, including facility capacity, insurance acceptance, public transportation, and travel costs.

Facilities Performance Indicators Report 2013-14: Tracking Your Facilities Vital Signs

ERIC Educational Resources Information Center

APPA: Association of Higher Education Facilities Officers, 2015

2015-01-01

This paper features an expanded Web-based "Facilities Performance Indicators (FPI) Report." The purpose of APPA: Association of Higher Education Facilities Officers (APPA's) Facilities Performance Indicators is to provide a representative set of statistics about facilities in educational institutions. "The Facilities Performance…

Linking Academic Strengths to Economic Development: Seven Habits for Effective Partnership in University-Based Economic Development.

ERIC Educational Resources Information Center

O'Brien, Gregory M. St. L.; Grace, Norma E.; Williams, Elizabeth M.; Paradise, Louis V.; Gibbs, Patrick M.

2003-01-01

Describes the University of New Orleans' Research and Technology Foundation, which relied heavily on Steven Covey's "The 7 Habits of Highly Effective People" to create an innovative model of ownership, construction, and financing to overcome paralyzing barriers to facility development. The effort has resulted in multiple development…

The Relationship between Principal Leadership Effectiveness and School Performance in South Carolina High Schools

ERIC Educational Resources Information Center

Lempesis, Costa

2009-01-01

A critical component for successful schools is effective leadership. In the 1980's the concept of leadership emerged and the rules changed for school principals (Lashway, 2002). Previously, administrators were primarily evaluated based upon their abilities in managing school facilities and operations efficiently. Academics became the new focus.…

Development of a large-scale, outdoor, ground-based test capability for evaluating the effect of rain on airfoil lift

NASA Technical Reports Server (NTRS)

Bezos, Gaudy M.; Campbell, Bryan A.

1993-01-01

A large-scale, outdoor, ground-based test capability for acquiring aerodynamic data in a simulated rain environment was developed at the Langley Aircraft Landing Dynamics Facility (ALDF) to assess the effect of heavy rain on airfoil performance. The ALDF test carriage was modified to transport a 10-ft-chord NACA 64210 wing section along a 3000-ft track at full-scale aircraft approach speeds. An overhead rain simulation system was constructed along a 525-ft section of the track with the capability of producing simulated rain fields of 2, 10, 30, and 40 in/hr. The facility modifications, the aerodynamic testing and rain simulation capability, the design and calibration of the rain simulation system, and the operational procedures developed to minimize the effect of wind on the simulated rain field and aerodynamic data are described in detail. The data acquisition and reduction processes are also presented along with sample force data illustrating the environmental effects on data accuracy and repeatability for the 'rain-off' test condition.

Comparison of Knowledge and Attitudes Using Computer-Based and Face-to-Face Personal Hygiene Training Methods in Food Processing Facilities

ERIC Educational Resources Information Center

Fenton, Ginger D.; LaBorde, Luke F.; Radhakrishna, Rama B.; Brown, J. Lynne; Cutter, Catherine N.

2006-01-01

Computer-based training is increasingly favored by food companies for training workers due to convenience, self-pacing ability, and ease of use. The objectives of this study were to determine if personal hygiene training, offered through a computer-based method, is as effective as a face-to-face method in knowledge acquisition and improved…

Performance of the 2 × 4-cell superconducting linac module for the THz-FEL facility

NASA Astrophysics Data System (ADS)

Kui, Zhou; Chenglong, Lao; Dai, Wu; Xing, Luo; Jianxin, Wang; Dexin, Xiao; Lijun, Shan; Tianhui, He; Xuming, Shen; Sifen, Lin; Linde, Yang; Hanbin, Wang; Xingfan, Yang; Ming, Li; Xiangyang, Lu

2018-07-01

A high average power THz radiation facility has been developed by the China Academy of Engineering Physics. It is the first CW THz user facility based on superconducting accelerator technology in China. The superconducting linac module, which contains two 4-cell 1.3 GHz TESLA-like superconducting radio frequency cavities, is a major component of this facility. The expected electron energy gain is 6-8 MeV with a field gradient of 8-10 MV/m. The design and fabrication of the linac module is complete. This paper discusses its assembly and results from cyromodule tests and beam commissioning. At 2 K, the cryomodule works smoothly and stably. Both cavities have achieved effective field gradients of 10 MV/m. In beam loading experiments, 8 MeV, 5 mA electron beams with an energy spread less than 0.2% have been produced, which satisfies our requirements.

Barriers to management of cardiovascular risk in a low-resource setting using hypertension as an entry point.

PubMed

Mendis, Shanthi; Abegunde, Dele; Oladapo, Olulola; Celletti, Francesca; Nordet, Porfirio

2004-01-01

Assess capacity of health-care facilities in a low-resource setting to implement the absolute risk approach for assessment of cardiovascular risk in hypertensive patients and effective management of hypertension. A descriptive cross-sectional study in Egbeda and Oluyole local government areas of Oyo State in Nigeria in 56 randomly selected primary- (n = 42) and secondary-level (n = 2) health-care and private health-care (n = 12) facilities. One thousand consecutive, known hypertensives attending the selected facilities for follow-up, and health-care providers working in the above randomly selected facilities, were interviewed. About two-thirds of hypertensives utilized primary-care centers both for diagnosis and for follow-up. Laboratory and other investigations to exclude secondary hypertension or to assess target organ damage were not available in the majority of facilities, particularly in primary care. A considerable knowledge and awareness gap related to hypertension and its complications was found, both among patients and health-care providers. Blood pressure control rates were poor (28% with systolic blood pressure (SBP) < 140 mmHg and diastolic blood pressure (DBP) < 90 mmHg] and drug prescription patterns were not evidence based and cost effective. The majority of patients (73%) in this low socio-economic group (mean monthly income 73 US dollars) had to pay fully, out of their own pocket, for consultations and medications. If the absolute risk approach for assessment of risk and effective management of hypertension is to be implemented in low-resource settings, appropriate policy measures need to be taken to improve the competency of health-care providers, to provide basic laboratory facilities and to develop affordable financing mechanisms.

Improving antimicrobial use among health workers in first-level facilities: results from the multi-country evaluation of the Integrated Management of Childhood Illness strategy.

PubMed Central

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

2004-01-01

OBJECTIVE: The objective of this study was to assess the effect of Integrated Management of Childhood Illness (IMCI) case management training on the use of antimicrobial drugs among health-care workers treating young children at first-level facilities. Antimicrobial drugs are an essential child-survival intervention. Ensuring that children younger than five who need these drugs receive them promptly and correctly can save their lives. Prescribing these drugs only when necessary and ensuring that those who receive them complete the full course can slow the development of antimicrobial resistance. METHODS: Data collected through observation-based surveys in randomly selected first-level health facilities in Brazil, Uganda and the United Republic of Tanzania were statistically analysed. The surveys were carried out as part of the multi-country evaluation of IMCI effectiveness, cost and impact (MCE). FINDINGS: Results from three MCE sites show that children receiving care from health workers trained in IMCI are significantly more likely to receive correct prescriptions for antimicrobial drugs than those receiving care from workers not trained in IMCI.They are also more likely to receive the first dose of the drug before leaving the health facility, to have their caregiver advised how to administer the drug, and to have caregivers who are able to describe correctly how to give the drug at home as they leave the health facility. CONCLUSIONS: IMCI case management training is an effective intervention to improve the rational use of antimicrobial drugs for sick children visiting first-level health facilities in low-income and middle-income countries. PMID:15508195

Determinants and trends in health facility-based deliveries and caesarean sections among married adolescent girls in Bangladesh.

PubMed

Shahabuddin, A S M; Delvaux, Thérèse; Utz, Bettina; Bardají, Azucena; De Brouwere, Vincent

2016-09-15

To identify the determinants and measure the trends in health facility-based deliveries and caesarean sections among married adolescent girls in Bangladesh. In order to measure the trends in health facility-based deliveries and caesarean sections, Bangladesh Demographic Health Survey (BDHS) data sets were analysed (BDHS; 1993-1994, 1996-1997, 1999-2000, 2004, 2007, 2011). The BDHS 2011 data sets were analysed to identify the determinants of health facility-based deliveries and caesarean sections. A total of 2813 adolescent girls (aged 10-19 years) were included for analysis. Bivariate and multivariate analyses were performed. Health facility-based deliveries have continuously increased among adolescents in Bangladesh over the past two decades from 3% in 1993-1994 to 24.5% in 2011. Rates of population-based and facility-based caesarean sections have increased linearly among all age groups of women including adolescents. Although the country's overall (population-based) caesarean section rate among adolescents was within acceptable range (11.6%), a rate of nearly 50% health facility level caesarean sections among adolescent girls is alarming. Among adolescent girls, use of antenatal care (ANC) appeared to be the most important predictor of health facility-based delivery (OR: 4.04; 95% CI 2.73 to 5.99), whereas the wealth index appeared as the most important predictor of caesarean sections (OR: 5.7; 95% CI 2.74 to 12.1). Maternal health-related interventions should be more targeted towards adolescent girls in order to encourage them to access ANC and promote health facility-based delivery. Rising trends of caesarean sections require further investigation on indication and provider-client-related determinants of these interventions among adolescent girls in Bangladesh. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Examining the potential role of a supervised injection facility in Saskatoon, Saskatchewan, to avert HIV among people who inject drugs

PubMed Central

Jozaghi, Ehsan; Jackson, Asheka

2015-01-01

Background: Research predicting the public health and fiscal impact of Supervised Injection Facilities (SIFs), across different cities in Canada, has reported positive results on the reduction of HIV cases among People Who Inject Drugs (PWID). Most of the existing studies have focused on the outcomes of Insite, located in the Vancouver Downtown Eastside (DTES). Previous attention has not been afforded to other affected areas of Canada. The current study seeks to address this deficiency by assessing the cost-effectiveness of opening a SIF in Saskatoon, Saskatchewan. Methods: We used two different mathematical models commonly used in the literature, including sensitivity analyses, to estimate the number of HIV infections averted due to the establishment of a SIF in the city of Saskatoon, Saskatchewan. Results: Based on cumulative cost-effectiveness results, SIF establishment is cost-effective. The benefit to cost ratio was conservatively estimated to be 1.35 for the first two potential facilities. The study relied on 34% and 14% needle sharing rates for sensitivity analyses. The result for both sensitivity analyses and the base line estimates indicated positive prospects for the establishment of a SIF in Saskatoon. Conclusion: The opening of a SIF in Saskatoon, Saskatchewan is financially prudent in the reduction of tax payers’ expenses and averting HIV infection rates among PWID PMID:26029896

Using PACS and wavelet-based image compression in a wide-area network to support radiation therapy imaging applications for satellite hospitals

NASA Astrophysics Data System (ADS)

Smith, Charles L.; Chu, Wei-Kom; Wobig, Randy; Chao, Hong-Yang; Enke, Charles

1999-07-01

An ongoing PACS project at our facility has been expanded to include providing and managing images used for routine clinical operation of the department of radiation oncology. The intent of our investigation has been to enable out clinical radiotherapy service to enter the tele-medicine environment through the use of a PACS system initially implemented in the department of radiology. The backbone for the imaging network includes five CT and three MR scanners located across three imaging centers. A PC workstation in the department of radiation oncology was used to transmit CT imags to a satellite facility located approximately 60 miles from the primary center. Chest CT images were used to analyze network transmission performance. Connectivity established between the primary department and satellite has fulfilled all image criteria required by the oncologist. Establishing the link tot eh oncologist at the satellite diminished bottlenecking of imaging related tasks at the primary facility due to physician absence. A 30:1 compression ratio using a wavelet-based algorithm provided clinically acceptable images treatment planning. Clinical radiotherapy images can be effectively managed in a wide- area-network to link satellite facilities to larger clinical centers.

Availability and utilization of obstetric and newborn care in Guinea: A national needs assessment.

PubMed

Baguiya, Adama; Meda, Ivlabèhiré Bertrand; Millogo, Tieba; Kourouma, Mamadou; Mouniri, Halima; Kouanda, Seni

2016-11-01

To assess the availability and utilization of emergency obstetric and neonatal care (EmONC) in Guinea given the high maternal and neonatal mortality rates. We used the Guinea 2012 needs assessment data collected via a national cross-sectional census of health facilities conducted from September to October 2012. All public, private, and faith-based health facilities that performed at least one delivery during the period of the study were included. A total of 502 health facilities were visited, of which 81 were hospitals. Only 15 facilities were classified as fully functioning EmONC facilities, all of which were reference hospitals. None of the first level health facilities were fully functioning EmONC facilities. The ratio of availability of EmONC was one fully functioning EmONC facility for 745 415 inhabitants. The institutional delivery rate was 32.3% and the proportion of all births in EmONC facilities was 7.1%. Met need for EmONC was 12.2%. Among 201 maternal deaths in EmONC facilities, 69 were due to indirect causes. The intrapartum and very early neonatal death rate was 39 deaths per 1000 live births. The study showed low availability of EmONC services and underutilization of the available services. Further investigation is needed to evaluate the effect of the current policy of user fees exemption for deliveries and prenatal care in Guinea. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Nursing home case-mix reimbursement in Mississippi and South Dakota.

PubMed

Arling, Greg; Daneman, Barry

2002-04-01

To evaluate the effects of nursing home case-mix reimbursement on facility case mix and costs in Mississippi and South Dakota. Secondary data from resident assessments and Medicaid cost reports from 154 Mississippi and 107 South Dakota nursing facilities in 1992 and 1994, before and after implementation of new case-mix reimbursement systems. The study relied on a two-wave panel design to examine case mix (resident acuity) and direct care costs in 1-year periods before and after implementation of a nursing home case-mix reimbursement system. Cross-lagged regression models were used to assess change in case mix and costs between periods while taking into account facility characteristics. Facility-level measures were constructed from Medicaid cost reports and Minimum Data Set-Plus assessment records supplied by each state. Resident case mix was based on the RUG-III classification system. Facility case-mix scores and direct care costs increased significantly between periods in both states. Changes in facility costs and case mix were significantly related in a positive direction. Medicare utilization and the rate of hospitalizations from the nursing facility also increased significantly between periods, particularly in Mississippi. The case-mix reimbursement systems appeared to achieve their intended goals: improved access for heavy-care residents and increased direct care expenditures in facilities with higher acuity residents. However, increases in Medicare utilization may have influenced facility case mix or costs, and some facilities may have been unprepared to care for higher acuity residents, as indicated by increased rates of hospitalization.

Do Hospital-Owned Skilled Nursing Facilities Provide Better Post-Acute Care Quality?

PubMed Central

Norton, Edward C.; Grabowski, David C.

2016-01-01

As hospitals are increasingly held accountable for patients' post-discharge outcomes under new payment models, hospitals may choose to acquire skilled nursing facilities (SNFs) to better manage these outcomes. This raises the question of whether patients discharged to hospital-based SNFs have better outcomes. In unadjusted comparisons, hospital-based SNF patients have much lower Medicare utilization in the 180 days following discharge relative to freestanding SNF patients. We solved the problem of differential selection into hospital-based and freestanding SNFs by using differential distance from home to the nearest hospital with a SNF relative to the distance from home to the nearest hospital without a SNF as an instrument. We found that hospital-based SNF patients spent roughly 5 more days in the community and 6 fewer days in the SNF in the 180 days following their original hospital discharge with no significant effect on mortality or hospital readmission. PMID:27661738

D-Side: A Facility and Workforce Planning Group Multi-criteria Decision Support System for Johnson Space Center

NASA Technical Reports Server (NTRS)

Tavana, Madjid

2005-01-01

"To understand and protect our home planet, to explore the universe and search for life, and to inspire the next generation of explorers" is NASA's mission. The Systems Management Office at Johnson Space Center (JSC) is searching for methods to effectively manage the Center's resources to meet NASA's mission. D-Side is a group multi-criteria decision support system (GMDSS) developed to support facility decisions at JSC. D-Side uses a series of sequential and structured processes to plot facilities in a three-dimensional (3-D) graph on the basis of each facility alignment with NASA's mission and goals, the extent to which other facilities are dependent on the facility, and the dollar value of capital investments that have been postponed at the facility relative to the facility replacement value. A similarity factor rank orders facilities based on their Euclidean distance from Ideal and Nadir points. These similarity factors are then used to allocate capital improvement resources across facilities. We also present a parallel model that can be used to support decisions concerning allocation of human resources investments across workforce units. Finally, we present results from a pilot study where 12 experienced facility managers from NASA used D-Side and the organization's current approach to rank order and allocate funds for capital improvement across 20 facilities. Users evaluated D-Side favorably in terms of ease of use, the quality of the decision-making process, decision quality, and overall value-added. Their evaluations of D-Side were significantly more favorable than their evaluations of the current approach. Keywords: NASA, Multi-Criteria Decision Making, Decision Support System, AHP, Euclidean Distance, 3-D Modeling, Facility Planning, Workforce Planning.

Mitigating disrespect and abuse during childbirth in Tanzania: an exploratory study of the effects of two facility-based interventions in a large public hospital.

PubMed

Ratcliffe, Hannah L; Sando, David; Lyatuu, Goodluck Willey; Emil, Faida; Mwanyika-Sando, Mary; Chalamilla, Guerino; Langer, Ana; McDonald, Kathleen P

2016-07-18

There is emerging evidence that disrespect and abuse (D&A) during facility-based childbirth is prevalent in countries throughout the world and a barrier to achieving good maternal health outcomes. However, much work remains in the identification of effective interventions to prevent and eliminate D&A during facility-based childbirth. This paper describes an exploratory study conducted in a large referral hospital in Dar es Salaam, Tanzania that sought to measure D&A, introduce a package of interventions to reduce its incidence, and evaluate their effectiveness. After extensive consultation with critical constituencies, two discrete interventions were implemented: (1) Open Birth Days (OBD), a birth preparedness and antenatal care education program, and (2) a workshop for healthcare providers based on the Health Workers for Change curriculum. Each intervention was designed to increase knowledge of patient rights and birth preparedness; increase and improve patient-provider and provider-administrator communication; and improve women's experience and provider attitudes. The effects of the interventions were assessed using a pre-post design and a range of tools: pre-post questionnaires for OBD participants and pre-post questionnaires for workshop participants; structured interviews with healthcare providers and administrators; structured interviews with women who gave birth at the study facility; and direct observations of patient-provider interactions during labor and delivery. Comparisons before and after the interventions showed an increase in patient and provider knowledge of user rights across multiple dimensions, as well as women's knowledge of the labor and delivery process. Women reported feeling better prepared for delivery and provider attitudes towards them improved, with providers reporting higher levels of empathy for the women they serve and better interpersonal relationships. Patients and providers reported improved communication, which direct observations confirmed. Additionally, women reported feeling more empowered and confident during delivery. Provider job satisfaction increased substantially from baseline levels, as did user reports of satisfaction and perceptions of care quality. Collectively, the outcomes of this study indicate that the tested interventions have the potential to be successful in promoting outcomes that are prerequisite to reducing disrespect and abuse. However, a more rigorous evaluation is needed to determine the full impact of these interventions.

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

ERIC Educational Resources Information Center

Center for Population Options, Washington, DC.

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

Atomic oxygen interaction with spacecraft materials: Relationship between orbital and ground-based testing for materials certification

NASA Technical Reports Server (NTRS)

Cross, Jon B.; Koontz, Steven L.; Lan, Esther H.

1993-01-01

The effects of atomic oxygen on boron nitride (BN), silicon nitride (Si3N4), Intelsat 6 solar cell interconnects, organic polymers, and MoS2 and WS2 dry lubricant, were studied in Low Earth Orbit (LEO) flight experiments and in a ground based simulation facility. Both the inflight and ground based experiments employed in situ electrical resistance measurements to detect penetration of atomic oxygen through materials and Electron Spectroscopy for Chemical Analysis (ESCA) analysis to measure chemical composition changes. Results are given. The ground based results on the materials studied to date show good qualitative correlation with the LEO flight results, thus validating the simulation fidelity of the ground based facility in terms of reproducing LEO flight results. In addition it was demonstrated that ground based simulation is capable of performing more detailed experiments than orbital exposures can presently perform. This allows the development of a fundamental understanding of the mechanisms involved in the LEO environment degradation of materials.

Dose equivalent rate constants and barrier transmission data for nuclear medicine facility dose calculations and shielding design.

PubMed

Kusano, Maggie; Caldwell, Curtis B

2014-07-01

A primary goal of nuclear medicine facility design is to keep public and worker radiation doses As Low As Reasonably Achievable (ALARA). To estimate dose and shielding requirements, one needs to know both the dose equivalent rate constants for soft tissue and barrier transmission factors (TFs) for all radionuclides of interest. Dose equivalent rate constants are most commonly calculated using published air kerma or exposure rate constants, while transmission factors are most commonly calculated using published tenth-value layers (TVLs). Values can be calculated more accurately using the radionuclide's photon emission spectrum and the physical properties of lead, concrete, and/or tissue at these energies. These calculations may be non-trivial due to the polyenergetic nature of the radionuclides used in nuclear medicine. In this paper, the effects of dose equivalent rate constant and transmission factor on nuclear medicine dose and shielding calculations are investigated, and new values based on up-to-date nuclear data and thresholds specific to nuclear medicine are proposed. To facilitate practical use, transmission curves were fitted to the three-parameter Archer equation. Finally, the results of this work were applied to the design of a sample nuclear medicine facility and compared to doses calculated using common methods to investigate the effects of these values on dose estimates and shielding decisions. Dose equivalent rate constants generally agreed well with those derived from the literature with the exception of those from NCRP 124. Depending on the situation, Archer fit TFs could be significantly more accurate than TVL-based TFs. These results were reflected in the sample shielding problem, with unshielded dose estimates agreeing well, with the exception of those based on NCRP 124, and Archer fit TFs providing a more accurate alternative to TVL TFs and a simpler alternative to full spectral-based calculations. The data provided by this paper should assist in improving the accuracy and tractability of dose and shielding calculations for nuclear medicine facility design.

Towards deriving Ni-rich cathode and oxide-based anode materials from hydroxides by sharing a facile co-precipitation method.

PubMed

Qiu, Haifa; Du, Tengfei; Wu, Junfeng; Wang, Yonglong; Liu, Jian; Ye, Shihai; Liu, Sheng

2018-05-22

Although intensive studies have been conducted on layered transition metal oxide(TMO)-based cathode materials and metal oxide-based anode materials for Li-ion batteries, their precursors generally follow different or even complex synthesis routes. To share one route for preparing precursors of the cathode and anode materials, herein, we demonstrate a facile co-precipitation method to fabricate Ni-rich hydroxide precursors of Ni0.8Co0.1Mn0.1(OH)2. Ni-rich layered oxide of LiNi0.8Co0.1Mn0.1O2 is obtained by lithiation of the precursor in air. An NiO-based anode material is prepared by calcining the precursor or multi-walled carbon nanotubes (MWCNTs) incorporated precursors. The pre-addition of ammonia solution can simplify the co-precipitation procedures and the use of an air atmosphere can also make the heat treatment facile. LiNi0.8Co0.1Mn0.1O2 as the cathode material delivers a reversible capacity of 194 mA h g-1 at 40 mA g-1 and a notable cycling retention of 88.8% after 100 cycles at 200 mA g-1. This noticeable performance of the cathode arises from a decent particle morphology and high crystallinity of the layered oxides. As the anode material, the MWCNTs-incorporated oxides deliver a much higher reversible capacity of 811.1 mA h g-1 after 200 cycles compared to the pristine oxides without MWCNTs. The improvement on electrochemical performance can be attributed to synergistic effects from MWCNTs incorporation, including reinforced electronic conductivity, rich meso-pores and an alleviated volume effect. This facile and sharing method may offer an integrated and economical approach for commercial production of Ni-rich electrode materials for Li-ion batteries.

Characterization of in-flight performance of ion propulsion systems

NASA Astrophysics Data System (ADS)

Sovey, James S.; Rawlin, Vincent K.

1993-06-01

In-flight measurements of ion propulsion performance, ground test calibrations, and diagnostic performance measurements were reviewed. It was found that accelerometers provided the most accurate in-flight thrust measurements compared with four other methods that were surveyed. An experiment has also demonstrated that pre-flight alignment of the thrust vector was sufficiently accurate so that gimbal adjustments and use of attitude control thrusters were not required to counter disturbance torques caused by thrust vector misalignment. The effects of facility background pressure, facility enhanced charge-exchange reactions, and contamination on ground-based performance measurements are also discussed. Vacuum facility pressures for inert-gas ion thruster life tests and flight qualification tests will have to be less than 2 mPa to ensure accurate performance measurements.

Characterization of in-flight performance of ion propulsion systems

NASA Technical Reports Server (NTRS)

Sovey, James S.; Rawlin, Vincent K.

1993-01-01

In-flight measurements of ion propulsion performance, ground test calibrations, and diagnostic performance measurements were reviewed. It was found that accelerometers provided the most accurate in-flight thrust measurements compared with four other methods that were surveyed. An experiment has also demonstrated that pre-flight alignment of the thrust vector was sufficiently accurate so that gimbal adjustments and use of attitude control thrusters were not required to counter disturbance torques caused by thrust vector misalignment. The effects of facility background pressure, facility enhanced charge-exchange reactions, and contamination on ground-based performance measurements are also discussed. Vacuum facility pressures for inert-gas ion thruster life tests and flight qualification tests will have to be less than 2 mPa to ensure accurate performance measurements.

Low Earth orbital atomic oxygen environmental simulation facility for space materials evaluation

NASA Technical Reports Server (NTRS)

Stidham, Curtis R.; Banks, Bruce A.; Stueber, Thomas J.; Dever, Joyce A.; Rutledge, Sharon K.; Bruckner, Eric J.

1993-01-01

Simulation of low Earth orbit atomic oxygen for accelerated exposure in ground-based facilities is necessary for the durability evaluation of space power system component materials for Space Station Freedom (SSF) and future missions. A facility developed at the National Aeronautics and Space Administrations's (NASA) Lewis Research Center provides accelerated rates of exposure to a directed or scattered oxygen beam, vacuum ultraviolet (VUV) radiation, and offers in-situ optical characterization. The facility utilizes an electron-cyclotron resonance (ECR) plasma source to generate a low energy oxygen beam. Total hemispherical spectral reflectance of samples can be measured in situ over the wavelength range of 250 to 2500 nm. Deuterium lamps provide VUV radiation intensity levels in the 115 to 200 nm range of three to five equivalent suns. Retarding potential analyses show distributed ion energies below 30 electron volts (eV) for the operating conditions most suited for high flux, low energy testing. Peak ion energies are below the sputter threshold energy (approximately 30 eV) of the protective coatings on polymers that are evaluated in the facility, thus allowing long duration exposure without sputter erosion. Neutral species are expected to be at thermal energies of approximately .04 eV to .1 eV. The maximum effective flux level based on polyimide Kapton mass loss is 4.4 x 10 exp 6 atoms/((sq. cm)*s), thus providing a highly accelerated testing capability.

Gravitational Biology Facility on Space Station: Meeting the needs of space biology

NASA Technical Reports Server (NTRS)

Allen, Katherine; Wade, Charles

1992-01-01

The Gravitational Biology Facility (GBF) is a set of generic laboratory equipment needed to conduct research on Space Station Freedom (SSF), focusing on Space Biology Program science (Cell and Developmental Biology and Plant Biology). The GBF will be functional from the earliest utilization flights through the permanent manned phase. Gravitational biology research will also make use of other Life Sciences equipment on the space station as well as existing equipment developed for the space shuttle. The facility equipment will be developed based on requirements derived from experiments proposed by the scientific community to address critical questions in the Space Biology Program. This requires that the facility have the ability to house a wide variety of species, various methods of observation, and numerous methods of sample collection, preservation, and storage. The selection of the equipment will be done by the members of a scientific working group (5 members representing cell biology, 6 developmental biology, and 6 plant biology) who also provide requirements to design engineers to ensure that the equipment will meet scientific needs. All equipment will undergo extensive ground based experimental validation studies by various investigators addressing a variety of experimental questions. Equipment will be designed to be adaptable to other space platforms. The theme of the Gravitational Biology Facility effort is to provide optimal and reliable equipment to answer the critical questions in Space Biology as to the effects of gravity on living systems.

Facility-based delivery in the context of Zimbabwe's HIV epidemic--missed opportunities for improving engagement with care: a community-based serosurvey.

PubMed

Buzdugan, Raluca; McCoy, Sandra I; Webb, Karen; Mushavi, Angela; Mahomva, Agnes; Padian, Nancy S; Cowan, Frances M

2015-12-17

In developing countries, facility-based delivery is recommended for maternal and neonatal health, and for prevention of mother-to-child HIV transmission (PMTCT). However, little is known about whether or not learning one's HIV status affects one's decision to deliver in a health facility. We examined this association in Zimbabwe. We analyzed data from a 2012 cross-sectional community-based serosurvey conducted to evaluate Zimbabwe's accelerated national PMTCT program. Eligible women (≥16 years old and mothers of infants born 9-18 months before the survey) were randomly sampled from the catchment areas of 157 health facilities in five of ten provinces. Participants were interviewed about where they delivered and provided blood samples for HIV testing. Overall 8796 (77 %) mothers reported facility-based delivery; uptake varied by community (30-100%). The likelihood of facility-based delivery was not associated with maternal HIV status. Women who self-reported being HIV-positive before delivery were as likely to deliver in a health facility as women who were HIV-negative, irrespective of when they learned their status - before (adjusted prevalence ratio (PRa) = 1.04, 95% confidence interval (CI) = 1.00-1.09) or during pregnancy (PRa = 1.05, 95% CI = 1.01-1.09). Mothers who had not accessed antenatal care or tested for HIV were most likely to deliver outside a health facility (69%). Overall, however 77% of home deliveries occurred among women who had accessed antenatal care and were HIV-tested. Uptake of facility-based delivery was similar among HIV-infected and HIV-uninfected mothers, which was somewhat unexpected given the substantial technical and financial investment aimed at retaining HIV-positive women in care in Zimbabwe.

Proton Radiation Therapy in the Hospital Environment: Conception, Development, and Operation of the Initial Hospital-Based Facility

NASA Astrophysics Data System (ADS)

Slater, James M.; Slater, Jerry D.; Wroe, Andrew J.

The world's first hospital-based proton treatment center opened at Loma Linda University Medical Center in 1990, following two decades of development. Patients' needs were the driving force behind its conception, development, and execution; the primary needs were delivery of effective conformal doses of ionizing radiation and avoidance of normal tissue to the maximum extent possible. The facility includes a proton synchrotron and delivery system developed in collaboration with physicists and engineers at Fermi National Accelerator Laboratory and from other high-energy-physics laboratories worldwide. The system, operated and maintained by Loma Linda personnel, was designed to be safe, reliable, flexible in utilization, efficient in use, and upgradeable to meet demands of changing patient needs and advances in technology. Since the facility opened, nearly 14,000 adults and children have been treated for a wide range of cancers and other diseases. Ongoing research is expanding the applications of proton therapy, while reducing costs.

High Performance Solid Polymer Electrolytes for Rechargeable Batteries: A Self‐Catalyzed Strategy toward Facile Synthesis

PubMed Central

Cui, Yanyan; Liang, Xinmiao; Chai, Jingchao; Cui, Zili; Wang, Qinglei; He, Weisheng; Liu, Xiaochen; Feng, Jiwen

2017-01-01

Abstract It is urgent to seek high performance solid polymer electrolytes (SPEs) via a facile chemistry and simple process. The lithium salts are composed of complex anions that are stabilized by a Lewis acid agent. This Lewis acid can initiate the ring opening polymerization. Herein, a self‐catalyzed strategy toward facile synthesis of crosslinked poly(ethylene glycol) diglycidyl ether‐based solid polymer electrolyte (C‐PEGDE) is presented. It is manifested that the poly(ethylene glycol) diglycidyl ether‐based solid polymer electrolyte possesses a superior electrochemical stability window up to 4.5 V versus Li/Li+ and considerable ionic conductivity of 8.9 × 10−5 S cm−1 at ambient temperature. Moreover, the LiFePO4/C‐PEGDE/Li batteries deliver stable charge/discharge profiles and considerable rate capability. It is demonstrated that this self‐catalyzed strategy can be a very effective approach for high performance solid polymer electrolytes. PMID:29201612

Changing the role of traditional birth attendants in Yirol West County, South Sudan.

