Improving the explanation capabilities of advisory systems

NASA Technical Reports Server (NTRS)

Porter, Bruce; Souther, Art

1993-01-01

A major limitation of current advisory systems (e.g., intelligent tutoring systems and expert systems) is their restricted ability to give explanations. The goal of our research is to develop and evaluate a flexible explanation facility, one that can dynamically generate responses to questions not anticipated by the system's designers and that can tailor these responses to individual users. To achieve this flexibility, we are developing a large knowledge base, a viewpoint construction facility, and a modeling facility. In the long term we plan to build and evaluate advisory systems with flexible explanation facilities for scientists in numerous domains. In the short term, we are focusing on a single complex domain in biological science, and we are working toward two important milestones: (1) building and evaluating an advisory system with a flexible explanation facility for freshman-level students studying biology; and (2) developing general methods and tools for building similar explanation facilities in other domains.

Improving the explanation capabilities of advisory systems

NASA Technical Reports Server (NTRS)

Porter, Bruce; Souther, Art

1994-01-01

A major limitation of current advisory systems (e.g., intelligent tutoring systems and expert systems) is their restricted ability to give explanations. The goal of our research is to develop and evaluate a flexible explanation facility, one that can dynamically generate responses to questions not anticipated by the system's designers and that can tailor these responses to individual users. To achieve this flexibility, we are developing a large knowledge base, a viewpoint construction facility, and a modeling facility. In the long term we plan to build and evaluate advisory systems with flexible explanation facilities for scientists in numerous domains. In the short term, we are focusing on a single complex domain in biological science, and we are working toward two important milestones: (1) building and evaluating an advisory system with a flexible explanation facility for freshman-level students studying biology, and (2) developing general methods and tools for building similar explanation facilities in other domains.

Integrating palliative care in long-term care facilities across Europe (PACE): protocol of a cluster randomized controlled trial of the 'PACE Steps to Success' intervention in seven countries.

PubMed

Smets, Tinne; Onwuteaka-Philipsen, Bregje B D; Miranda, Rose; Pivodic, Lara; Tanghe, Marc; van Hout, Hein; Pasman, Roeline H R W; Oosterveld-Vlug, Mariska; Piers, Ruth; Van Den Noortgate, Nele; Wichmann, Anne B; Engels, Yvonne; Vernooij-Dassen, Myrra; Hockley, Jo; Froggatt, Katherine; Payne, Sheila; Szczerbińska, Katarzyna; Kylänen, Marika; Leppäaho, Suvi; Barańska, Ilona; Gambassi, Giovanni; Pautex, Sophie; Bassal, Catherine; Deliens, Luc; Van den Block, Lieve

2018-03-12

Several studies have highlighted the need for improvement in palliative care delivered to older people long-term care facilities. However, the available evidence on how to improve palliative care in these settings is weak, especially in Europe. We describe the protocol of the PACE trial aimed to 1) evaluate the effectiveness and cost-effectiveness of the 'PACE Steps to Success' palliative care intervention for older people in long-term care facilities, and 2) assess the implementation process and identify facilitators and barriers for implementation in different countries. We will conduct a multi-facility cluster randomised controlled trial in Belgium, Finland, Italy, the Netherlands, Poland, Switzerland and England. In total, 72 facilities will be randomized to receive the 'Pace Steps to Success intervention' or to 'care as usual'. Primary outcome at resident level: quality of dying (CAD-EOLD); and at staff level: staff knowledge of palliative care (Palliative Care Survey). resident's quality of end-of-life care, staff self-efficacy, self-perceived educational needs, and opinions on palliative care. Economic outcomes: direct costs and quality-adjusted life years (QALYs). Measurements are performed at baseline and after the intervention. For the resident-level outcomes, facilities report all deaths of residents in and outside the facilities over a previous four-month period and structured questionnaires are sent to (1) the administrator, (2) staff member most involved in care (3) treating general practitioner, and (4) a relative. For the staff-level outcomes, all staff who are working in the facilities are asked to complete a structured questionnaire. A process evaluation will run alongside the effectiveness evaluation in the intervention group using the RE-AIM framework. The lack of high quality trials in palliative care has been recognized throughout the field of palliative care research. This cross-national cluster RCT designed to evaluate the impact of the palliative care intervention for long-term care facilities 'PACE Steps to Success' in seven countries, will provide important evidence concerning the effectiveness as well as the preconditions for optimal implementation of palliative care in nursing homes, and this within different health care systems. The study is registered at www.isrctn.com - ISRCTN14741671 (FP7-HEALTH-2013-INNOVATION-1 603111) Registration date: July 30, 2015.

Core commands across airway facilities systems.

DOT National Transportation Integrated Search

2003-05-01

This study takes a high-level approach to evaluate computer systems without regard to the specific method of : interaction. This document analyzes the commands that Airway Facilities (AF) use across different systems and : the meanings attributed to ...

Evaluation of an Indoor Sonic Boom Subjective Test Facility at NASA Langley Research Center

NASA Technical Reports Server (NTRS)

Loubeau, Alexandra; Rathsam, Jonathan; Klos, Jacob

2011-01-01

A sonic boom simulator at NASA Langley Research Center has been constructed for research on human response to low-amplitude sonic booms heard indoors. Research in this facility will ultimately lead to development of a psychoacoustic model for single indoor booms. The first subjective test was designed to explore indoor human response to variations in sonic boom rise time and amplitude. Another goal was to identify loudness level variability across listener locations within the facility. Finally, the test also served to evaluate the facility as a laboratory research tool for studying indoor human response to sonic booms. Subjects listened to test sounds and were asked to rate their annoyance relative to a reference boom. Measurements of test signals were conducted for objective analysis and correlation with subjective responses. Results confirm the functionality of the facility and effectiveness of the test methods and indicate that loudness level does not fully describe indoor annoyance to the selected sonic boom signals.

Improving district facility readiness: a 12-month evaluation of a data-driven health systems strengthening intervention in rural Rwanda.

PubMed

Iyer, Hari S; Kamanzi, Emmanuel; Mugunga, Jean Claude; Finnegan, Karen; Uwingabiye, Alice; Shyaka, Edward; Niyonzima, Saleh; Hirschhorn, Lisa R; Drobac, Peter C

2015-01-01

While health systems strengthening (HSS) interventions are recommended by global health policy experts to improve population health in resource-limited settings, few examples exist of evaluations of HSS interventions conducted at the district level. In 2009, a partnership between Partners In Health (PIH), a non-governmental organization, and the Rwandan Ministry of Health (RMOH) was provided funds to implement and evaluate a district-level HSS intervention in two rural districts of Rwanda. The partnership provided limited funds to 14 health centers for targeted systems support in 2010; six others received support prior to the intervention (reference). RMOH health systems norms were mapped across the WHO HSS framework, scored from 0 to 10 and incorporated into a rapid survey assessing 11 domains of facility readiness. Stakeholder meetings allowed partnership leaders to review results, set priorities, and allocate resources. Investments included salary support, infrastructure improvements, medical equipment, and social support for patients. We compared facility domain scores from the start of the intervention to 12 months and tested for correlation between change in score and change in funding allocation to assess equity in our approach. We found significant improvements among intervention facilities from baseline to 12 months across several domains [infrastructure (+4, p=0.0001), clinical services (+1.2, p=0.03), infection and sanitation control (+0.6, p=0.03), medical equipment (+1.0, p=0.02), information use (+2, p=0.002)]. Composite score across domains improved from 6.2 at baseline to 7.4 at 12 months (p=0.002). Across facilities, 50% had composite scores greater than the average score among reference facilities (7.4) at 12 months compared to none at baseline. Rapid facility surveys, stakeholder engagement, and information feedback can be used for gap analysis and resource allocation. This approach can achieve effective use of limited resources, improve facility readiness, and ensure consistency of facility capacity to provide quality care at the district level.

Improving district facility readiness: a 12-month evaluation of a data-driven health systems strengthening intervention in rural Rwanda

PubMed Central

Iyer, Hari S.; Kamanzi, Emmanuel; Mugunga, Jean Claude; Finnegan, Karen; Uwingabiye, Alice; Shyaka, Edward; Niyonzima, Saleh; Hirschhorn, Lisa R.; Drobac, Peter C.

2015-01-01

Background While health systems strengthening (HSS) interventions are recommended by global health policy experts to improve population health in resource-limited settings, few examples exist of evaluations of HSS interventions conducted at the district level. In 2009, a partnership between Partners In Health (PIH), a non-governmental organization, and the Rwandan Ministry of Health (RMOH) was provided funds to implement and evaluate a district-level HSS intervention in two rural districts of Rwanda. Design The partnership provided limited funds to 14 health centers for targeted systems support in 2010; six others received support prior to the intervention (reference). RMOH health systems norms were mapped across the WHO HSS framework, scored from 0 to 10 and incorporated into a rapid survey assessing 11 domains of facility readiness. Stakeholder meetings allowed partnership leaders to review results, set priorities, and allocate resources. Investments included salary support, infrastructure improvements, medical equipment, and social support for patients. We compared facility domain scores from the start of the intervention to 12 months and tested for correlation between change in score and change in funding allocation to assess equity in our approach. Results We found significant improvements among intervention facilities from baseline to 12 months across several domains [infrastructure (+4, p=0.0001), clinical services (+1.2, p=0.03), infection and sanitation control (+0.6, p=0.03), medical equipment (+1.0, p=0.02), information use (+2, p=0.002)]. Composite score across domains improved from 6.2 at baseline to 7.4 at 12 months (p=0.002). Across facilities, 50% had composite scores greater than the average score among reference facilities (7.4) at 12 months compared to none at baseline. Conclusions Rapid facility surveys, stakeholder engagement, and information feedback can be used for gap analysis and resource allocation. This approach can achieve effective use of limited resources, improve facility readiness, and ensure consistency of facility capacity to provide quality care at the district level. PMID:26140729

Design and evaluation guidelines for Department of Energy facilities subjected to natural phenomena hazards

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

Kennedy, R.P.; Short, S.A.; McDonald, J.R.

1990-06-01

The Department of Energy (DOE) and the DOE Natural Phenomena Hazards Panel have developed uniform design and evaluation guidelines for protection against natural phenomena hazards at DOE sites throughout the United States. The goal of the guidelines is to assure that DOE facilities can withstand the effects of natural phenomena such as earthquakes, extreme winds, tornadoes, and flooding. The guidelines apply to both new facilities (design) and existing facilities (evaluation, modification, and upgrading). The intended audience is primarily the civil/structural or mechanical engineers conducting the design or evaluation of DOE facilities. The likelihood of occurrence of natural phenomena hazards atmore » each DOE site has been evaluated by the DOE Natural Phenomena Hazard Program. Probabilistic hazard models are available for earthquake, extreme wind/tornado, and flood. Alternatively, site organizations are encouraged to develop site-specific hazard models utilizing the most recent information and techniques available. In this document, performance goals and natural hazard levels are expressed in probabilistic terms, and design and evaluation procedures are presented in deterministic terms. Design/evaluation procedures conform closely to common standard practices so that the procedures will be easily understood by most engineers. Performance goals are expressed in terms of structure or equipment damage to the extent that: (1) the facility cannot function; (2) the facility would need to be replaced; or (3) personnel are endangered. 82 refs., 12 figs., 18 tabs.« less

Evaluation and use of U.S. Environmental Protection Agency Clean Watersheds Needs Survey data to quantify nutrient loads to surface water, 1978–2012

USGS Publications Warehouse

Ivahnenko, Tamara I.

2017-12-07

Changes in municipal and industrial point-source discharges over time have been an important factor affecting nutrient trends in many of the Nation’s streams and rivers. This report documents how three U.S. Environmental Protection Agency (EPA) national datasets—the Permit Compliance System, the Integrated Compliance Information System, and the Clean Watersheds Needs Survey—were evaluated for use in the U.S. Geological Survey National Water-Quality Assessment project to assess the causes of nutrient trends. This report also describes how a database of total nitrogen load and total phosphorous load was generated for select wastewater treatment facilities in the United States based on information reported in the EPA Clean Watersheds Needs Survey. Nutrient loads were calculated for the years 1978, 1980, 1982, 1984, 1986, 1988, 1990, 1992, 1996, 2000, 2004, 2008, and 2012 based on average nitrogen and phosphorous concentrations for reported treatment levels and on annual reported flow values.The EPA Permit Compliance System (PCS) and Integrated Compliance Information System (ICIS), which monitor point-source facility discharges, together are the Nation’s most spatially comprehensive dataset for nutrients released to surface waters. However, datasets for many individual facilities are incomplete, the PCS/ICIS historical data date back only to 1989, and historical data are available for only a limited number of facilities. Additionally, inconsistencies in facility reporting make it difficult to track or identify changes in nutrient discharges over time. Previous efforts made by the U.S. Geological Survey to “fill in” gaps in the PCS/ICIS data were based on statistical methods—missing data were filled in through the use of a statistical model based on the Standard Industrial Classification code, size, and flow class of the facility and on seasonal nutrient discharges of similar facilities. This approach was used to estimate point-source loads for a single point in time; it was not evaluated for use in generating a consistent data series over time.Another national EPA dataset that is available is the Clean Watersheds Needs Survey (CWNS), conducted every 4 years beginning 1973. The CWNS is an assessment of the capital needs of wastewater facilities to meet the water-quality goals set in the Clean Water Act. Data collected about these facilities include location and contact information for the facilities; population served; flow and treatment level of the facility; estimated capital needs to upgrade, repair, or improve facilities for water quality; and nonpoint-source best management practices.Total nitrogen and total phosphorous load calculations for each of the CWNS years were based on treatment level information and average annual outflow (in million gallons per day) from each of the facilities that had reported it. Treatment levels categories (such as Primary, Secondary, or Advanced) were substituted with average total nitrogen and total phosphorous concentrations for each treatment level based on those reported in literature. The CWNS dataset, like the PCS/ICIS dataset, has years where facilities did not report either a treatment level or an annual average outflow, or both. To fill in the data gaps, simple linear assumptions were made based on each facility’s responses to the survey in years bracketing the data gap or immediately before or after the data gap if open ended. Treatment level and flow data unique to each facility were used to complete the CWNS dataset for that facility.

Evaluating the Implementation of Home-Based Videoconferencing for Providing Mental Health Services.

PubMed

Interian, Alejandro; King, Arlene R; St Hill, Lauren M; Robinson, Claire H; Damschroder, Laura J

2018-01-01

The Veterans Health Administration (VHA) has recently implemented video-to-home (V2H) telehealth as part of a strategy to improve access to mental health treatment. Implementation research of this modality is needed, given that V2H telehealth transforms the traditional face-to-face delivery of mental health services. To address this need, V2H implementation was evaluated by examining barriers and facilitators that were associated with level of staff V2H experience and factors that differentiated facilities with various levels of V2H performance. Semistructured interviews with VHA personnel (N=33) from three facilities were conducted. The facilities were selected by overall number of mental health V2H visits during fiscal year (FY) 2015 as well as by growth in number of visits from FY 2014 through FY 2015. Factors influencing implementation were identified through qualitative analyses that contrasted responses by groups of participants with three different levels of V2H experience (no experience, limited experience, most experience) as well as three facilities that differed in V2H productivity (high visit count, high visit growth, and low visit count and low visit growth). Providers seemed to encounter different barriers and facilitators depending on their level of experience with V2H. Site-level analyses illustrated the importance of logistical support, especially for providers who are newly adopting the technology. Other factors that differentiated the facilities were also identified and described. Key factors related to implementation of V2H telehealth pertained to provider buy-in and logistical support. Facility-level strategies that address these factors may enhance provider progression from nonuse to sustained use.

Factors promoting resident deaths at aged care facilities in Japan: a review.

PubMed

Sugimoto, Kentaro; Ogata, Yasuko; Kashiwagi, Masayo

2018-03-01

Due to an increasingly ageing population, the Japanese government has promoted elderly deaths in aged care facilities. However, existing facilities were not designed to provide resident end-of-life care and the proportion of aged care facility deaths is currently less than 10%. Consequently, the present review evaluated the factors that promote aged care facility resident deaths in Japan from individual- and facility-level perspectives to exploring factors associated with increased resident deaths. To achieve this, MEDLINE, CINAHL, Web of Science and Ichushi databases were searched on 23 January 2016. Influential factors were reviewed for two healthcare services (insourcing and outsourcing facilities) as well as external healthcare agencies operating outside facilities. Of the original 2324 studies retrieved, 42 were included in analysis. Of these studies, five focused on insourcing, two on outsourcing, seven on external agencies and observed facility/agency-level factors. The other 28 studies identified individual-level factors related to death in aged care facilities. The present review found that at both facility and individual levels, in-facility resident deaths were associated with healthcare service provision, confirmation of resident/family end-of-life care preference and staff education. Additionally, while outsourcing facilities did not require employment of physicians/nursing staff to accommodate resident death, these facilities required visits by physicians and nursing staff from external healthcare agencies as well as residents' healthcare input. This review also found few studies examining outsourcing facilities. The number of healthcare outsourcing facilities is rapidly increasing as a result of the Japanese government's new tax incentives. Consequently, there may be an increase in elderly deaths in outsourcing healthcare facilities. Accordingly, it is necessary to identify the factors associated with residents' deaths at outsourcing facilities. © 2016 The Authors. Health and Social Care in the Community Published by John Wiley & Sons Ltd.

Factors that affect implementation of a nurse staffing directive: results from a qualitative multi-case evaluation.

PubMed

Robinson, Claire H; Annis, Ann M; Forman, Jane; Krein, Sarah L; Yankey, Nicholas; Duffy, Sonia A; Taylor, Beth; Sales, Anne E

2016-08-01

To assess implementation of the Veterans Health Administration staffing methodology directive. In 2010 the Veterans Health Administration promulgated a staffing methodology directive for inpatient nursing units to address staffing and budget forecasting. A qualitative multi-case evaluation approach assessed staffing methodology implementation. Semi-structured telephone interviews were conducted from March - June 2014 with Nurse Executives and their teams at 21 facilities. Interviews focused on the budgeting process, implementation experiences, use of data, leadership support, and training. An implementation score was created for each facility using a 4-point rating scale. The scores were used to select three facilities (low, medium and high implementation) for more detailed case studies. After analysing interview summaries, the evaluation team developed a four domain scoring structure: (1) integration of staffing methodology into budget development; (2) implementation of the Directive elements; (3) engagement of leadership and staff; and (4) use of data to support the staffing methodology process. The high implementation facility had leadership understanding and endorsement of staffing methodology, confidence in and ability to work with data, and integration of staffing methodology results into the budgeting process. The low implementation facility reported poor leadership engagement and little understanding of data sources and interpretation. Implementation varies widely across facilities. Implementing staffing methodology in facilities with complex and changing staffing needs requires substantial commitment at all organizational levels especially for facilities that have traditionally relied on historical levels to budget for staffing. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

Evaluating the Veterans Health Administration's Staffing Methodology Model: A Reliable Approach.