PubMed

Wilunda, Calistus; Dall'Oglio, Giovanni; Scanagatta, Chiara; Segafredo, Giulia; Lukhele, Bhekumusa Wellington; Takahashi, Risa; Putoto, Giovanni; Manenti, Fabio; Betrán, Ana Pilar

2017-01-01

Effective from May 2014, community-based traditional birth attendants (TBAs) in Yirol West County, South Sudan, were directed to start referring all women in labour to health facilities for childbirth instead of assisting them in the villages. This study aimed to understand the degree of integration of TBAs in the health system, to reveal the factors influencing the integration, and to explore the perceived solutions to the challenges faced by TBAs. A qualitative study utilising 11 focus group discussions with TBAs, 6 focus group discussions with women, and 18 key informant interviews with members of village health committees, staff of health facilities, and staff of the County Health Department was conducted. Data were analysed using qualitative content analysis. The study found that many TBAs were referring women to health facilities for delivery, but some were still attending to deliveries at home. Facilitators of the adoption of the new role by TBAs were: acceptance of the new TBAs' role by the community, women and TBAs, perceptions about institutional childbirth and risks of home childbirth, personal commitment and motivation by some TBAs, a good working relationship between community-based TBAs and health facility staff, availability of incentives for women at health facilities, and training of TBAs. Challenges of integrating TBAs in the health system included, among others, communication problems between TBAs and health care facilities, delays in seeking care by women, insecurity, lack of materials and supplies for TBAs, health system constraints, insufficient incentives for TBAs, long distances to health facilities and transportation problems. This study has revealed encouraging developments in TBAs' integration in the formal health system in Yirol West. However, there is need to address the challenges faced by TBAs in assuming their new role in order to sustain the integration.

Changing the role of traditional birth attendants in Yirol West County, South Sudan

PubMed Central

Dall’Oglio, Giovanni; Scanagatta, Chiara; Segafredo, Giulia; Lukhele, Bhekumusa Wellington; Takahashi, Risa; Putoto, Giovanni; Manenti, Fabio; Betrán, Ana Pilar

2017-01-01

Effective from May 2014, community-based traditional birth attendants (TBAs) in Yirol West County, South Sudan, were directed to start referring all women in labour to health facilities for childbirth instead of assisting them in the villages. This study aimed to understand the degree of integration of TBAs in the health system, to reveal the factors influencing the integration, and to explore the perceived solutions to the challenges faced by TBAs. A qualitative study utilising 11 focus group discussions with TBAs, 6 focus group discussions with women, and 18 key informant interviews with members of village health committees, staff of health facilities, and staff of the County Health Department was conducted. Data were analysed using qualitative content analysis. The study found that many TBAs were referring women to health facilities for delivery, but some were still attending to deliveries at home. Facilitators of the adoption of the new role by TBAs were: acceptance of the new TBAs’ role by the community, women and TBAs, perceptions about institutional childbirth and risks of home childbirth, personal commitment and motivation by some TBAs, a good working relationship between community-based TBAs and health facility staff, availability of incentives for women at health facilities, and training of TBAs. Challenges of integrating TBAs in the health system included, among others, communication problems between TBAs and health care facilities, delays in seeking care by women, insecurity, lack of materials and supplies for TBAs, health system constraints, insufficient incentives for TBAs, long distances to health facilities and transportation problems. This study has revealed encouraging developments in TBAs’ integration in the formal health system in Yirol West. However, there is need to address the challenges faced by TBAs in assuming their new role in order to sustain the integration. PMID:29095824

Maternal residential proximity to nuclear facilities and low birth weight in offspring in Texas.

PubMed

Gong, Xi; Benjamin Zhan, F; Lin, Yan

2017-03-01

Health effects of close residential proximity to nuclear facilities have been a concern for both the general public and health professionals. Here, a study is reported examining the association between maternal residential proximity to nuclear facilities and low birth weight (LBW) in offspring using data from 1996 through 2008 in Texas, USA. A case-control study design was used together with a proximity-based model for exposure assessment. First, the LBW case/control births were categorized into multiple proximity groups based on distances between their maternal residences and nuclear facilities. Then, a binary logistic regression model was used to examine the association between maternal residential proximity to nuclear facilities and low birth weight in offspring. The odds ratios were adjusted for birth year, public health region of maternal residence, child's sex, gestational weeks, maternal age, education, and race/ethnicity. In addition, sensitivity analyses were conducted for the model. Compared with the reference group (more than 50 km from a nuclear facility), the exposed groups did not show a statistically significant increase in LBW risk [adjusted odds ratio (aOR) 0.91 (95% confidence interval (CI): 0.81, 1.03) for group 40-50 km; aOR 0.98 (CI 0.84, 1.13) for group 30-40 km; aOR 0.95 (CI 0.79, 1.15) for group 20-30 km; aOR 0.86 (CI 0.70, 1.04) for group 10-20 km; and aOR 0.98 (CI 0.59, 1.61) for group 0-10 km]. These results were also confirmed by results of the sensitivity analyses. The results suggest that maternal residential proximity to nuclear facilities is not a significant factor for LBW in offspring.

Concept design theory and model for multi-use space facilities: Analysis of key system design parameters through variance of mission requirements

NASA Astrophysics Data System (ADS)

Reynerson, Charles Martin

This research has been performed to create concept design and economic feasibility data for space business parks. A space business park is a commercially run multi-use space station facility designed for use by a wide variety of customers. Both space hardware and crew are considered as revenue producing payloads. Examples of commercial markets may include biological and materials research, processing, and production, space tourism habitats, and satellite maintenance and resupply depots. This research develops a design methodology and an analytical tool to create feasible preliminary design information for space business parks. The design tool is validated against a number of real facility designs. Appropriate model variables are adjusted to ensure that statistical approximations are valid for subsequent analyses. The tool is used to analyze the effect of various payload requirements on the size, weight and power of the facility. The approach for the analytical tool was to input potential payloads as simple requirements, such as volume, weight, power, crew size, and endurance. In creating the theory, basic principles are used and combined with parametric estimation of data when necessary. Key system parameters are identified for overall system design. Typical ranges for these key parameters are identified based on real human spaceflight systems. To connect the economics to design, a life-cycle cost model is created based upon facility mass. This rough cost model estimates potential return on investments, initial investment requirements and number of years to return on the initial investment. Example cases are analyzed for both performance and cost driven requirements for space hotels, microgravity processing facilities, and multi-use facilities. In combining both engineering and economic models, a design-to-cost methodology is created for more accurately estimating the commercial viability for multiple space business park markets.

Core components for effective infection prevention and control programmes: new WHO evidence-based recommendations.

PubMed

Storr, Julie; Twyman, Anthony; Zingg, Walter; Damani, Nizam; Kilpatrick, Claire; Reilly, Jacqui; Price, Lesley; Egger, Matthias; Grayson, M Lindsay; Kelley, Edward; Allegranzi, Benedetta

2017-01-01

Health care-associated infections (HAI) are a major public health problem with a significant impact on morbidity, mortality and quality of life. They represent also an important economic burden to health systems worldwide. However, a large proportion of HAI are preventable through effective infection prevention and control (IPC) measures. Improvements in IPC at the national and facility level are critical for the successful containment of antimicrobial resistance and the prevention of HAI, including outbreaks of highly transmissible diseases through high quality care within the context of universal health coverage. Given the limited availability of IPC evidence-based guidance and standards, the World Health Organization (WHO) decided to prioritize the development of global recommendations on the core components of effective IPC programmes both at the national and acute health care facility level, based on systematic literature reviews and expert consensus. The aim of the guideline development process was to identify the evidence and evaluate its quality, consider patient values and preferences, resource implications, and the feasibility and acceptability of the recommendations. As a result, 11 recommendations and three good practice statements are presented here, including a summary of the supporting evidence, and form the substance of a new WHO IPC guideline.

Effectiveness of the Home Based Life Saving Skills training by community health workers on knowledge of danger signs, birth preparedness, complication readiness and facility delivery, among women in Rural Tanzania.

PubMed

August, Furaha; Pembe, Andrea B; Mpembeni, Rose; Axemo, Pia; Darj, Elisabeth

2016-06-02

In spite of government efforts, maternal mortality in Tanzania is currently at more than 400 per 100,000 live births. Community-based interventions that encourage safe motherhood and improved health-seeking behaviour through acquiring knowledge on the danger signs and improving birth preparedness, and, ultimately, reduce maternal mortality, have been initiated in different parts of low-income countries. Our aim was to evaluate if the Home Based Life Saving Skills education by community health workers would improve knowledge of danger signs, birth preparedness and complication readiness and facility-based deliveries in a rural community in Tanzania. A quasi-experimental study design was used to evaluate the effectiveness of Home Based Life Saving Skills education to pregnant women and their families through a community intervention. An intervention district received training with routine care. A comparison district continued to receive routine antenatal care. A structured household questionnaire was used in order to gather information from women who had delivered a child within the last two years before the intervention. This questionnaire was used in both the intervention and comparison districts before and after the intervention. The net intervention effect was estimated using the difference between the differences in the intervention and control districts at baseline and endline. A total of 1,584 and 1,486 women were interviewed at pre-intervention and post intervention, respectively. We observed significant improvement of knowledge of three or more danger signs during pregnancy (15.2 % vs. 48.1 %) with a net intervention effect of 29.0 % (95 % CI: 12.8-36.2; p < .0001) compared to the comparison district. There was significant effect on the knowledge of three or more danger signs during childbirth (15.3 % vs. 43.1 %) with a net intervention effect of 18.3 % (95 % CI: 11.4-25.2; p < .0001) and postpartum for those mentioning three or more of the signs (8.8 % vs. 19.8 %) with net effect of 9.4 % (95 % CI: 6.4-15.7; p < .0001). Birth preparedness practice improved for those who made more than three actions (20.8 vs. 35.3 %) with a net intervention effect of 10.3 % (95 % CI: 10.3-20.3; p < .0001) between the intervention and control district at pre-intervention and post intervention. Utilisation of antenatal care with four visits improved significantly (43.4 vs. 67.8 %) with net effect of 25.3 % (95 % CI: 16.9-33.2; p < .0001), use of facility delivery improved in the intervention area (75.6 vs. 90.2 %; p = 0.0002) but there was no significant net effect 11.5 % (95 % CI: -5.1-39.6; p = 0.123) compared to comparison district. This study shows that a community-based intervention employing community health workers as teachers in delivering Home Based Life Saving Skills program to pregnant women and their families improved their knowledge of danger signs during pregnancy, childbirth and postpartum, preparedness for childbirth and increased deliveries at health facilities which employ skilled health workers in this rural community.

New spatial clustering-based models for optimal urban facility location considering geographical obstacles

NASA Astrophysics Data System (ADS)

Javadi, Maryam; Shahrabi, Jamal

2014-03-01

The problems of facility location and the allocation of demand points to facilities are crucial research issues in spatial data analysis and urban planning. It is very important for an organization or governments to best locate its resources and facilities and efficiently manage resources to ensure that all demand points are covered and all the needs are met. Most of the recent studies, which focused on solving facility location problems by performing spatial clustering, have used the Euclidean distance between two points as the dissimilarity function. Natural obstacles, such as mountains and rivers, can have drastic impacts on the distance that needs to be traveled between two geographical locations. While calculating the distance between various supply chain entities (including facilities and demand points), it is necessary to take such obstacles into account to obtain better and more realistic results regarding location-allocation. In this article, new models were presented for location of urban facilities while considering geographical obstacles at the same time. In these models, three new distance functions were proposed. The first function was based on the analysis of shortest path in linear network, which was called SPD function. The other two functions, namely PD and P2D, were based on the algorithms that deal with robot geometry and route-based robot navigation in the presence of obstacles. The models were implemented in ArcGIS Desktop 9.2 software using the visual basic programming language. These models were evaluated using synthetic and real data sets. The overall performance was evaluated based on the sum of distance from demand points to their corresponding facilities. Because of the distance between the demand points and facilities becoming more realistic in the proposed functions, results indicated desired quality of the proposed models in terms of quality of allocating points to centers and logistic cost. Obtained results show promising improvements of the allocation, the logistics costs and the response time. It can also be inferred from this study that the P2D-based model and the SPD-based model yield similar results in terms of the facility location and the demand allocation. It is noted that the P2D-based model showed better execution time than the SPD-based model. Considering logistic costs, facility location and response time, the P2D-based model was appropriate choice for urban facility location problem considering the geographical obstacles.

Progress towards implementation of ACT malaria case-management in public health facilities in the Republic of Sudan: a cluster-sample survey

PubMed Central

2012-01-01

Background Effective malaria case-management based on artemisinin-based combination therapy (ACT) and parasitological diagnosis is a major pillar within the 2007-2012 National Malaria Strategic Plan in the Sudan. Three years after the launch of the strategy a health facility survey was undertaken to evaluate case-management practices and readiness of the health facilities and health workers to implement a new malaria case-management strategy. Methods A cross-sectional, cluster sample survey was undertaken at public health facilities in 15 states of Sudan. Data were collected using quality-of-care assessment methods. The main outcomes were the proportions of facilities with ACTs and malaria diagnostics; proportions of health workers exposed to malaria related health systems support activities; and composite and individual indicators of case-management practices for febrile outpatients stratified by age, availability of ACTs and diagnostics, use of malaria diagnostics, and test result. Results We evaluated 244 facilities, 294 health workers and 1,643 consultations for febrile outpatients (425 < 5 years and 1,218 ≥ 5 years). Health facility and health worker readiness was variable: chloroquine was available at only 5% of facilities, 73% stocked recommended artesunate and sulfadoxine/pyrimethamine (AS+SP), 51% had the capacity to perform parasitological diagnosis, 53% of health workers had received in-service training on ACTs, 24% were trained in the use of malaria Rapid Diagnostic Tests, and 19% had received a supervisory visit including malaria case-management. At all health facilities 46% of febrile patients were parasitologically tested and 35% of patients were both, tested and treated according to test result. At facilities where AS+SP and malaria diagnostics were available 66% of febrile patients were tested and 51% were both, tested and treated according to test result. Among test positive patients 64% were treated with AS+SP but 24% were treated with artemether monotherapy. Among test negative patients only 17% of patients were treated for malaria. The majority of ACT dispensing and counseling practices were suboptimal. Conclusions Five years following change of the policy from chloroquine to ACTs and 3 years before the end of the new malaria strategic plan chloroquine was successfully phased out from public facilities in Sudan, however, an important gap remained in the availability of ACTs, diagnostic capacities and coverage with malaria case-management activities. The national scale-up of diagnostics, using the findings of this survey as well as future qualitative research, should present an opportunity not only to expand existing testing capacities but also to implement effective support interventions to bridge the health systems gaps and support corrective case-management measures, including the discontinuation of artemether monotherapy treatment. PMID:22221821

Removing user fees for basic health services: a pilot study and national roll-out in Afghanistan

PubMed Central

Steinhardt, Laura C; Aman, Iqbal; Pakzad, Iqbalshah; Kumar, Binay; Singh, Lakhwinder P; Peters, David H

2011-01-01

Background User fees for primary care tend to suppress utilization, and many countries are experimenting with fee removal. Studies show that additional inputs are needed after removing fees, although well-documented experiences are lacking. This study presents data on the effects of fee removal on facility quality and utilization in Afghanistan, based on a pilot experiment and subsequent nationwide ban on fees. Methods Data on utilization and observed structural and perceived overall quality of health care were compared from before-and-after facility assessments, patient exit interviews and catchment area household surveys from eight facilities where fees were removed and 14 facilities where fee levels remained constant, as part of a larger health financing pilot study from 2005 to 2007. After a national user fee ban was instituted in 2008, health facility administrative data were analysed to assess subsequent changes in utilization and quality. Results The pilot study analysis indicated that observed and perceived quality increased across facilities but did not differ by fee removal status. Difference-in-difference analysis showed that utilization at facilities previously charging both service and drug fees increased by 400% more after fee removal, prompting additional inputs from service providers, compared with facilities that previously only charged service fees or had no change in fees (P = 0.001). Following the national fee ban, visits for curative care increased significantly (P < 0.001), but institutional deliveries did not. Services typically free before the ban—immunization and antenatal care—had immediate increases in utilization but these were not sustained. Conclusion Both pilot and nationwide data indicated that curative care utilization increased following fee removal, without differential changes in quality. Concerns raised by non-governmental organizations, health workers and community leaders over the effects of lost revenue and increased utilization require continued effort to raise revenues, monitor health worker and patient perceptions, and carefully manage health facility performance. PMID:22027924

Preferences for working in rural clinics among trainee health professionals in Uganda: a discrete choice experiment.

PubMed

Rockers, Peter C; Jaskiewicz, Wanda; Wurts, Laura; Kruk, Margaret E; Mgomella, George S; Ntalazi, Francis; Tulenko, Kate

2012-07-23

Health facilities require teams of health workers with complementary skills and responsibilities to efficiently provide quality care. In low-income countries, failure to attract and retain health workers in rural areas reduces population access to health services and undermines facility performance, resulting in poor health outcomes. It is important that governments consider health worker preferences in crafting policies to address attraction and retention in underserved areas. We investigated preferences for job characteristics among final year medical, nursing, pharmacy, and laboratory students at select universities in Uganda. Participants were administered a cadre-specific discrete choice experiment that elicited preferences for attributes of potential job postings they were likely to pursue after graduation. Job attributes included salary, facility quality, housing, length of commitment, manager support, training tuition, and dual practice opportunities. Mixed logit models were used to estimate stated preferences for these attributes. Data were collected from 246 medical students, 132 nursing students, 50 pharmacy students and 57 laboratory students. For all student-groups, choice of job posting was strongly influenced by salary, facility quality and manager support, relative to other attributes. For medical and laboratory students, tuition support for future training was also important, while pharmacy students valued opportunities for dual practice. In Uganda, financial and non-financial incentives may be effective in attracting health workers to underserved areas. Our findings contribute to mounting evidence that salary is not the only important factor health workers consider when deciding where to work. Better quality facilities and supportive managers were important to all students. Similarities in preferences for these factors suggest that team-based, facility-level strategies for attracting health workers may be appropriate. Improving facility quality and training managers to be more supportive of facility staff may be particularly cost-effective, as investments are borne once while benefits accrue to a range of health workers at the facility.

Fire safety of ground-based space facilities on the spaceport ;Vostochny;

NASA Astrophysics Data System (ADS)

Artamonov, Vladimir S.; Gordienko, Denis M.; Melikhov, Anatoly S.

2017-06-01

The facilities of the spaceport ;Vostochny; and the innovative technologies for fire safety to be implemented are considered. The planned approaches and prospects for fire safety ensuring at the facilities of the spaceport ;Vostochny; are presented herein, based on the study of emergency situations having resulted in fire accidents and explosion cases at the facilities supporting space vehicles operation.

Facile solid-state synthesis of highly dispersed Cu nanospheres anchored on coal-based activated carbons as an efficient heterogeneous catalyst for the reduction of 4-nitrophenol

NASA Astrophysics Data System (ADS)

Wang, Shan; Gao, Shasha; Tang, Yakun; Wang, Lei; Jia, Dianzeng; Liu, Lang

2018-04-01

Coal-based activated carbons (AC) were acted as the support, Cu/AC catalysts were synthesized by a facile solid-state reaction combined with subsequent heat treatment. In Cu/AC composites, highly dispersed Cu nanospheres were anchored on AC. The catalytic activity for 4-nitrophenol (4-NP) was investigated, the effects of activation temperature and copper loading on the catalytic performance were studied. The catalysts exhibited very high catalytic activity and moderate chemical stability due to the unique characteristics of the particle-assembled nanostructures, the high surface area and the porous structure of coal-based AC and the good dispersion of metal particles. Design and preparation of non-noble metal composite catalysts provide a new direction for improving the added value of coal.

US-Russian Cooperation in Upgrading MC&A System at Rosatom Facilities: Measurement of Nuclear Materials

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

Powell, Danny H; Jensen, Bruce A

2011-01-01

Improve protection of weapons-usable nuclear material from theft or diversion through the development and support of a nationwide sustainable and effective Material Control and Accountability (MC&A) program based on material measurement. The material protection, control, and accountability (MPC&A) cooperation has yielded significant results in implementing MC&A measurements at Russian nuclear facilities: (1) Establishment of MEM WG and MEMS SP; (2) Infrastructure for development, certification, and distribution of RMs; and (3) Coordination on development and implementation of MMs.

Effect of an Education Presentation On the Knowledge and Awareness of Urinary Tract Infection among Non-Licensed and Licensed Health Care Workers in Long-Term Care Facilities.

PubMed

Freeman-Jobson, Jennifer H; Rogers, Jamie L; Ward-Smith, Peggy

2016-01-01

This article presents the findings of a pre-test, post-test quality improvement project that describes the change in knowledge from prior to and following an evidence-based education presentation. The presentation addressed the clinical symptoms, diagnostic processes, interventions, and responsibilities of licensed and unlicensed health care workers employed in long-term care facilities related to prevention and detection of non-catheter-related urinary tract infections. Results indicate that the education presentation improved knowledge in specific.

Analysis of the X-ray emission spectra of copper, germanium and rubidium plasmas produced at the Phelix laser facility

NASA Astrophysics Data System (ADS)

Comet, M.; Pain, J.-C.; Gilleron, F.; Piron, R.; Denis-Petit, D.; Méot, V.; Gosselin, G.; Morel, P.; Hannachi, F.; Gobet, F.; Tarisien, M.; Versteegen, M.

2017-03-01

We present the analysis of X-ray emission spectra of copper, germanium and rubidium plasmas measured at the Phelix laser facility. The laser intensity was around 6×1014 W.cm-2. The analysis is based on the hypothesis of an homogeneous plasma in local thermodynamic equilibrium using an effective temperature. This temperature is deduced from hydrodynamic simulations and collisional-radiative computations. Spectra are then calculated using the LTE opacity codes OPAMCDF and SCO-RCG and compared to experimental data.

Improving Long-Term Care Facility Disaster Preparedness and Response: A Literature Review.

PubMed

Pierce, J Rush; Morley, Sarah K; West, Theresa A; Pentecost, Percy; Upton, Lori A; Banks, Laura

2017-02-01

Long-term care facilities (LTCFs) and their residents are especially susceptible to disruptions associated with natural disasters and often have limited experience and resources for disaster planning and response. Previous reports have offered disaster planning and response recommendations. We could not find a comprehensive review of studied interventions or facility attributes that affect disaster outcomes in LTCFs and their residents. We reviewed articles published from 1974 through September 30, 2015, that studied disaster characteristics, facility characteristics, patient characteristics, or an intervention that affected outcomes for LTCFs experiencing or preparing for a disaster. Twenty-one articles were included in the review. All of the articles fell into 1 of the following categories: facility or disaster characteristics that predicted preparedness or response, interventions to improve preparedness, and health effects of disaster response, most often related to facility evacuation. All of the articles described observational studies that were heterogeneous in design and metrics. We believe that the evidence-based literature supports 6 specific recommendations for facilities, governmental agencies, health care communities and academia. These include integrated and coordinated disaster planning, staff training, careful consideration before governments order mandatory evacuations, anticipation of the increased medical needs of LTCF residents following a disaster, and the need for more outcomes research. (Disaster Med Public Health Preparedness. 2017;11:140-149).

Environmental Assessment of the General Plan and Maintenance of Patrick Air Force Base, Florida

DTIC Science & Technology

2012-07-17

water consumption . Per the National Energy Conservation Policy Act, sustainable design principles and life-cycle cost- effective technologies will...attached EA concluded that no significant adverse effects will result. No significant adverse cumulative impacts will result from activities associated...resources will be considered an adverse effect , however, sufficient documentation had been received for Facilities 1322, 1327, 1330, 1425, 1432, 1437 and

Taking stock: protocol for evaluating a family planning supply chain intervention in Senegal.

PubMed

Cavallaro, Francesca L; Duclos, Diane; Baggaley, Rebecca F; Penn-Kekana, Loveday; Goodman, Catherine; Vahanian, Alice; Santos, Andreia C; Bradley, John; Paintain, Lucy; Gallien, Jérémie; Gasparrini, Antonio; Hasselback, Leah; Lynch, Caroline A

2016-04-21

In Senegal, only 12% of women of reproductive age in union (WRAU) were using contraceptives and another 29% had an unmet need for contraceptives in 2010-11. One potential barrier to accessing contraceptives is the lack of stock availability in health facilities where women seek them. Multiple supply chain interventions have been piloted in low- and middle-income countries with the aim of improving contraceptive availability in health facilities. However, there is limited evidence on the effect of these interventions on contraceptive availability in facilities, and in turn on family planning use in the population. This evaluation protocol pertains to a supply chain intervention using performance-based contracting for contraceptive distribution that was introduced throughout Senegal between 2012 and 2015. This multi-disciplinary research project will include quantitative, qualitative and economic evaluations. Trained researchers in the different disciplines will implement the studies separately but alongside each other, sharing findings throughout the project to inform each other's data collection. A non-randomised study with stepped-wedge design will be used to estimate the effect of the intervention on contraceptive stock availability in health facilities, and on the modern contraceptive prevalence rate among women in Senegal, compared to the current pull-based distribution model used for other commodities. Secondary data from annual Service Provision Assessments and Demographic and Health Surveys will be used for this study. Data on stock availability and monthly family planning consultations over a 4-year period will be collected from 200 health facilities in five regions to perform time series analyses. A process evaluation will be conducted to understand the extent to which the intervention was implemented as originally designed, the acceptability of third-party logisticians within the health system and potential unintended consequences. These will be assessed using monthly indicator data from the implementer and multiple ethnographic methods, including in-depth interviews with key informants and stakeholders at all levels of the distribution system, observations of third-party logisticians and clinic diaries. An economic evaluation will estimate the cost of the intervention, as well as its cost-effectiveness compared to the current supply chain model. Given the very limited evidence base, there is an important need for a comprehensive standardised approach to evaluating supply chain management, and distribution specifically. This evaluation will help address this evidence gap by providing rigorous evidence on whether private performance-based contracting for distribution of contraceptives can contribute to improving access to family planning in low- and middle-income countries.

18. Topside facility, interior of facility manager's room, view towards ...

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

18. Topside facility, interior of facility manager's room, view towards west. Lyon - Whiteman Air Force Base, Oscar O-1 Minuteman Missile Alert Facility, Southeast corner of Twelfth & Vendenberg Avenues, Knob Noster, Johnson County, MO

Assessing the pro-poor effect of different contracting schemes for health services on health facilities in rural Afghanistan.

PubMed

Alonge, Olakunle; Gupta, Shivam; Engineer, Cyrus; Salehi, Ahmad Shah; Peters, David H

2015-12-01

Despite progress in improving health outcomes in Afghanistan by contracting public health services through non-governmental organizations (NGOs), inequity in access persists between the poor and non-poor. This study examined the distributive effect of different contracting types on primary health services provision between the poor and non-poor in rural Afghanistan. Contracts to NGOs were made to deliver a common set of primary care services in each province, with the funding agencies determining contract terms. The contracting approaches could be classified into three contracting out types (CO-1, CO-2 and CO-3) and a contracting-in (CI) approach based on the contract terms, design and implementation. Exit interviews of patients attending randomly sampled primary health facilities were collected through systematic sampling across 28 provinces at two time points. The outcome, the odds that a client attending a health facility is poor, was modelled using logistic regression with a robust variance estimator, and the effect of contracting was estimated using the difference-in-difference approach combined with stratified analyses. The sample covered 5960 interviews from 306 health facilities in 2005 and 2008. The adjusted odds of a poor client attending a health facility over time increased significantly for facilities under CO-1 and CO-2, with odds ratio of 2.82 (1.49, 5.36) P-value 0.001 and 2.00 (1.33, 3.02) P-value 0.001, respectively. The odds ratios for those under CO-3 and CI were not statistically significantly different over time. When compared with the non-contracting facilities, the adjusted ratio of odds ratios of poor status among clients was significantly higher for only those under CO-1, ratio of 2.50 (1.32, 4.74) P-value 0.005. CO-1 arrangement which allows contractors to decide on how funds are allocated within a fixed lump sum with non-negotiable deliverables, and actively managed through an independent government agency, is effective in improving equity of health services provision. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

A distributed data base management facility for the CAD/CAM environment

NASA Technical Reports Server (NTRS)

Balza, R. M.; Beaudet, R. W.; Johnson, H. R.

1984-01-01

Current/PAD research in the area of distributed data base management considers facilities for supporting CAD/CAM data management in a heterogeneous network of computers encompassing multiple data base managers supporting a variety of data models. These facilities include coordinated execution of multiple DBMSs to provide for administration of and access to data distributed across them.

33 CFR 157.304 - Shore-based reception facility: standards.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 33 Navigation and Navigable Waters 2 2011-07-01 2011-07-01 false Shore-based reception facility: standards. 157.304 Section 157.304 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND... CARRYING OIL IN BULK Exemption From § 157.10a or § 157.10c § 157.304 Shore-based reception facility...

33 CFR 157.304 - Shore-based reception facility: standards.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Shore-based reception facility: standards. 157.304 Section 157.304 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND... CARRYING OIL IN BULK Exemption From § 157.10a or § 157.10c § 157.304 Shore-based reception facility...

Shared use of school facilities with community organizations and afterschool physical activity program participation: a cost-benefit assessment.

PubMed

Kanters, Michael A; Bocarro, Jason N; Filardo, Mary; Edwards, Michael B; McKenzie, Thomas L; Floyd, Myron F

2014-05-01

Partnerships between school districts and community-based organizations to share school facilities during afterschool hours can be an effective strategy for increasing physical activity. However, the perceived cost of shared use has been noted as an important reason for restricting community access to schools. This study examined shared use of middle school facilities, the amount and type of afterschool physical activity programs provided at middle schools together with the costs of operating the facilities. Afterschool programs were assessed for frequency, duration, and type of structured physical activity programs provided and the number of boys and girls in each program. School operating costs were used to calculate a cost per student and cost per building square foot measure. Data were collected at all 30 middle schools in a large school district over 12 months in 2010-2011. Policies that permitted more use of school facilities for community-sponsored programs increased participation in afterschool programs without a significant increase in operating expenses. These results suggest partnerships between schools and other community agencies to share facilities and create new opportunities for afterschool physical activity programs are a promising health promotion strategy. © 2014, American School Health Association.

Suggested Procedures For Evaluating The Effectiveness Of Freeway Hov Facilities

DOT National Transportation Integrated Search

1991-02-01

THIS REPORT PRESENTS THE RESULTS OF THE STATE-OF-THE-ART REVIEW OF EVALUATION PRACTICES USED WITH DIFFERENT HIGH-OCCUPANCY VEHICLE (HOV) LANE PROJECTS IN NORTH AMERICA. BASED ON THIS REVIEW, SUGGESTED PROCEDURES ARE OUTLINED FOR CONDUCTING BEFORE-AND...

Effective recycling of manganese oxide cathodes for lithium based batteries

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

Poyraz, Altug S.; Huang, Jianping; Cheng, Shaobo

A facile cathode recycling process is demonstrated where the previously used binder-free self-supporting cathodes (BFSSC) are removed from a cell, heat treated, and then inserted into a new cell restoring the delivered capacity and cycle life.

Facilities Performance Indicators Report 2012-13: Tracking Your Facilities Vital Signs

ERIC Educational Resources Information Center

APPA: Association of Higher Education Facilities Officers, 2014

2014-01-01

This paper features an expanded Web-based "Facilities Performance Indicators (FPI) Report." The purpose of APPA's Facilities Performance Indicators is to provide a representative set of statistics about facilities in educational institutions. "The Facilities Performance Indicators Report" is designed for survey…

Comparing the nutrition environment and practices of home- and centre-based child-care facilities.

PubMed

Martyniuk, Olivia J M; Vanderloo, Leigh M; Irwin, Jennifer D; Burke, Shauna M; Tucker, Patricia

2016-03-01

To assess and compare the nutrition environment and practices (as they relate to pre-schoolers) of centre- and home-based child-care facilities. Using a cross-sectional study design, nineteen child-care facilities (ten centre-based, nine home-based) were assessed for one full day using the Environment and Policy Assessment and Observation (EPAO) tool (consisting of a day-long observation/review of the nutrition environment, practices and related documents). Specifically, eight nutrition-related subscales were considered. Child-care facilities in London, Ontario, Canada. Child-care facilities were recruited through directors at centre-based programmes and the providers of home-based programmes. The mean total nutrition environment EPAO scores for centre- and home-based facilities were 12·3 (sd 1·94) and 10·8 (sd 0·78) out of 20 (where a higher score indicates a more supportive environment with regard to nutrition), respectively. The difference between the total nutrition environment EPAO score for centre- and home-based facilities was approaching significance (P=0·055). For both types of facilities, the highest nutrition subscale score (out of 20) was achieved in the staff behaviours domain (centre mean=17·4; home mean=17·0) and the lowest was in the nutrition training and education domain (centre mean=3·6; home mean=2·0). Additional research is needed to confirm these findings. In order to better support child-care staff and enhance the overall nutrition environment in child care, modifications to food practices could be adopted. Specifically, the nutritional quality of foods/beverages provided to pre-schoolers could be improved, nutrition-related training for child-care staff could be provided, and a nutrition curriculum could be created to educate pre-schoolers about healthy food choices.