PubMed

Taylor, Beth; Yankey, Nicholas; Robinson, Claire; Annis, Ann; Haddock, Kathleen S; Alt-White, Anna; Krein, Sarah L; Sales, Anne

2015-01-01

All Veterans Health Administration facilities have been mandated to use a standardized method of determining appropriate direct-care staffing by nursing personnel. A multi-step process was designed to lead to projection of full-time equivalent employees required for safe and effective care across all inpatient units. These projections were intended to develop appropriate budgets for each facility. While staffing levels can be increased, even in facilities subject to budget and personnel caps, doing so requires considerable commitment at all levels of the facility. This commitment must come from front-line nursing personnel to senior leadership, not only in nursing and patient care services, but throughout the hospital. Learning to interpret and rely on data requires a considerable shift in thinking for many facilities, which have relied on historical levels to budget for staffing, but which does not take into account the dynamic character of nursing units and patient need.

Implementation of Best Practices in Obesity Prevention in Child Care Facilities: The Arizona Empower Program, 2013–2015

PubMed Central

Papa, Jillian; Rodriguez, Gertrudes; Robinson, Deborah

2017-01-01

Introduction Obesity is a major health concern in every US age group. Approximately one in 4 children in Arizona’s Special Supplemental Nutrition Program for Women, Infants, and Children is overweight or obese. The Arizona Department of Health Services developed the Empower program to promote healthy environments in licensed child care facilities. The program consists of 10 standards, including one standard for each of these 5 areas: physical activity and screen time, breastfeeding, fruit juice and water, family-style meals, and staff training. The objective of this evaluation was to determine the level of implementation of these 5 Empower standards. Methods A self-assessment survey was completed from July 2013 through June 2015 by 1,850 facilities to evaluate the level of implementation of 5 Empower standards. We calculated the percentage of facilities that reported the degree to which they implemented each standard and identified common themes in comments recorded in the survey. Results All facilities reported either full or partial implementation of the 5 standards. Of 1,678 facilities, 21.7% (n = 364) reported full implementation of all standards, and 78.3% (n = 1,314) reported at least partial implementation. Staff training, which has only one component, had the highest level of implementation: 77.4% (n = 1,299) reported full implementation. Only 44.0% (n = 738) reported full implementation of the standard on a breastfeeding-friendly environment. Conclusion Arizona child care facilities have begun to implement the Empower program, but facilities will need more education, technical assistance, and support in some areas to fully implement the program. PMID:28880840

Implementation of Best Practices in Obesity Prevention in Child Care Facilities: The Arizona Empower Program, 2013-2015.

PubMed

Papa, Jillian; Agostinelli, Joan; Rodriguez, Gertrudes; Robinson, Deborah

2017-09-07

Obesity is a major health concern in every US age group. Approximately one in 4 children in Arizona's Special Supplemental Nutrition Program for Women, Infants, and Children is overweight or obese. The Arizona Department of Health Services developed the Empower program to promote healthy environments in licensed child care facilities. The program consists of 10 standards, including one standard for each of these 5 areas: physical activity and screen time, breastfeeding, fruit juice and water, family-style meals, and staff training. The objective of this evaluation was to determine the level of implementation of these 5 Empower standards. A self-assessment survey was completed from July 2013 through June 2015 by 1,850 facilities to evaluate the level of implementation of 5 Empower standards. We calculated the percentage of facilities that reported the degree to which they implemented each standard and identified common themes in comments recorded in the survey. All facilities reported either full or partial implementation of the 5 standards. Of 1,678 facilities, 21.7% (n = 364) reported full implementation of all standards, and 78.3% (n = 1,314) reported at least partial implementation. Staff training, which has only one component, had the highest level of implementation: 77.4% (n = 1,299) reported full implementation. Only 44.0% (n = 738) reported full implementation of the standard on a breastfeeding-friendly environment. Arizona child care facilities have begun to implement the Empower program, but facilities will need more education, technical assistance, and support in some areas to fully implement the program.

Effects of Epoetin Alfa Titration Practices, Implemented After Changes to Product Labeling, on Hemoglobin Levels, Transfusion Use, and Hospitalization Rates.

PubMed

Molony, Julia T; Monda, Keri L; Li, Suying; Beaubrun, Anne C; Gilbertson, David T; Bradbury, Brian D; Collins, Allan J

2016-08-01

Little is known about epoetin alfa (EPO) dosing at dialysis centers after implementation of the US Medicare prospective payment system and revision of the EPO label in 2011. Retrospective cohort study. Approximately 412,000 adult hemodialysis patients with Medicare Parts A and B as primary payer in 2009 to 2012 to describe EPO dosing and hemoglobin patterns; of these, about 70,000 patients clustered in about 1,300 dialysis facilities to evaluate facility-level EPO titration practices and patient-level outcomes in 2012. Facility EPO titration practices when hemoglobin levels were <10 and >11g/dL (grouped treatment variable) determined from monthly EPO dosing and hemoglobin level patterns. Patient mean hemoglobin levels, red blood cell transfusion rates, and all-cause and cause-specific hospitalization rates using a facility-based analysis. Monthly EPO dose and hemoglobin level, red blood cell transfusion rates, and all-cause and cause-specific hospitalization rates. Monthly EPO doses declined across all hemoglobin levels, with the greatest decline in patients with hemoglobin levels < 10g/dL (July-October 2011). In 2012, nine distinct facility titration practices were identified. Across groups, mean hemoglobin levels differed slightly (10.5-10.8g/dL) but within-patient hemoglobin standard deviations were similar (∼0.68g/dL). Patients at facilities implementing greater dose reductions and smaller dose escalations had lower hemoglobin levels and higher transfusion rates. In contrast, patients at facilities that implemented greater dose escalations (and large or small dose reductions) had higher hemoglobin levels and lower transfusion rates. There were no clinically meaningful differences in all-cause or cause-specific hospitalization events across groups. Possibly incomplete claims data; excluded small facilities and those without consistent titration patterns; hemoglobin levels reported monthly; inferred facility practice from observed dosing. Following prospective payment system implementation and labeling revisions, EPO doses declined significantly. Under the new label, facility EPO titration practices were associated with mean hemoglobin levels (but not standard deviations) and transfusion use, but not hospitalization rates. Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Evaluation of components, subsystems, and networks for high rate, high frequency space communications

NASA Technical Reports Server (NTRS)

Kerczewski, Robert J.; Ivancic, William D.; Zuzek, John E.

1991-01-01

The development of new space communications technologies by NASA has included both commercial applications and space science requirements. At NASA's Lewis Research Center, methods and facilities have been developed for evaluating these new technologies in the laboratory. NASA's Systems Integration, Test and Evaluation (SITE) Space Communication System Simulator is a hardware-based laboratory simulator for evaluating space communications technologies at the component, subsystem, system, and network level, geared toward high frequency, high data rate systems. The SITE facility is well-suited for evaluation of the new technologies required for the Space Exploration Initiative (SEI) and advanced commercial systems. This paper describes the technology developments and evaluation requirements for current and planned commercial and space science programs. Also examined are the capabilities of SITE, the past, present, and planned future configurations of the SITE facility, and applications of SITE to evaluation of SEI technology.

Development and use of hydrogen-air torches in an altitude facility

NASA Technical Reports Server (NTRS)

Lottig, Roy A.; Huber, Gary T.

1993-01-01

A hydrogen-air ignition torch concept that had been used successfully in two rocket engine test facilities to consume excess hydrogen in their exhausters at atmospheric conditions was experimentally evaluated and developed in an altitude test facility at NASA Lewis Research Center. The idea was to use several of these torches in conjunction with hydrogen detectors and dilution air to prevent excess accumulation of unburned hydrogen or mixtures of hydrogen and air exceeding the sea-level lower flammability limit in the altitude facility exhaust system during hydrogen-fueled propulsion system tests. The torches were evaluated for a range of fuel-to-air ratios from 0.09 to 0.39 and for a range of exit diameters from 19/64 to 49/64 in. From the results of these tests a torch geometry and a fuel-to-air ratio were selected that produced a reasonably sized torch exhaust flame for consumption of unburned hydrogen at altitude pressures from sea level to 4 psia.

Network Performance Evaluation Model for assessing the impacts of high-occupancy vehicle facilities

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

Janson, B.N.; Zozaya-Gorostiza, C.; Southworth, F.

1986-09-01

A model to assess the impacts of major high-occupancy vehicle (HOV) facilities on regional levels of energy consumption and vehicle air pollution emissions in urban aeas is developed and applied. This model can be used to forecast and compare the impacts of alternative HOV facility design and operation plans on traffic patterns, travel costs, model choice, travel demand, energy consumption and vehicle emissions. The model is designed to show differences in the overall impacts of alternative HOV facility types, locations and operation plans rather than to serve as a tool for detailed engineering design and traffic planning studies. The Networkmore » Performance Evaluation Model (NETPEM) combines several urban transportation planning models within a multi-modal network equilibrium framework including modules with which to define the type, location and use policy of the HOV facility to be tested, and to assess the impacts of this facility.« less

The Effectiveness and Need for Facility Based Nurse Aide Training Competency Evaluation Programs.

PubMed

Mileski, Michael; McIlwain, Amber S; Kruse, Clemens Scott; Lieneck, Cristian; Sokan, Amanda

2016-01-01

It has become crucial for nursing facilities to rapidly train future nurse aides and remove any barriers to their matriculation into the field of care. Facilities feel the organizational burden of insufficient staffing and need to lever all effective programs to train future employees. The facility-based, Nurse Aide Training Competency Evaluation Programs (NATCEP) serve as a viable option to help fill shortages in the professional medical workforce. Data were analyzed from the National Nursing Assistant Survey to provide an overview of the benefits of using facility-trained nurse aides, versus those trained elsewhere, including their own perceptions of training and abilities. These findings also show the importance of facility based training programs for nurse aides on a global level. Providing training on site increases the efficiency and proficiency of nurse aides, making the transition to caregivers an easier for students, employers and residents.

Impact of glycolate anion on aqueous corrosion in DWPF and downstream facilities

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

Mickalonis, J. I.

2015-12-15

Glycolic acid is being evaluated as an alternate reductant in the preparation of high level waste for the Defense Waste Processing Facility (DWPF) at the Savannah River Site (SRS). During processing, the glycolic acid may not be completely consumed with small quantities of the glycolate anion being carried forward to other high level waste (HLW) facilities. The impact of the glycolate anion on the corrosion of the materials of construction (MoC) throughout the waste processing system has not been previously evaluated. A literature review had revealed that corrosion data were not available for the MoCs in glycolic-bearing solutions applicable tomore » SRS systems. Data on the material compatibility with only glycolic acid or its derivative products were identified; however, data were limited for solutions containing glycolic acid or the glycolate anion.« less

Evaluation of an operational malaria outbreak identification and response system in Mpumalanga Province, South Africa.

PubMed

Coleman, Marlize; Coleman, Michael; Mabuza, Aaron M; Kok, Gerdalize; Coetzee, Maureen; Durrheim, David N

2008-04-27

To evaluate the performance of a novel malaria outbreak identification system in the epidemic prone rural area of Mpumalanga Province, South Africa, for timely identification of malaria outbreaks and guiding integrated public health responses. Using five years of historical notification data, two binomial thresholds were determined for each primary health care facility in the highest malaria risk area of Mpumalanga province. Whenever the thresholds were exceeded at health facility level (tier 1), primary health care staff notified the malaria control programme, which then confirmed adequate stocks of malaria treatment to manage potential increased cases. The cases were followed up at household level to verify the likely source of infection. The binomial thresholds were reviewed at village/town level (tier 2) to determine whether additional response measures were required. In addition, an automated electronic outbreak identification system at town/village level (tier 2) was integrated into the case notification database (tier 3) to ensure that unexpected increases in case notification were not missed.The performance of these binomial outbreak thresholds was evaluated against other currently recommended thresholds using retrospective data. The acceptability of the system at primary health care level was evaluated through structured interviews with health facility staff. Eighty four percent of health facilities reported outbreaks within 24 hours (n = 95), 92% (n = 104) within 48 hours and 100% (n = 113) within 72 hours. Appropriate response to all malaria outbreaks (n = 113, tier 1, n = 46, tier 2) were achieved within 24 hours. The system was positively viewed by all health facility staff. When compared to other epidemiological systems for a specified 12 month outbreak season (June 2003 to July 2004) the binomial exact thresholds produced one false weekly outbreak, the C-sum 12 weekly outbreaks and the mean + 2 SD nine false weekly outbreaks. Exceeding the binomial level 1 threshold triggered an alert four weeks prior to an outbreak, but exceeding the binomial level 2 threshold identified an outbreak as it occurred. The malaria outbreak surveillance system using binomial thresholds achieved its primary goal of identifying outbreaks early facilitating appropriate local public health responses aimed at averting a possible large-scale epidemic in a low, and unstable, malaria transmission setting.

Institutionalizing and sustaining social change in health systems: the case of Uganda.

PubMed

Hage, Jerald; Valadez, Joseph J

2017-11-01

The key to high impact health services is institutionalizing and sustaining programme evaluation. Uganda represents a success story in the use of a specific programme evaluation method: Lot Quality Assurance Sampling (LQAS). Institutionalization is defined by two C's: competent programme evaluators and control mechanisms that effectively use evaluation data to improve health services. Sustainability means continued training and funding for the evaluation approach. Social science literature that researches institutionalization has emphasized 'stability', whereas in global health, the issue is determining how to improve the impact of services by 'changing' programmes. In Uganda, we measured the extent of the institutionalization and sustainability of evaluating programmes that produce change in nine districts sampled to represent three largely rural regions and varying levels of effective health programmes. We used the proportion of mothers with children aged 0-11 months who delivered in a health facility as the principal indicator to measure programme effectiveness. Interviews and focus groups were conducted among directors, evaluation supervisors, data collectors in the district health offices, and informant interviews conducted individually at the central government level. Seven of the nine districts demonstrated a high level of institutionalization of evaluation. The two others had only conducted one round of programme evaluation. When we control for the availability of health facilities, we find that the degree of institutionalization is moderately related to the prevalence of the delivery of a baby in a health facility. Evaluation was institutionalized at the central government level. Sustainability existed at both levels. Several measures indicate that lessons from the nine district case studies may be relevant to the 74 districts that had at least two rounds of programme evaluation. We note that there is an association between the evaluation data being used to change health services, and the four separate indicators being used to measure women's health and child survival services. We conclude that the two C's (competent evaluators and control mechanisms) have been critical for sustaining programme evaluation in Uganda. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Institutionalizing and sustaining social change in health systems: the case of Uganda

PubMed Central

Hage, Jerald; Valadez, Joseph J

2017-01-01

Abstract The key to high impact health services is institutionalizing and sustaining programme evaluation. Uganda represents a success story in the use of a specific programme evaluation method: Lot Quality Assurance Sampling (LQAS). Institutionalization is defined by two C’s: competent programme evaluators and control mechanisms that effectively use evaluation data to improve health services. Sustainability means continued training and funding for the evaluation approach. Social science literature that researches institutionalization has emphasized ‘stability’, whereas in global health, the issue is determining how to improve the impact of services by ‘changing’ programmes. In Uganda, we measured the extent of the institutionalization and sustainability of evaluating programmes that produce change in nine districts sampled to represent three largely rural regions and varying levels of effective health programmes. We used the proportion of mothers with children aged 0–11 months who delivered in a health facility as the principal indicator to measure programme effectiveness. Interviews and focus groups were conducted among directors, evaluation supervisors, data collectors in the district health offices, and informant interviews conducted individually at the central government level. Seven of the nine districts demonstrated a high level of institutionalization of evaluation. The two others had only conducted one round of programme evaluation. When we control for the availability of health facilities, we find that the degree of institutionalization is moderately related to the prevalence of the delivery of a baby in a health facility. Evaluation was institutionalized at the central government level. Sustainability existed at both levels. Several measures indicate that lessons from the nine district case studies may be relevant to the 74 districts that had at least two rounds of programme evaluation. We note that there is an association between the evaluation data being used to change health services, and the four separate indicators being used to measure women's health and child survival services. We conclude that the two C’s (competent evaluators and control mechanisms) have been critical for sustaining programme evaluation in Uganda. PMID:28981663

Criticality Safety Evaluation for Small Sample Preparation and Non-Destructive Assay (NDA) Operations in Wing 7 Basement of the CMR Facility

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

Kunkle, Paige Elizabeth; Zhang, Ning

Nuclear Criticality Safety (NCS) has reviewed the fissionable material small sample preparation and NDA operations in Wing 7 Basement of the CMR Facility. This is a Level-1 evaluation conducted in accordance with NCS-AP-004 [Reference 1], formerly NCS-GUIDE-01, and the guidance set forth on use of the Standard Criticality Safety Requirements (SCSRs) [Reference 2]. As stated in Reference 2, the criticality safety evaluation consists of both the SCSR CSED and the SCSR Application CSED. The SCSR CSED is a Level-3 CSED [Reference 3]. This Level-1 CSED is the SCSR Application CSED. This SCSR Application (Level-1) evaluation does not derive controls, itmore » simply applies controls derived from the SCSR CSED (Level-3) for the application of operations conducted here. The controls derived in the SCSR CSED (Level-3) were evaluated via the process described in Section 6.6.5 of SD-130 (also reproduced in Section 4.3.5 of NCS-AP-004 [Reference 1]) and were determined to not meet the requirements for consideration of elevation into the safety basis documentation for CMR. According to the guidance set forth on use of the SCSRs [Reference 2], the SCSR CSED (Level-3) is also applicable to the CMR Facility because the process and the normal and credible abnormal conditions in question are bounded by those that are described in the SCSR CSED. The controls derived in the SCSR CSED include allowances for solid materials and solution operations. Based on the operations conducted at this location, there are less-than-accountable (LTA) amounts of 233U. Based on the evaluation documented herein, the normal and credible abnormal conditions that might arise during the execution of this process will remain subcritical with the following recommended controls.« less

An empirical study of the influence of demographic variable on the choice criteria for assisted living facilities.