Planetary and Space Simulation Facilities PSI at DLR for Astrobiology

NASA Astrophysics Data System (ADS)

Rabbow, E.; Rettberg, P.; Panitz, C.; Reitz, G.

2008-09-01

Ground based experiments, conducted in the controlled planetary and space environment simulation facilities PSI at DLR, are used to investigate astrobiological questions and to complement the corresponding experiments in LEO, for example on free flying satellites or on space exposure platforms on the ISS. In-orbit exposure facilities can only accommodate a limited number of experiments for exposure to space parameters like high vacuum, intense radiation of galactic and solar origin and microgravity, sometimes also technically adapted to simulate extraterrestrial planetary conditions like those on Mars. Ground based experiments in carefully equipped and monitored simulation facilities allow the investigation of the effects of simulated single environmental parameters and selected combinations on a much wider variety of samples. In PSI at DLR, international science consortia performed astrobiological investigations and space experiment preparations, exposing organic compounds and a wide range of microorganisms, reaching from bacterial spores to complex microbial communities, lichens and even animals like tardigrades to simulated planetary or space environment parameters in pursuit of exobiological questions on the resistance to extreme environments and the origin and distribution of life. The Planetary and Space Simulation Facilities PSI of the Institute of Aerospace Medicine at DLR in Köln, Germany, providing high vacuum of controlled residual composition, ionizing radiation of a X-ray tube, polychromatic UV radiation in the range of 170-400 nm, VIS and IR or individual monochromatic UV wavelengths, and temperature regulation from -20°C to +80°C at the sample size individually or in selected combinations in 9 modular facilities of varying sizes are presented with selected experiments performed within.

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

PubMed

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

2016-03-01

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

The insertion device magnetic measurement facility: Prototype and operational procedures

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

Burkel, L.; Dejus, R.; Maines, J.

1993-03-01

This report is a description of the current status of the magnetic measurement facility and is a basic instructional manual for the operation of the facility and its components. Please refer to the appendices for more detailed information about specific components and procedures. The purpose of the magnetic measurement facility is to take accurate measurements of the magnetic field in the gay of the IDs in order to determine the effect of the ID on the stored particle beam and the emitted radiation. The facility will also play an important role when evaluating new ideas, novel devices, and inhouse prototypesmore » as part of the ongoing research and development program at the APS. The measurements will be performed with both moving search coils and moving Hall probes. The IDs will be evaluated by computer modeling of the emitted radiation for any given (measured) magnetic field map. The quality of the magnetic field will be described in terms of integrated multipoles for the effect on Storage Ring performance and in terms of the derived trajectories for the emitted radiation. Before being installed on the Storage Ring, every device will be measured and characterized to assure that it is compatible with Storage Ring requirements and radiation specifications. The accuracy that the APS needs to achieve for magnetic measurements will be based on these specifications.« less

Proposal for a new categorization of aseptic processing facilities based on risk assessment scores.

PubMed

Katayama, Hirohito; Toda, Atsushi; Tokunaga, Yuji; Katoh, Shigeo

2008-01-01

Risk assessment of aseptic processing facilities was performed using two published risk assessment tools. Calculated risk scores were compared with experimental test results, including environmental monitoring and media fill run results, in three different types of facilities. The two risk assessment tools used gave a generally similar outcome. However, depending on the tool used, variations were observed in the relative scores between the facilities. For the facility yielding the lowest risk scores, the corresponding experimental test results showed no contamination, indicating that these ordinal testing methods are insufficient to evaluate this kind of facility. A conventional facility having acceptable aseptic processing lines gave relatively high risk scores. The facility showing a rather high risk score demonstrated the usefulness of conventional microbiological test methods. Considering the significant gaps observed in calculated risk scores and in the ordinal microbiological test results between advanced and conventional facilities, we propose a facility categorization based on risk assessment. The most important risk factor in aseptic processing is human intervention. When human intervention is eliminated from the process by advanced hardware design, the aseptic processing facility can be classified into a new risk category that is better suited for assuring sterility based on a new set of criteria rather than on currently used microbiological analysis. To fully benefit from advanced technologies, we propose three risk categories for these aseptic facilities.

Experimental Fuels Facility Re-categorization Based on Facility Segmentation

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

Reiss, Troy P.; Andrus, Jason

The Experimental Fuels Facility (EFF) (MFC-794) at the Materials and Fuels Complex (MFC) located on the Idaho National Laboratory (INL) Site was originally constructed to provide controlled-access, indoor storage for radiological contaminated equipment. Use of the facility was expanded to provide a controlled environment for repairing contaminated equipment and characterizing, repackaging, and treating waste. The EFF facility is also used for research and development services, including fuel fabrication. EFF was originally categorized as a LTHC-3 radiological facility based on facility operations and facility radiological inventories. Newly planned program activities identified the need to receive quantities of fissionable materials in excessmore » of the single parameter subcritical limit in ANSI/ANS-8.1, “Nuclear Criticality Safety in Operations with Fissionable Materials Outside Reactors” (identified as “criticality list” quantities in DOE-STD-1027-92, “Hazard Categorization and Accident Analysis Techniques for Compliance with DOE Order 5480.23, Nuclear Safety Analysis Reports,” Attachment 1, Table A.1). Since the proposed inventory of fissionable materials inside EFF may be greater than the single parameter sub-critical limit of 700 g of U-235 equivalent, the initial re-categorization is Hazard Category (HC) 2 based upon a potential criticality hazard. This paper details the facility hazard categorization performed for the EFF. The categorization was necessary to determine (a) the need for further safety analysis in accordance with LWP-10802, “INL Facility Categorization,” and (b) compliance with 10 Code of Federal Regulations (CFR) 830, Subpart B, “Safety Basis Requirements.” Based on the segmentation argument presented in this paper, the final hazard categorization for the facility is LTHC-3. Department of Energy Idaho (DOE-ID) approval of the final hazard categorization determined by this hazard assessment document (HAD) was required per the DOE-ID Supplemental Guidance for DOE-STD-1027-92 based on the proposed downgrade of the initial facility categorization of Hazard Category 2.« less

Facility-Based Delivery during the Ebola Virus Disease Epidemic in Rural Liberia: Analysis from a Cross-Sectional, Population-Based Household Survey

PubMed Central

Griffiths, Thomas; Kanjee, Zahir; Battistoli, Dale; Dorr, Lorenzo; Lorenzen, Breeanna; Thomson, Dana R.; Waters, Ami; Roberts, Ruth; Smith, Wilmot L.; Kraemer, John D.

2016-01-01

Background The Ebola virus disease (EVD) epidemic has threatened access to basic health services through facility closures, resource diversion, and decreased demand due to community fear and distrust. While modeling studies have attempted to estimate the impact of these disruptions, no studies have yet utilized population-based survey data. Methods and Findings We conducted a two-stage, cluster-sample household survey in Rivercess County, Liberia, in March–April 2015, which included a maternal and reproductive health module. We constructed a retrospective cohort of births beginning 4 y before the first day of survey administration (beginning March 24, 2011). We then fit logistic regression models to estimate associations between our primary outcome, facility-based delivery (FBD), and time period, defined as the pre-EVD period (March 24, 2011–June 14, 2014) or EVD period (June 15, 2014–April 13, 2015). We fit both univariable and multivariable models, adjusted for known predictors of facility delivery, accounting for clustering using linearized standard errors. To strengthen causal inference, we also conducted stratified analyses to assess changes in FBD by whether respondents believed that health facility attendance was an EVD risk factor. A total of 1,298 women from 941 households completed the survey. Median age at the time of survey was 29 y, and over 80% had a primary education or less. There were 686 births reported in the pre-EVD period and 212 in the EVD period. The unadjusted odds ratio of facility-based delivery in the EVD period was 0.66 (95% confidence interval [CI] 0.48–0.90, p-value = 0.010). Adjustment for potential confounders did not change the observed association, either in the principal model (adjusted odds ratio [AOR] = 0.70, 95%CI 0.50–0.98, p = 0.037) or a fully adjusted model (AOR = 0.69, 95%CI 0.50–0.97, p = 0.033). The association was robust in sensitivity analyses. The reduction in FBD during the EVD period was observed among those reporting a belief that health facilities are or may be a source of Ebola transmission (AOR = 0.59, 95%CI 0.36–0.97, p = 0.038), but not those without such a belief (AOR = 0.90, 95%CI 0.59–1.37, p = 0.612). Limitations include the possibility of FBD secular trends coincident with the EVD period, recall errors, and social desirability bias. Conclusions We detected a 30% decreased odds of FBD after the start of EVD in a rural Liberian county with relatively few cases. Because health facilities never closed in Rivercess County, this estimate may under-approximate the effect seen in the most heavily affected areas. These are the first population-based survey data to show collateral disruptions to facility-based delivery caused by the West African EVD epidemic, and they reinforce the need to consider the full spectrum of implications caused by public health emergencies. PMID:27482706

Planning of dairy farm and dairy plant based ecotourism

NASA Astrophysics Data System (ADS)

Sarnyoto, A. S.; Tama, I. P.; Tantrika, C. F. M.

2017-06-01

One of a dairy production company producing pasteurized milk and yoghurt drink, whose brand has widely known in East Java, has a factory plant in Batu City, one of tourism destinations in Indonesia. Behind the factory plant, there is a vacant land with an estimated total area of 2.3 ha and a vacant cowshed which had not been used for cattle ranching. Because of that, the company planned to develop the vacant land as a dairy farm and plant based ecotourism. In addition, dairy farm and dairy plant based tourism attractions are still rarely found in Batu. Thus, the first aim of this study was to analyse the potencies of the company that related to future plans of ecotourism built. The second aim was to set up the strategies that can be done in order to actualize the ecotourism project. The next aim was to plan the ecotourism, especially the facilities planning and the facilities arrangement on the vacant land. Strategic management approach was used to analyse the potencies and to determine the strategies. To select the proper facilities, tourists were asked to give appraisal by using questionnaire. Appraisal result was mapped onto four quadrants spatial map to see advantages and shortcomings of each facility along with choosing the right facilities to be built. Those facilities and tourist activities were compared with ecotourism criteria to make sure that the facilities were appropriate to provide not only entertainment but also ecotourism function. To arrange the chosen facilities, the step in Systematic Layout Planning were conducted to generate a propose layout of facilities arrangement. Based on potencies analysis, in Internal-External matrix, the company current position was on quadrant 2 (grow and build), with the most appropriate strategy was intensive or integrative. The proposed strategies were to build the new infrastructure, to renovate cowshed, and to add new tourism facilities on the land. There were 11 selected facilities based on MDS. Moreover, based on SLP, a facility layout had been designed and been proposed to be built on the vacant land behind the factory as the new ecotourism destination.

Economic evaluation of a task-shifting intervention for common mental disorders in India

PubMed Central

Buttorff, Christine; Hock, Rebecca S; Weiss, Helen A; Naik, Smita; Araya, Ricardo; Kirkwood, Betty R; Chisholm, Daniel

2012-01-01

Abstract Objective To carry out an economic evaluation of a task-shifting intervention for the treatment of depressive and anxiety disorders in primary-care settings in Goa, India. Methods Cost–utility and cost–effectiveness analyses based on generalized linear models were performed within a trial set in 24 public and private primary-care facilities. Subjects were randomly assigned to an intervention or a control arm. Eligible subjects in the intervention arm were given psycho-education, case management, interpersonal psychotherapy and/or antidepressants by lay health workers. Subjects in the control arm were treated by physicians. The use of health-care resources, the disability of each subject and degree of psychiatric morbidity, as measured by the Revised Clinical Interview Schedule, were determined at 2, 6 and 12 months. Findings Complete data, from all three follow-ups, were collected from 1243 (75.4%) and 938 (81.7%) of the subjects enrolled in the study facilities from the public and private sectors, respectively. Within the public facilities, subjects in the intervention arm showed greater improvement in all the health outcomes investigated than those in the control arm. Time costs were also significantly lower in the intervention arm than in the control arm, whereas health system costs in the two arms were similar. Within the private facilities, however, the effectiveness and costs recorded in the two arms were similar. Conclusion Within public primary-care facilities in Goa, the use of lay health workers in the care of subjects with common mental disorders was not only cost–effective but also cost-saving. PMID:23226893

Range Process Simulation Tool

NASA Technical Reports Server (NTRS)

Phillips, Dave; Haas, William; Barth, Tim; Benjamin, Perakath; Graul, Michael; Bagatourova, Olga

2005-01-01

Range Process Simulation Tool (RPST) is a computer program that assists managers in rapidly predicting and quantitatively assessing the operational effects of proposed technological additions to, and/or upgrades of, complex facilities and engineering systems such as the Eastern Test Range. Originally designed for application to space transportation systems, RPST is also suitable for assessing effects of proposed changes in industrial facilities and large organizations. RPST follows a model-based approach that includes finite-capacity schedule analysis and discrete-event process simulation. A component-based, scalable, open architecture makes RPST easily and rapidly tailorable for diverse applications. Specific RPST functions include: (1) definition of analysis objectives and performance metrics; (2) selection of process templates from a processtemplate library; (3) configuration of process models for detailed simulation and schedule analysis; (4) design of operations- analysis experiments; (5) schedule and simulation-based process analysis; and (6) optimization of performance by use of genetic algorithms and simulated annealing. The main benefits afforded by RPST are provision of information that can be used to reduce costs of operation and maintenance, and the capability for affordable, accurate, and reliable prediction and exploration of the consequences of many alternative proposed decisions.

[The situation and associated factors of facility-based HIV testing among men who sex with men in Beijing].

PubMed

Ren, X L; Mi, G D; Zhao, Y; Rou, K M; Zhang, D P; Geng, L; Chen, Z H; Wu, Z Y

2017-04-06

Objective: To understand the prevalence of facility-based HIV testing and its associated factors among men who have sex with men (MSM) in Beijing city. Methods: An application-based cross-sectional survey was employed to understand HIV site test situation and associated factors. The survey was carried out from May 14(th) to 21(st), 2016. Users of a smart phone application for gay dating were recruited and those eligible for this survey were investigated with an online self-administered questionnaire. Information of demographics, sexual behaviors, facility-based HIV testing history and recreational drug abuses were collected. The multivariate logistic regression was used to make comparison among different groups and assess associated factors. Results: A total of 7 494 participants were enrolled in the survey with mean age of (28.81 ± 7.38) years, 87.14% (6 530/7 494) sought sexual partners through internet. The proportion of facility-based HIV testing in 1 year was 42.55% (3 189/7 494), MSM who were 25-29 years had higher proportion of facility-based HIV testing in 1 year, the proportion was 45.56%(1 104/2 423). Among MSM who could insist in using condom during anal sex (50.46% (1 539/3 050)), the proportion of HIV site testing in 1 year was higher. The MSM who reported seeking healthcare for symptoms of a sexually transmitted infections (STIs) in the past year or ever using recreational drug had higher proportion of facility-based HIV testing, the proportions were 56.81% (409/720) and 52.00% (1 340/4 917), respectively. Compared with alone cohabitation, cohabitating was associated with decreased odds of HIV facility-based testing in past 1 year(odds ratio ( OR )= 0.79, P< 0.001). Compared with homosexual sexual orientation, bisexual sexual orientation was associated with decreased odds of facility-based HIV testing ( OR= 0.83, P= 0.004). With the increasing of number of male anal sex partners, the odds of HIV facility-based testing was increasing ( OR= 1.31, P< 0.001) But with the decreasing of the frequency of condom using with male anal sex partners, the odds of facility-based HIV testing was decreasing ( OR= 0.85, P= 0.014). Using recreational drugs ( OR= 1.36, P< 0.001) and seeking healthcare for symptoms of a STI in the past 1 year ( OR= 1.73, P< 0.001) were associated with decreased odds of HIV site testing. Conclusion: MSM in Beijing had lower proportion of facility-based HIV testing in past 1 year. Multiple anal sex partners, using recreational drugs, seeking healthcare for symptoms of a STI in the past year, cohabitating, bisexual sexual orientation, and lower frequency of condom using with male anal sex partners were associated with the odds of HIV facility-based testing in past 1 year.

The relationship between science classroom facility conditions and ninth grade students' attitudes toward science

NASA Astrophysics Data System (ADS)

Ford, Angela Y.

Over half of the school facilities in America are in poor condition. Unsatisfactory school facilities have a negative impact on teaching and learning. The purpose of this correlational study was to identify the relationship between high school science teachers' perceptions of the school science environment (instructional equipment, demonstration equipment, and physical facilities) and ninth grade students' attitudes about science through their expressed enjoyment of science, importance of time spent on science, and boredom with science. A sample of 11,523 cases was extracted, after a process of data mining, from a databank of over 24,000 nationally representative ninth graders located throughout the United States. The instrument used to survey these students was part of the High School Longitudinal Study of 2009 (HSLS:2009). The research design was multiple linear regression. The results showed a significant relationship between the science classroom conditions and students' attitudes. Demonstration equipment and physical facilities were the best predictors of effects on students' attitudes. Conclusions based on this study and recommendations for future research are made.

The role of institutions on the effectiveness of malaria treatment in the Ghanaian health sector.

PubMed

Amporfu, Eugenia; Nonvignon, Justice

2015-04-19

The Ghanaian health sector has undertaken several policies to help improve the quality of care received by patients. This includes the construction of several health facilities, the increase in the training of health workers, especially nurses, and the introduction of incentive packages (such as salary increase) to motivate health workers. The important question is to what extent does the institutional arrangement between the health facilities and the government as well as between health workers and public health facility administration affect the quality of care? The objective of this study is to find the effect of institutional factors on the quality of care. The institutional factors examined were mainly the extent of decentralization between government and health facilities, as well as between health workers and facility administration, the hiring procedure, and job satisfaction. The study used primary data on former patients from sixty six health facilities in three administrative regions of Ghana: the Northern, the Ashanti and the Greater Accra regions. The quality indicator used was effectiveness of treatment as determined by the patient. Ordered logit regression was run for the indicator with patient and health facility characteristics as well as institutional factors as independent variables. The sample size was 2248. The results showed that the patient's level of formal education had a strong influence on the effectiveness of treatment. In addition, effectiveness of treatment differed according to the administrative region in which the facility was located, and according to the extent of decentralization between health facility and government. The quality of instruments used for treatment, the working conditions for health workers, and job satisfaction had no effect on the effectiveness of treatment. Decentralization, the flow of information from government to health facilities and from health facility administrators to health workers are important in ensuring effectiveness. The study recommends further decentralization between health facilities as well as between health workers and administrators. In addition, the study recommends the involvement of health facilities in malaria programs to ensure the flow of information needed for effectiveness of treatment.

Using antibiograms to improve antibiotic prescribing in skilled nursing facilities.

PubMed

Furuno, Jon P; Comer, Angela C; Johnson, J Kristie; Rosenberg, Joseph H; Moore, Susan L; MacKenzie, Thomas D; Hall, Kendall K; Hirshon, Jon Mark

2014-10-01

Antibiograms have effectively improved antibiotic prescribing in acute-care settings; however, their effectiveness in skilled nursing facilities (SNFs) is currently unknown. To develop SNF-specific antibiograms and identify opportunities to improve antibiotic prescribing. Cross-sectional and pretest-posttest study among residents of 3 Maryland SNFs. Antibiograms were created using clinical culture data from a 6-month period in each SNF. We also used admission clinical culture data from the acute care facility primarily associated with each SNF for transferred residents. We manually collected all data from medical charts, and antibiograms were created using WHONET software. We then used a pretest-posttest study to evaluate the effectiveness of an antibiogram on changing antibiotic prescribing practices in a single SNF. Appropriate empirical antibiotic therapy was defined as an empirical antibiotic choice that sufficiently covered the infecting organism, considering antibiotic susceptibilities. We reviewed 839 patient charts from SNF and acute care facilities. During the initial assessment period, 85% of initial antibiotic use in the SNFs was empirical, and thus only 15% of initial antibiotics were based on culture results. Fluoroquinolones were the most frequently used empirical antibiotics, accounting for 54.5% of initial prescribing instances. Among patients with available culture data, only 35% of empirical antibiotic prescribing was determined to be appropriate. In the single SNF in which we evaluated antibiogram effectiveness, prevalence of appropriate antibiotic prescribing increased from 32% to 45% after antibiogram implementation; however, this was not statistically significant ([Formula: see text]). Implementation of antibiograms may be effective in improving empirical antibiotic prescribing in SNFs.

The BetterBirth Program: Pursuing Effective Adoption and Sustained Use of the WHO Safe Childbirth Checklist Through Coaching-Based Implementation in Uttar Pradesh, India

PubMed Central

Kara, Nabihah; Firestone, Rebecca; Kalita, Tapan; Gawande, Atul A; Kumar, Vishwajeet; Kodkany, Bhala; Saurastri, Rajiv; Pratap Singh, Vinay; Maji, Pinki; Karlage, Ami; Hirschhorn, Lisa R; Semrau, Katherine EA

2017-01-01

Shifting childbirth into facilities has not improved health outcomes for mothers and newborns as significantly as hoped. Improving the quality and safety of care provided during facility-based childbirth requires helping providers to adhere to essential birth practices—evidence-based behaviors that reduce harm to and save lives of mothers and newborns. To achieve this goal, we developed the BetterBirth Program, which we tested in a matched-pair, cluster-randomized controlled trial in Uttar Pradesh, India. The goal of this intervention was to improve adoption and sustained use of the World Health Organization Safe Childbirth Checklist (SCC), an organized collection of 28 essential birth practices that are known to improve the quality of facility-based childbirth care. Here, we describe the BetterBirth Program in detail, including its 4 main features: implementation tools, an implementation strategy of coaching, an implementation pathway (Engage-Launch-Support), and a sustainability plan. This coaching-based implementation of the SCC motivates and empowers care providers to identify, understand, and resolve the barriers they face in using the SCC with the resources already available. We describe important lessons learned from our experience with the BetterBirth Program as it was tested in the BetterBirth Trial. For example, the emphasis on relationship building and respect led to trust between coaches and birth attendants and helped influence change. In addition, the cloud-based data collection and feedback system proved a valuable asset in the coaching process. More research on coaching-based interventions is required to refine our understanding of what works best to improve quality and safety of care in various settings. (After publication of this article, the impact results of the BetterBirth intervention were published in the New England Journal of Medicine [volume 377, pages 2313-2324, doi: 10.1056/NEJMoa1701075]. The results showed that the intervention had no significant effect on maternal or perinatal mortality or maternal morbidity, despite having positive effects on essential birth practices.) PMID:28655801

Plant-based plume-scale mapping of tritium contamination in desert soils

USGS Publications Warehouse

Andraski, Brian J.; Stonestrom, David A.; Michel, R.L.; Halford, K.J.; Radyk, J.C.

2005-01-01

Plant-based techniques were tested for field-scale evaluation of tritium contamination adjacent to a low-level radioactive waste (LLRW) facility in the Amargosa Desert, Nevada. Objectives were to (i) characterize and map the spatial variability of tritium in plant water, (ii) develop empirical relations to predict and map subsurface contamination from plant-water concentrations, and (iii) gain insight into tritium migration pathways and processes. Plant sampling [creosote bush, Larrea tridentata (Sessé & Moc. ex DC.) Coville] required one-fifth the time of soil water vapor sampling. Plant concentrations were spatially correlated to a separation distance of 380 m; measurement uncertainty accounted for <0.1% of the total variability in the data. Regression equations based on plant tritium explained 96 and 90% of the variation in root-zone and sub-root-zone soil water vapor concentrations, respectively. The equations were combined with kriged plant-water concentrations to map subsurface contamination. Mapping showed preferential lateral movement of tritium through a dry, coarse-textured layer beneath the root zone, with concurrent upward movement through the root zone. Analysis of subsurface fluxes along a transect perpendicular to the LLRW facility showed that upward diffusive-vapor transport dominates other transport modes beneath native vegetation. Downward advective-liquid transport dominates at one endpoint of the transect, beneath a devegetated road immediately adjacent to the facility. To our knowledge, this study is the first to document large-scale subsurface vapor-phase tritium migration from a LLRW facility. Plant-based methods provide a noninvasive, cost-effective approach to mapping subsurface tritium migration in desert areas.

Designing better methane mitigation policies: the challenge of distributed small sources in the natural gas sector

NASA Astrophysics Data System (ADS)

Ravikumar, Arvind P.; Brandt, Adam R.

2017-04-01

Methane—a short-lived and potent greenhouse gas—presents a unique challenge: it is emitted from a large number of highly distributed and diffuse sources. In this regard, the United States’ Environmental Protection Agency (EPA) has recommended periodic leak detection and repair surveys at oil and gas facilities using optical gas imaging technology. This regulation requires an operator to fix all detected leaks within a set time period. Whether such ‘find-all-fix-all’ policies are effective depends on significant uncertainties in the character of emissions. In this work, we systematically analyze the effect of facility-related and mitigation-related uncertainties on regulation effectiveness. Drawing from multiple publicly-available datasets, we find that: (1) highly-skewed leak-size distributions strongly influence emissions reduction potential; (2) variations in emissions estimates across facilities leads to large variability in mitigation effectiveness; (3) emissions reductions from optical gas imaging-based leak detection programs can range from 15% to over 70%; and (4) while implementation costs are uniformly lower than EPA estimates, benefits from saved gas are highly variable. Combining empirical evidence with model results, we propose four policy options for effective methane mitigation: performance-oriented targets for accelerated emission reductions, flexible policy mechanisms to account for regional variation, technology-agnostic regulations to encourage adoption of the most cost-effective measures, and coordination with other greenhouse gas mitigation policies to reduce unintended spillover effects.

Ecological solid fuels, effective heating devices for communal management and their testing methods

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

Kubica, K.

1995-12-31

The national balance of primary energy consumption is almost 90% based upon coal. Coal is used not only in electricity production, but also in the communal sector - in heating facilities comprising chiefly local boiler houses and private households.

When the management of nurse absenteeism becomes a cause of absenteeism: a study based on a comparison of two health care facilities.

PubMed

Damart, Sébastien; Kletz, Frédéric

2016-01-01

The study aims to explore perceptions of the causes of nurse absenteeism. Nurse absenteeism is rising in many countries. However, there is little evidence as to how strategies adopted in order to cushion the effects of absenteeism on workload influence absenteeism itself. The study used a 'qualitative' method based on cognitive mapping techniques in order to represent perceptions about absenteeism graphically. The study was conducted in two health-care facilities with a sample of 55 interviewees. Absenteeism is due in part to strategies adopted in order to cushion the effects of absenteeism on organisations. Furthermore, the strategies are self-legitimising. The more they are used, the more they are regarded as normal and useful. A plan to reduce absenteeism among nurses must explicitly take into account the strategies used to cushion its impact. To cushion the effects of absenteeism among caregivers, managers must make trade-offs that take into account, for example, the workload or disruption linked to the substitution of personnel. © 2014 John Wiley & Sons Ltd.

Translating evidence into policy for cardiovascular disease control in India

PubMed Central

2011-01-01

Cardiovascular diseases (CVD) are leading causes of premature mortality in India. Evidence from developed countries shows that mortality from these can be substantially prevented using population-wide and individual-based strategies. Policy initiatives for control of CVD in India have been suggested but evidence of efficacy has emerged only recently. These initiatives can have immediate impact in reducing morbidity and mortality. Of the prevention strategies, primordial involve improvement in socioeconomic status and literacy, adequate healthcare financing and public health insurance, effective national CVD control programme, smoking control policies, legislative control of saturated fats, trans fats, salt and alcohol, and development of facilities for increasing physical activity through better urban planning and school-based and worksite interventions. Primary prevention entails change in medical educational curriculum and improved healthcare delivery for control of CVD risk factors-smoking, hypertension, dyslipidemia and diabetes. Secondary prevention involves creation of facilities and human resources for optimum acute CVD care and secondary prevention. There is need to integrate various policy makers, develop effective policies and modify healthcare systems for effective delivery of CVD preventive care. PMID:21306620

Facility Effect Characterization Test of NASA's HERMeS Hall Thruster

NASA Technical Reports Server (NTRS)

Huang, Wensheng; Kamhawi, Hani; Haag, Thomas W.; Ortega, Alejandro Lopez; Mikellides, Ioannis G.

2016-01-01

A test to characterize the effect of varying background pressure on NASA's 12.5-kW Hall Effect Rocket with Magnetic Shielding had being completed. This thruster is the baseline propulsion system for the Solar Electric Propulsion Technology Demonstration Mission (SEP TDM). Potential differences in thruster performance and oscillation characteristics when in ground facilities versus on-orbit are considered a primary risk for the propulsion system of the Asteroid Redirect Robotic Mission, which is a candidate for SEP TDM. The first primary objective of this test was to demonstrate that the tools being developed to predict the zero-background-pressure behavior of the thruster can provide self-consistent results. The second primary objective of this test was to provide data for refining a physics-based model of the thruster plume that will be used in spacecraft interaction studies. Diagnostics deployed included a thrust stand, Faraday probe, Langmuir probe, retarding potential analyzer, Wien filter spectrometer, and high-speed camera. From the data, a physics-based plume model was refined. Comparisons of empirical data to modeling results are shown.

Potential negative impacts of nuclear activities on local economies: Rethinking the issue

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

Metz, W.C.

1994-10-01

Surveys of public opinion about perceptions of risk associated with the nuclear fuel cycle have shown that the public professes a widespread feeling of dread, a fear of associated stigmas, and a concern about possible catastrophic nuclear accidents. Various interest groups and state governments that oppose congressionally mandated siting of centralized high-level radioactive waste (HLW) storage and disposal facilities are using this negative imagery to create a powerful, emotional obstacle to the siting process. From statistical analyses of images and location preferences, researchers have claimed that possible significant economic losses could potentially accompany the siting of HLW facilities. However, severalmore » paradoxes, or self-contradictory statements, apparently exist between the responses expressed in surveys and the actual economic and demographic behavior evidenced in the marketplace. Federal policymakers need to evaluate whether the request for a change in siting policy is based on subjective fear of a potential negative economic effect or on proven negative effects. Empirically observed behavior does not support predicted negative economic effects based on survey responses. 41 refs.« less

Rapid urban malaria appraisal (RUMA) in sub-Saharan Africa

PubMed Central

Wang, Shr-Jie; Lengeler, Christian; Smith, Thomas A; Vounatsou, Penelope; Cissé, Guéladio; Diallo, Diadie A; Akogbeto, Martin; Mtasiwa, Deo; Teklehaimanot, Awash; Tanner, Marcel

2005-01-01

Background The rapid urban malaria appraisal (RUMA) methodology aims to provide a cost-effective tool to conduct rapid assessments of the malaria situation in urban sub-Saharan Africa and to improve the understanding of urban malaria epidemiology. Methods This work was done in Yopougon municipality (Abidjan), Cotonou, Dar es Salaam and Ouagadougou. The study design consists of six components: 1) a literature review, 2) the collection of available health statistics, 3) a risk mapping, 4) school parasitaemia surveys, 5) health facility-based surveys and 6) a brief description of the health care system. These formed the basis of a multi-country evaluation of RUMA's feasibility, consistency and usefulness. Results A substantial amount of literature (including unpublished theses and statistics) was found at each site, providing a good overview of the malaria situation. School and health facility-based surveys provided an overview of local endemicity and the overall malaria burden in different city areas. This helped to identify important problems for in-depth assessment, especially the extent to which malaria is over-diagnosed in health facilities. Mapping health facilities and breeding sites allowed the visualization of the complex interplay between population characteristics, health services and malaria risk. However, the latter task was very time-consuming and required special expertise. RUMA is inexpensive, costing around 8,500–13,000 USD for a six to ten-week period. Conclusion RUMA was successfully implemented in four urban areas with different endemicity and proved to be a cost-effective first approach to study the features of urban malaria and provide an evidence basis for planning control measures. PMID:16153298

Effect of horizontal curves on urban arterial crashes.

PubMed

Banihashemi, Mohamadreza

2016-10-01

The crash prediction models of the Highway Safety Manual (HSM), 2010 estimate the expected number of crashes for different facility types. Models in Part C Chapter 12 of the first edition of the HSM include crash prediction models for divided and undivided urban arterials. Each of the HSM crash prediction models for highway segments is comprised of a "Safety Performance Function," a function of AADT and segment length, plus, a series of "Crash Modification Factors" (CMFs). The SPF estimates the expected number of crashes for the site if the site features are of base condition. The effects of the other features of the site, if their values are different from base condition, are carried out through use of CMFs. The existing models for urban arterials do not have any CMF for horizontal curvature. The goal of this research is to investigate if the horizontal alignment has any significant effect on crashes on any of these types of facilities and if so, to develop a CMF for this feature. Washington State cross sectional data from the Highway Safety Information System (HSIS), 2014 was used in this research. Data from 2007 to 2009 was used to conduct the investigation. The 2010 data was used to validate the results. As the results showed, the horizontal curvature has significant safety effect on two-lane undivided urban arterials with speed limits of 35 mph and higher and using a CMF for horizontal curvature in the crash prediction model of this type of facility improves the prediction of crashes significantly, for both tangent and curve segments. Copyright © 2016 Elsevier Ltd. All rights reserved.