PubMed

O'Bryan, D; Clow, K E; O'Bryan, J; Kurtz, D

1996-01-01

Despite the growth and prevalence of assisted-living facilities, empirical marketing research for these facilities is scarce. The objectives of this study were to determine the relative importance of three sets of evaluation criteria in the initial selection of an assisted-living facility, and determine whether the relative importance of these three sets of criteria differed by gender, marital status, level of household, age, or income of the consumer. Survey responses from 279 households indicates that primary service criteria are relatively more important than facilities amenities or organized social activities in the initial selection of an assisted-living facility. The relative importance of the choice criteria differed markedly by gender of the consumer, but marital status, level of household income, and age of the consumer did not have as great an impact on consumers' choice criteria.

Human health risk characterization of petroleum coke calcining facility emissions.

PubMed

Singh, Davinderjit; Johnson, Giffe T; Harbison, Raymond D

2015-12-01

Calcining processes including handling and storage of raw petroleum coke may result in Particulate Matter (PM) and gaseous emissions. Concerns have been raised over the potential association between particulate and aerosol pollution and adverse respiratory health effects including decrements in lung function. This risk characterization evaluated the exposure concentrations of ambient air pollutants including PM10 and gaseous pollutants from a petroleum coke calciner facility. The ambient air pollutant levels were collected through monitors installed at multiple locations in the vicinity of the facility. The measured and modeled particulate levels in ambient air from the calciner facility were compared to standards protective of public health. The results indicated that exposure levels were, on occasions at sites farther from the facility, higher than the public health limit of 150 μg/m(3) 24-h average for PM10. However, the carbon fraction demonstrated that the contribution from the calciner facility was de minimis. Exposure levels of the modeled SO2, CO, NOx and PM10 concentrations were also below public health air quality standards. These results demonstrate that emissions from calcining processes involving petroleum coke, at facilities that are well controlled, are below regulatory standards and are not expected to produce a public health risk. Copyright © 2015 Elsevier Inc. All rights reserved.

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

PubMed

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

2005-08-01

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

Facility-Level Factors Influencing Retention of Patients in HIV Care in East Africa.

PubMed

Rachlis, Beth; Bakoyannis, Giorgos; Easterbrook, Philippa; Genberg, Becky; Braithwaite, Ronald Scott; Cohen, Craig R; Bukusi, Elizabeth A; Kambugu, Andrew; Bwana, Mwebesa Bosco; Somi, Geoffrey R; Geng, Elvin H; Musick, Beverly; Yiannoutsos, Constantin T; Wools-Kaloustian, Kara; Braitstein, Paula

2016-01-01

Losses to follow-up (LTFU) remain an important programmatic challenge. While numerous patient-level factors have been associated with LTFU, less is known about facility-level factors. Data from the East African International epidemiologic Databases to Evaluate AIDS (EA-IeDEA) Consortium was used to identify facility-level factors associated with LTFU in Kenya, Tanzania and Uganda. Patients were defined as LTFU if they had no visit within 12 months of the study endpoint for pre-ART patients or 6 months for patients on ART. Adjusting for patient factors, shared frailty proportional hazard models were used to identify the facility-level factors associated with LTFU for the pre- and post-ART periods. Data from 77,362 patients and 29 facilities were analyzed. Median age at enrolment was 36.0 years (Interquartile Range: 30.1, 43.1), 63.9% were women and 58.3% initiated ART. Rates (95% Confidence Interval) of LTFU were 25.1 (24.7-25.6) and 16.7 (16.3-17.2) per 100 person-years in the pre-ART and post-ART periods, respectively. Facility-level factors associated with increased LTFU included secondary-level care, HIV RNA PCR turnaround time >14 days, and no onsite availability of CD4 testing. Increased LTFU was also observed when no nutritional supplements were provided (pre-ART only), when TB patients were treated within the HIV program (pre-ART only), and when the facility was open ≤4 mornings per week (ART only). Our findings suggest that facility-based strategies such as point of care laboratory testing and separate clinic spaces for TB patients may improve retention.

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.

How to improve patient retention in an antiretroviral treatment program in Ethiopia: a mixed-methods study

PubMed Central

2014-01-01

Background Patient retention, defined as continuous engagement of patients in care, is one of the crucial indicators for monitoring and evaluating the performance of antiretroviral treatment (ART) programs. It has been identified that suboptimal patient retention in care is one of the challenges of ART programs in many settings. ART programs have, therefore, been striving hard to identify and implement interventions that improve their suboptimal levels of retention. The objective of this study was to develop a framework for improving patient retention in care based on interventions implemented in health facilities that have achieved higher levels of retention in care. Methods A mixed-methods study, based on the positive deviance approach, was conducted in Ethiopia in 2011/12. Quantitative data were collected to estimate and compare the levels of retention in care in nine health facilities. Key informant interviews and focus group discussions were conducted to identify a package of interventions implemented in the health facilities with relatively higher or improving levels of retention. Results Retention in care in the Ethiopian ART program was found to be variable across health facilities. Among hospitals, the poorest performer had 0.46 (0.35, 0.60) times less retention than the reference; among health centers, the poorest performers had 0.44 (0.28, 0.70) times less retention than the reference. Health facilities with higher and improving patient retention were found to implement a comprehensive package of interventions: (1) retention promoting activities by health facilities, (2) retention promoting activities by community-based organizations, (3) coordination of these activities by case manager(s), and (4) patient information systems by data clerk(s). On the contrary, such interventions were either poorly implemented or did not exist in health facilities with lower retention in care. A framework to improve retention in care was developed based on the evidence found by applying the positive deviance approach. Conclusion A framework for improving retention in care of patients on ART was developed. We recommend that health facilities implement the framework, monitor and evaluate their levels of retention in care, and, if necessary, adapt the framework to their own contexts. PMID:24475889

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

Source term model evaluations for the low-level waste facility performance assessment

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

Yim, M.S.; Su, S.I.

1995-12-31

The estimation of release of radionuclides from various waste forms to the bottom boundary of the waste disposal facility (source term) is one of the most important aspects of LLW facility performance assessment. In this work, several currently used source term models are comparatively evaluated for the release of carbon-14 based on a test case problem. The models compared include PRESTO-EPA-CPG, IMPACTS, DUST and NEFTRAN-II. Major differences in assumptions and approaches between the models are described and key parameters are identified through sensitivity analysis. The source term results from different models are compared and other concerns or suggestions are discussed.

Better antiretroviral therapy outcomes at primary healthcare facilities: an evaluation of three tiers of ART services in four South African provinces.

PubMed

Fatti, Geoffrey; Grimwood, Ashraf; Bock, Peter

2010-09-21

There are conflicting reports of antiretroviral therapy (ART) effectiveness comparisons between primary healthcare (PHC) facilities and hospitals in low-income settings. This comparison has not been evaluated on a broad scale in South Africa. A retrospective cohort study was conducted including ART-naïve adults from 59 facilities in four provinces in South Africa, enrolled between 2004 and 2007. Kaplan-Meier estimates, competing-risks Cox regression, generalised estimating equation population-averaged models and logistic regression were used to compare death, loss to follow-up (LTFU) and virological suppression (VS) between PHC, district and regional hospitals. 29 203 adults from 47 PHC facilities, nine district hospitals and three regional hospitals were included. Patients at PHC facilities had more advanced WHO stage disease when starting ART. Retention in care was 80.1% (95% CI: 79.3%-80.8%), 71.5% (95% CI: 69.1%-73.8%) and 68.7% (95% CI: 67.0%-69.7%) at PHC, district and regional hospitals respectively, after 24 months of treatment (P<0.0001). In adjusted regression analyses, LTFU was independently increased at regional hospitals (aHR 2.19; 95% CI: 1.94-2.47) and mortality was independently elevated at district hospitals (aHR 1.60; 95% CI: 1.30-1.99) compared to PHC facilities after 12 months of ART. District and regional hospital patients had independently reduced probabilities of VS, aOR 0.76 (95% CI: 0.59-0.97) and 0.64 (95% CI: 0.56-0.75) respectively compared to PHC facilities over 24 months of treatment. ART outcomes were superior at PHC facilities, despite PHC patients having more advanced clinical stage disease when starting ART, suggesting that ART can be adequately provided at this level and supporting the South African government's call for rapid up-scaling of ART at the primary level of care. Further prospective research is required to determine the degree to which outcome differences are attributable to either facility level characteristics or patient co-morbidity at hospital level.

Validity of self-assessment in a quality improvement collaborative in Ecuador.