Medicaid program; home and community-based services waivers for individuals age 65 or older--HCFA. Interim final rule with comment period.

PubMed

1992-06-30

This interim final rule amends current Medicaid regulations to permit States to offer, under a Secretarial waiver, a wide array of home and community-based services to individuals age 65 or older who are determined, but for the provision of these services, to be likely to require the level of care furnished in a skilled nursing facility (SNF) or intermediate care facility (ICF) (nursing facility (NF) effective October 1, 1990). The rule allows Federal payment for these and other long term care services, up to an amount specified in section 1915(d)(5)(B) of the Social Security Act, subject to HCFA's approval of the States' requests for waivers and certain assurances made by the States. Once granted, waivers are in effect for 3 years, unless terminated by the State with notice to the Secretary, and are renewable for periods of 5 years. Periodic evaluation, assessment, and review of the care furnished under the waivers is required. This rule implements section 4102 of the Omnibus Budget Reconciliation Act of 1987, as modified by section 411(k) of the Medicare Catastrophic Coverage Act of 1988, section 8432 of the Technical and Miscellaneous Revenue Act of 1988, and section 4741(b) of the Omnibus Budget Reconciliation Act of 1990. This rule is being issued in final and, for the most part, without a delay in the effective date for the reasons explained in section IV, "Waiver of Proposed Rulemaking and Delay in the Effective Date."

MicroArray Facility: a laboratory information management system with extended support for Nylon based technologies.

PubMed

Honoré, Paul; Granjeaud, Samuel; Tagett, Rebecca; Deraco, Stéphane; Beaudoing, Emmanuel; Rougemont, Jacques; Debono, Stéphane; Hingamp, Pascal

2006-09-20

High throughput gene expression profiling (GEP) is becoming a routine technique in life science laboratories. With experimental designs that repeatedly span thousands of genes and hundreds of samples, relying on a dedicated database infrastructure is no longer an option.GEP technology is a fast moving target, with new approaches constantly broadening the field diversity. This technology heterogeneity, compounded by the informatics complexity of GEP databases, means that software developments have so far focused on mainstream techniques, leaving less typical yet established techniques such as Nylon microarrays at best partially supported. MAF (MicroArray Facility) is the laboratory database system we have developed for managing the design, production and hybridization of spotted microarrays. Although it can support the widely used glass microarrays and oligo-chips, MAF was designed with the specific idiosyncrasies of Nylon based microarrays in mind. Notably single channel radioactive probes, microarray stripping and reuse, vector control hybridizations and spike-in controls are all natively supported by the software suite. MicroArray Facility is MIAME supportive and dynamically provides feedback on missing annotations to help users estimate effective MIAME compliance. Genomic data such as clone identifiers and gene symbols are also directly annotated by MAF software using standard public resources. The MAGE-ML data format is implemented for full data export. Journalized database operations (audit tracking), data anonymization, material traceability and user/project level confidentiality policies are also managed by MAF. MicroArray Facility is a complete data management system for microarray producers and end-users. Particular care has been devoted to adequately model Nylon based microarrays. The MAF system, developed and implemented in both private and academic environments, has proved a robust solution for shared facilities and industry service providers alike.

MicroArray Facility: a laboratory information management system with extended support for Nylon based technologies

PubMed Central

Honoré, Paul; Granjeaud, Samuel; Tagett, Rebecca; Deraco, Stéphane; Beaudoing, Emmanuel; Rougemont, Jacques; Debono, Stéphane; Hingamp, Pascal

2006-01-01

Background High throughput gene expression profiling (GEP) is becoming a routine technique in life science laboratories. With experimental designs that repeatedly span thousands of genes and hundreds of samples, relying on a dedicated database infrastructure is no longer an option. GEP technology is a fast moving target, with new approaches constantly broadening the field diversity. This technology heterogeneity, compounded by the informatics complexity of GEP databases, means that software developments have so far focused on mainstream techniques, leaving less typical yet established techniques such as Nylon microarrays at best partially supported. Results MAF (MicroArray Facility) is the laboratory database system we have developed for managing the design, production and hybridization of spotted microarrays. Although it can support the widely used glass microarrays and oligo-chips, MAF was designed with the specific idiosyncrasies of Nylon based microarrays in mind. Notably single channel radioactive probes, microarray stripping and reuse, vector control hybridizations and spike-in controls are all natively supported by the software suite. MicroArray Facility is MIAME supportive and dynamically provides feedback on missing annotations to help users estimate effective MIAME compliance. Genomic data such as clone identifiers and gene symbols are also directly annotated by MAF software using standard public resources. The MAGE-ML data format is implemented for full data export. Journalized database operations (audit tracking), data anonymization, material traceability and user/project level confidentiality policies are also managed by MAF. Conclusion MicroArray Facility is a complete data management system for microarray producers and end-users. Particular care has been devoted to adequately model Nylon based microarrays. The MAF system, developed and implemented in both private and academic environments, has proved a robust solution for shared facilities and industry service providers alike. PMID:16987406

Membrane Lipids as Indicators for Viable Bacterial Communities Inhabiting Petroleum Systems.

PubMed

Gruner, Andrea; Mangelsdorf, Kai; Vieth-Hillebrand, Andrea; Horsfield, Brian; van der Kraan, Geert M; Köhler, Thomas; Janka, Christoph; Morris, Brandon E L; Wilkes, Heinz

2017-08-01

Microbial activity in petroleum reservoirs has been implicated in a suite of detrimental effects including deterioration of petroleum quality, increases in oil sulfur content, biofouling of steel pipelines and other infrastructures, and well plugging. Here, we present a biogeochemical approach, using phospholipid fatty acids (PLFAs), for detecting viable bacteria in petroleum systems. Variations within the bacterial community along water flow paths (producing well, topside facilities, and injection well) can be elucidated in the field using the same technique, as shown here within oil production plants in the Molasse Basin of Upper Austria. The abundance of PLFAs is compared to total cellular numbers, as detected by qPCR of the 16S rDNA gene, to give an overall comparison between the resolutions of both methods in a true field setting. Additionally, the influence of biocide applications on lipid- and DNA-based quantification was investigated. The first oil field, Trattnach, showed significant PLFA abundances and cell numbers within the reservoir and topside facilities. In contrast, the second field (Engenfeld) showed very low PLFA levels overall, likely due to continuous treatment of the topside facilities with a glutaraldehyde-based antimicrobial. In comparison, Trattnach is dosed once per week in a batch fashion. Changes within PLFA compositions across the flow path, throughout the petroleum production plants, point to cellular adaptation within the system and may be linked to shifts in the dominance of certain bacterial types in oil reservoirs versus topside facilities. Overall, PLFA-based monitoring provides a useful tool to assess the abundance and high-level taxonomic diversity of viable microbial populations in oil production wells, topside infrastructure, pipelines, and other related facilities.

Irradiation setup at the U-120M cyclotron facility

NASA Astrophysics Data System (ADS)

Křížek, F.; Ferencei, J.; Matlocha, T.; Pospíšil, J.; Príbeli, P.; Raskina, V.; Isakov, A.; Štursa, J.; Vaňát, T.; Vysoká, K.

2018-06-01

This paper describes parameters of the proton beams provided by the U-120M cyclotron and the related irradiation setup at the open access irradiation facility at the Nuclear Physics Institute of the Czech Academy of Sciences. The facility is suitable for testing radiation hardness of various electronic components. The use of the setup is illustrated by a measurement of an error rate for errors caused by Single Event Transients in an SRAM-based Xilinx XC3S200 FPGA. This measurement provides an estimate of a possible occurrence of Single Event Transients. Data suggest that the variation of error rate of the Single Event Effects for different clock phase shifts is not significant enough to use clock phase alignment with the beam as a fault mitigation technique.

10 CFR 70.64 - Requirements for new facilities or new processes at existing facilities.

Code of Federal Regulations, 2011 CFR

2011-01-01

... behavior of items relied on for safety. (b) Facility and system design and facility layout must be based on... existing facilities. (a) Baseline design criteria. Each prospective applicant or licensee shall address the following baseline design criteria in the design of new facilities. Each existing licensee shall address the...

10 CFR 70.64 - Requirements for new facilities or new processes at existing facilities.

Code of Federal Regulations, 2013 CFR

2013-01-01

... behavior of items relied on for safety. (b) Facility and system design and facility layout must be based on... existing facilities. (a) Baseline design criteria. Each prospective applicant or licensee shall address the following baseline design criteria in the design of new facilities. Each existing licensee shall address the...

10 CFR 70.64 - Requirements for new facilities or new processes at existing facilities.

Code of Federal Regulations, 2012 CFR

2012-01-01

... behavior of items relied on for safety. (b) Facility and system design and facility layout must be based on... existing facilities. (a) Baseline design criteria. Each prospective applicant or licensee shall address the following baseline design criteria in the design of new facilities. Each existing licensee shall address the...

10 CFR 70.64 - Requirements for new facilities or new processes at existing facilities.

Code of Federal Regulations, 2014 CFR

2014-01-01

... behavior of items relied on for safety. (b) Facility and system design and facility layout must be based on... existing facilities. (a) Baseline design criteria. Each prospective applicant or licensee shall address the following baseline design criteria in the design of new facilities. Each existing licensee shall address the...

Facilities Performance Indicators Report, 2004-05. Facilities Core Data Survey

ERIC Educational Resources Information Center

Glazner, Steve, Ed.

2006-01-01

The purpose of "Facilities Performance Indicators" is to provide a representative set of statistics about facilities in educational institutions. The second iteration of the web-based Facilities Core Data Survey was posted and available to facilities professionals at more than 3,000 institutions in the Fall of 2005. The website offered a printed…

Analysis of Residual Acceleration Effects on Transport and Segregation During Directional Solidification of Tin-Bismuth in the MEPHISTO Furnace Facility

NASA Technical Reports Server (NTRS)

Alexander, J. Iwan D.; Lizee, Arnaud

1996-01-01

The object of this work, started in March of 1995, is to approach the problem of determining the transport conditions (and effects of residual acceleration) during the plane-front directional solidification of a tin-bismuth alloy under low gravity conditions. The work involves using a combination of 2- and 3-D numerical models, scaling analyses, 1-D models and the results of ground-based and low-gravity experiments. The experiments conducted in the MEPHISTO furnace facility during the USMP-3 spaceflight which took place earlier this year (22 Feb. - 6 Mar. 1996). This experiment represents an unprecedented opportunity to make a quantitative correlation between residual accelerations and the response of an actual experimental solidification system

Use of cellular phone contacts to increase return rates for immunization services in Kenya.

PubMed

Mokaya, Evans; Mugoya, Isaac; Raburu, Jane; Shimp, Lora

2017-01-01

In Kenya, failure to complete immunization schedules by children who previously accessed immunization services is an obstacle to ensuring that children are fully immunized. Home visit approaches used to track defaulting children have not been successful in reducing the drop-out rate. This study tested the use of phone contacts as an approach for tracking immunization defaulters in twelve purposively-selected facilities in three districts of western Kenya. For nine months, children accessing immunization services in the facilities were tracked and caregivers were asked their reasons for defaulting. In all of the facilities, caregiver phone ownership was above 80%. In 11 of the 12 facilities, defaulter rates between pentavalent1 and pentavalent3 vaccination doses reduced significantly to within the acceptable level of < 10%. Caregivers provided reliable contact information and health workers positively perceived phone-based defaulter communications. Tracking a defaulter required on average 2 minutes by voice and Ksh 6 ($ 0.07). Competing tasks and concerns about vaccinating sick children and side-effects were the most cited reasons for caregivers defaulting. Notably, a significant number of children categorised as defaulters had been vaccinated in a different facility (and were therefore "false defaulters"). Use of phone contacts for follow-up is a feasible and cost-effective method for tracking defaulters. This approach should complement traditional home visits, especially for caregivers without phones. Given communication-related reasons for defaulting, it is important that immunization programs scale-up community education activities. A system for health facilities to share details of defaulting children should be established to reduce "false defaulters".

Use of cellular phone contacts to increase return rates for immunization services in Kenya

PubMed Central

Mokaya, Evans; Mugoya, Isaac; Raburu, Jane; Shimp, Lora

2017-01-01

Introduction In Kenya, failure to complete immunization schedules by children who previously accessed immunization services is an obstacle to ensuring that children are fully immunized. Home visit approaches used to track defaulting children have not been successful in reducing the drop-out rate. Methods This study tested the use of phone contacts as an approach for tracking immunization defaulters in twelve purposively-selected facilities in three districts of western Kenya. For nine months, children accessing immunization services in the facilities were tracked and caregivers were asked their reasons for defaulting. Results In all of the facilities, caregiver phone ownership was above 80%. In 11 of the 12 facilities, defaulter rates between pentavalent1 and pentavalent3 vaccination doses reduced significantly to within the acceptable level of < 10%. Caregivers provided reliable contact information and health workers positively perceived phone-based defaulter communications. Tracking a defaulter required on average 2 minutes by voice and Ksh 6 ($ 0.07). Competing tasks and concerns about vaccinating sick children and side-effects were the most cited reasons for caregivers defaulting. Notably, a significant number of children categorised as defaulters had been vaccinated in a different facility (and were therefore “false defaulters”). Conclusion Use of phone contacts for follow-up is a feasible and cost-effective method for tracking defaulters. This approach should complement traditional home visits, especially for caregivers without phones. Given communication-related reasons for defaulting, it is important that immunization programs scale-up community education activities. A system for health facilities to share details of defaulting children should be established to reduce “false defaulters”. PMID:29138660

Effect of an innovative community based health program on maternal health service utilization in north and south central Ethiopia: a community based cross sectional study.

PubMed

Afework, Mesganaw Fantahun; Admassu, Kesteberhan; Mekonnen, Alemayehu; Hagos, Seifu; Asegid, Meselech; Ahmed, Saifuddin

2014-04-04

Among Millennium Development Goals, achieving the fifth goal (MDG-5) of reducing maternal mortality poses the greatest challenge in Sub-Saharan Africa. Ethiopia has one of the highest maternal mortality ratios in the world with unacceptably low maternal health service utilization. The Government of Ethiopia introduced an innovative community-based intervention as a national strategy under the Health Sector Development Program. This new approach, known as the Health Extension Program, aims to improve access to and equity in essential health services through community based Health Extension Workers. The objective of the study is to assess the role of Health Extension Workers in improving women's utilization of antenatal care, delivery at health facility and postnatal care services. A cross sectional household survey was conducted in early 2012 in two districts of northern and south central parts of Ethiopia. Data were collected from 4949 women who had delivered in the two years preceding the survey. Logistic regression analysis was performed to determine the association between visit by Health Extension Workers during pregnancy and use of maternal health services, controlling for the effect of other confounding factors. The non-adjusted analysis showed that antenatal care attendance at least four times during pregnancy was significantly associated with visit by Health Extension Workers [Odds Ratio 3.46(95% CI 3.07,3.91)], whereas health facility delivery (skilled attendance at birth) was not significantly associated with visit by Health Extension Workers during pregnancy [Odds Ratio 0.87(95% CI 0.25,2.96)]. When adjusted for other factors the association of HEWs visit during pregnancy was weaker for antenatal care attendance [Adjusted Odds Ratio: 1.35(95% CI: 1.05, 1.72)] but positively and significantly associated with health facility delivery [Adjusted Odds Ratio 1.96(1.25,3.06)]. In general HEWs visit during pregnancy improved utilization of maternal health services. Health facility delivery is heavily affected by other factors. Meaningful improvement in skilled attendance at birth (health facility delivery) should include addressing other factors on top of visits by HEWs during pregnancy and specific target oriented interventions during visits by HEWs to support skilled attendance at birth.

Evaluating Commercial and Private Cloud Services for Facility-Scale Geodetic Data Access, Analysis, and Services

NASA Astrophysics Data System (ADS)

Meertens, C. M.; Boler, F. M.; Ertz, D. J.; Mencin, D.; Phillips, D.; Baker, S.

2017-12-01

UNAVCO, in its role as a NSF facility for geodetic infrastructure and data, has succeeded for over two decades using on-premises infrastructure, and while the promise of cloud-based infrastructure is well-established, significant questions about suitability of such infrastructure for facility-scale services remain. Primarily through the GeoSciCloud award from NSF EarthCube, UNAVCO is investigating the costs, advantages, and disadvantages of providing its geodetic data and services in the cloud versus using UNAVCO's on-premises infrastructure. (IRIS is a collaborator on the project and is performing its own suite of investigations). In contrast to the 2-3 year time scale for the research cycle, the time scale of operation and planning for NSF facilities is for a minimum of five years and for some services extends to a decade or more. Planning for on-premises infrastructure is deliberate, and migrations typically take months to years to fully implement. Migrations to a cloud environment can only go forward with similar deliberate planning and understanding of all costs and benefits. The EarthCube GeoSciCloud project is intended to address the uncertainties of facility-level operations in the cloud. Investigations are being performed in a commercial cloud environment (Amazon AWS) during the first year of the project and in a private cloud environment (NSF XSEDE resource at the Texas Advanced Computing Center) during the second year. These investigations are expected to illuminate the potential as well as the limitations of running facility scale production services in the cloud. The work includes running parallel equivalent cloud-based services to on premises services and includes: data serving via ftp from a large data store, operation of a metadata database, production scale processing of multiple months of geodetic data, web services delivery of quality checked data and products, large-scale compute services for event post-processing, and serving real time data from a network of 700-plus GPS stations. The evaluation is based on a suite of metrics that we have developed to elucidate the effectiveness of cloud-based services in price, performance, and management. Services are currently running in AWS and evaluation is underway.

The three waves in implementation of facility-based kangaroo mother care: a multi-country case study from Asia.

PubMed

Bergh, Anne-Marie; de Graft-Johnson, Joseph; Khadka, Neena; Om'Iniabohs, Alyssa; Udani, Rekha; Pratomo, Hadi; De Leon-Mendoza, Socorro

2016-01-27

Kangaroo mother care has been highlighted as an effective intervention package to address high neonatal mortality pertaining to preterm births and low birth weight. However, KMC uptake and service coverage have not progressed well in many countries. The aim of this case study was to understand the institutionalisation processes of facility-based KMC services in three Asian countries (India, Indonesia and the Philippines) and the reasons for the slow uptake of KMC in these countries. Three main data sources were available: background documents providing insight in the state of implementation of KMC in the three countries; visits to a selection of health facilities to gauge their progress with KMC implementation; and data from interviews and meetings with key stakeholders. The establishment of KMC services at individual facilities began many years before official prioritisation for scale-up. Three major themes were identified: pioneers of facility-based KMC; patterns of KMC knowledge and skills dissemination; and uptake and expansion of KMC services in relation to global trends and national policies. Pioneers of facility-based KMC were introduced to the concept in the 1990s and established the practice in a few individual tertiary or teaching hospitals, without further spread. A training method beneficial to the initial establishment of KMC services in a country was to send institutional health-professional teams to learn abroad, notably in Colombia. Further in-country cascading took place afterwards and still later on KMC was integrated into newborn and obstetric care programs. The patchy uptake and expansion of KMC services took place in three phases aligned with global trends of the time: the pioneer phase with individual champions while the global focus was on child survival (1998-2006); the newborn-care phase (2007-2012); and lastly the current phase where small babies are also included in action plans. This paper illustrates the complexities of implementing a new healthcare intervention. Although preterm care is currently in the limelight, clear and concerted country-led KMC scale-up strategies with associated operational plans and budgets are essential for successful scale-up.

Environmental Assessment, Project MOUNTAINVIEW Facility, Buckley Air Force Base, Colorado

DTIC Science & Technology

2011-10-01

Overall, construction and demolition activities would have the potential to result in adverse effects on surface water quality, but the development of a ... Studied in Detail This EA examines potential effects of the Proposed Action and No Action Alternative on 10 resource areas: noise, land use, air...not in a floodplain. Any potential indirect effects on floodplains would be addressed through the use of storm water best management practices

Environmental Assessment for the Aeromedical Evacuation Formal Training Unit, Wright-Patterson Air Force Base

DTIC Science & Technology

2012-05-01

adverse health effects (HHS 2010). However, propylene glycol requires oxygen for breakdown, which can deplete surface waters of dissolved oxygen ...and the Human Effectiveness Directorate (RH), plus supporting functions. Facility 20840 contains a high-bay area that houses two C-130 training...aircrew training program that develops and maintains a high state of mission readiness for immediate and effective deployments across the range of

Antenatal care strengthening for improved health behaviours in Jimma, Ethiopia, 2009-2011: An effectiveness study.

PubMed

Villadsen, Sarah Fredsted; Negussie, Dereje; GebreMariam, Abebe; Tilahun, Abebech; Girma, Tsinuel; Friis, Henrik; Rasch, Vibeke

2016-09-01

health systems in low-income settings are not sufficiently reaching the poor, and global disparities in reproductive health persist. The frequency and quality of health education during antenatal care is often low. Further studies are needed on how to improve the performance of health systems in low income settings to improve maternal and child health. to assess the effectiveness of a participatory antenatal care intervention on health behaviours and to illuminate how the different socioeconomic groups responded to the intervention in Jimma, Ethiopia. SETTING, INTERVENTION AND MEASUREMENTS: an intervention was designed participatorily and comprised trainings, supervisions, equipment, health education material, and adaption of guidelines. It was implemented at public facilities. Household surveys, before (2008) and after (2010) intervention, were conducted amongst all women who had given birth within the previous 12 months. The effect of the intervention was assessed by comparing the change in health behaviours (number of antenatal visits, health facility delivery, breast feeding, preventive infant health check, and infant immunisation) from before to after the intervention period at intervention sites, relative to control sites, using logistic mixed effect regression. on the basis of 1357 women included before and 2262 after the intervention, there were positive effects of the intervention on breast feeding practices (OR 3.0, 95% CI: 1.4; 3.6) and preventive infant health check (OR 2.4, 95% CI: 1.5; 3.5). There was no effect on infant immunisation coverage and negative effect on number of antenatal visits. The effect on various outcomes was modified by maternal education, and results indicate increased health facility delivery (OR 2.4, 95% CI: 0.8; 6.9) and breast feeding practices (OR 18.2, 95% CI: 5.2;63.6) among women with no education. the facility based intervention improved some, but not all health behaviours. The improvements indicated amongst the most disadvantaged antenatal care attendants in breast feeding and health facility delivery are encouraging and underline the need to scale up priority of antenatal care in the effort to reduce maternal and child health inequity. Copyright © 2016 Elsevier Ltd. All rights reserved.

Potential cost-effectiveness of supervised injection facilities in Toronto and Ottawa, Canada.

PubMed

Enns, Eva A; Zaric, Gregory S; Strike, Carol J; Jairam, Jennifer A; Kolla, Gillian; Bayoumi, Ahmed M

2016-03-01

Supervised injection facilities (legally sanctioned spaces for supervised consumption of illicitly obtained drugs) are controversial public health interventions. We determined the optimal number of facilities in two Canadian cities using health economic methods. Dynamic compartmental model of HIV and hepatitis C transmission through sexual contact and sharing of drug use equipment. Toronto and Ottawa, Canada. Simulated population of each city. Zero to five supervised injection facilities. Direct health-care costs and quality-adjusted life-years (QALYs) over 20 years, discounted at 5% per year; incremental cost-effectiveness ratios. In Toronto, one facility cost $4.1 million and resulted in a gain of 385 QALYs over 20 years, for an incremental cost-effectiveness ratio (ICER) of $10,763 per QALY [95% credible interval (95CrI): cost-saving to $278,311]. Establishing one facility in Ottawa had an ICER of $6127 per QALY (95CrI: cost-saving to $179,272). At a $50,000 per QALY threshold, three facilities would be cost-effective in Toronto and two in Ottawa. The probability that establishing three, four, or five facilities in Toronto was cost-effective was 17, 21, and 41%, respectively. Establishing one, two, or three facilities in Ottawa was cost-effective with 13, 35, and 41% probability, respectively. Establishing no facility was unlikely to be the most cost-effective option (14% in Toronto and 10% in Ottawa). In both cities, results were robust if the reduction in needle-sharing among clients of the facilities was at least 50% and fixed operating costs were less than $2.0 million. Using a $50,000 per quality-adjusted life-years threshold for cost-effectiveness, it is likely to be cost-effective to establish at least three legally sanctioned spaces for supervised injection of illicitly obtained drugs in Toronto, Canada and two in Ottawa, Canada. © 2015 Society for the Study of Addiction.

The Benefits of Incorporating Shipping Containers into the Climate Change Adaption Plans at NASA Wallops Flight Facility

NASA Technical Reports Server (NTRS)

Hamilton, Carl Kenneth Gonzaga

2017-01-01

The National Aeronautics and Space Administration has several centers and facilities located near the coast that are undoubtedly susceptible to climate change. One of those facilities is Wallops Flight Facility on the Eastern Shore of Virginia which is separated into three areas: Main Base, Mainland, and the Island. Wallops Island has numerous buildings and assets that are vulnerable to flood inundation, intense storms, and storm surge. The shoreline of Wallops Island is prone to beach erosion and is slated for another beach replenishment project in 2019. In addition, current climate projections for NASAs centers and facilities, conducted by the Climate Adaptation Science Investigators, warn of inevitable increases in annual temperature, precipitation, sea level rise, and extreme events such as heat waves. The aforementioned vulnerabilities Wallops Island faces in addition to the projections of future climate change reveal an urgency for NASA to adjust how new buildings at its centers and facilities near the coast are built to adapt to the inevitable effects of climate change. Although the agency has made strides to mitigate the effects of climate change by incorporating L.E.E.D. into new buildings that produce less greenhouse gas, the strides for the agency to institute clear climate adaptation policies for the buildings at its centers and facilities near the coast seem to lag behind. As NASA continues to formulate formidable climate change adaptation plans for its centers and facilities, an architectural trend that should be examined for its potential to replace several old buildings at Wallops Island is shipping containers buildings. Shipping containers or Intermodal Steel Building Units offer an array of benefits such as strength, durability, versatility, modular, and since they can be upcycled, they are also eco-friendly. Some disadvantages of shipping containers are they contain harmful chemicals, insulation must be added, fossil fuels must be used to transport them to the site, and multiple ISBUs are needed. However, the benefits of shipping container buildings could be utilized at NASA centers or facilities near the coast such as Wallops Island on new buildings that are designed to adapt to the impending effects of climate change. Thus, this Masters Research Project will explore how those benefits can be incorporated into the climate change adaptation plans at Wallops Island and make recommendations for policy guidelines and shipping container buildings specific to Wallops Island.

Evaluation of the impact of the voucher and accreditation approach on improving reproductive health behaviors and status in Kenya.

PubMed

Warren, Charlotte; Abuya, Timothy; Obare, Francis; Sunday, Joseph; Njue, Rebecca; Askew, Ian; Bellows, Ben

2011-03-23

Alternatives to the traditional 'supply-side' approach to financing service delivery are being explored. These strategies are termed results-based finance, demand-side health financing or output-based aid which includes a range of interventions that channel government or donor subsidies to the user rather than the provider. Initial pilot assessments of reproductive health voucher programs suggest that, they can increase access and use, reducing inequities and enhancing program efficiency and service quality. However, there is a paucity of evidence describing how the programs function in different settings, for various reproductive health services. Population Council, funded by the Bill and Melinda Gates Foundation, intends to generate evidence around the 'voucher and accreditation' approaches to improving the reproductive health of low income women in Kenya. A quasi-experimental study will investigate the impact of the voucher approach on improving reproductive health behaviors, reproductive health status and reducing inequities at the population level; and assessing the effect of vouchers on increasing access to, and quality of, and reducing inequities in the use of selected reproductive health services. The study comprises of four populations: facilities, providers, women of reproductive health age using facilities and women and men who have been pregnant and/or used family planning within the previous 12 months. The study will be carried out in samples of health facilities - public, private and faith-based in: three districts; Kisumu, Kiambu, Kitui and two informal settlements in Nairobi which are accredited to provide maternal and newborn health and family planning services to women holding vouchers for the services; and compared with a matched sample of non-accredited facilities. Health facility assessments (HFA) will be conducted at two stages to track temporal changes in quality of care and utilization. Facility inventories, structured observations, and client exit interviews will be used to collect comparable data across facilities. Health providers will also be interviewed and observed providing care. A population survey of about 3000 respondents will also be carried out in areas where vouchers are distributed and similar locations where vouchers are not distributed.

The Effect of Increased Travel Reimbursement Rates on Health Care Utilization in the VA

ERIC Educational Resources Information Center

Nelson, Richard E.; Hicken, Bret; West, Alan; Rupper, Randall

2012-01-01

Purpose: The reimbursement rate that eligible veterans receive for travel to Department of Veterans Affairs (VA) facilities increased from 11 to 28.5 cents per mile on February 1, 2008. We examined the effect of this policy change on utilization of outpatient, inpatient, and pharmacy services, stratifying veterans based on distance from a VA…

Effectiveness of a Mobile Short-Message-Service–Based Disease Outbreak Alert System in Kenya

PubMed Central

Njeru, Ian; Zurovac, Dejan; Tipo, Shikanga O; Kareko, David; Mwau, Matilu; Morita, Kouichi

2016-01-01

We conducted a randomized, controlled trial to test the effectiveness of a text-messaging system used for notification of disease outbreaks in Kenya. Health facilities that used the system had more timely notifications than those that did not (19.2% vs. 2.6%), indicating that technology can enhance disease surveillance in resource-limited settings. PMID:26981628

How front-line healthcare workers respond to stock-outs of essential medicines in the Eastern Cape Province of South Africa.

PubMed

Hodes, R; Price, I; Bungane, N; Toska, E; Cluver, L

2017-08-25

Shortages of essential medicines are a daily occurrence in many of South Africa (SA)'s public health facilities. This study focuses on the responses of healthcare workers to stock-outs, investigating how actors at the 'front line' of public health delivery understand, experience and respond to shortages of essential medicines and equipment in their facilities. Findings are based on focus groups, observations and interviews with healthcare workers and patients at healthcare facilities in the Eastern Cape Province of SA, conducted as part of the Mzantsi Wakho study. The research revealed a discrepancy between 'informal' definitions of stock-outs and their reporting through formal stock-out management channels. Front-line healthcare workers had designed their own systems for classifying the severity of stock-outs, based on the product in question, and on their potential to access stocks from other facilities. Beyond formal systems of procurement and supply, healthcare workers had established vast networks of alternative communication and action, often using personal resources to procure medical supplies. Stock-outs were only reported when informal methods of stock-sharing did not secure top-up supplies. These findings have implications for understanding the frequency and severity of stock-outs, and for taking action to prevent and manage stock-outs effectively.

Feasibility study for a biomedical experimental facility based on LEIR at CERN.

PubMed

Abler, Daniel; Garonna, Adriano; Carli, Christian; Dosanjh, Manjit; Peach, Ken

2013-07-01

In light of the recent European developments in ion beam therapy, there is a strong interest from the biomedical research community to have more access to clinically relevant beams. Beamtime for pre-clinical studies is currently very limited and a new dedicated facility would allow extensive research into the radiobiological mechanisms of ion beam radiation and the development of more refined techniques of dosimetry and imaging. This basic research would support the current clinical efforts of the new treatment centres in Europe (for example HIT, CNAO and MedAustron). This paper presents first investigations on the feasibility of an experimental biomedical facility based on the CERN Low Energy Ion Ring LEIR accelerator. Such a new facility could provide beams of light ions (from protons to neon ions) in a collaborative and cost-effective way, since it would rely partly on CERN's competences and infrastructure. The main technical challenges linked to the implementation of a slow extraction scheme for LEIR and to the design of the experimental beamlines are described and first solutions presented. These include introducing new extraction septa into one of the straight sections of the synchrotron, changing the power supply configuration of the magnets, and designing a new horizontal beamline suitable for clinical beam energies, and a low-energy vertical beamline for particular radiobiological experiments.

Feasibility study for a biomedical experimental facility based on LEIR at CERN

PubMed Central

Abler, Daniel; Garonna, Adriano; Carli, Christian; Dosanjh, Manjit; Peach, Ken

2013-01-01

In light of the recent European developments in ion beam therapy, there is a strong interest from the biomedical research community to have more access to clinically relevant beams. Beamtime for pre-clinical studies is currently very limited and a new dedicated facility would allow extensive research into the radiobiological mechanisms of ion beam radiation and the development of more refined techniques of dosimetry and imaging. This basic research would support the current clinical efforts of the new treatment centres in Europe (for example HIT, CNAO and MedAustron). This paper presents first investigations on the feasibility of an experimental biomedical facility based on the CERN Low Energy Ion Ring LEIR accelerator. Such a new facility could provide beams of light ions (from protons to neon ions) in a collaborative and cost-effective way, since it would rely partly on CERN's competences and infrastructure. The main technical challenges linked to the implementation of a slow extraction scheme for LEIR and to the design of the experimental beamlines are described and first solutions presented. These include introducing new extraction septa into one of the straight sections of the synchrotron, changing the power supply configuration of the magnets, and designing a new horizontal beamline suitable for clinical beam energies, and a low-energy vertical beamline for particular radiobiological experiments. PMID:23824122

Australia's TERN: Advancing Ecosystem Data Management in Australia

NASA Astrophysics Data System (ADS)

Phinn, S. R.; Christensen, R.; Guru, S.