PubMed

Hermida, Jorge; Broughton, Edward I; Miller Franco, Lynne

2011-12-01

Health care quality improvement (QI) efforts commonly use self-assessment to measure compliance with quality standards. This study investigates the validity of self-assessment of quality indicators. Cross sectional. A maternal and newborn care improvement collaborative intervention conducted in health facilities in Ecuador in 2005. Four external evaluators were trained in abstracting medical records to calculate six indicators reflecting compliance with treatment standards. About 30 medical records per month were examined at 12 participating health facilities for a total of 1875 records. The same records had already been reviewed by QI teams at these facilities (self-assessment). Overall compliance, agreement (using the Kappa statistic), sensitivity and specificity were analyzed. We also examined patterns of disagreement and the effect of facility characteristics on levels of agreement. External evaluators reported compliance of 69-90%, while self-assessors reported 71-92%, with raw agreement of 71-95% and Kappa statistics ranging from fair to almost perfect agreement. Considering external evaluators as the gold standard, sensitivity of self-assessment ranged from 90 to 99% and specificity from 48 to 86%. Simpler indicators had fewer disagreements. When disagreements occurred between self-assessment and external valuators, the former tended to report more positive findings in five of six indicators, but this tendency was not of a magnitude to change program actions. Team leadership, understanding of the tools and facility size had no overall impact on the level of agreement. When compared with external evaluation (gold standard), self-assessment was found to be sufficiently valid for tracking QI team performance. Sensitivity was generally higher than specificity. Simplifying indicators may improve validity.

Protoflight photovoltaic power module system-level tests in the space power facility

NASA Technical Reports Server (NTRS)

Rivera, Juan C.; Kirch, Luke A.

1989-01-01

Work Package Four, which includes the NASA-Lewis and Rocketdyne, has selected an approach for the Space Station Freedom Photovoltaic (PV) Power Module flight certification that combines system level qualification and acceptance testing in the thermal vacuum environment: The protoflight vehicle approach. This approach maximizes ground test verification to assure system level performance and to minimize risk of on-orbit failures. The preliminary plans for system level thermal vacuum environmental testing of the protoflight PV Power Module in the NASA-Lewis Space Power Facility (SPF), are addressed. Details of the facility modifications to refurbish SPF, after 13 years of downtime, are briefly discussed. The results of an evaluation of the effectiveness of system level environmental testing in screening out incipient part and workmanship defects and unique failure modes are discussed. Preliminary test objectives, test hardware configurations, test support equipment, and operations are presented.

Hydrologic evaluation methodology for estimating water movement through the unsaturated zone at commercial low-level radioactive waste disposal site

USGS Publications Warehouse

Meyer, P.D.; Rockhold, M.L.; Nichols, W.E.; Gee, G.W.

1996-01-01

This report identifies key technical issues related to hydrologic assessment of water flow in the unsaturated zone at low-level radioactive waste (LLW) disposal facilities. In addition, a methodology for incorporating these issues in the performance assessment of proposed LLW disposal facilities is identified and evaluated. The issues discussed fall into four areas:Estimating the water balance at a site (i.e., infiltration, runoff, water storage, evapotranspiration, and recharge);Analyzing the hydrologic performance of engineered components of a facility;Evaluating the application of models to the prediction of facility performance; andEstimating the uncertainty in predicted facility performance.An estimate of recharge at a LLW site is important since recharge is a principal factor in controlling the release of contaminants via the groundwater pathway. The most common methods for estimating recharge are discussed in Chapter 2. Many factors affect recharge; the natural recharge at an undisturbed site is not necessarily representative either of the recharge that will occur after the site has been disturbed or of the flow of water into a disposal facility at the site. Factors affecting recharge are discussed in Chapter 2.At many sites engineered components are required for a LLW facility to meet performance requirements. Chapter 3 discusses the use of engineered barriers to control the flow of water in a LLW facility, with a particular emphasis on cover systems. Design options and the potential performance and degradation mechanisms of engineered components are also discussed.Water flow in a LLW disposal facility must be evaluated before construction of the facility. In addition, hydrologic performance must be predicted over a very long time frame. For these reasons, the hydrologic evaluation relies on the use of predictive modeling. In Chapter 4, the evaluation of unsaturated water flow modeling is discussed. A checklist of items is presented to guide the evaluation. Several computer simulation codes that were used in the examples (Chapter 6) are discussed with respect to this checklist. The codes used include HELP, UNSAT-H, and VAM3DCG.To provide a defensible estimate of water flow in a LLW disposal facility, the uncertainty associated with model predictions must be considered. Uncertainty arises because of the highly heterogeneous nature of most subsurface environments and the long time frame required in the analysis. Sources of uncertainty in hydrologic evaluation of the unsaturated zone and several approaches for analysis are discussed in Chapter 5. The methods of analysis discussed include a bounding approach, sensitivity analysis, and Monte Carlo simulation.To illustrate the application of the discussion in Chapters 2 through 5, two examples are presented in Chapter 6. The first example is of a below ground vault located in a humid environment. The second example looks at a shallow land burial facility located in an arid environment. The examples utilize actual site-specific data and realistic facility designs. The two examples illustrate the issues unique to humid and arid sites as well as the issues common to all LLW sites. Strategies for addressing the analytical difficulties arising in any complex hydrologic evaluation of the unsaturated zone are demonstrated.The report concludes with some final observations and recommendations.

Radiation streaming and skyshine evaluation for a proposed low-level radioactive waste assured isolation facility.

PubMed

Arno, Matthew; Hamilton, Ian S

2003-10-01

Texas is investigating the idea of building a long term waste storage facility, also known as an Assured Isolation Facility. This is an above-ground, retrievable low-level radioactive waste storage facility. A preliminary, scoping-level analysis has been extended to consider more complex scenarios of radiation streaming and skyshine by using MCNP to model the facility in greater detail. Using bounding source term assumptions, the radiation doses and dose rates are found to exceed applicable limits by an order of magnitude. By altering the facility design to fill in the hollow cores of the prefabricated concrete slabs used in the roof over the "high-gamma" rooms where the waste with greatest gamma radiation intensity is stored, dose rates outside the facility decrease by an order of magnitude. With the modified design, the annual dose at the site fenceline is less than the 1 mSv annual limit for exposure of the public. Within the site perimeter, modifying the roof results in an order of magnitude drop in the dose rate for personnel outside the facility and on the facility roof, as well as a significant drop inside the facility. Radiation streaming inside the facility can be lowered almost two orders of magnitude by placing operational restrictions to keep at least two rows of waste containers in front of the high-gamma room to cut down on the size of the path for streaming.

Readiness for Implementation of Lung Cancer Screening. A National Survey of Veterans Affairs Pulmonologists.

PubMed

Tukey, Melissa H; Clark, Jack A; Bolton, Rendelle; Kelley, Michael J; Slatore, Christopher G; Au, David H; Wiener, Renda Soylemez

2016-10-01

To mitigate the potential harms of screening, professional societies recommend that lung cancer screening be conducted in multidisciplinary programs with the capacity to provide comprehensive care, from screening through pulmonary nodule evaluation to treatment of screen-detected cancers. The degree to which this standard can be met at the national level is unknown. To assess the readiness of clinical facilities in a national healthcare system for implementation of comprehensive lung cancer screening programs, as compared with the ideal described in policy recommendations. This was a cross-sectional, self-administered survey of staff pulmonologists in pulmonary outpatient clinics in Veterans Health Administration facilities. The facility-level response rate was 84.1% (106 of 126 facilities with pulmonary clinics); 88.7% of facilities showed favorable provider perceptions of the evidence for lung cancer screening, and 73.6% of facilities had a favorable provider-perceived local context for screening implementation. All elements of the policy-recommended infrastructure for comprehensive screening programs were present in 36 of 106 facilities (34.0%); the most common deficiencies were the lack of on-site positron emission tomography scanners or radiation oncology services. Overall, 26.5% of Veterans Health Administration facilities were ideally prepared for lung cancer screening implementation (44.1% if the policy recommendations for on-site positron emission tomography scanners and radiation oncology services were waived). Many facilities may be less than ideally positioned for the implementation of comprehensive lung cancer screening programs. To ensure safe, effective screening, hospitals may need to invest resources or coordinate care with facilities that can offer comprehensive care for screening through downstream evaluation and treatment of screen-detected cancers.

Segmental Versican Expression in the Trabecular Meshwork and Involvement in Outflow Facility

PubMed Central

Keller, Kate E.; Bradley, John M.; Vranka, Janice A.

2011-01-01

Purpose. Versican is a large proteoglycan with numerous chondroitin sulfate (CS) glycosaminoglycan (GAG) side chains attached. To assess versican's potential contributions to aqueous humor outflow resistance, its segmental distribution in the trabecular meshwork (TM) and the effect on outflow facility of silencing the versican gene were evaluated. Methods. Fluorescent quantum dots (Qdots) were perfused to label outflow pathways of anterior segments. Immunofluorescence with confocal microscopy and quantitative RT-PCR were used to determine versican protein and mRNA distribution relative to Qdot-labeled regions. Lentiviral delivery of shRNA-silencing cassettes to TM cells in perfused anterior segment cultures was used to evaluate the involvement of versican and CS GAG chains in outflow facility. Results. Qdot uptake by TM cells showed considerable segmental variability in both human and porcine outflow pathways. Regional levels of Qdot labeling were inversely related to versican protein and mRNA levels; versican levels were relatively high in sparsely Qdot-labeled regions and low in densely labeled regions. Versican silencing decreased outflow facility in human and increased facility in porcine anterior segments. However, RNAi silencing of ChGn, an enzyme unique to CS GAG biosynthesis, increased outflow facility in both species. The fibrillar pattern of versican immunostaining in the TM juxtacanalicular region was disrupted after versican silencing in perfusion culture. Conclusions. Versican appears to be a central component of the outflow resistance, where it may organize GAGs and other ECM components to facilitate and control open flow channels in the TM. However, the exact molecular organization of this resistance appears to differ between human and porcine eyes. PMID:21596823

RCRA Facility Investigation report for Waste Area Grouping 6 at Oak Ridge National Laboratory, Oak Ridge, Tennessee. Volume 2. Sections 4 through 9

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

None

1991-09-01

This report presents compiled information concerning a facility investigation of waste area group 6(WAG-6), of the solid waste management units (SWMU's) at Oak Ridge National Laboratory (ORNL). The WAG is a shallow ground disposal area for low-level radioactive wastes and chemical wastes. The report contains information on hydrogeological data, contaminant characterization, radionuclide concentrations, risk assessment and baseline human health evaluation including a toxicity assessment, and a baseline environmental evaluation.