2013-12-01

Globally, there is a consistent movement towards more open, collaborative and transparent science, where the publication and citation of data is considered standard practice. Australia's Terrestrial Ecosystem Research Network (TERN) is a national research infrastructure investment designed to support the ecosystem science community through all stages of the data lifecycle. TERN has developed and implemented a comprehensive network of ';hard' and ';soft' infrastructure that enables Australia's ecosystem scientists to collect, publish, store, share, discover and re-use data in ways not previously possible. The aim of this poster is to demonstrate how TERN has successfully delivered infrastructure that is enabling a significant cultural and practical shift in Australia's ecosystem science community towards consistent approaches for data collection, meta-data, data licensing, and data publishing. TERN enables multiple disciplines, within the ecosystem sciences to more effectively and efficiently collect, store and publish their data. A critical part of TERN's approach has been to build on existing data collection activities, networks and skilled people to enable further coordination and collaboration to build each data collection facility and coordinate data publishing. Data collection in TERN is through discipline based facilities, covering long term collection of: (1) systematic plot based measurements of vegetation structure, composition and faunal biodiversity; (2) instrumented towers making systematic measurements of solar, water and gas fluxes; and (3) satellite and airborne maps of biophysical properties of vegetation, soils and the atmosphere. Several other facilities collect and integrate environmental data to produce national products for fauna and vegetation surveys, soils and coastal data, as well as integrated or synthesised products for modelling applications. Data management, publishing and sharing in TERN are implemented through a tailored data licensing framework suitable for ecosystem data, national standards for metadata, a DOI-minting service, and context-appropriate data repositories and portals. The TERN Data infrastructure is based on loosely coupled 'network of networks.' Overall, the data formats used across the TERN facilities vary from NetCDF, comma-separated values and descriptive documents. Metadata standards include ISO19115, Ecological Metadata Language and rich semantic enabled contextual information. Data services vary from Web Mapping Service, Web Feature Service, OpeNDAP, file servers and KNB Metacat. These approaches enable each data collection facility to maintain their discipline based data collection and storage protocols. TERN facility meta-data are harvested regularly for the central TERN Data Discovery Portal and converted to a national standard format. This approach enables centralised discovery, access, and re-use of data simply and effectively, while maintaining disciplinary diversity. Effort is still required to support the cultural shift towards acceptance of effective data management, publication, sharing and re-use as standard practice. To this end TERN's future activities will be directed to supporting this transformation and undertaking ';education' to enable ecosystem scientists to take full advantage of TERN's infrastructure, and providing training and guidance for best practice data management.

Particle swarm optimization based space debris surveillance network scheduling

NASA Astrophysics Data System (ADS)

Jiang, Hai; Liu, Jing; Cheng, Hao-Wen; Zhang, Yao

2017-02-01

The increasing number of space debris has created an orbital debris environment that poses increasing impact risks to existing space systems and human space flights. For the safety of in-orbit spacecrafts, we should optimally schedule surveillance tasks for the existing facilities to allocate resources in a manner that most significantly improves the ability to predict and detect events involving affected spacecrafts. This paper analyzes two criteria that mainly affect the performance of a scheduling scheme and introduces an artificial intelligence algorithm into the scheduling of tasks of the space debris surveillance network. A new scheduling algorithm based on the particle swarm optimization algorithm is proposed, which can be implemented in two different ways: individual optimization and joint optimization. Numerical experiments with multiple facilities and objects are conducted based on the proposed algorithm, and simulation results have demonstrated the effectiveness of the proposed algorithm.

Utilisation of health services and geography: deconstructing regional differences in barriers to facility-based delivery in Nepal.

PubMed

Hodge, Andrew; Byrne, Abbey; Morgan, Alison; Jimenez-Soto, Eliana

2015-03-01

While established that geographical inaccessibility is a key barrier to the utilisation of health services, it remains unknown whether disparities are driven only by limited access to these services, or are also attributable to health behaviour. Significant disparities exist in health outcomes and the coverage of many critical health services between the mountains region of Nepal and the rest of the country, yet the principal factors driving these regional disparities are not well understood. Using national representative data from the 2011 Nepal Demographic and Health Survey, we examine the extent to which observable factors explain the overall differences in the utilisation of maternal health services. We apply nonlinear Blinder-Oaxaca-type decomposition methods to quantify the effect that differences in measurable characteristics have on the regional coverage gap in facility-based delivery. The mean coverage of facility-based deliveries was 18.6 and 36.3 % in the mountains region and the rest of Nepal, respectively. Between 54.8 and 74.1 % of the regional coverage gap was explained by differences in observed characteristics. Factors influencing health behaviours (proxied by mothers' education, TV viewership and tobacco use, and household wealth) and subjective distance to the health facility were the major factors, contributing between 52.9 and 62.5 % of the disparity. Mothers' birth history was also noteworthy. Policies simultaneously addressing access and health behaviours appear necessary to achieve greater coverage and better health outcomes for women and children in isolated areas.

Effectiveness of the WHO SCC on improving adherence to essential practices during childbirth, in resource constrained settings.

PubMed

Kumar, Somesh; Yadav, Vikas; Balasubramaniam, Sudharsanam; Jain, Yashpal; Joshi, Chandra Shekhar; Saran, Kailash; Sood, Bulbul

2016-11-08

India accounts for 27 % of world's neonatal deaths. Although more Indian women deliver in facilities currently than a decade ago, early neonatal mortality has not declined, likely because of insufficient quality of care. The WHO Safe Childbirth Checklist (SCC) was developed to support health workers to perform essential practices known to reduce preventable maternal and new-born deaths around the time of childbirth. Despite promising early research many outstanding questions remain about effectiveness of the SCC in low-resource settings. In collaboration with the Ministry of Health SCC was modified for Indian context and introduced in 101 intervention facilities in Rajasthan, India and 99 facilities served as comparison to study if it reduces mortality. This Quasi experimental Observational intervention-comparison was embedded in this larger program to test whether a program for introduction of SCC with simple implementation package was associated with increased adherence to 28 evidence-based practices. This study was conducted in 8 intervention and 8 comparison sites. Program interventions to promote appropriate use of the SCC included orienting providers to the checklist, modest modifications of the SCC to promote provider uptake and accountability, ensuring availability of essential supplies, and providing supportive supervision for helping providers in using the SCC. The SCC was used by providers in 86 % of 240 deliveries observed in the eight intervention facilities. Providers in the intervention group significantly adhered to practices included in the SCC than providers in the comparison group controlling for baseline scores and confounders. Women delivering in the intervention facilities received on an average 11.5 more of the 28 practices included compared with women in the comparison facilities. For selected practices provider performance in the intervention group increased as much as 93 % than comparison sites. Use of the SCC and provider performance of best practices increased in intervention facilities reflecting improvement in quality of facility childbirth care for women and new-born in low resource settings.

32 CFR 766.4 - Policy.

Code of Federal Regulations, 2010 CFR

2010-07-01

... to land at a facility, provided such aircraft is not engaging in air commerce, and such landing is... to base or operate from a facility for personal convenience nor base at a facility under the guise of... engaging in air commerce, and such landing is for official business required by written orders. Such...

Accessibility to health care facilities in Montreal Island: an application of relative accessibility indicators from the perspective of senior and non-senior residents.

PubMed

Paez, Antonio; Mercado, Ruben G; Farber, Steven; Morency, Catherine; Roorda, Matthew

2010-10-25

Geographical access to health care facilities is known to influence health services usage. As societies age, accessibility to health care becomes an increasingly acute public health concern. It is known that seniors tend to have lower mobility levels, and it is possible that this may negatively affect their ability to reach facilities and services. Therefore, it becomes important to examine the mobility situation of seniors vis-a-vis the spatial distribution of health care facilities, to identify areas where accessibility is low and interventions may be required. Accessibility is implemented using a cumulative opportunities measure. Instead of assuming a fixed bandwidth (i.e. a distance threshold) for measuring accessibility, in this paper the bandwidth is defined using model-based estimates of average trip length. Average trip length is an all-purpose indicator of individual mobility and geographical reach. Adoption of a spatial modelling approach allows us to tailor these estimates of travel behaviour to specific locations and person profiles. Replacing a fixed bandwidth with these estimates permits us to calculate customized location- and person-based accessibility measures that allow inter-personal as well as geographical comparisons. The case study is Montreal Island. Geo-coded travel behaviour data, specifically average trip length, and relevant traveller's attributes are obtained from the Montreal Household Travel Survey. These data are complemented with information from the Census. Health care facilities, also geo-coded, are extracted from a comprehensive business point database. Health care facilities are selected based on Standard Industrial Classification codes 8011-21 (Medical Doctors and Dentists). Model-based estimates of average trip length show that travel behaviour varies widely across space. With the exception of seniors in the downtown area, older residents of Montreal Island tend to be significantly less mobile than people of other age cohorts. The combination of average trip length estimates with the spatial distribution of health care facilities indicates that despite being more mobile, suburban residents tend to have lower levels of accessibility compared to central city residents. The effect is more marked for seniors. Furthermore, the results indicate that accessibility calculated using a fixed bandwidth would produce patterns of exposure to health care facilities that would be difficult to achieve for suburban seniors given actual mobility patterns. The analysis shows large disparities in accessibility between seniors and non-seniors, between urban and suburban seniors, and between vehicle owning and non-owning seniors. This research was concerned with potential accessibility levels. Follow up research could consider the results reported here to select case studies of actual access and usage of health care facilities, and related health outcomes.

Downgrading Nuclear Facilities to Radiological Facilities

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

Jarry, Jeffrey F.; Farr, Jesse Oscar; Duran, Leroy

2015-08-01

Based on inventory reductions and the use of alternate storage facilities, the Sandia National Laboratories (SNL) downgraded 4 SNL Hazard Category 3 (HC-3) nuclear facilities to less-than-HC-3 radiological facilities. SNL’s Waste Management and Pollution Prevention Department (WMPPD) managed the HC-3 nuclear facilities and implemented the downgrade. This paper will examine the downgrade process,

Facility-Level Characteristics Associated with Serious Suicide Attempts and Deaths from Suicide in Juvenile Justice Residential Facilities

ERIC Educational Resources Information Center

Gallagher, Catherine A.; Dobrin, Adam

2006-01-01

Little is known about how facility-level characteristics affect the risk of suicide and suicide attempts in juvenile justice residential facilities. This leaves facility administrators and mental health providers without evidence-based guidance on how the facility itself affects risks. The current study uses data from two recently developed…

The Aged Residential Care Healthcare Utilization Study (ARCHUS): a multidisciplinary, cluster randomized controlled trial designed to reduce acute avoidable hospitalizations from long-term care facilities.

PubMed

Connolly, Martin J; Boyd, Michal; Broad, Joanna B; Kerse, Ngaire; Lumley, Thomas; Whitehead, Noeline; Foster, Susan

2015-01-01

To assess effect of a complex, multidisciplinary intervention aimed at reducing avoidable acute hospitalization of residents of residential aged care (RAC) facilities. Cluster randomized controlled trial. RAC facilities with higher than expected hospitalizations in Auckland, New Zealand, were recruited and randomized to intervention or control. A total of 1998 residents of 18 intervention facilities and 18 control facilities. A facility-based complex intervention of 9 months' duration. The intervention comprised gerontology nurse specialist (GNS)-led staff education, facility bench-marking, GNS resident review, and multidisciplinary (geriatrician, primary-care physician, pharmacist, GNS, and facility nurse) discussion of residents selected using standard criteria. Primary end point was avoidable hospitalizations. Secondary end points were all acute admissions, mortality, and acute bed-days. Follow-up was for a total of 14 months. The intervention did not affect main study end points: number of acute avoidable hospital admissions (RR 1.07; 95% CI 0.85-1.36; P = .59) or mortality (RR 1.11; 95% CI 0.76-1.61; P = .62). This multidisciplinary intervention, packaging selected case review, and staff education had no overall impact on acute hospital admissions or mortality. This may have considerable implications for resourcing in the acute and RAC sectors in the face of population aging. Australian and New Zealand Clinical Trials Registry (ACTRN12611000187943). Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Sub-national variation in measles vaccine coverage and outbreak risk: a case study from a 2010 outbreak in Malawi.

PubMed

Kundrick, Avery; Huang, Zhuojie; Carran, Spencer; Kagoli, Matthew; Grais, Rebecca Freeman; Hurtado, Northan; Ferrari, Matthew

2018-06-15

Despite progress towards increasing global vaccination coverage, measles continues to be one of the leading, preventable causes of death among children worldwide. Whether and how to target sub-national areas for vaccination campaigns continues to remain a question. We analyzed three metrics for prioritizing target areas: vaccination coverage, susceptible birth cohort, and the effective reproductive ratio (R E ) in the context of the 2010 measles epidemic in Malawi. Using case-based surveillance data from the 2010 measles outbreak in Malawi, we estimated vaccination coverage from the proportion of cases reporting with a history of prior vaccination at the district and health facility catchment scale. Health facility catchments were defined as the set of locations closer to a given health facility than to any other. We combined these estimates with regional birth rates to estimate the size of the annual susceptible birth cohort. We also estimated the effective reproductive ratio, R E , at the health facility polygon scale based on the observed rate of exponential increase of the epidemic. We combined these estimates to identify spatial regions that would be of high priority for supplemental vaccination activities. The estimated vaccination coverage across all districts was 84%, but ranged from 61 to 99%. We found that 8 districts and 354 health facility catchments had estimated vaccination coverage below 80%. Areas that had highest birth cohort size were frequently large urban centers that had high vaccination coverage. The estimated R E ranged between 1 and 2.56. The ranking of districts and health facility catchments as priority areas varied depending on the measure used. Each metric for prioritization may result in discrete target areas for vaccination campaigns; thus, there are tradeoffs to choosing one metric over another. However, in some cases, certain areas may be prioritized by all three metrics. These areas should be treated with particular concern. Furthermore, the spatial scale at which each metric is calculated impacts the resulting prioritization and should also be considered when prioritizing areas for vaccination campaigns. These methods may be used to allocate effort for prophylactic campaigns or to prioritize response for outbreak response vaccination.

Lessons learned: clinicians' post-occupancy perspective of facility design involvement.

PubMed

Reno, Kathy; Okland, Kathy; Finis, Nanne; Lamantia, Gina; Call, Roger; Cardon, Kerrie; Gerber, Deborah; Zeigler, Janet

2014-01-01

The research was conducted to determine clinician knowledge needs for competent involvement with the facility design process as well as to gather lessons learned on building stronger design teams. As clinical stakeholders are invited to the healthcare facility design table, the question arises as to the ability of professionally diverse team members to translate each other's comments and ideas accurately. In the past, hospitals were designed by a handful of hospital leaders and architects. More recently, multiple players have become involved throughout the design and construction of new healthcare facilities. Clinical consultants from two international healthcare companies observed that many clinicians were unprepared to effectively translate their needs to the architectural community or to competently utilize architectural tools and documents. A qualitative, post-occupancy cross-case study was conducted to understand how clinicians could increase their competencies for successful involvement in facility design. Focus group interviews were held with teams from healthcare facilities occupying their new facility for more than 6 months and less than 2 years. Curriculum topics were validated and additional areas recommended based on the interviews. Open-ended questioins on lessons learned provided several new dimensions to the research. Although validating the curriculum was the initial intent, the feedback from the focus groups on lessons learned provided rich concepts for practice implications and further research on post-occupancy. Decision-making, design process, interdisciplinary, planning, post-occupancy.

Notepad Is NOT Bad: Employing Yahoo! Notepad as an Online Research Diary in Educational Enquiry Based on a PhD Study

ERIC Educational Resources Information Center

Abdallah, Mahmoud Mohammad Sayed

2011-01-01

Reflective tools have been gaining ground in educational research. Diaries, especially electronic ones, can be effective in enabling researchers to organise and reflect upon their research. Online diaries are flexible Web-based facilities since the recording process can be conducted quickly and smoothly. Here, I report on using Yahoo! Notepad as…

Psychosocial determinants and perceived environmental barriers as mediators of the effectiveness of a web-based tailored intervention promoting physical activity in adolescents: the HELENA Activ-O-Meter.

PubMed

Cook, Tina Louisa; De Bourdeaudhuij, Ilse; Maes, Lea; Haerens, Leen; Grammatikaki, Evangelia; Widhalm, Kurt; Kwak, Lydia; Plada, Maria; Moreno, Luis Alberto; Tountas, Yannis; Zampelas, Antonis; Manios, Yannis

2014-05-01

The aim was to examine if psychosocial determinants (attitudes, self-efficacy, social support from a sports partner) and perceived environmental barriers (PEB) of physical activity (PA) mediated the effect of a 3-month Internet-based intervention on PA in European adolescents. A sample of 536 adolescents (51% boys) aged 12-17 years were randomly assigned to intervention or control condition. Questionnaires were used to assess different PA behaviors, psychosocial determinants and PEB at baseline and at 3-month follow-up. Mediating effects were assessed with the bootstrapping method. PEB regarding neighborhood safety mediated the effect of the intervention on all PA indices. PEB regarding sports facilities availability at neighborhood and PEB regarding sport-related facilities availability at school mediated the effect of the intervention on moderate to vigorous PA (MVPA) and moderate PA (in leisure time and at school, respectively). Social support from a sports partner suppressed the effect of the intervention on vigorous PA and MVPA. No other factor had a mediation effect. All PEB measures appear to mediate PA behaviors of different intensities and in different contexts. Interventions promoting PA in adolescents should also focus on improving the targeted PEB as mediators of engagement in PA to bring the desired effects in actual behaviors.

Expansion tunnel characterization and development of non-intrusive microwave plasma diagnostics

NASA Astrophysics Data System (ADS)

Dufrene, Aaron T.

The focus of this research is the development of non-intrusive microwave diagnostics for characterization of expansion tunnels. The main objectives of this research are to accurately characterize the LENS XX expansion tunnel facility, develop non-intrusive RF diagnostics that will work in short-duration expansion tunnel testing, and to determine plasma properties and other information that might otherwise be unknown, less accurate, intrusive, or more difficult to determine through conventional methods. Testing was completed in LENS XX, a new large-scale expansion tunnel facility at CUBRC, Inc. This facility is the largest known expansion tunnel in the world with an inner diameter of 24 inches, a 96 inch test section, and an end-to-end length of more than 240 ft. Expansion tunnels are currently the only facilities capable of generating high-enthalpy test conditions with minimal or no freestream dissociation or ionization. However, short test times and freestream noise at some conditions have limited development of these facilities. To characterize the LENS XX facility, the first step is to evaluate the facility pressure, vacuum, temperature, and other mechanical restrictions to derive a theoretical testing parameter space. Test condition maps are presented for a variety of parameters and gases based on 1D perfect gas dynamics. Test conditions well beyond 10 km/s or 50 MJ/kg are identified with minimum test times of 200 us. Additionally, a four-chamber expansion tube configuration is considered for extending the stagnation enthalpy range of the facility even further. A microwave shock speed diagnostic measures primary and secondary shock speeds accurately every 30 in. down the entire length of the facility resulting in a more accurate determination of freestream conditions required for computational comparisons. The high resolution of this measurement is used to assess shock speed attenuation as well as secondary diaphragm performance. Negligible shock attenuation is reported over a large range of test conditions and gases, and this is attributed to the large diameter of the LENS XX driven and expansion tubes. Shock tube boundary layer growth solutions based on Mirels's theory confirm LENS XX test conditions should not be adversely affected by viscous effects. Mirels's theory is applied to both large- and small-scale expansion tube facilities to determine displacement thicknesses, and quasi one-dimensional solutions show how viscous effects become significant in long, smaller diameter facilities. In collaboration with ElectroDynamic Applications, Inc., (EDA) plasma frequency measurements are made in two different configurations using a swept microwave frequency power reflection measurement. Electric field characteristics of EDA's probe are presented and show current probe design is ideal for measuring properties of shock layers that are 1-2 cm thick. Electron density and radio frequency communication characteristics through a shock layer on the lee side of a capsule up to 8.9 km/s and in a stagnation configuration up to 5.4 km/s in air are reported.

Dense cold baryonic matter

NASA Astrophysics Data System (ADS)

Stavinskiy, A. V.

2017-09-01

A possibility of studying cold nuclear matter on the Nuclotron-NICA facility at baryonic densities characteristic of and higher than at the center of a neutron star is considered based on the data from cumulative processes. A special rare-event kinematic trigger for collisions of relativistic ions is proposed for effective selection of events accompanied by production of dense baryonic systems. Possible manifestations of new matter states under these unusual conditions and an experimental program for their study are discussed. Various experimental setups are proposed for these studies, and a possibility of using experimental setups at the Nuclotron-NICA facility for this purpose is considered.

Flight test techniques for validating simulated nuclear electromagnetic pulse aircraft responses

NASA Technical Reports Server (NTRS)

Winebarger, R. M.; Neely, W. R., Jr.

1984-01-01

An attempt has been made to determine the effects of nuclear EM pulses (NEMPs) on aircraft systems, using a highly instrumented NASA F-106B to document the simulated NEMP environment at the Kirtland Air Force Base's Vertically Polarized Dipole test facility. Several test positions were selected so that aircraft orientation relative to the test facility would be the same in flight as when on the stationary dielectric stand, in order to validate the dielectric stand's use in flight configuration simulations. Attention is given to the flight test portions of the documentation program.

Environmental Assessment for Developing Renewable Energy Enhanced Use Lease Facilities at Robins Air Force Base

DTIC Science & Technology

2013-12-15

Blufftown is underlain by igneous and metamorphic rocks which are equivalent to those of the Georgia Piedmont. Potable and process waters are produced...Final Environmental Assessment for Developing Renewable Energy Enhanced Use Lease Facilities at Robins Air Force Base...TITLE AND SUBTITLE Final Environmental Assessment for Developing Renewable Energy Enhanced Use Lease Facilities at Robins Air Force Base 5a. CONTRACT

Environmental Assessment for Developing Renewable Energy Enhanced Use Lease Facilities at Robins Air Force Base

DTIC Science & Technology

2013-12-15

underlain by igneous and metamorphic rocks which are equivalent to those of the Georgia Piedmont. Potable and process waters are produced from the...Final Environmental Assessment for Developing Renewable Energy Enhanced Use Lease Facilities at Robins Air Force Base...RENEWABLE ENERGY ENHANCED USE LEASE FACILITIES AT ROBINS AIR FORCE BASE In accordance with the National Environmental Policy Act (NEPA) of 1969 (42 U.S

Environmental Assessment: Proposed Training Facilities, Hill Air Force Base, Utah

DTIC Science & Technology

2013-08-08

FA8201-09-D-0002 Facilities, Hill Air Force Base, Utah 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Klein, Randal 5d...PERFORMING ORGANIZATION REPORT NUMBER Streamline Consulting, LLC 1713 N. Sweetwater Lane Farmington, Utah 84025...proposes to construct new training facilities at Hill Air Force Base, Utah . The findings of this EA indicate that the proposed action would not have

Conducting a study of Internet-based video conferencing for assessing acute medical problems in a nursing facility.

PubMed Central

Weiner, Michael; Schadow, Gunther; Lindbergh, Donald; Warvel, Jill; Abernathy, Greg; Perkins, Susan M.; Dexter, Paul R.; McDonald, Clement J.

2002-01-01

We expect the use of real-time, interactive video conferencing to grow, due to more affordable technology and new health policies. Building and implementing portable systems to enable conferencing between physicians and patients requires durable equipment, committed staff, reliable service, and adequate protection and capture of data. We are studying the use of Internet-based conferencing between on-call physicians and patients residing in a nursing facility. We describe the challenges we experienced in constructing the study. Initiating and orchestrating unscheduled conferences needs to be easy, and requirements for training staff in using equipment should be minimal. Studies of health outcomes should include identification of medical conditions most amenable to benefit from conferencing, and outcomes should include positive as well as negative effects. PMID:12463950

Two-dimensional silicon-based detectors for ion beam therapy

NASA Astrophysics Data System (ADS)

Martišíková, M.; Granja, C.; Jakůbek, J.; Hartmann, B.; Telsemeyer, J.; Huber, L.; Brons, S.; Pospíšil, S.; Jäkel, O.

2012-02-01

Radiation therapy with ion beams is a highly precise kind of cancer treatment. As ion beams traverse material, the highest ionization density occurs at the end of their path. Due to this Bragg-peak, ion beams enable higher dose conformation to the tumor and increased sparing of the surrounding tissue, in comparison to standard radiation therapy using high energy photons. Ions heavier than protons offer in addition increased biological effectiveness and lower scattering. The Heidelberg Ion Beam Therapy Center (HIT) is a state-of-the-art ion beam therapy facility and the first hospital-based facility in Europe. It provides proton and carbon ion treatments. A synchrotron is used for ion acceleration. For dose delivery to the patient, narrow pencil-like beams are scanned over the target volume.

Impact of the raising immunizations safely and effectively (RISE) program on healthcare worker influenza immunization rates in long term care settings.

PubMed

Nace, David A; Handler, Steven M; Hoffman, Erika L; Perera, Subashan

2012-11-01

National influenza immunization rates for healthcare workers (HCW) in long-term care (LTC) remain unacceptably low. This poses a serious public health threat to residents. Prior work has suggested high staff turnover rates as a contributing factor to low immunization rates. There is a critical need to identify and deploy successful models of HCW influenza immunization programs to LTC facilities. This report describes one potential model that has been successfully initiated in a network of LTC facilities. All facilities served by a single regional LTC pharmacy were invited to participate in a HCW influenza immunization program. This voluntary immunization program began in 2005 and continues to the present. As part of the program, the pharmacy promoted organizational change by assuming oversight and control of HCW immunization policies and processes for all facilities. Primary and secondary outcomes are the number of facilities reaching HCW influenza immunization rates of 60% and 80%. Fourteen of the 16 LTC facilities participated. Facilities were diverse and included both nursing and assisted living facilities; unionized and nonunionized facilities; and urban, suburban, and rural facilities. The pharmacy provided educational and communication materials, centralized data collection using a standardized definition for HCW immunization rates, and facility feedback. All 14 LTC facilities achieved the primary goal of 60% and nearly two thirds reached the secondary goal of 80%. Twenty percent reached the new Healthy People 2020 goal of 90%. It is possible for LTC facilities to improve HCW immunization rates using a pharmacy based, voluntary HCW influenza immunization approach. Such an approach may help attenuate the negative influence of staff turnover on HCW immunizations. Attainment of the new Health People 2020 goals still remains a challenge and may require mandatory programs. Copyright © 2012 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

Air modelling as an alternative to sampling for low-level radioactive airborne releases

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

Morgenstern, M.Y.; Hueske, K.

1995-05-01

This paper describes our efforts to assess the effect of airborne releases at one DOE laboratory using air modelling based on historical data. Among the facilities affected by these developments is Los Alamos National Laboratory (LANL) in New Mexico. RCRA, as amended by the Hazardous and Solid Waste Amendments (HSWA) in 1984, requires all facilities which involve the treatment, storage, and disposal of hazardous waste obtain a RCRA/HSWA waste facility permit. LANL complied with CEARP by initiating a process of identifying potential release sites associated with LANL operations prior to filing a RCRA/HSWA permit application. In the process of preparingmore » the RCRA/HSWA waste facility permit application to the U.S. Environmental Protection Agency (EPA), a total of 603 Solid Waste Management Units (SWMUs) were identified as part of the requirements of the HSWA Module VIH permit requirements. The HSWA Module VIII permit requires LANL to determine whether there have been any releases of hazardous waste or hazardous constituents from SWMUs at the facility dating from the 1940`s by performing a RCRA Facility Investigation to address known or suspected releases from specified SWMUs to affected media (i.e. soil, groundwater, surface water, and air). Among the most troublesome of the potential releases sites are those associated with airborne radioactive releases. In order to assess health risks associated with radioactive contaminants in a manner consistent with exposure standards currently in place, the DOE and LANL have established Screening Action Levels (SALs) for radioactive soil contamination. The SALs for each radionuclide in soil are derived from calculations based on a residential scenario in which individuals are exposed to contaminated soil via inhalation and ingestion as well as external exposure to gamma emitters in the soil. The applicable SALs are shown.« less

Trends in health facility deliveries and caesarean sections by wealth quintile in Morocco between 1987 and 2012.

PubMed

Cresswell, Jenny A; Assarag, Bouchra; Meski, Fatima-Zahra; Filippi, Veronique; Ronsmans, Carine

2015-05-01

To examine trends in the utilisation of facility-based delivery care and caesareans in Morocco between 1987 and 2012, particularly among the poor, and to assess whether uptake increased at the time of introduction of policies or programmes aimed at improving access to intrapartum care. Using data from nationally representative household surveys and routine statistics, our analysis focused on whether women delivered within a facility, and whether the delivery was by caesarean; analyses were stratified by relative wealth quintile and public/private sector where possible. A segmented Poisson regression model was used to assess whether trends changed at key events. Uptake of facility-based deliveries and caesareans in Morocco has risen considerably over the past two decades, particularly among the poor. The rate of increase in facility deliveries was much faster in the poorest quintile (annual increase RR: 1.09; 95% CI: 1.07-1.11) than the richest quintile (annual increase RR: 1.01; 95% CI: 1.02-1.02). A similar pattern was observed for caesareans (annual increase among poorest RR: 1.13; 95% CI: 1.07-1.19 vs. annual increase among richest RR: 1.08; 95% CI: 1.06-1.10). We found no significant acceleration in trend coinciding with any of the events investigated. Morocco's success in improving uptake of facility deliveries and caesareans is likely to be the result of the synergistic effects of comprehensive demand and supply-side strategies, including a major investment in human resources and free delivery care. Equity still needs to be improved; however, the overall trend is positive. © 2015 John Wiley & Sons Ltd.

Maternal and neonatal health impact of obstetrical risk insurance scheme in Mauritania: a quasi experimental before-and-after study.

PubMed

Philibert, Aline; Ravit, Marion; Ridde, Valéry; Dossa, Inès; Bonnet, Emmanuel; Bedecarrats, Florent; Dumont, Alexandre

2017-04-01

A variety of health financing schemes shaped on pre-payment scheme have been implemented across Sub-Saharan Africa (SSA) to address the Millennium Development Goals (MDGs). In Mauritania, the Obstetric Risk Insurance package (ORI) focusing on maternal and perinatal health has been progressively implemented at the health district level since 2002. Here, our main objective was to assess the effectiveness of the ORI in increasing facility-based delivery rates, as well as increases in family planning, antenatal and postnatal care, caesarean delivery and neonatal health, from demographic and health survey data between 2002 and 2011. We also examined whether the effects of the ORI varied between strata of the population. The study was based on a quasi-experimental before-and-after design to assess the causal link between availability of ORI and increase in use of maternal health services and neonatal mortality. In combination with geographical information system, difference-in-differences and odd ratio approaches were used to address our objectives. Indicators of access to care for pregnant women and neonatal health and improved in both non-intervention and intervention groups during the study period. There was no global effect of the availability of ORI on facility-based delivery rates, nor on the use of antenatal and postnatal care services, except for qualified antenatal services. However, delivery rates in local health centres with ORI increased more rapidly than in those with no ORI, the contrary was shown for hospitals. Caesarean delivery and family planning decreased with ORI. Although late neonatal mortality rates remained low in the country, a significant decrease was seen in districts without ORI. Except for some strata of the population, ORI has not really met its objective of attracting more pregnant women towards facility-based health care. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

A bounding-based solution approach for the continuous arc covering problem

NASA Astrophysics Data System (ADS)

Wei, Ran; Murray, Alan T.; Batta, Rajan

2014-04-01

Road segments, telecommunication wiring, water and sewer pipelines, canals and the like are important features of the urban environment. They are often conceived of and represented as network-based arcs. As a result of the usefulness and significance of arc-based features, there is a need to site facilities along arcs to serve demand. Examples of such facilities include surveillance equipment, cellular towers, refueling centers and emergency response stations, with the intent of being economically efficient as well as providing good service along the arcs. While this amounts to a continuous location problem by nature, various discretizations are generally relied upon to solve such problems. The result is potential for representation errors that negatively impact analysis and decision making. This paper develops a solution approach for the continuous arc covering problem that theoretically eliminates representation errors. The developed approach is applied to optimally place acoustic sensors and cellular base stations along a road network. The results demonstrate the effectiveness of this approach for ameliorating any error and uncertainty in the modeling process.