Evaluating the heat pump alternative for heating enclosed wastewater treatment facilities in cold regions

NASA Astrophysics Data System (ADS)

Martel, C. J.; Phetteplace, G. E.

1982-05-01

This report presents a five-step procedure for evaluating the technical and economic feasibility of using heat pumps to recover heat from treatment plant effluent. The procedure is meant to be used at the facility planning level by engineers who are unfamiliar with this technology. An example of the use of the procedure and general design information are provided. Also, the report reviews the operational experience with heat pumps at wastewater plants located in Fairbanks, Alaska, Madison, Wisconsin, and Wilton, Maine.

E-Area Low-Level Waste Facility Vadose Zone Model: Confirmation of Water Mass Balance for Subsidence Scenarios

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

Dyer, J. A.

In preparation for the next revision of the E-Area Low-Level Waste Facility (LLWF) Performance Assessment (PA), a mass balance model was developed in Microsoft Excel to confirm correct implementation of intact- and subsided-area infiltration profiles for the proposed closure cap in the PORFLOW vadose-zone model. The infiltration profiles are based on the results of Hydrologic Evaluation of Landfill Performance (HELP) model simulations for both intact and subsided cases.

Remedial site evaluation report for the waste area grouping 10 wells associated with the new hydrofracture facility at Oak Ridge National Laboratory, Oak Ridge, Tennessee. Volume 1: Evaluation, interpretation, and data summary

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

NONE

1996-08-01

The Oak Ridge National Laboratory (ORNL) in Oak Ridge, Tennessee, is operated for the U.S. Department of Energy (DOE) by Lockheed Martin Energy System (Energy Systems). ORNL has pioneered waste disposal technologies since World War II as part of its DOE mission. In the late 1950s, at the request of the National Academy of Sciences, efforts were made to develop a permanent disposal alternative to the surface and tanks at ORNL. One such technology, the hydrofracture process, involved inducing fractures in a geologic host formation (a low-permeability shale) at depths of up to 1100 ft and injecting a radioactive groutmore » slurry containing low-level liquid or tank sludge waste, cement, and other additives at an injection pressure of 2000 to 8500 psi. The objective of the effort was to develop a grout dig could be injected as a slurry and would solidify after injection, thereby entombing the radioisotopes contained in the low-level liquid or tank sludge waste. Four sites at ORNL were used: two experimental (HF-1 and HF-2); one developmental, later converted to batch process [Old Hydrofracture Facility (BF-3)]; and one production facility [New Hydrofracture Facility (BF-4)]. This document provides the environmental, restoration program with information about the the results of an evaluation of WAG 10 wells associated with the New Hydrofracture Facility at ORNL.« less

Assessing the need for an update of a probabilistic seismic hazard analysis using a SSHAC Level 1 study and the Seismic Hazard Periodic Reevaluation Methodology

DOE PAGES

Payne, Suzette J.; Coppersmith, Kevin J.; Coppersmith, Ryan; ...

2017-08-23

A key decision for nuclear facilities is evaluating the need for an update of an existing seismic hazard analysis in light of new data and information that has become available since the time that the analysis was completed. We introduce the newly developed risk-informed Seismic Hazard Periodic Review Methodology (referred to as the SHPRM) and present how a Senior Seismic Hazard Analysis Committee (SSHAC) Level 1 probabilistic seismic hazard analysis (PSHA) was performed in an implementation of this new methodology. The SHPRM offers a defensible and documented approach that considers both the changes in seismic hazard and engineering-based risk informationmore » of an existing nuclear facility to assess the need for an update of an existing PSHA. The SHPRM has seven evaluation criteria that are employed at specific analysis, decision, and comparison points which are applied to seismic design categories established for nuclear facilities in United States. The SHPRM is implemented using a SSHAC Level 1 study performed for the Idaho National Laboratory, USA. The implementation focuses on the first six of the seven evaluation criteria of the SHPRM which are all provided from the SSHAC Level 1 PSHA. Finally, to illustrate outcomes of the SHPRM that do not lead to the need for an update and those that do, the example implementations of the SHPRM are performed for nuclear facilities that have target performance goals expressed as the mean annual frequency of unacceptable performance at 1x10 -4, 4x10 -5 and 1x10 -5.« less

Assessing the need for an update of a probabilistic seismic hazard analysis using a SSHAC Level 1 study and the Seismic Hazard Periodic Reevaluation Methodology

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

Payne, Suzette J.; Coppersmith, Kevin J.; Coppersmith, Ryan

A key decision for nuclear facilities is evaluating the need for an update of an existing seismic hazard analysis in light of new data and information that has become available since the time that the analysis was completed. We introduce the newly developed risk-informed Seismic Hazard Periodic Review Methodology (referred to as the SHPRM) and present how a Senior Seismic Hazard Analysis Committee (SSHAC) Level 1 probabilistic seismic hazard analysis (PSHA) was performed in an implementation of this new methodology. The SHPRM offers a defensible and documented approach that considers both the changes in seismic hazard and engineering-based risk informationmore » of an existing nuclear facility to assess the need for an update of an existing PSHA. The SHPRM has seven evaluation criteria that are employed at specific analysis, decision, and comparison points which are applied to seismic design categories established for nuclear facilities in United States. The SHPRM is implemented using a SSHAC Level 1 study performed for the Idaho National Laboratory, USA. The implementation focuses on the first six of the seven evaluation criteria of the SHPRM which are all provided from the SSHAC Level 1 PSHA. Finally, to illustrate outcomes of the SHPRM that do not lead to the need for an update and those that do, the example implementations of the SHPRM are performed for nuclear facilities that have target performance goals expressed as the mean annual frequency of unacceptable performance at 1x10 -4, 4x10 -5 and 1x10 -5.« less

Rurality and nursing home quality: evidence from the 2004 National Nursing Home Survey.

PubMed

Kang, Yu; Meng, Hongdao; Miller, Nancy A

2011-12-01

To evaluate the impact of rural geographic location on nursing home quality of care in the United States. The study used cross-sectional observational design. We obtained resident- and facility-level data from 12,507 residents in 1,174 nursing homes from the 2004 National Nursing Home Survey. We used multilevel regression models to predict risk-adjusted rates of hospitalization, influenza and pneumococcal vaccination, and moderate to severe pain while controlling for resident and facility characteristics. Adjusting for covariates, residents in rural facilities were more likely to experience hospitalization (odds ratio [OR] = 1.50, 95% confidence interval [CI] = 1.16-1.94) and moderate to severe pain (OR = 1.68, 95% CI = 1.35-2.09). Significant facility-level predictors of higher quality included higher percentage of Medicaid beneficiaries, accreditation status, and special care programs. Medicare payment findings were mixed. Significant resident-level predictors included dementia diagnosis and being a "long-stay" resident. Rural residents were more likely to reside in facilities without accreditations or special care programs, factors that increased their odds of receiving poorer quality of care. Policy efforts to enhance Medicare payment approaches as well as increase rural facilities' accreditation status and provision of special care programs will likely reduce quality of care disparities in facilities.

The effect of user fee exemption on the utilization of maternal health care at mission health facilities in Malawi

PubMed Central

Manthalu, Gerald; Yi, Deokhee; Farrar, Shelley; Nkhoma, Dominic

2016-01-01

The Government of Malawi has signed contracts called service level agreements (SLAs) with mission health facilities in order to exempt their catchment populations from paying user fees. Government in turn reimburses the facilities for the services that they provide. SLAs started in 2006 with 28 out of 165 mission health facilities and increased to 74 in 2015. Most SLAs cover only maternal, neonatal and in some cases child health services due to limited resources. This study evaluated the effect of user fee exemption on the utilization of maternal health services. The difference-in-differences approach was combined with propensity score matching to evaluate the causal effect of user fee exemption. The gradual uptake of the policy provided a natural experiment with treated and control health facilities. A second control group, patients seeking non-maternal health care at CHAM health facilities with SLAs, was used to check the robustness of the results obtained using the primary control group. Health facility level panel data for 142 mission health facilities from 2003 to 2010 were used. User fee exemption led to a 15% (P <  0.01) increase in the mean proportion of women who made at least one antenatal care (ANC) visit during pregnancy, a 12% (P < 0.05) increase in average ANC visits and an 11% (P < 0.05) increase in the mean proportion of pregnant women who delivered at the facilities. No effects were found for the proportion of pregnant women who made the first ANC visit in the first trimester and the proportion of women who made postpartum care visits. We conclude that user fee exemption is an important policy for increasing maternal health care utilization. For certain maternal services, however, other determinants may be more important. PMID:27175033

Lewis and Clark Elementary School Riverview Gardens School District, St. Louis, Missouri. Profile of a Significant School.

ERIC Educational Resources Information Center

Gilliland, John W.