View of Facility 222 (on right) and Facility 221 through ...

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

View of Facility 222 (on right) and Facility 221 through trees (parapet of latter above trees) from the parade ground. - U.S. Naval Base, Pearl Harbor, Gymnasium & Theater, Neville Way, Pearl City, Honolulu County, HI

Unique life sciences research facilities at NASA Ames Research Center

NASA Technical Reports Server (NTRS)

Mulenburg, G. M.; Vasques, M.; Caldwell, W. F.; Tucker, J.

1994-01-01

The Life Science Division at NASA's Ames Research Center has a suite of specialized facilities that enable scientists to study the effects of gravity on living systems. This paper describes some of these facilities and their use in research. Seven centrifuges, each with its own unique abilities, allow testing of a variety of parameters on test subjects ranging from single cells through hardware to humans. The Vestibular Research Facility allows the study of both centrifugation and linear acceleration on animals and humans. The Biocomputation Center uses computers for 3D reconstruction of physiological systems, and interactive research tools for virtual reality modeling. Psycophysiological, cardiovascular, exercise physiology, and biomechanical studies are conducted in the 12 bed Human Research Facility and samples are analyzed in the certified Central Clinical Laboratory and other laboratories at Ames. Human bedrest, water immersion and lower body negative pressure equipment are also available to study physiological changes associated with weightlessness. These and other weightlessness models are used in specialized laboratories for the study of basic physiological mechanisms, metabolism and cell biology. Visual-motor performance, perception, and adaptation are studied using ground-based models as well as short term weightlessness experiments (parabolic flights). The unique combination of Life Science research facilities, laboratories, and equipment at Ames Research Center are described in detail in relation to their research contributions.

Space facilities: Meeting future needs for research, development, and operations

NASA Technical Reports Server (NTRS)

1994-01-01

The National Facilities Study (NFS) represents an interagency effort to develop a comprehensive and integrated long-term plan for world-class aeronautical and space facilities that meet current and projected needs for commercial and government aerospace research and development and space operations. At the request of NASA and the DOD, the National Research Council's Committee on Space Facilities has reviewed the space related findings of the NFS. The inventory of more than 2800 facilities will be an important resource, especially if it continues to be updated and maintained as the NFS report recommends. The data in the inventory provide the basis for a much better understanding of the resources available in the national facilities infrastructure, as well as extensive information on which to base rational decisions about current and future facilities needs. The working groups have used the inventory data and other information to make a set of recommendations that include estimates of cast savings and steps for implementation. While it is natural that the NFS focused on cost reduction and consolidations, such a study is most useful to future planning if it gives equal weight to guiding the direction of future facilities needed to satisfy legitimate national aspirations. Even in the context of cost reduction through facilities closures and consolidations, the study is timid about recognizing and proposing program changes and realignments of roles and missions to capture what could be significant savings and increased effectiveness. The recommendations of the Committee on Space Facilities are driven by the clear need to be more realistic and precise both in recognizing current incentives and disincentives in the aerospace industry and in forecasting future conditions for U.S. space activities.

Space facilities: Meeting future needs for research, development, and operations

NASA Astrophysics Data System (ADS)

The National Facilities Study (NFS) represents an interagency effort to develop a comprehensive and integrated long-term plan for world-class aeronautical and space facilities that meet current and projected needs for commercial and government aerospace research and development and space operations. At the request of NASA and the DOD, the National Research Council's Committee on Space Facilities has reviewed the space related findings of the NFS. The inventory of more than 2800 facilities will be an important resource, especially if it continues to be updated and maintained as the NFS report recommends. The data in the inventory provide the basis for a much better understanding of the resources available in the national facilities infrastructure, as well as extensive information on which to base rational decisions about current and future facilities needs. The working groups have used the inventory data and other information to make a set of recommendations that include estimates of cast savings and steps for implementation. While it is natural that the NFS focused on cost reduction and consolidations, such a study is most useful to future planning if it gives equal weight to guiding the direction of future facilities needed to satisfy legitimate national aspirations. Even in the context of cost reduction through facilities closures and consolidations, the study is timid about recognizing and proposing program changes and realignments of roles and missions to capture what could be significant savings and increased effectiveness. The recommendations of the Committee on Space Facilities are driven by the clear need to be more realistic and precise both in recognizing current incentives and disincentives in the aerospace industry and in forecasting future conditions for U.S. space activities.

Final Environmental Assessment: Base-Wide Building Demolition Arnold Air Force Base, Tennessee

DTIC Science & Technology

2006-02-01

Building • Engine Test Facility ( ETF )-B Exhauster • ETF -A Airside • ETF -A Exhauster • ETF -A Reefer • CE Facility • Rocket Storage • Von Karman Gas...Executive Order ESA Endangered Species Act ETF Engine Test Facility FamCamp Family Camping Area P:\\ARNOLDAFB\\333402DO42COMPLIANCE\\DEMOLITION...Fabrication Shop • Natural Resources Building • Salt Storage Building • Administration Building • Engine Test Facility ( ETF )-B Exhauster • ETF -A

Capabilities and constraints of NASA's ground-based reduced gravity facilities

NASA Technical Reports Server (NTRS)

Lekan, Jack; Neumann, Eric S.; Sotos, Raymond G.

1993-01-01

The ground-based reduced gravity facilities of NASA have been utilized to support numerous investigations addressing various processes and phenomina in several disciplines for the past 30 years. These facilities, which include drop towers, drop tubes, aircraft, and sounding rockets are able to provide a low gravity environment (gravitational levels that range from 10(exp -2)g to 10(exp -6)g) by creating a free fall or semi-free fall condition where the force of gravity on an experiment is offset by its linear acceleration during the 'fall' (drop or parabola). The low gravity condition obtained on the ground is the same as that of an orbiting spacecraft which is in a state of perpetual free fall. The gravitational levels and associated duration times associated with the full spectrum of reduced gravity facilities including spaced-based facilities are summarized. Even though ground-based facilities offer a relatively short experiment time, this available test time has been found to be sufficient to advance the scientific understanding of many phenomena and to provide meaningful hardware tests during the flight experiment development process. Also, since experiments can be quickly repeated in these facilities, multistep phenomena that have longer characteristic times associated with them can sometimes be examined in a step-by-step process. There is a large body of literature which has reported the study results achieved through using reduced-gravity data obtained from the facilities.

Simplifying ART cohort monitoring: can pharmacy stocks provide accurate estimates of patients retained on antiretroviral therapy in Malawi?

PubMed

Tweya, Hannock; Feldacker, Caryl; Ben-Smith, Anne; Harries, Anthony D; Komatsu, Ryuichi; Jahn, Andreas; Phiri, Sam; Tassie, Jean-Michel

2012-07-20

Routine monitoring of patients on antiretroviral therapy (ART) is crucial for measuring program success and accurate drug forecasting. However, compiling data from patient registers to measure retention in ART is labour-intensive. To address this challenge, we conducted a pilot study in Malawi to assess whether patient ART retention could be determined using pharmacy records as compared to estimates of retention based on standardized paper- or electronic based cohort reports. Twelve ART facilities were included in the study: six used paper-based registers and six used electronic data systems. One ART facility implemented an electronic data system in quarter three and was included as a paper-based system facility in quarter two only. Routine patient retention cohort reports, paper or electronic, were collected from facilities for both quarter two [April-June] and quarter three [July-September], 2010. Pharmacy stock data were also collected from the 12 ART facilities over the same period. Numbers of ART continuation bottles recorded on pharmacy stock cards at the beginning and end of each quarter were documented. These pharmacy data were used to calculate the total bottles dispensed to patients in each quarter with intent to estimate the number of patients retained on ART. Information for time required to determine ART retention was gathered through interviews with clinicians tasked with compiling the data. Among ART clinics with paper-based systems, three of six facilities in quarter two and four of five facilities in quarter three had similar numbers of patients retained on ART comparing cohort reports to pharmacy stock records. In ART clinics with electronic systems, five of six facilities in quarter two and five of seven facilities in quarter three had similar numbers of patients retained on ART when comparing retention numbers from electronically generated cohort reports to pharmacy stock records. Among paper-based facilities, an average of 13 4 hours was needed to calculate patient retention for cohort reporting using patient registers as compared to 2.25 hours using pharmacy stock cards. The numbers of patients retained on ART as estimated using pharmacy stock records were largely similar to estimates based on either paper registers or electronic data system. Furthermore, less time and staff effort was needed to estimate ART patient retention using pharmacy stock records versus paper-based registers. Reinforcing ARV stock management may improve the precision of estimates.

75 FR 9451 - Notice of Receipt and Availability of Environmental Report Supplement 2 for the Proposed GE...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-02

... Availability of Environmental Report Supplement 2 for the Proposed GE-Hitachi Global Laser Enrichment Laser- Based Uranium Enrichment Facility On January 13, 2009, GE-Hitachi Global Laser Enrichment, LLC (GLE) was..., operation, and decommissioning of a laser-based uranium enrichment facility. The proposed facility would be...

Information security management system planning for CBRN facilities

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

Lenaeu, Joseph D.; O'Neil, Lori Ross; Leitch, Rosalyn M.

The focus of this document is to provide guidance for the development of information security management system planning documents at chemical, biological, radiological, or nuclear (CBRN) facilities. It describes a risk-based approach for planning information security programs based on the sensitivity of the data developed, processed, communicated, and stored on facility information systems.

77 FR 29620 - Notice of Availability of Record of Decision for TRIDENT Support Facilities Explosives Handling...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-18

... TRIDENT Support Facilities Explosives Handling Wharf at Naval Base Kitsap at Bangor, Kitsap County, WA... existing Explosives Handling Wharf in Hood Canal on the waterfront of Naval Base Kitsap (NBK) at Bangor, WA... Stevenson, Naval Facilities Engineering Command Northwest, 1101 Tautog Circle, Silverdale, WA 98315-1101...

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

Burkel, L.; Dejus, R.; Maines, J.

This report is a description of the current status of the magnetic measurement facility and is a basic instructional manual for the operation of the facility and its components. Please refer to the appendices for more detailed information about specific components and procedures. The purpose of the magnetic measurement facility is to take accurate measurements of the magnetic field in the gay of the IDs in order to determine the effect of the ID on the stored particle beam and the emitted radiation. The facility will also play an important role when evaluating new ideas, novel devices, and inhouse prototypesmore » as part of the ongoing research and development program at the APS. The measurements will be performed with both moving search coils and moving Hall probes. The IDs will be evaluated by computer modeling of the emitted radiation for any given (measured) magnetic field map. The quality of the magnetic field will be described in terms of integrated multipoles for the effect on Storage Ring performance and in terms of the derived trajectories for the emitted radiation. Before being installed on the Storage Ring, every device will be measured and characterized to assure that it is compatible with Storage Ring requirements and radiation specifications. The accuracy that the APS needs to achieve for magnetic measurements will be based on these specifications.« less

Atmospheric concentrations of polybrominated diphenyl ethers at near-source sites.

PubMed

Cahill, Thomas M; Groskova, Danka; Charles, M Judith; Sanborn, James R; Denison, Michael S; Baker, Lynton

2007-09-15

Concentrations of polybrominated diphenyl ethers (PBDEs) were determined in air samples from near suspected sources, namely an indoors computer laboratory, indoors and outdoors at an electronics recycling facility, and outdoors at an automotive shredding and metal recycling facility. The results showed that (1) PBDE concentrations in the computer laboratorywere higherwith computers on compared with the computers off, (2) indoor concentrations at an electronics recycling facility were as high as 650,000 pg/m3 for decabromodiphenyl ether (PBDE 209), and (3) PBDE 209 concentrations were up to 1900 pg/m3 at the downwind fenceline at an automotive shredding/metal recycling facility. The inhalation exposure estimates for all the sites were typically below 110 pg/kg/day with the exception of the indoor air samples adjacent to the electronics shredding equipment, which gave exposure estimates upward of 40,000 pg/kg/day. Although there were elevated inhalation exposures at the three source sites, the exposure was not expected to cause adverse health effects based on the lowest reference dose (RfD) currently in the Integrated Risk Information System (IRIS), although these RfD values are currently being re-evaluated by the U.S. Environmental Protection Agency. More research is needed on the potential health effects of PBDEs.

A facility monitoring system: The single most valuable and cost-effective tool available to an energy manager

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

Holmes, W.A.

Energy engineering and management combines engineering problem-solving and financial management techniques to reduce utility costs. At present, substantial amounts of time and money are being spent in order to attempt to quantify energy consumption and costs and define opportunities for savings. Unfortunately, accurate verification of results is often overlooked. Advances in technology during the last few years have made the installation of a permanent, PC-based monitoring system possible for any facility, often for no more than the cost of a detailed study. By investing initially in a monitoring system rather than audits or studies, the actual consumption and cost datamore » will be available on a continuing basis and can be used to produce immediate operational savings, more accurately analyze opportunities requiring capital investments, and to verify actual savings resulting from changes. A permanent monitoring system, installed as the first step in a utility cost reduction effort, to identify where and how energy is used in a facility on a dynamic and real-time basis, can provide the most valuable and cost-effective tool available to an energy manager. The resulting data allows energy consumption patterns and utility costs to be understood and managed in the same manner as all other costs within a facility.« less

Sexually transmitted disease syndromic case management through public sector facilities: development and assessment study in Punjab Pakistan.

PubMed

Khan, Muhammad Amir; Javed, Wajiha; Ahmed, Maqsood; Walley, John; Munir, Muhammad Arif

2014-01-01

Sexually transmitted infections (STIs) are a priority health problem. We proposed a prospective study in two districts of Punjab, using an intervention package, which included guidelines and protocols on syndrome-based management of STIs, adapted in light of technical guidelines from the National AIDS Control Program and the World Health Organization. The aim of this study was to assess the operational effectiveness of STI case management guidelines and to assess factors that determine the adherence to guidelines for management of STIs at public health facilities in Pakistan. A prospective study lasting 18 months (January 2008 to June 2009), which reviewed early implementation experiences of updated case management guidelines for delivery of syndrome-based STI/reproductive tract infection care, through public-sector health care facilities. The project was implemented in two districts of Punjab, Sargodha and Jhang. A Cox regression model with stratification was done. The prevalence of STI was 26 per 100,000 patients. In women, the reported symptoms were 80% vaginal discharge and 12% abdominal pain. Forty-four percent of men had a genital ulcer and 29% of men had genital discharge. Age of participants ranged from 13 to 60 years. The study comprised 28.6% men and 71.4% women. The majority of the population attending these clinics was from rural areas (70%). The variables independently associated with adherence to guidelines were availability of male paramedic, age of patient, and type of diagnosis made. There was an important interaction (effect modification) present between the area of health facility and patient sex. Screening, diagnosis, and treatment costs for many STIs are expensive and thus an easier, low-cost, syndrome-based public health strategy is the adoption of the proposed STI syndrome case management guidelines. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

Developing and Implementing a Quality Assurance Strategy for Electroconvulsive Therapy.

PubMed

Hollingsworth, Jessa; Baliko, Beverly; McKinney, Selina; Rosenquist, Peter

2018-04-17

The literature provides scant guidance in effective quality assurance strategies concerning the use of electroconvulsive therapy (ECT) for the treatment of psychiatric conditions. Numerous guidelines are published that provide guidance in the delivery of care; however, little has been done to determine how a program or facility might ensure compliance to best practice for safety, tolerability, and efficacy in performing ECT. The objective of this project was to create a quality assurance strategy specific to ECT. Determining standards for quality care and clarifying facility policy were key outcomes in establishing an effective quality assurance strategy. An audit tool was developed utilizing quality criteria derived from a systematic review of ECT practice guidelines, peer review, and facility policy. All ECT procedures occurring over a 2-month period of May to June 2017 were retrospectively audited and compared against target compliance rates set for the facility's ECT program. Facility policy was adapted to reflect quality standards, and audit findings were used to inform possible practice change initiatives, were used to create benchmarks for continuous quality monitoring, and were integrated into regular hospital quality meetings. Clarification on standards of care and the use of clinical auditing in ECT was an effective starting point in the development of a quality assurance strategy. Audit findings were successfully integrated into the hospital's overall quality program, and recognition of practice compliance informed areas for future quality development and policy revision in this small community-based hospital in the southeastern United States. This project sets the foundation for a quality assurance strategy that can be used to help monitor procedural safety and guide future improvement efforts in delivering ECT. Although it is just the first step in creating meaningful quality improvement, setting clear standards and identifying areas of greatest clinical need were crucial beginning for this hospital's growing program.

An integrated analytical framework for quantifying the LCOE of waste-to-energy facilities for a range of greenhouse gas emissions policy and technical factors.

PubMed

Townsend, Aaron K; Webber, Michael E

2012-07-01

This study presents a novel integrated method for considering the economics of waste-to-energy (WTE) facilities with priced greenhouse gas (GHG) emissions based upon technical and economic characteristics of the WTE facility, MSW stream, landfill alternative, and GHG emissions policy. The study demonstrates use of the formulation for six different policy scenarios and explores sensitivity of the results to ranges of certain technical parameters as found in existing literature. The study shows that details of the GHG emissions regulations have large impact on the levelized cost of energy (LCOE) of WTE and that GHG regulations can either increase or decrease the LCOE of WTE depending on policy choices regarding biogenic fractions from combusted waste and emissions from landfills. Important policy considerations are the fraction of the carbon emissions that are priced (i.e. all emissions versus only non-biogenic emissions), whether emissions credits are allowed due to reducing fugitive landfill gas emissions, whether biogenic carbon sequestration in landfills is credited against landfill emissions, and the effectiveness of the landfill gas recovery system where waste would otherwise have been buried. The default landfill gas recovery system effectiveness assumed by much of the industry yields GHG offsets that are very close to the direct non-biogenic GHG emissions from a WTE facility, meaning that small changes in the recovery effectiveness cause relatively larger changes in the emissions factor of the WTE facility. Finally, the economics of WTE are dependent on the MSW stream composition, with paper and wood being advantageous, metal and glass being disadvantageous, and plastics, food, and yard waste being either advantageous or disadvantageous depending upon the avoided tipping fee and the GHG emissions price. Copyright © 2012 Elsevier Ltd. All rights reserved.

Factor-Based Student Rating in Academic Performance in Southern Province of Rwanda

ERIC Educational Resources Information Center

Rulinda, Ephrard; Role, Elizabeth; Makewa, Lazarus Ndiku

2013-01-01

This study examined students' perception on academic performance using five-factor ratings namely, principal's instructional leadership, school climate, school facilities, teachers' effectiveness and family support. Data for this study were collected from selected Parent's Private Seventh-Day Adventist Secondary Schools (PPSDASS) in Southern…

Final Environmental Assessment Airfield Storm Drainage System Repair Joint Base Andrews-Naval Air Facility Washington, MD

DTIC Science & Technology

2015-06-01

sediment control plan during project implementation would be expected to minimize any adverse effects on resident fish species during construction. In... Effective August 8, 2007, under the authority of the Endangered Species Act of 1973, as amended, the U.S. Fish and Wildlife Service (Service) removed...of storm sewer pipe and 122 manholes of the airfield stormwater drainage network. Summary of Anticipated Environmental Effects Associated with the

Influence of Cracks in Cementitious Engineered Barriers in a Near-Surface Disposal System: Assessment Analysis of the Belgian Case

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

Perko, Janez; Seetharam, Suresh C.; Jacques, Diederik

2013-07-01

In large cement-based structures such as a near surface disposal facility for radioactive waste voids and cracks are inevitable. However, the pattern and nature of cracks are very difficult to predict reliably. Cracks facilitate preferential water flow through the facility because their saturated hydraulic conductivity is generally higher than the conductivity of the cementitious matrix. Moreover, sorption within the crack is expected to be lower than in the matrix and hence cracks in engineered barriers can act as a bypass for radionuclides. Consequently, understanding the effects of crack characteristics on contaminant fluxes from the facility is of utmost importance inmore » a safety assessment. In this paper we numerically studied radionuclide leaching from a crack-containing cementitious containment system. First, the effect of cracks on radionuclide fluxes is assessed for a single repository component which contains a radionuclide source (i.e. conditioned radwaste). These analyses reveal the influence of cracks on radionuclide release from the source. The second set of calculations deals with the safety assessment results for the planned near-surface disposal facility for low-level radioactive waste in Dessel (Belgium); our focus is on the analysis of total system behaviour in regards to release of radionuclide fluxes from the facility. Simulation results are interpreted through a complementary safety indicator (radiotoxicity flux). We discuss the possible consequences from different scenarios of cracks and voids. (authors)« less

Marketing on a shoestring.

PubMed

Sutton, J

1999-01-01

Marketing includes the many steps taken to sell a product or service from its conception to its purchase or use. In healthcare, three cost-effective audiences to target are referring physicians and their staffs, local HMOs and PPOs, facility employees and patients. The potential users of such services--your target audience--should be made aware of new offerings such as the addition of special procedures, a new piece of equipment, or perhaps a new physician with special capabilities. To ensure a productive effort, a marketing attempt must follow two cardinal rules: first, the product or service offered must be of high quality and, second, the marketing effort must be carried out consistently. An effective marketing campaign should create an impression within the community about the facility by emphasizing those aspects of the department or facility that make it unique. Are its hours of operation adequate? Do its personnel project a professional attitude and demeanor? Does it have a specialty that makes it unique within the healthcare community? The most powerful marketing tool of all is word of mouth, which is based on the judgments clients make after visiting the facility-department or facility employees smile and greet visitors, they are polite and helpful on the telephone, their attitudes are professional, and so forth. Such impressions are worth millions in goodwill and can be used as a marketing tool. Last, an actual case study from my hospital explains how we determined the need for and marketed an open MRI system.

Health worker preferences for performance-based payment schemes in a rural health district in Burkina Faso.

PubMed

Yé, Maurice; Diboulo, Eric; Kagoné, Moubassira; Sié, Ali; Sauerborn, Rainer; Loukanova, Svetla

2016-01-01

One promising way to improve the motivation of healthcare providers and the quality of healthcare services is performance-based incentives (PBIs) also referred as performance-based financing. Our study aims to explore healthcare providers' preferences for an incentive scheme based on local resources, which aimed at improving the quality of maternal and child health care in the Nouna Health District. A qualitative and quantitative survey was carried out in 2010 involving 94 healthcare providers within 34 health facilities. In addition, in-depth interviews involving a total of 33 key informants were conducted at health facility levels. Overall, 85% of health workers were in favour of an incentive scheme based on the health district's own financial resources (95% CI: [71.91; 88.08]). Most health workers (95 and 96%) expressed a preference for financial incentives (95% CI: [66.64; 85.36]) and team-based incentives (95% CI: [67.78; 86.22]), respectively. The suggested performance indicators were those linked to antenatal care services, prevention of mother-to-child human immunodeficiency virus transmission, neonatal care, and immunization. The early involvement of health workers and other stakeholders in designing an incentive scheme proved to be valuable. It ensured their effective participation in the process and overall acceptance of the scheme at the end. This study is an important contribution towards the designing of effective PBI schemes.

Health worker preferences for performance-based payment schemes in a rural health district in Burkina Faso

PubMed Central

Yé, Maurice; Diboulo, Eric; Kagoné, Moubassira; Sié, Ali; Sauerborn, Rainer; Loukanova, Svetla

2016-01-01

Background One promising way to improve the motivation of healthcare providers and the quality of healthcare services is performance-based incentives (PBIs) also referred as performance-based financing. Our study aims to explore healthcare providers’ preferences for an incentive scheme based on local resources, which aimed at improving the quality of maternal and child health care in the Nouna Health District. Design A qualitative and quantitative survey was carried out in 2010 involving 94 healthcare providers within 34 health facilities. In addition, in-depth interviews involving a total of 33 key informants were conducted at health facility levels. Results Overall, 85% of health workers were in favour of an incentive scheme based on the health district's own financial resources (95% CI: [71.91; 88.08]). Most health workers (95 and 96%) expressed a preference for financial incentives (95% CI: [66.64; 85.36]) and team-based incentives (95% CI: [67.78; 86.22]), respectively. The suggested performance indicators were those linked to antenatal care services, prevention of mother-to-child human immunodeficiency virus transmission, neonatal care, and immunization. Conclusions The early involvement of health workers and other stakeholders in designing an incentive scheme proved to be valuable. It ensured their effective participation in the process and overall acceptance of the scheme at the end. This study is an important contribution towards the designing of effective PBI schemes. PMID:26739784

FACILITY 316. EXTERIOR OBLIQUE OF FRONT AS SEEN FROM FACILITY ...

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

FACILITY 316. EXTERIOR OBLIQUE OF FRONT AS SEEN FROM FACILITY 362. VIEW FACING SOUTH. - U.S. Naval Base, Pearl Harbor, Naval Housing Area Hospital Point, Pharmacist's Quarters Type, 13-16 First Street, Pearl City, Honolulu County, HI

Challenges in implementing uncomplicated malaria treatment in children: a health facility survey in rural Malawi.

PubMed

Kabaghe, Alinune N; Phiri, Mphatso D; Phiri, Kamija S; van Vugt, Michèle

2017-10-18

Prompt and effective malaria treatment are key in reducing transmission, disease severity and mortality. With the current scale-up of artemisinin-based combination therapy (ACT) coverage, there is need to focus on challenges affecting implementation of the intervention. Routine indicators focus on utilization and coverage, neglecting implementation quality. A health system in rural Malawi was assessed for uncomplicated malaria treatment implementation in children. A cross-sectional health facility survey was conducted in six health centres around the Majete Wildlife Reserve in Chikwawa district using a health system effectiveness approach to assess uncomplicated malaria treatment implementation. Interviews with health facility personnel and exit interviews with guardians of 120 children under 5 years were conducted. Health workers appropriately prescribed an ACT and did not prescribe an ACT to 73% (95% CI 63-84%) of malaria rapid diagnostic test (RDT) positive and 98% (95% CI 96-100%) RDT negative children, respectively. However, 24% (95% CI 13-37%) of children receiving artemisinin-lumefantrine had an inappropriate dose by weight. Health facility findings included inadequate number of personnel (average: 2.1 health workers per 10,000 population), anti-malarial drug stock-outs or not supplied, and inconsistent health information records. Guardians of 59% (95% CI 51-69%) of children presented within 24 h of onset of child's symptoms. The survey presents an approach for assessing treatment effectiveness, highlighting bottlenecks which coverage indicators are incapable of detecting, and which may reduce quality and effectiveness of malaria treatment. Health service provider practices in prescribing and dosing anti-malarial drugs, due to drug stock-outs or high patient load, risk development of drug resistance, treatment failure and exposure to adverse effects.

Texas certified volunteer Long-Term Care Ombudsmen: perspectives of role and effectiveness.

PubMed

Ostwald, Sharon K; Runge, Anke; Lees, Emily J; Patterson, Gina D

2003-01-01

Under the federally mandated Long-Term Care Ombudsman Program (LTCOP), certified volunteer ombudsmen (CVO) advocate for the welfare and rights of residents in nursing facilities. In Texas, the Department on Aging contracts with 28 agencies to deliver the LTCOP in respective regions. Regional ombudsman staff in charge of a group of CVOs administers each local program. The volunteer ombudsman role is threefold: advocate, mediator, and friendly visitor. This descriptive study used a 75-item mail survey designed to gain a better understanding of CVOs' perspectives of their role and effectiveness. A total of 361 active, certified volunteers participated, representing all of the 28 regional Texas ombudsman programs. A series of focus groups was used to amplify survey data. Findings indicate overall role satisfaction, although perception of satisfaction varied with volunteers' age, length of service, level of education, and work experience. Volunteers felt most effective in promoting residents' rights and welfare, and least effective in dealing with financial exploitation, nutrition, and hydration issues. Although not always able to achieve desired changes, most volunteers believed that the ombudsman presence was a positive force. A need for improved understanding and support of the ombudsman role among facility staff and regulatory agents was exposed. CVOs' potentially favorable impact on the institutional setting in general, and facility personnel in particular, is dependent on the support from state personnel and regional ombudsman staff as well as the willingness of nursing facility staff to cooperate. Volunteers' sense of performance effectiveness is essential to the success of the LTCOP. Specific recommendations based on study findings are intended to assist in assuring continuous program quality improvement purposed to ensure residents' quality of life.

Environmental analysis of the operation of Oak Ridge National Laboratory (X-10 site)

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

Boyle, J.W.; Blumberg, R.; Cotter, S.J.

1982-11-01

An environmental analysis of the operation of the Oak Ridge National Laboratory (ORNL) facilities in Bethel Valley and Melton Valley was conducted to present to the public information concerning the extent to which recognizable effects, or potential effects, on the environment may occur. The analysis addresses current operations of the ORNL X-10 site and completed operations that may continue to have residual effects. Solid wastes from ORNL operations at the Y-12 site which are transported to the X-10 site for burial (e.g., Biology Division animal wastes) are included as part of X-10 site operation. Socioeconomic effects are associated primarily withmore » the communities where employees live and with the Knoxville Bureau of Economic Analysis economic area as a whole. Therefore, ORNL employees at both Y-12 and X-10 sites are included in the ORNL socioeconomic impact analysis. An extensive base of environmental data was accumulated for this report. Over 80 reports related to ORNL facilities and/or operations are cited as well as many open-literature citations. Environmental effects of the operation of ORNL result from operational discharges from the onsite facilities; construction and/or modification of facilities, transportation to and from the site of persons, goods and services; socioeconomic impacts to the local, regional, and general population; and accidental discharges if they should occur. Operational discharges to the environnment are constrained by federal, state, and local regulations and by criteria established by the US Department of Energy to minimize adverse impacts. It is the purpose of this document to evaluate the operation of the ORNL insofar as impacts beyond the site boundary may occur or have the potential for occurrence.« less

Payment methods for outpatient care facilities

PubMed Central

Yuan, Beibei; He, Li; Meng, Qingyue; Jia, Liying

2017-01-01

Background Outpatient care facilities provide a variety of basic healthcare services to individuals who do not require hospitalisation or institutionalisation, and are usually the patient's first contact. The provision of outpatient care contributes to immediate and large gains in health status, and a large portion of total health expenditure goes to outpatient healthcare services. Payment method is one of the most important incentive methods applied by purchasers to guide the performance of outpatient care providers. Objectives To assess the impact of different payment methods on the performance of outpatient care facilities and to analyse the differences in impact of payment methods in different settings. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), 2016, Issue 3, part of the Cochrane Library (searched 8 March 2016); MEDLINE, OvidSP (searched 8 March 2016); Embase, OvidSP (searched 24 April 2014); PubMed (NCBI) (searched 8 March 2016); Dissertations and Theses Database, ProQuest (searched 8 March 2016); Conference Proceedings Citation Index (ISI Web of Science) (searched 8 March 2016); IDEAS (searched 8 March 2016); EconLit, ProQuest (searched 8 March 2016); POPLINE, K4Health (searched 8 March 2016); China National Knowledge Infrastructure (searched 8 March 2016); Chinese Medicine Premier (searched 8 March 2016); OpenGrey (searched 8 March 2016); ClinicalTrials.gov, US National Institutes of Health (NIH) (searched 8 March 2016); World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (searched 8 March 2016); and the website of the World Bank (searched 8 March 2016). In addition, we searched the reference lists of included studies and carried out a citation search for the included studies via ISI Web of Science to find other potentially relevant studies. We also contacted authors of the main included studies regarding any further published or unpublished work. Selection criteria Randomised trials, non-randomised trials, controlled before-after studies, interrupted time series, and repeated measures studies that compared different payment methods for outpatient health facilities. We defined outpatient care facilities in this review as facilities that provide health services to individuals who do not require hospitalisation or institutionalisation. We only included methods used to transfer funds from the purchaser of healthcare services to health facilities (including groups of individual professionals). These include global budgets, line-item budgets, capitation, fee-for-service (fixed and unconstrained), pay for performance, and mixed payment. The primary outcomes were service provision outcomes, patient outcomes, healthcare provider outcomes, costs for providers, and any adverse effects. Data collection and analysis At least two review authors independently extracted data and assessed the risk of bias. We conducted a structured synthesis. We first categorised the comparisons and outcomes and then described the effects of different types of payment methods on different categories of outcomes. We used a fixed-effect model for meta-analysis within a study if a study included more than one indicator in the same category of outcomes. We used a random-effects model for meta-analysis across studies. If the data for meta-analysis were not available in some studies, we calculated the median and interquartile range. We reported the risk ratio (RR) for dichotomous outcomes and the relative change for continuous outcomes. Main results We included 21 studies from Afghanistan, Burundi, China, Democratic Republic of Congo, Rwanda, Tanzania, the United Kingdom, and the United States of health facilities providing primary health care and mental health care. There were three kinds of payment comparisons. 1) Pay for performance (P4P) combined with some existing payment method (capitation or different kinds of input-based payment) compared to the existing payment method We included 18 studies in this comparison, however we did not include five studies in the effects analysis due to high risk of bias. From the 13 studies, we found that the extra P4P incentives probably slightly improved the health professionals' use of some tests and treatments (adjusted RR median = 1.095, range 1.01 to 1.17; moderate-certainty evidence), and probably led to little or no difference in adherence to quality assurance criteria (adjusted percentage change median = -1.345%, range -8.49% to 5.8%; moderate-certainty evidence). We also found that P4P incentives may have led to little or no difference in patients' utilisation of health services (adjusted RR median = 1.01, range 0.96 to 1.15; low-certainty evidence) and may have led to little or no difference in the control of blood pressure or cholesterol (adjusted RR = 1.01, range 0.98 to 1.04; low-certainty evidence). 2) Capitation combined with P4P compared to fee-for-service (FFS) One study found that compared with FFS, a capitated budget combined with payment based on providers' performance on antibiotic prescriptions and patient satisfaction probably slightly reduced antibiotic prescriptions in primary health facilities (adjusted RR 0.84, 95% confidence interval 0.74 to 0.96; moderate-certainty evidence). 3) Capitation compared to FFS Two studies compared capitation to FFS in mental health centres in the United States. Based on these studies, the effects of capitation compared to FFS on the utilisation and costs of services were uncertain (very low-certainty evidence). Authors' conclusions Our review found that if policymakers intend to apply P4P incentives to pay health facilities providing outpatient services, this intervention will probably lead to a slight improvement in health professionals' use of tests or treatments, particularly for chronic diseases. However, it may lead to little or no improvement in patients' utilisation of health services or health outcomes. When considering using P4P to improve the performance of health facilities, policymakers should carefully consider each component of their P4P design, including the choice of performance measures, the performance target, payment frequency, if there will be additional funding, whether the payment level is sufficient to change the behaviours of health providers, and whether the payment to facilities will be allocated to individual professionals. Unfortunately, the studies included in this review did not help to inform those considerations. Well-designed comparisons of different payment methods for outpatient health facilities in low- and middle-income countries and studies directly comparing different designs (e.g. different payment levels) of the same payment method (e.g. P4P or FFS) are needed. Payment methods for outpatient care facilities Review aim The aim of this Cochrane review was to assess the effect of different payment systems for outpatient care facilities. We collected and analysed all relevant studies to answer this question and included 21 studies. Key messages Pay-for-performance systems probably have only small benefits or make little or no difference to healthcare provider behaviour or patients' use of healthcare services. We are uncertain whether they cause harm. We are uncertain about the benefits and harms of other payments systems because the research is lacking or of very low certainty. What was studied in the review? Many healthcare services are offered to patients through outpatient facilities rather than to inpatients in hospitals. Outpatient facilities are also known as ambulatory care facilities, and include primary healthcare centres, outpatient clinics, urgent care centres, family planning centres, mental health centres, and dental clinics. Different systems to reimburse outpatient (ambulatory) care facilities for their services are available to governments and health insurers. These systems include: • budget systems, where the facility is given a fixed amount of money in advance to cover expenses for a fixed period; • capitation payment systems, where the facility is paid a fixed amount of money in advance to provide specific services to each enrolled patient for a fixed period; • fee-for-service systems, where payment is based on the specific services that the healthcare facility provides; • pay-for-performance systems, where payment is partly based on the performance of the facility's healthcare providers. Different payment systems can have different effects on how healthcare facilities deliver care. These changes can be intentional or unintentional and can lead to both benefits and harms. At best, a payment system can encourage healthcare providers to offer the right healthcare services to the right patients in the best and most cost-efficient way. However, payment systems can also lead providers to offer poor-quality, expensive, and unnecessary care, which can ultimately have a negative impact on patients' health. This Cochrane review assessed the effect of different payment systems for outpatient care facilities. Other Cochrane reviews have assessed the effect of different payment systems for individual healthcare professionals and for inpatient facilities. Main results We found 21 relevant studies from the United Kingdom, the United States, Rwanda, Burundi, Tanzania, Afghanistan, China, and Democratic Republic of Congo. Most of the studies were from primary healthcare facilities. The studies assessed capitation systems, fee-for-service systems, and different types of pay-for-performance systems. Pay-for-performance systems: • probably slightly improve providers' use of some tests and treatments; • probably lead to little or no difference in providers' compliance with quality assurance criteria; • may lead to little or no difference in patients' use of health services; • may lead to little or no difference in patients' health status. Capitation combined with a pay-for-performance system targeted at reducing antibiotic use probably slightly reduces antibiotic prescriptions when compared to a fee-for-service system. Two studies compared capitation with fee-for-service systems, however, we assessed the certainty of the evidence as very low. We did not find any relevant studies that assessed budget systems. How up-to-date is this review? We searched for studies that had been published up to March 2016. PMID:28253540

Activity-based costing of health-care delivery, Haiti.

PubMed

McBain, Ryan K; Jerome, Gregory; Leandre, Fernet; Browning, Micaela; Warsh, Jonathan; Shah, Mahek; Mistry, Bipin; Faure, Peterson Abnis I; Pierre, Claire; Fang, Anna P; Mugunga, Jean Claude; Gottlieb, Gary; Rhatigan, Joseph; Kaplan, Robert

2018-01-01

To evaluate the implementation of a time-driven activity-based costing analysis at five community health facilities in Haiti. Together with stakeholders, the project team decided that health-care providers should enter start and end times of the patient encounter in every fifth patient's medical dossier. We trained one data collector per facility, who manually entered the time recordings and patient characteristics in a database and submitted the data to a cloud-based data warehouse each week. We calculated the capacity cost per minute for each resource used. An automated web-based platform multiplied reported time with capacity cost rate and provided the information to health-facilities administrators. Between March 2014 and June 2015, the project tracked the clinical services for 7162 outpatients. The cost of care for specific conditions varied widely across the five facilities, due to heterogeneity in staffing and resources. For example, the average cost of a first antenatal-care visit ranged from 6.87 United States dollars (US$) at a low-level facility to US$ 25.06 at a high-level facility. Within facilities, we observed similarly variation in costs, due to factors such as patient comorbidities, patient arrival time, stocking of supplies at facilities and type of visit. Time-driven activity-based costing can be implemented in low-resource settings to guide resource allocation decisions. However, the extent to which this information will drive observable changes at patient, provider and institutional levels depends on several contextual factors, including budget constraints, management, policies and the political economy in which the health system is situated.

Activity-based costing of health-care delivery, Haiti

PubMed Central

Jerome, Gregory; Leandre, Fernet; Browning, Micaela; Warsh, Jonathan; Shah, Mahek; Mistry, Bipin; Faure, Peterson Abnis I; Pierre, Claire; Fang, Anna P; Mugunga, Jean Claude; Gottlieb, Gary; Rhatigan, Joseph; Kaplan, Robert

2018-01-01

Abstract Objective To evaluate the implementation of a time-driven activity-based costing analysis at five community health facilities in Haiti. Methods Together with stakeholders, the project team decided that health-care providers should enter start and end times of the patient encounter in every fifth patient’s medical dossier. We trained one data collector per facility, who manually entered the time recordings and patient characteristics in a database and submitted the data to a cloud-based data warehouse each week. We calculated the capacity cost per minute for each resource used. An automated web-based platform multiplied reported time with capacity cost rate and provided the information to health-facilities administrators. Findings Between March 2014 and June 2015, the project tracked the clinical services for 7162 outpatients. The cost of care for specific conditions varied widely across the five facilities, due to heterogeneity in staffing and resources. For example, the average cost of a first antenatal-care visit ranged from 6.87 United States dollars (US$) at a low-level facility to US$ 25.06 at a high-level facility. Within facilities, we observed similarly variation in costs, due to factors such as patient comorbidities, patient arrival time, stocking of supplies at facilities and type of visit. Conclusion Time-driven activity-based costing can be implemented in low-resource settings to guide resource allocation decisions. However, the extent to which this information will drive observable changes at patient, provider and institutional levels depends on several contextual factors, including budget constraints, management, policies and the political economy in which the health system is situated. PMID:29403096

Learning to Change: Does Life Skills Training Lead to Reduced Incident Reports among Inmates in a Medium/Minimum Correctional Facility?

ERIC Educational Resources Information Center

Hunte, Rose S.

2010-01-01

There have been numerous research on the effect of education on behavior as it relates to recidivism. However, the base of knowledge is lacking in research discussing the effect of education on the behavior of inmates in an Omaha correctional institution. This study hypothesized that inmates engaging in life skills training would demonstrate a…

Justification for, and design of, an economical programmable multiple flight simulator

NASA Technical Reports Server (NTRS)

Kreifeldt, J. G.; Wittenber, J.; Macdonald, G.

1981-01-01

The considered research interests in air traffic control (ATC) studies revolve about the concept of distributed ATC management based on the assumption that the pilot has a cockpit display of traffic and navigation information (CDTI) via CRT graphics. The basic premise is that a CDTI equipped pilot can, in coordination with a controller, manage a part of his local traffic situation thereby improving important aspects of ATC performance. A modularly designed programmable flight simulator system is prototyped as a means of providing an economical facility of up to eight simulators to interface with a mainframe/graphics system for ATC experimentation, particularly CDTI-distributed management in which pilot-pilot interaction can have a determining effect on system performance. Need for a multiman simulator facility is predicted on results from an earlier three simulator facility.

The development of the advanced cryogenic radiometer facility at NRC

NASA Astrophysics Data System (ADS)

Gamouras, A.; Todd, A. D. W.; Côté, É.; Rowell, N. L.

2018-02-01

The National Research Council (NRC) of Canada has established a next generation facility for the primary realization of optical radiant power. The main feature of this facility is a new cryogenic electrical substitution radiometer with a closed-cycle helium cryocooler. A monochromator-based approach allows for detector calibrations at any desired wavelength. A custom-designed motion apparatus includes two transfer standard radiometer mounting ports which has increased our measurement capability by allowing the calibration of two photodetectors in one measurement cycle. Measurement uncertainties have been improved through several upgrades, including newly designed and constructed transimpedance amplifiers for the transfer standard radiometers, and a higher power broadband light source. The most significant improvements in uncertainty arise from the enhanced characteristics of the new cryogenic radiometer including its higher cavity absorptance and reduced non-equivalence effects.

Can nursing facility staff with minimal education be successfully trained with computer-based training?

PubMed

Walker, Bonnie L; Harrington, Susan S

2004-05-01

This study compares the effects of computer-based and instructor-led training on long-term care staff with a high school education or less on fire safety knowledge, attitudes, and practices. Findings show that both methods of instruction were effective in increasing staff tests scores from pre- to posttest. Scores of both groups were lower at follow-up three months later but continued to be higher than at pretest. Staff with a high school education increased scores more than those without a high school diploma.

Practice and Educational Effect of a Project Based Learning Program Collaborated with Local Enterprises

NASA Astrophysics Data System (ADS)

Nagashima, Masaaki; Kondo, Yasuo; Tanaka, Hisataka; Miyachika, Kouitsu; Akiyama, Masahiko; Ishibuchi, Nobutaka; Hayakawa, Motozo

The ICEE (Innovation Center for Engineering Education) was founded in April 2004 as an educational facility in the Faculty of Engineering of Tottori University. The ICEE plans the development and training of creative professionals in all fields of engineering through Project Based Learning (PBL) programs in collaboration with local enterprises. In this report, the outline and the educational effect of the education program are described. Through PBL programs, we can give problem finding and solving abilities, self-initiative and communicative skill to the students.

Does a voucher program improve reproductive health service delivery and access in Kenya?

PubMed

Njuki, Rebecca; Abuya, Timothy; Kimani, James; Kanya, Lucy; Korongo, Allan; Mukanya, Collins; Bracke, Piet; Bellows, Ben; Warren, Charlotte E

2015-05-23

Current assessments on Output-Based Aid (OBA) programs have paid limited attention to the experiences and perceptions of the healthcare providers and facility managers. This study examines the knowledge, attitudes, and experiences of healthcare providers and facility managers in the Kenya reproductive health output-based approach voucher program. A total of 69 in-depth interviews with healthcare providers and facility managers in 30 voucher accredited facilities were conducted. The study hypothesized that a voucher program would be associated with improvements in reproductive health service provision. Data were transcribed and analyzed by adopting a thematic framework analysis approach. A combination of inductive and deductive analysis was conducted based on previous research and project documents. Facility managers and providers viewed the RH-OBA program as a feasible system for increasing service utilization and improving quality of care. Perceived benefits of the program included stimulation of competition between facilities and capital investment in most facilities. Awareness of family planning (FP) and gender-based violence (GBV) recovery services voucher, however, remained lower than the maternal health voucher service. Relations between the voucher management agency and accredited facilities as well as existing health systems challenges affect program functions. Public and private sector healthcare providers and facility managers perceive value in the voucher program as a healthcare financing model. They recognize that it has the potential to significantly increase demand for reproductive health services, improve quality of care and reduce inequities in the use of reproductive health services. To improve program functioning going forward, there is need to ensure the benefit package and criteria for beneficiary identification are well understood and that the public facilities are permitted greater autonomy to utilize revenue generated from the voucher program.

Facilities Performance Indicators Report 2011-12: Tracking Your Facilities Vital Signs

ERIC Educational Resources Information Center

APPA: Association of Higher Education Facilities Officers, 2013

2013-01-01

This paper provides an expanded Web-based "Facilities Performance Indicators (FPI) Report." The purpose of APPA's Facilities Performance Indicators is to provide a representative set of statistics about facilities in educational institutions. APPA's Information and Research Committee's goal for this year was to enhance the…

77 FR 31841 - Notice of Applications for Authorization To Abandon Facilities and Services and To Acquire...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-30

... To Abandon Facilities and Services and To Acquire Facilities by Merger Steuben Gas Storage Company... Field Storage Facilities (Adrian Field) which Steuben operates pursuant to certificates of public... authorization to charge market based rates following its acquisition of the Adrian Field Storage Facility. The...

Cost effectiveness of facility-based care, home-based care and mobile clinics for provision of antiretroviral therapy in Uganda.

PubMed

Babigumira, Joseph B; Sethi, Ajay K; Smyth, Kathleen A; Singer, Mendel E

2009-01-01

Stakeholders in HIV/AIDS care currently use different programmes for provision of antiretroviral therapy (ART) in Uganda. It is not known which of these represents the best value for money. To compare the cost effectiveness of home-based care (HBC), facility-based care (FBC) and mobile clinic care (MCC) for provision of ART in Uganda. Incremental cost-effectiveness analysis was performed using decision and Markov modeling of adult AIDS patients in WHO Clinical Stage 3 and 4 from the perspective of the Ugandan healthcare system. The main outcome measures were cost (year 2008 values), life expectancy in life-years (LY) and the incremental cost-effectiveness ratio (ICER) measured as cost per QALY or LY gained over 10 years. Ten-year mean undiscounted life expectancy was lowest for FBC (3.6 LY), followed by MCC (4.3 LY) and highest for HBC (5.3 LY), while the mean discounted QALYs were also lowest for FBC (2.3), followed by MCC (2.9) and highest for HBC (3.7). The 10-year mean costs per patient were lowest for FBC ($US3212), followed by MCC ($US4782) and highest for HBC ($US7033). The ICER was lower for MCC versus FBC ($US2241 per LY and $US2615 per QALY) than for HBC versus MCC ($US2251 per LY and $US2814 per QALY). FBC remained cost effective in univariate and probabilistic sensitivity analyses. FBC appears to be the most cost-effective programme for provision of ART in Uganda. This analysis supports the implementation of FBC for scale-up and sustainability of ART in Uganda. HBC and MCC would be competitive only if there is increased access, increased adherence or reduced cost.

Cost Effectiveness of Facility-Based Care, Home-Based Care and Mobile Clinics for Provision of Antiretroviral Therapy in Uganda

PubMed Central

Babigumira, Joseph B.; Sethi, Ajay K.; Smyth, Kathleen A.; Singer, Mendel E.

2012-01-01

Background Stakeholders in HIV/AIDS care currently use different programmes for provision of antiretroviral therapy (ART) in Uganda. It is not known which of these represents the best value for money. Objective To compare the cost effectiveness of home-based care (HBC), facility-based care (FBC) and mobile clinic care (MCC) for provision of ART in Uganda. Methods Incremental cost-effectiveness analysis was performed using decision and Markov modeling of adult AIDS patients in WHO Clinical Stage 3 and 4 from the perspective of the Ugandan healthcare system. The main outcome measures were cost (year 2008 values), life expectancy in life-years (LY) and the incremental cost-effectiveness ratio (ICER) measured as cost per QALY or LY gained over 10 years. Results Ten-year mean undiscounted life expectancy was lowest for FBC (3.6 LY), followed by MCC (4.3 LY) and highest for HBC (5.3 LY), while the mean discounted QALYs were also lowest for FBC (2.3), followed by MCC (2.9) and highest for HBC (3.7). The 10-year mean costs per patient were lowest for FBC ($US3212), followed by MCC ($US4782) and highest for HBC ($US7033). The ICER was lower for MCC versus FBC ($US2241 per LY and $US2615 per QALY) than for HBC versus MCC ($US2251 per LY and $US2814 per QALY). FBC remained cost effective in univariate and probabilistic sensitivity analyses. Conclusions FBC appears to be the most cost-effective programme for provision of ART in Uganda. This analysis supports the implementation of FBC for scale-up and sustainability of ART in Uganda. HBC and MCC would be competitive only if there is increased access, increased adherence or reduced cost. PMID:19888795

Hospital choice factors: a case study in Turkey.

PubMed

Akinci, Fevzi; Esatoğlu, A Ezel; Tengilimoglu, Dilaver; Parsons, Amy

2004-01-01

In an attempt to test the robustness of the numerous American findings related to hospital choice in the context of another country, this study examines the factors affecting hospital choice decisions of 869 patients in three public and one private hospital policlinics in Ankara, Turkey and attempts to determine their importance levels. Identification of these factors and determining their effect levels is important in concentrating management efforts on these key areas and in formulating effective marketing strategies to retain and expand hospital patient bases in the future. Our findings highlight the importance of accessibility of hospital services to consumers in hospital choice as well as the role of hospital's image, its physical appearance, and technological capabilities in informing such choices. American health care managers can use these findings to further understand how patients make choices related to health care facilities and to develop marketing strategies that may more effectively market their facilities.

Proceedings of the NASA Workshop on Atomic Oxygen Effects. [low earth orbital environment

NASA Technical Reports Server (NTRS)

Brinza, David E. (Editor)

1987-01-01

A workshop was held to address the scientific issues concerning the effects of atomic oxygen on materials in the low Earth orbital (LEO) environment. The program included 18 invited speakers plus contributed posters covering topics such as LEO spaceflight experiments, interaction mechanisms, and atomic oxygen source development. Discussion sessions were also held to organize a test program to evaluate atomic oxygen exposure facilities. The key issues raised in the workshop were: (1) the need to develop a reliable predictive model of the effects of long-term exposure of materials to the LEO environment; (2) the ability of ground-based exposure facilities to provide useful data for development of durable materials; and (3) accurate determination of the composition of the LEO environment. These proceedings include the invited papers, the abstracts for the contributed posters, and an account of the test program discussion sessions.

Morbidity profile of elderly outpatients attending selected sub-district Siddha health facilities in Tamil Nadu, India

PubMed Central

Selvaraj, Kalaiselvi; Srinivasan, Manikandan; Duraisamy, Venkatachalam; Ramaswamy, Gomathi; Venugopal, Vinayagamurthy; Chinnakali, Palanivel

2016-01-01

Background: Recently, under National Health Mission alternate systems of Medicine are mainstreamed in public health care system. Effective action plan generation, logistic arrangement and roll out of these alternate systems of Medicine needs understanding on profile of morbidities among attendees who come to these facilities. Objectives: This study was planned to report profile of morbidities, age and sex differentials in specific morbidities among geriatric attendees in secondary level siddha health facilities. Materials and Methods: A facility based cross sectional study was conducted among elderly person (60 years and above) attending Siddha outpatient department (OPD) from two of the randomly selected sub district level siddha facilities in Erode district, Tamil Nadu, India. Information on socio-demographic variables like age, gender, education and clinical profile (diagnosis) were collected from records already maintained in the siddha OPD. Morbidities were summarized in terms of proportions based on age and gender. Age and sex specific differentials on specific morbidities were compared using ‘z’ test. Results: Of 2710 patients who visited these two siddha facilities during the reference period, 763 (28.1%) patients were elderly. Arthritis (45.2%), neuritis (8.8%), diabetes (6.6%), bronchial asthma (5.2%), hemiplegia (3.7%) were the top five morbidities diagnosed and treated among elderly attending the siddha OPD. There was a predilection towards elderly male for morbidities such as bronchial asthma and hemiplegia compared to elderly female. Similarly, higher proportions of lumbar spondylosis, hypertension and fungal skin diseases were reported among aged 80 years or more compared to elderly aged 60-79 years. Conclusion: Elderly constitute more than one fourth of outpatients load from siddha health facilities. Degenerative diseases like arthritis and non-communicable diseases were the common morbidities in this age group. Geriatric clinics and mobile clinics under siddha system may help in improving health care services. PMID:27621518

Reducing Stock-Outs of Life Saving Malaria Commodities Using Mobile Phone Text-Messaging: SMS for Life Study in Kenya

PubMed Central

Githinji, Sophie; Kigen, Samwel; Memusi, Dorothy; Nyandigisi, Andrew; Mbithi, Agneta M.; Wamari, Andrew; Muturi, Alex N.; Jagoe, George; Barrington, Jim; Snow, Robert W.; Zurovac, Dejan

2013-01-01

Background Health facility stock-outs of life saving malaria medicines are common across Africa. Innovative ways of addressing this problem are urgently required. We evaluated whether SMS based reporting of stocks of artemether-lumefantrine (AL) and rapid diagnostic tests (RDT) can result in reduction of stock-outs at peripheral facilities in Kenya. Methods/Findings All 87 public health facilities in five Kenyan districts were included in a 26 week project. Weekly facility stock counts of four AL packs and RDTs were sent via structured incentivized SMS communication process from health workers’ personal mobile phones to a web-based system accessed by district managers. The mean health facility response rate was 97% with a mean formatting error rate of 3%. Accuracy of stock count reports was 79% while accuracy of stock-out reports was 93%. District managers accessed the system 1,037 times at an average of eight times per week. The system was accessed in 82% of the study weeks. Comparing weeks 1 and 26, stock-out of one or more AL packs declined by 38 percentage-points. Total AL stock-out declined by 5 percentage-points and was eliminated by the end of the project. Stock-out declines of individual AL packs ranged from 14 to 32 percentage-points while decline in RDT stock-outs was 24 percentage-points. District managers responded to 44% of AL and 73% of RDT stock-out signals by redistributing commodities between facilities. In comparison with national trends, stock-out declines in study areas were greater, sharper and more sustained. Conclusions Use of simple SMS technology ensured high reporting rates of reasonably accurate, real-time facility stock data that were used by district managers to undertake corrective actions to reduce stock-outs. Future work on stock monitoring via SMS should focus on assessing response rates without use of incentives and demonstrating effectiveness of such interventions on a larger scale. PMID:23349786

The counter effects of the accident at Fukushima Dai-ichi nuclear power station

NASA Astrophysics Data System (ADS)

Murakami, Kenta

2017-01-01

The counter effects of the accident at the Fukushima Dai-ichi Nuclear Power Station are discussed in this paper. Though decommission and remediation have been conducted in the facility and surrounding area, ninety thousand residences near the facility are still under the evacuation order. Four nuclear power units have already restarted under the new regulatory framework, but two of them in Fukui prefecture stop the operation due to the provisional disposition declared by Ohtsu district court in Shiga prefecture. Reinforcement of the latter layer of the defense in depth has been improved in many ways. The improvement of decision-making process is very important in latter layers of the defense in depth, in contrast the plant behaviors are automatically decided based on their design in the prior layers.

Design and installation of a ferromagnetic wall in tokamak geometry

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

Hughes, P. E., E-mail: peh2109@columbia.edu; Levesque, J. P.; Rivera, N.

Low-activation ferritic steels are leading material candidates for use in next-generation fusion development experiments such as a prospective component test facility and DEMO power reactor. Understanding the interaction of plasmas with a ferromagnetic wall will provide crucial physics for these facilities. In order to study ferromagnetic effects in toroidal geometry, a ferritic wall upgrade was designed and installed in the High Beta Tokamak–Extended Pulse (HBT-EP). Several material options were investigated based on conductivity, magnetic permeability, vacuum compatibility, and other criteria, and the material of choice (high-cobalt steel) is characterized. Installation was accomplished quickly, with minimal impact on existing diagnostics andmore » overall machine performance, and initial results demonstrate the effects of the ferritic wall on plasma stability.« less

Utilization of health facilities and predictors of health-seeking behavior for under-five children with acute diarrhea in slums of Addis Ababa, Ethiopia: a community-based cross-sectional study.

PubMed

Adane, Metadel; Mengistie, Bezatu; Mulat, Worku; Kloos, Helmut; Medhin, Girmay

2017-04-04

Information on health-seeking behavior and utilization of health facilities in slums of Addis Ababa is scarce, impeding the implementation of effective interventions. The purpose of this study is to assess the status of health facilities utilization and predictors for health-seeking behavior of mothers/caregivers of under-five children with acute diarrhea in slums of Addis Ababa, Ethiopia. A community-based cross-sectional study design was employed in five rounds of surveys in seven kebeles in slums of Addis Ababa among 472 mothers/caregivers of 472 under-five children with acute diarrhea in reference to Andersen's behavioral model. Data were entered into EpiData Version 3.1 and analyzed using STATA Version 14.0. Descriptive statistics were used to examine patterns of health facilities utilization and multivariable logistic regression analysis was applied to identify predictors associated with health-seeking behavior. Most mothers/caregivers (70.8%) sought care either at home (14.2%) or health facilities (56.6%), whereas 29.2% reported that they did not seek any care. Of those who consulted health facilities, government health facilities (76.9%) were more utilized than private (18.0%) and informal (5.1%) health facilities. Nearly all (93.9%) of the mothers/caregivers using government health facilities used health centers, and of those who took their children to private health facilities (60.9%) used clinics and 26.1% used pharmacies/drug vendors. Mothers/caregivers visiting health facilities obtained mainly oral rehydration salt (ORS) (39.8%) and home-recommended fluids (HRF) (40.3%), but few of them (11.9%) obtained ORS plus zinc supplementation. Predisposing factors of literacy of mothers/caregivers (adjusted odds ratio (AOR) = 2.4; 95% CI 1.4-4.1) and occupation (AOR = 2.6; 95% CI 1.5-4.6), the enabling factors of households monthly income of 50 United States Dollars (US$) and above (AOR = 2.9; 95% CI 1.5-5.6) and availability of nearest health facilities within 15 min walking distance (AOR = 3.3; 95% CI 1.7-6.6), and the need factors of recognizing danger signs of fever (AOR = 4.3; 95% CI 2.4-7.6) and vomiting (AOR = 3.3; 95% CI 1.8-5.9) were significantly associated with health-seeking behavior. Increasing the proximity of health facilities in slums and health education and socioeconomic development programs targeting illiterate mothers/caregivers and poor households may promote and increase health-seeking behavior and the accessibility of health facilities for the treatment of acute diarrhea in under-five children in Addis Ababa slums.

Design of carbon therapy facility based on 10 years experience at HIMAC

NASA Astrophysics Data System (ADS)

Noda, K.; Furukawa, T.; Iwata, Y.; Kanai, T.; Kanazawa, M.; Kanematsu, N.; Kitagawa, A.; Komori, M.; Minohara, S.; Murakami, T.; Muramatsu, M.; Sato, S.; Sato, Y.; Shibuya, S.; Torikoshi, M.; Yamada, S.

2006-06-01

Since 1994, the clinical trial for cancer therapy with HIMAC has successfully progressed, and more than 2100 cancer patients have been treated with a carbon beam. Based on the development of the accelerator and irradiation technologies for 10 years, we have designed a new carbon-therapy facility for widespread use in Japan, and key technologies for the new facility have been developed. We describe the conceptual design of the new facility and the status of development for the key technologies.

Human Research Initiative (HRI)

NASA Technical Reports Server (NTRS)

Motil, Brian

2003-01-01

A code U initiative starting in the FY04 budget includes specific funding for 'Phase Change' and 'Multiphase Flow Research' on the ISS. NASA GRC developed a concept for two facilities based on funding/schedule constraints: 1) Two Phase Flow Facility (TphiFFy) which assumes integrating into FIR; 2) Contact Line Dynamics Experiment Facility (CLiDE) which assumes integration into MSG. Each facility will accommodate multiple experiments conducted by NRA selected PIs with an overall goal of enabling specific NASA strategic objectives. There may also be a significant ground-based component.

Modern tornado design of nuclear and other potentially hazardous facilities

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

Stevenson, J.D.; Zhao, Y.

Tornado wind loads and other tornado phenomena, including tornado missiles and differential pressure effects, have not usually been considered in the design of conventional industrial, commercial, or residential facilities in the United States; however, tornado resistance has often become a design requirement for certain hazardous facilities, such as large nuclear power plants and nuclear materials and waste storage facilities, as well as large liquefied natural gas storage facilities. This article provides a review of current procedures for the design of hazardous industrial facilities to resist tornado effects. 23 refs., 19 figs., 13 tabs.

42 CFR 422.553 - Effect of leasing of an MA organization's facilities.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 3 2011-10-01 2011-10-01 false Effect of leasing of an MA organization's... Ownership or Leasing of Facilities During Term of Contract § 422.553 Effect of leasing of an MA organization's facilities. (a) General effect of leasing. If an MA organization leases all or part of its...

42 CFR 422.553 - Effect of leasing of an MA organization's facilities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Effect of leasing of an MA organization's... Ownership or Leasing of Facilities During Term of Contract § 422.553 Effect of leasing of an MA organization's facilities. (a) General effect of leasing. If an MA organization leases all or part of its...

42 CFR 422.553 - Effect of leasing of an MA organization's facilities.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 3 2014-10-01 2014-10-01 false Effect of leasing of an MA organization's... Change of Ownership or Leasing of Facilities During Term of Contract § 422.553 Effect of leasing of an MA organization's facilities. (a) General effect of leasing. If an MA organization leases all or part of its...

42 CFR 422.553 - Effect of leasing of an MA organization's facilities.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 3 2012-10-01 2012-10-01 false Effect of leasing of an MA organization's... Change of Ownership or Leasing of Facilities During Term of Contract § 422.553 Effect of leasing of an MA organization's facilities. (a) General effect of leasing. If an MA organization leases all or part of its...

42 CFR 422.553 - Effect of leasing of an MA organization's facilities.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 3 2013-10-01 2013-10-01 false Effect of leasing of an MA organization's... Change of Ownership or Leasing of Facilities During Term of Contract § 422.553 Effect of leasing of an MA organization's facilities. (a) General effect of leasing. If an MA organization leases all or part of its...

Uptake of wheel-filtration among clients of a supervised injecting facility: Can structured education work?

PubMed

Steele, Maureen; Silins, Edmund; Flaherty, Ian; Hiley, Sarah; van Breda, Nick; Jauncey, Marianne

2018-01-01

Wheel-filtration of pharmaceutical opioid tablets is a recognised harm reduction strategy, but uptake of the practice among people who inject drugs is low. The study aimed to: (i) examine perceptions of filtration practices; (ii) provide structured education on wheel-filtration; and (iii) assess uptake of the practice. Frequent opioid tablet injectors (n = 30) attending a supervised injecting facility in Sydney, Australia, received hands-on instruction on wheel-filtration based on recommended practice. Pre-education, post-education and follow-up questionnaires were administered. Wheel-filtration was generally regarded as better than cotton-filtration (the typical method) in terms of perceived effects on health, ease of use and overall drug effect. Sixty-eight percent of those who said they would try wheel-filtration after the education had actually done so. Of those who usually used cotton-filtration, over half (60%) had used wheel-filtration two weeks later. Uptake of safer preparation methods for pharmaceutical opioid tablets increases after structured education in wheel-filtration. Findings suggest that SIFs are an effective site for this kind of education. Supervised injecting facility workers are uniquely positioned to provide harm reduction education at the time of injection. [Steele M, Silins E, Flaherty I, Hiley S, van Breda N, Jauncey M. Uptake of wheel-filtration among clients of a supervised injecting facility: Can structured education work? Drug Alcohol Rev 2018;37:116-120]. © 2017 Australasian Professional Society on Alcohol and other Drugs.

The effect of state medicaid case-mix payment on nursing home resident acuity.

PubMed

Feng, Zhanlian; Grabowski, David C; Intrator, Orna; Mor, Vincent

2006-08-01

To examine the relationship between Medicaid case-mix payment and nursing home resident acuity. Longitudinal Minimum Data Set (MDS) resident assessments from 1999 to 2002 and Online Survey Certification and Reporting (OSCAR) data from 1996 to 2002, for all freestanding nursing homes in the 48 contiguous U.S. states. We used a facility fixed-effects model to examine the effect of introducing state case-mix payment on changes in nursing home case-mix acuity. Facility acuity was measured by aggregating the nursing case-mix index (NCMI) from the MDS using the Resource Utilization Group (Version III) resident classification system, separately for new admits and long-stay residents, and by an OSCAR-derived index combining a range of activity of daily living dependencies and special treatment measures. We followed facilities over the study period to create a longitudinal data file based on the MDS and OSCAR, respectively, and linked facilities with longitudinal data on state case-mix payment policies for the same period. Across three acuity measures and two data sources, we found that states shifting to case-mix payment increased nursing home acuity levels over the study period. Specifically, we observed a 2.5 percent increase in the average acuity of new admits and a 1.3 to 1.4 percent increase in the acuity of long-stay residents, following the introduction of case-mix payment. The adoption of case-mix payment increased access to care for higher acuity Medicaid residents.

Increase in facility-based deliveries associated with a maternal health voucher programme in informal settlements in Nairobi, Kenya.

PubMed

Bellows, Ben; Kyobutungi, Catherine; Mutua, Martin Kavao; Warren, Charlotte; Ezeh, Alex

2013-03-01

To measure whether there was an association between the introduction of an output-based voucher programme and the odds of a facility-based delivery in two Nairobi informal settlements. Nairobi Urban Health and Demographic Surveillance System (NUHDSS) and two cross-sectional household surveys in Korogocho and Viwandani informal settlements in 2004-05 and 2006-08. Odds of facility-based delivery were estimated before and after introduction of an output-based voucher. Supporting NUHDSS data were used to determine whether any trend in maternal health care was coincident with immunizations, a non-voucher outpatient service. As part of NUHDSS, households in Korogocho and Viwandani reported place of delivery and the presence of a skilled birth attendant (2003-10) and vaccination coverage (2003-09). A detailed maternal and child health (MCH) tool was added to NUHDSS (September 2006-10). Prospective enrolment in NUHDSS-MCH was conditional on having a newborn after September 2006. In addition to recording mother's place of delivery, NUHDSS-MCH recorded the use of the voucher. There were significantly greater odds of a facility-based delivery among respondents during the voucher programme compared with similar respondents prior to voucher launch. Testing whether unrelated outpatient care also increased, a falsification exercise found no significant increase in immunizations for children 12-23 months of age in the same period. Although the proportion completing any antenatal care (ANC) visit remained above 95% of all reported pregnancies and there was a significant increase in facility-based deliveries, the proportion of women completing 4+ ANC visits was significantly lower during the voucher programme. A positive association was observed between vouchers and facility-based deliveries in Nairobi. Although there is a need for higher quality evidence and validation in future studies, this statistically significant and policy relevant finding suggests that increases in facility-based deliveries can be achieved through output-based finance models that target subsidies to underserved populations.

FACILITY 317. EXTERIOR OF FRONT SIDE, WITH FACILITY 316 BEYOND ...

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

FACILITY 317. EXTERIOR OF FRONT SIDE, WITH FACILITY 316 BEYOND ON THE LEFT. VIEW FACING NORTH. - U.S. Naval Base, Pearl Harbor, Naval Housing Area Hospital Point, Pharmacist's Quarters Type, 13-16 First Street, Pearl City, Honolulu County, HI

Controlling nosocomial infection based on structure of hospital social networks.

PubMed

Ueno, Taro; Masuda, Naoki

2008-10-07

Nosocomial infection (i.e. infection in healthcare facilities) raises a serious public health problem, as implied by the existence of pathogens characteristic to healthcare facilities such as methicillin-resistant Staphylococcus aureus and hospital-mediated outbreaks of influenza and severe acute respiratory syndrome. For general communities, epidemic modeling based on social networks is being recognized as a useful tool. However, disease propagation may occur in a healthcare facility in a manner different from that in a urban community setting due to different network architecture. We simulate stochastic susceptible-infected-recovered dynamics on social networks, which are based on observations in a hospital in Tokyo, to explore effective containment strategies against nosocomial infection. The observed social networks in the hospital have hierarchical and modular structure in which dense substructure such as departments, wards, and rooms, are globally but only loosely connected, and do not reveal extremely right-skewed distributions of the number of contacts per individual. We show that healthcare workers, particularly medical doctors, are main vectors (i.e. transmitters) of diseases on these networks. Intervention methods that restrict interaction between medical doctors and their visits to different wards shrink the final epidemic size more than intervention methods that directly protect patients, such as isolating patients in single rooms. By the same token, vaccinating doctors with priority rather than patients or nurses is more effective. Finally, vaccinating individuals with large betweenness centrality (frequency of mediating connection between pairs of individuals along the shortest paths) is superior to vaccinating ones with large connectedness to others or randomly chosen individuals, which was suggested by previous model studies.

Differential effects of community health worker visits across social and economic groups in Uttar Pradesh, India: a link between social inequities and health disparities.

PubMed

Seth, Aparna; Tomar, Shweta; Singh, Kultar; Chandurkar, Dharmendra; Chakraverty, Amit; Dey, Arnab; Das, Arup K; Hay, Katherine; Saggurti, Niranjan; Boyce, Sabrina; Raj, Anita; Silverman, Jay G

2017-03-07

Uttar Pradesh (UP) accounts for the largest number of neonatal deaths in India. This study explores potential socio-economic inequities in household-level contacts by community health workers (CHWs) and whether the effects of such household-level contacts on receipt of health services differ across populations in this state. A multistage sampling design identified live births in the last 12 months across the 25 highest-risk districts of UP (N = 4912). Regression models described the relations between household demographics (caste, religion, wealth, literacy) and CHW contact, and interactions of demographics and CHW contact in predicting health service utilization (> = 4 antenatal care (ANC) visits, facility delivery, modern contraceptive use). No differences were found in likelihood of CHW contact based on caste, religion, wealth or literacy. Associations of CHW contact with receipt of ANC and facility delivery were significantly affected by religion, wealth and literacy. CHW contact increased the odds of 4 or more ANC visits only among non-Muslim women, increased the odds of both four or more ANC visits and facility delivery only among lower wealth women, increased the odds of facility delivery to a greater degree among illiterate vs. literate women. CHW visits play a vital role in promoting utilization of critical maternal health services in UP. However, significant social inequities exist in associations of CHW visits with such service utilization. Research to clarify these inequities, as well as training for CHWs to address potential biases in the qualities or quantity of their visits based on household socio-economic characteristics is recommended.

Combustion Of Interacting Droplet Arrays In Microgravity

NASA Technical Reports Server (NTRS)

Dietrich, D. L.; Struk, P. M.; Ikegami, M.; Xu, G.

2003-01-01

Theory and experiments involving single droplet combustion date back to 1953, with the first microgravity work appearing in 1956. The problem of a spherical droplet burning in an infinite, quiescent microgravity environment is a classical problem in combustion research with the classical solution appearing in nearly every textbook on combustion. The microgravity environment offered by ground-based facilities such as drop towers and space-based facilities is ideal for studying the problem experimentally. A recent review by Choi and Dryer shows significant advances in droplet combustion have been made by studying the problem experimentally in microgravity and comparing the results to one dimensional theoretical and numerical treatments of the problem. Studying small numbers of interacting droplets in a well-controlled geometry represents a logical step in extending single droplet investigations to more practical spray configurations. Studies of droplet interactions date back to Rex and co-workers, and were recently summarized by Annamalai and Ryan. All previous studies determined the change in the burning rate constant, k, or the flame characteristics as a result of interactions. There exists almost no information on how droplet interactions a effect extinction limits, and if the extinction limits change if the array is in the diffusive or the radiative extinction regime. Thus, this study examined experimentally the effect that droplet interactions have on the extinction process by investigating the simplest array configuration, a binary droplet array. The studies were both in normal gravity, reduced pressure ambients and microgravity facilities. The microgravity facilities were the 2.2 and 5.2 second drop towers at the NASA Glenn Research Center and the 10 second drop tower at the Japan Microgravity Center. The experimental apparatus and the data analysis techniques are discussed in detail elsewhere.

Using health-facility data to assess subnational coverage of maternal and child health indicators, Kenya.

PubMed

Maina, Isabella; Wanjala, Pepela; Soti, David; Kipruto, Hillary; Droti, Benson; Boerma, Ties

2017-10-01

To develop a systematic approach to obtain the best possible national and subnational statistics for maternal and child health coverage indicators from routine health-facility data. Our approach aimed to obtain improved numerators and denominators for calculating coverage at the subnational level from health-facility data. This involved assessing data quality and determining adjustment factors for incomplete reporting by facilities, then estimating local target populations based on interventions with near-universal coverage (first antenatal visit and first dose of pentavalent vaccine). We applied the method to Kenya at the county level, where routine electronic reporting by facilities is in place via the district health information software system. Reporting completeness for facility data were well above 80% in all 47 counties and the consistency of data over time was good. Coverage of the first dose of pentavalent vaccine, adjusted for facility reporting completeness, was used to obtain estimates of the county target populations for maternal and child health indicators. The country and national statistics for the four-year period 2012/13 to 2015/16 showed good consistency with results of the 2014 Kenya demographic and health survey. Our results indicated a stagnation of immunization coverage in almost all counties, a rapid increase of facility-based deliveries and caesarean sections and limited progress in antenatal care coverage. While surveys will continue to be necessary to provide population-based data, web-based information systems for health facility reporting provide an opportunity for more frequent, local monitoring of progress, in maternal and child health.

Rayleigh Scattering for Measuring Flow in a Nozzle Testing Facility

NASA Technical Reports Server (NTRS)

Gomez, Carlos R.; Panda, Jayanta

2006-01-01

A molecular Rayleigh-scattering-based air-density measurement system was built in a large nozzle-and-engine-component test facility for surveying supersonic plumes from jet-engine exhaust. A molecular Rayleigh-scattering-based air-density measurement system was built in a large nozzle-and-enginecomponent test facility for surveying supersonic plumes from jet-engine exhaust

Financial Literacy Curriculum: The Effect on Offender Money Management Skills

ERIC Educational Resources Information Center

Koenig, Lori A.

2007-01-01

Offenders involved in this study lacked basic financial knowledge which presented a barrier to their success upon release. The researcher modified existing curriculum and created a course in financial literacy for offenders within a medium security correctional facility based upon their personal experiences. The offenders gained financial…

Chapter 8: Fire Performance of Cross-Laminated Timber Assemblies (2012 US Edition)

Treesearch

Christian Dagenais; Robert H. White; Kuma Sumathipala

2012-01-01

Cross-laminated timber (CLT) is a promising wood-based structural component and has potential to provide cost-effective building solutions for residential, commercial and institutional buildings as well as large industrial facilities. Market acceptance of CLT requires that it meets the applicable building code requirements.

New Zealand health reforms: effect on ophthalmic practice.

PubMed

Raynel, S; Reynolds, H

1999-01-01

Are specialized ophthalmic units with inpatient facilities going to disappear in the New Zealand public health system? We have entered the era of cost containment, business methodologies, bench marking, day case surgery, and technologic advances. The dilemma for nursing is maintenance of a skill base with dwindling clinical practice areas.

Designing Schools Based on Brain Research.

ERIC Educational Resources Information Center

Chermayeff, Peter; Townsend, Ted

An audiotape explains an Iowa rainforest project that promotes experiential learning for children, and explores the effects of the physical environment on the brain. The project is a one-of-a-kind private/partnership that has created a fully integrated, seamless educational facility that combines a public school (prekindergarten through fifth…

Space station accommodations for lunar base elements: A study

NASA Technical Reports Server (NTRS)

Weidman, Deene J.; Cirillo, William; Llewellyn, Charles; Kaszubowski, Martin; Kienlen, E. Michael, Jr.

1987-01-01

The results of a study conducted at NASA-LaRC to assess the impact on the space station of accommodating a Manned Lunar Base are documented. Included in the study are assembly activities for all infrastructure components, resupply and operations support for lunar base elements, crew activity requirements, the effect of lunar activities on Cape Kennedy operations, and the effect on space station science missions. Technology needs to prepare for such missions are also defined. Results of the study indicate that the space station can support the manned lunar base missions with the addition of a Fuel Depot Facility and a heavy lift launch vehicle to support the large launch requirements.

A facile electrochemical sensor for nonylphenol determination based on the enhancement effect of cetyltrimethylammonium bromide.

PubMed

Lu, Qing; Zhang, Weina; Wang, Zhihui; Yu, Guangxia; Yuan, Yuan; Zhou, Yikai

2013-01-07

A facile electrochemical sensor for the determination of nonylphenol (NP) was fabricated in this work. Cetyltrimethylammonium bromide (CTAB), which formed a bilayer on the surface of the carbon paste (CP) electrode, displayed a remarkable enhancement effect for the electrochemical oxidation of NP. Moreover, the oxidation peak current of NP at the CTAB/CP electrode demonstrated a linear relationship with NP concentration, which could be applied in the direct determination of NP. Some experimental parameters were investigated, such as external solution pH, mode and time of accumulation, concentration and modification time of CTAB and so on. Under optimized conditions, a wide linear range from 1.0 × 10(-7) mol·L(-1) to 2.5 × 10(-5) mol·L(-1) was obtained for the sensor, with a low limit of detection at 1.0 × 10(-8) mol·L(-1). Several distinguishing advantages of the as-prepared sensor, including facile fabrication, easy operation, low cost and so on, suggest a great potential for its practical applications.

A study of the efficiency of hydrogen liquefaction. [jet aircraft applications

NASA Technical Reports Server (NTRS)

Baker, C. R.; Shaner, R. L.

1976-01-01

The search for an environmentally acceptable fuel to eventually replace petroleum-based fuels for long-range jet aircraft has singled out liquid hydrogen as an outstanding candidate. Hydrogen liquefaction is discussed, along with the effect of several operating parameters on process efficiency. A feasible large-scale commercial hydrogen liquefaction facility based on the results of the efficiency study is described. Potential future improvements in hydrogen liquefaction are noted.

Facility Composer (Trademark) and PACES (Trademark) Integration: Development of an XML Interface Based on Industry Foundation Classes

DTIC Science & Technology

2007-11-01

Engineer- ing Research Laboratory is currently developing a set of facility ‘architec- tural’ programming tools , called Facility ComposerTM (FC). FC...requirements in the early phases of project development. As the facility program, crite- ria, and requirements are chosen, these tools populate the IFC...developing a set of facility “ar- chitectural” programming tools , called Facility Composer (FC), to support the capture and tracking of facility criteria

Rainwater drainage management for urban development based on public-private partnership.

PubMed

Matsushita, J; Ozaki, M; Nishimura, S; Ohgaki, S

2001-01-01

The Urban Development Corporation (UDC) is one of the biggest implementation bodies for urban development in Japan. UDC has developed rainwater infiltration technology since 1975. This technology has effectively reduced runoff to a river and sewer system in the new town project areas. Recently, UDC has developed a new system which is defined as a "Rainwater Recycle Sewer System", which is supported by "Rainwater Storage and Infiltration Technology (RSIT)" applicable to new town creation and urban renewal. The new system consists of two elements: RSIT components based on Public-Private Partnership (PPP) and a stormwater drainage system. Herein, the private sector is responsible for the main part of RSIT, and the public sector is responsible for the stormwater drainage from the development area. As a result, the capacity of public facilities, such as rainwater sewers and stormwater reservoirs, can be reduced effectively. In parallel, the initial/running cost of public facilities is expected to be reduced. In conclusion, the authors would stress the importance of a co-maintenance system also based on PPP, which will be required especially in order to properly operate the whole system for the long term.

Development of CFC-Free Cleaning Processes at the NASA White Sands Test Facility

NASA Technical Reports Server (NTRS)

Beeson, Harold; Kirsch, Mike; Hornung, Steven; Biesinger, Paul

1995-01-01

The NASA White Sands Test Facility (WSTF) is developing cleaning and verification processes to replace currently used chlorofluorocarbon-113- (CFC-113-) based processes. The processes being evaluated include both aqueous- and solvent-based techniques. The presentation will include the findings of investigations of aqueous cleaning and verification processes that are based on a draft of a proposed NASA Kennedy Space Center (KSC) cleaning procedure. Verification testing with known contaminants, such as hydraulic fluid and commonly used oils, established correlations between nonvolatile residue and CFC-113. Recoveries ranged from 35 to 60 percent of theoretical. WSTF is also investigating enhancements to aqueous sampling for organics and particulates. Although aqueous alternatives have been identified for several processes, a need still exists for nonaqueous solvent cleaning, such as the cleaning and cleanliness verification of gauges used for oxygen service. The cleaning effectiveness of tetrachloroethylene (PCE), trichloroethylene (TCE), ethanol, hydrochlorofluorocarbon-225 (HCFC-225), tert-butylmethylether, and n-Hexane was evaluated using aerospace gauges and precision instruments and then compared to the cleaning effectiveness of CFC-113. Solvents considered for use in oxygen systems were also tested for oxygen compatibility using high-pressure oxygen autoignition and liquid oxygen mechanical impact testing.

The Alto Tandem and Isol Facility at IPN Orsay

NASA Astrophysics Data System (ADS)

Franchoo, Serge

Alto is an infrastructure for experimental nuclear physics in France that comprises both an on-line isotope-separation facility based on the photofission of uranium and a stable-ion beam facility based on a 14.5-MV tandem accelerator. The isotope-separation on-line section of Alto is dedicated to the production of neutron-rich radioactive ion beams (RIB) from the interaction of the γ-flux induced by a 50-MeV 10-µA electron beam in a uranium-carbide target. It is dimensioned for 1011 fissions per second. The RIB facility is exploited in alternating mode with the tandem-based section of Alto, capable of accelerating both light ions for nuclear astrophysics and heavy ions for γ-spectroscopy. The facility thereby offers the opportunity to deliver beams to a large range of physics programmes from nuclear to interdisciplinary physics. In this article, we present the Alto facility as well as some of the highlights and prospects of the experimental programme.

Case-Mix Adjusting Performance Measures in a Veteran Population: Pharmacy- and Diagnosis-Based Approaches

PubMed Central

Liu, Chuan-Fen; Sales, Anne E; Sharp, Nancy D; Fishman, Paul; Sloan, Kevin L; Todd-Stenberg, Jeff; Nichol, W Paul; Rosen, Amy K; Loveland, Susan

2003-01-01

Objective To compare the rankings for health care utilization performance measures at the facility level in a Veterans Health Administration (VHA) health care delivery network using pharmacy- and diagnosis-based case-mix adjustment measures. Data Sources/Study Setting The study included veterans who used inpatient or outpatient services in Veterans Integrated Service Network (VISN) 20 during fiscal year 1998 (October 1997 to September 1998; N=126,076). Utilization and pharmacy data were extracted from VHA national databases and the VISN 20 data warehouse. Study Design We estimated concurrent regression models using pharmacy or diagnosis information in the base year (FY1998) to predict health service utilization in the same year. Utilization measures included bed days of care for inpatient care and provider visits for outpatient care. Principal Findings Rankings of predicted utilization measures across facilities vary by case-mix adjustment measure. There is greater consistency within the diagnosis-based models than between the diagnosis- and pharmacy-based models. The eight facilities were ranked differently by the diagnosis- and pharmacy-based models. Conclusions Choice of case-mix adjustment measure affects rankings of facilities on performance measures, raising concerns about the validity of profiling practices. Differences in rankings may reflect differences in comparability of data capture across facilities between pharmacy and diagnosis data sources, and unstable estimates due to small numbers of patients in a facility. PMID:14596393

Trust-Based Relational Intervention (TBRI): A Systemic Approach to Complex Developmental Trauma

PubMed Central

Purvis, Karyn B.; Cross, David R.; Dansereau, Donald F.; Parris, Sheri R.

2013-01-01

Children and youth who have experienced foster care or orphanage-rearing have often experienced complex developmental trauma, demonstrating an interactive set of psychological and behavioral issues. Trust-Based Relational Intervention (TBRI) is a therapeutic model that trains caregivers to provide effective support and treatment for at-risk children. TBRI has been applied in orphanages, courts, residential treatment facilities, group homes, foster and adoptive homes, churches, and schools. It has been used effectively with children and youth of all ages and all risk levels. This article provides the research base for TBRI and examples of how it is applied. PMID:24453385

Determinants of use of health facility for childbirth in rural Hadiya zone, Southern Ethiopia.

PubMed

Asseffa, Netsanet Abera; Bukola, Fawole; Ayodele, Arowojolu

2016-11-16

Maternal mortality remains a major global public health concern despite many international efforts. Facility-based childbirth increases access to appropriate skilled attendance and emergency obstetric care services as the vast majority of obstetric complications occur during delivery. The purpose of the study was to determine the proportion of facility delivery and assess factors influencing utilization of health facility for childbirth. A cross-sectional study was conducted in two rural districts of Hadiya zone, southern Ethiopia. Participants who delivered within three years of the survey were selected by stratified random sampling. Trained interviewers administered a pre-tested semi-structured questionnaire. We employed bivariate analysis and logistic regression to identify determinants of facility-based delivery. Data from 751 participants showed that 26.9% of deliveries were attended in health facilities. In bivariate analysis, maternal age, education, husband's level of education, possession of radio, antenatal care, place of recent ANC attended, planned pregnancy, wealth quintile, parity, birth preparedness and complication readiness, being a model family and distance from the nearest health facility were associated with facility delivery. On multiple logistic regression, age, educational status, antenatal care, distance from the nearest health facility, wealth quintile, being a model family, planned pregnancy and place of recent ANC attended were the determinants of facility-based childbirth. Efforts to improve institutional deliveries in the region must strengthen initiatives that promote female education, opportunities for wealth creation, female empowerment and increased uptake of family planning among others. Service related barriers and cultural influences on the use of health facility for childbirth require further evaluation.

Overview taken from Facility 2 looking east down Avenue E ...

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

Overview taken from Facility 2 looking east down Avenue E (Russell Avenue). Facility 1 is on left, Facility 1G and 1C in center. View facing east - U.S. Naval Base, Pearl Harbor, Administration Annex, Near Russell Avenue (previously Avenue E), between of Facility Nos. 1C & 1E , Pearl City, Honolulu County, HI

Preliminary enquiry into the availability, price and quality of malaria rapid diagnostic tests in the private health sector of six malaria-endemic countries.

PubMed

Albertini, A; Djalle, D; Faye, B; Gamboa, D; Luchavez, J; Mationg, M L; Mwangoka, G; Oyibo, W; Bennett, J; Incardona, S; Lee, E

2012-02-01

This enquiry aimed to provide a snap-shot of availability, price and quality of malaria rapid diagnostic tests (RDTs) in private health facilities at selected sites in six malaria-endemic countries in Africa, South East Asia and South America. In each study site, data collectors surveyed private healthcare facilities which were selected based on accessibility from their home institution. Using a questionnaire, information was recorded about the facility itself and the malaria RDT(s) available. Where possible, a small number of RDTs were procured and quality control tested using a standardized procedure. Of the 324 private healthcare facilities visited, 35 outlets (mainly private clinics and hospitals) were found to supply 10 different types of RDTs products. RDT prices across the six countries ranged from US$1.00 to $16.81. Five of the 14 malaria RDTs collected failed quality control testing. In the private outlets sampled, the availability of RDTs was limited. Some of the RDTs whose quality we tested demonstrated inadequate sensitivity. This presents a number of risks. Given the more widespread distribution of antimalarials currently planned for private sector facilities, parasite-based diagnosis in this sector will be essential to adhere to the WHO guidelines for effective case management of malaria. Considerable regulation and quality control are also necessary to assure the availability of accurate and reliable RDTs, as well as adequate case management and provider adherence to RDT results. Public sector engagement is likely to be essential in this process. © 2011 Blackwell Publishing Ltd.

Effects of State Minimum Staffing Standards on Nursing Home Staffing and Quality of Care

PubMed Central

Park, Jeongyoung; Stearns, Sally C

2009-01-01

Objective To investigate the impact of state minimum staffing standards on the level of staffing and quality of nursing home care. Data Sources Online Survey and Certification Reporting System (OSCAR) merged with the Area Resource File from 1998 through 2001. Study Design Between 1998 and 2001, 16 states implemented or expanded staffing standards in excess of federal requirements, creating a natural experiment in comparison with facilities in states without new standards. Difference-in-differences models using facility fixed effects were estimated to determine the effect of state standards. Data Collection/Extraction Methods OSCAR data were linked to the data on market conditions and state policies. A total of 55,248 facility-year observations from 15,217 freestanding facilities were analyzed. Principal Findings Increased standards resulted in small staffing increases for facilities with staffing initially below or close to new standards. Yet the standards were associated with reductions in restraint use and the number of total deficiencies at all types of facilities. Conclusions Mandated staffing standards affect only low-staff facilities facing potential for penalties, and effects are small. Selected facility-level outcomes may show improvement at all facilities due to a general response to increased standards or to other quality initiatives implemented at the same time as staffing standards. PMID:18823448

Single-Event Effect Testing of the Linear Technology LTC6103HMS8#PBF Current Sense Amplifier

NASA Technical Reports Server (NTRS)

Yau, Ka-Yen; Campola, Michael J.; Wilcox, Edward

2016-01-01

The LTC6103HMS8#PBF (henceforth abbreviated as LTC6103) current sense amplifier from Linear Technology was tested for both destructive and non-destructive single-event effects (SEE) using the heavy-ion cyclotron accelerator beam at Lawrence Berkeley National Laboratory (LBNL) Berkeley Accelerator Effects (BASE) facility. During testing, the input voltages and output currents were monitored to detect single event latch-up (SEL) and single-event transients (SETs).

Probability-Based Design Criteria of the ASCE 7 Tsunami Loads and Effects Provisions (Invited)

NASA Astrophysics Data System (ADS)

Chock, G.

2013-12-01

Mitigation of tsunami risk requires a combination of emergency preparedness for evacuation in addition to providing structural resilience of critical facilities, infrastructure, and key resources necessary for immediate response and economic and social recovery. Critical facilities would include emergency response, medical, tsunami refuges and shelters, ports and harbors, lifelines, transportation, telecommunications, power, financial institutions, and major industrial/commercial facilities. The Tsunami Loads and Effects Subcommittee of the ASCE/SEI 7 Standards Committee is developing a proposed new Chapter 6 - Tsunami Loads and Effects for the 2016 edition of the ASCE 7 Standard. ASCE 7 provides the minimum design loads and requirements for structures subject to building codes such as the International Building Code utilized in the USA. In this paper we will provide a review emphasizing the intent of these new code provisions and explain the design methodology. The ASCE 7 provisions for Tsunami Loads and Effects enables a set of analysis and design methodologies that are consistent with performance-based engineering based on probabilistic criteria. . The ASCE 7 Tsunami Loads and Effects chapter will be initially applicable only to the states of Alaska, Washington, Oregon, California, and Hawaii. Ground shaking effects and subsidence from a preceding local offshore Maximum Considered Earthquake will also be considered prior to tsunami arrival for Alaska and states in the Pacific Northwest regions governed by nearby offshore subduction earthquakes. For national tsunami design provisions to achieve a consistent reliability standard of structural performance for community resilience, a new generation of tsunami inundation hazard maps for design is required. The lesson of recent tsunami is that historical records alone do not provide a sufficient measure of the potential heights of future tsunamis. Engineering design must consider the occurrence of events greater than scenarios in the historical record, and should properly be based on the underlying seismicity of subduction zones. Therefore, Probabilistic Tsunami Hazard Analysis (PTHA) consistent with source seismicity must be performed in addition to consideration of historical event scenarios. A method of Probabilistic Tsunami Hazard Analysis has been established that is generally consistent with Probabilistic Seismic Hazard Analysis in the treatment of uncertainty. These new tsunami design zone maps will define the coastal zones where structures of greater importance would be designed for tsunami resistance and community resilience. Structural member acceptability criteria will be based on performance objectives for a 2,500-year Maximum Considered Tsunami. The approach developed by the ASCE Tsunami Loads and Effects Subcommittee of the ASCE 7 Standard would result in the first national unification of tsunami hazard criteria for design codes reflecting the modern approach of Performance-Based Engineering.

Shared Use of Physical Activity Facilities Among North Carolina Faith Communities, 2013

PubMed Central

Edwards, Michael B.; Bocarro, Jason N.; Stein, Anna; Kanters, Michael A.; Sherman, Danielle Marie; Rhew, Lori K.; Stallings, Willona Marie; Bowen, Sarah K.

2017-01-01

Introduction Shared use of recreational facilities is a promising strategy for increasing access to places for physical activity. Little is known about shared use in faith-based settings. This study examined shared use practices and barriers in faith communities in North Carolina. Methods Faith communities in North Carolina (n = 234) completed an online survey (October–December 2013) designed to provide information about the extent and nature of shared use of recreational facilities. We used binary logistic regression to examine differences between congregations that shared use and those that did not share use. Results Most of the faith communities (82.9%) that completed the survey indicated that they share their facilities with outside individuals and organizations. Formal agreements were more common when faith communities shared indoor spaces such as gymnasiums and classroom meeting spaces than when they shared outdoor spaces such as playgrounds or athletic fields. Faith communities in the wealthiest counties were more likely to share their spaces than were faith communities in poorer counties. Faith communities in counties with the best health rankings were more likely to share facilities than faith communities in counties that had lower health rankings. The most frequently cited reasons faith communities did not share their facilities were that they did not know how to initiate the process of sharing their facilities or that no outside groups had ever asked. Conclusion Most faith communities shared their facilities for physical activity. Research is needed on the relationship between shared use and physical activity levels, including the effect of formalizing shared-use policies. PMID:28152362

Shared Use of Physical Activity Facilities Among North Carolina Faith Communities, 2013.

PubMed

Hardison-Moody, Annie; Edwards, Michael B; Bocarro, Jason N; Stein, Anna; Kanters, Michael A; Sherman, Danielle Marie; Rhew, Lori K; Stallings, Willona Marie; Bowen, Sarah K

2017-02-02

Shared use of recreational facilities is a promising strategy for increasing access to places for physical activity. Little is known about shared use in faith-based settings. This study examined shared use practices and barriers in faith communities in North Carolina. Faith communities in North Carolina (n = 234) completed an online survey (October-December 2013) designed to provide information about the extent and nature of shared use of recreational facilities. We used binary logistic regression to examine differences between congregations that shared use and those that did not share use. Most of the faith communities (82.9%) that completed the survey indicated that they share their facilities with outside individuals and organizations. Formal agreements were more common when faith communities shared indoor spaces such as gymnasiums and classroom meeting spaces than when they shared outdoor spaces such as playgrounds or athletic fields. Faith communities in the wealthiest counties were more likely to share their spaces than were faith communities in poorer counties. Faith communities in counties with the best health rankings were more likely to share facilities than faith communities in counties that had lower health rankings. The most frequently cited reasons faith communities did not share their facilities were that they did not know how to initiate the process of sharing their facilities or that no outside groups had ever asked. Most faith communities shared their facilities for physical activity. Research is needed on the relationship between shared use and physical activity levels, including the effect of formalizing shared-use policies.

Infection prevention and control standards in assisted living facilities: are residents' needs being met?

PubMed

Kossover, Rachel A; Chi, Carolyn J; Wise, Matthew E; Tran, Alvin H; Chande, Neha D; Perz, Joseph F

2014-01-01

Assisted living facilities (ALFs) provide housing and care to persons unable to live independently, and who often have increasing medical needs. Disease outbreaks illustrate challenges of maintaining adequate resident protections in these facilities. Describe current state laws on assisted living admissions criteria, medical oversight, medication administration, vaccination requirements, and standards for infection control training. We abstracted laws and regulations governing assisted living facilities for the 50 states using a structured abstraction tool. Selected characteristics were compared according to the time period in which the regulation took effect. Selected state health departments were queried regarding outbreaks identified in assisted living facilities. Of the 50 states, 84% specify health-based admissions criteria to assisted living facilities; 60% require licensed health care professionals to oversee medical care; 88% specifically allow subcontracting with outside entities to provide routine medical services onsite; 64% address medication administration by assisted living facility staff; 54% specify requirements for some form of initial infection control training for all staff; 50% require reporting of disease outbreaks to the health department; 18% specify requirements to offer or require vaccines to staff; 30% specify requirements to offer or require vaccines to residents. Twelve states identified approximately 1600 outbreaks from 2010 to 2013, with influenza or norovirus infections predominating. There is wide variation in how assisted living facilities are regulated in the United States. States may wish to consider regulatory changes that ensure safe health care delivery, and minimize risks of infections, outbreaks of disease, and other forms of harm among assisted living residents. Published by Elsevier Inc.