Development of a design for a new elementary school facility is traced through evaluation of various innovative facilities. Significant features include--(1) the spiral plan form, (2) centralized core levels including teacher work center, "perception" core, and interior stream aquariam, (3) the learning laboratory classroom suites, (4) a unique…

Systematic Evaluation Program (SEP) at Rocky Flats Plant: An overview of practical management issues for evaluation of natural phenomena hazards

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

Badwan, F.M.; Herring, K.S.

1993-08-01

Many of the buildings at the Rocky Flats Plant were designed and built before modern standards were developed, including standards for protection against extreme natural phenomenon such as tornadoes, earthquakes, and floods. The purpose of the SEP is to establish an integrated approach to assessing the design adequacy of specific high and moderate hazard Rocky Flats facilities from a safety perspective and to establish a basis for defining any needed facility improvements. The SEP is to be carried out in three Phases. In Phase 1, topics to be evaluated and an evaluation plan for each topic were developed. Any differencesmore » between Current Design Requirements (CDR) or acceptance criteria and the design of existing facilities, will be identified during Phase 2 and assessed using an integrated systematic approach during Phase 3. The integrated assessment performed during Phase 3 provides a process for evaluating the differences between existing facility design and CDRs so that decisions on corrective actions can be made on the basis of relative risk reduction and cost effectiveness. These efforts will ensure that a balanced and integrated level of safety is achieved for long-term operation of these buildings. Through appropriate selection of topics and identification of the structures, systems, and components to be evaluated, the SEP will address outstanding design issues related to the prevention and mitigation of design basis accidents, including those arising from natural phenomena. The objective of the SEP is not to bring these buildings into strict compliance with current requirements, but rather to ensure that an adequate level of safety is achieved in an economical fashion.« less

Variation in Management of Patients With Obstructive Coronary Artery Disease: Insights From the Veterans Affairs Clinical Assessment and Reporting Tool (VA CART) Program.

PubMed

Sandhu, Amneet; Stanislawski, Maggie A; Grunwald, Gary K; Guinn, Kathryn; Valle, Javier; Matlock, Daniel; Ho, P Michael; Maddox, Thomas M; Bradley, Steven M

2017-09-12

Little is known about facility-level variation in the use of revascularization procedures for the management of stable obstructive coronary artery disease. Furthermore, it is unknown if variation in the use of coronary revascularization is associated with use of other cardiovascular procedures. We evaluated all elective coronary angiograms performed in the Veterans Affairs system between September 1, 2007, and December 31, 2011, using the Clinical Assessment and Reporting Tool and identified patients with obstructive coronary artery disease. Patients were considered managed with revascularization if they received percutaneous coronary intervention (PCI) or coronary artery bypass grafting within 30 days of diagnosis. We calculated risk-adjusted facility-level rates of overall revascularization, PCI, and coronary artery bypass grafting. In addition, we determined the association between facility-level rates of revascularization and post-PCI stress testing. Among 15 650 patients at 51 Veterans Affairs sites who met inclusion criteria, the median rate of revascularization was 59.6% (interquartile range, 55.7%-66.7%). Across all facilities, risk-adjusted rates of overall revascularization varied from 41.5% to 88.1%, rate of PCI varied from 23.2% to 80.6%, and rate of coronary artery bypass graftingvariedfrom 7.5% to 36.5%. Of 6179 patients who underwent elective PCI, the median rate of stress testing in the 2 years after PCI was 33.7% (interquartile range, 30.7%-47.1%). There was no evidence of correlation between facility-level rate of revascularization and follow-up stress testing. Within the Veterans Affairs system, we observed large facility-level variation in rates of revascularization for obstructive coronary artery disease, with variation driven primarily by PCI. There was no association between facility-level use of revascularization and follow-up stress testing, suggesting use rates are specific to a particular procedure and not a marker of overall facility-level use. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

SuperCDMS Underground Detector Fabrication Facility

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

Platt, M.; Mahapatra, R.; Bunker, Raymond A.

The SuperCDMS SNOLAB dark matter experiment processes Ge and Si crystals into fully tested phonon and ionization detectors at surface fabrication and test facilities. If not mitigated, it is anticipated that trace-level production of radioisotopes in the crystals due to exposure to cosmic rays at (or above) sea level will result in the dominant source of background events in future dark matter searches using the current SuperCDMS detector technology. Fabrication and testing of detectors in underground facilities shielded from cosmic radiation is one way to directly reduce production of trace levels of radioisotopes, thereby improving experimental sensitivity for the discoverymore » of dark matter beyond the level of the current experiment. In this report, we investigate the cost and feasibility to establish a complete detector fabrication processing chain in an underground location to mitigate cosmogenic activation of the Ge and Si detector substrates. For a specific and concrete evaluation, we explore options for such a facility located at SNOLAB, an underground laboratory in Sudbury, Canada hosting the current and future experimental phases of SuperCDMS.« less

In Data We Trust? Comparison of Electronic Versus Manual Abstraction of Antimicrobial Prescribing Quality Metrics for Hospitalized Veterans With Pneumonia.

PubMed

Jones, Barbara E; Haroldsen, Candace; Madaras-Kelly, Karl; Goetz, Matthew B; Ying, Jian; Sauer, Brian; Jones, Makoto M; Leecaster, Molly; Greene, Tom; Fridkin, Scott K; Neuhauser, Melinda M; Samore, Matthew H

2018-07-01

Electronic health records provide the opportunity to assess system-wide quality measures. Veterans Affairs Pharmacy Benefits Management Center for Medication Safety uses medication use evaluation (MUE) through manual review of the electronic health records. To compare an electronic MUE approach versus human/manual review for extraction of antibiotic use (choice and duration) and severity metrics. Retrospective. Hospitalizations for uncomplicated pneumonia occurring during 2013 at 30 Veterans Affairs facilities. We compared summary statistics, individual hospitalization-level agreement, facility-level consistency, and patterns of variation between electronic and manual MUE for initial severity, antibiotic choice, daily clinical stability, and antibiotic duration. Among 2004 hospitalizations, electronic and manual abstraction methods showed high individual hospitalization-level agreement for initial severity measures (agreement=86%-98%, κ=0.5-0.82), antibiotic choice (agreement=89%-100%, κ=0.70-0.94), and facility-level consistency for empiric antibiotic choice (anti-MRSA r=0.97, P<0.001; antipseudomonal r=0.95, P<0.001) and therapy duration (r=0.77, P<0.001) but lower facility-level consistency for days to clinical stability (r=0.52, P=0.006) or excessive duration of therapy (r=0.55, P=0.005). Both methods identified widespread facility-level variation in antibiotic choice, but we found additional variation in manual estimation of excessive antibiotic duration and initial illness severity. Electronic and manual MUE agreed well for illness severity, antibiotic choice, and duration of therapy in pneumonia at both the individual and facility levels. Manual MUE showed additional reviewer-level variation in estimation of initial illness severity and excessive antibiotic use. Electronic MUE allows for reliable, scalable tracking of national patterns of antimicrobial use, enabling the examination of system-wide interventions to improve quality.

Expansion of Safe Abortion Services in Nepal Through Auxiliary Nurse‐Midwife Provision of Medical Abortion, 2011‐2013

PubMed Central

Basnett, Indira; Shrestha, Dirgha Raj; Shrestha, Meena Kumari; Shah, Mukta; Aryal, Shilu

2016-01-01

Introduction The termination of unwanted pregnancies up to 12 weeks’ gestation became legal in Nepal in 2002. Many interventions have taken place to expand access to comprehensive abortion care services. However, comprehensive abortion care services remain out of reach for women in rural and remote areas. This article describes a training and support strategy to train auxiliary nurse‐midwives (ANMs), already certified as skilled birth attendants, as medical abortion providers and expand geographic access to safe abortion care to the community level in Nepal. Methods This was a descriptive program evaluation. Sites and trainees were selected using standardized assessment tools to determine minimum facility requirements and willingness to provide medical abortion after training. Training was evaluated via posttests and observational checklists. Service statistics were collected through the government's facility logbook for safe abortion services (HMIS‐11). Results By the end of June 2014, medical abortion service had been expanded to 25 districts through 463 listed ANMs at 290 listed primary‐level facilities and served 25,187 women. Providers report a high level of confidence in their medical abortion skills and considerable clinical knowledge and capacity in medical abortion. Discussion The Nepali experience demonstrates that safe induced abortion care can be provided by ANMs, even in remote primary‐level health facilities. Post‐training support for providers is critical in helping ANMs handle potential barriers to medical abortion service provision and build lasting capacity in medical abortion. PMID:26860072

Technology Readiness Assessment of Department of Energy Waste Processing Facilities

DTIC Science & Technology

2007-09-11

Must Be Reliable, Robust, Flexible, and Durable 6 EM Is Piloting the TRA/AD2 Process Hanford Waste Treatment Plant ( WTP ) – The Initial Pilot Project...Evaluation WTP can only treat ~ ½ of the LAW in the time it will take to treat all the HLW. • There is a need for tank space that will get more urgent with...Facility before the WTP Pretreatment and High-Level Waste (HLW) Vitrification Facilities are available (Requires tank farm pretreatment capability) TRAs

Modelling Pedestrian Travel Time and the Design of Facilities: A Queuing Approach

PubMed Central

Rahman, Khalidur; Abdul Ghani, Noraida; Abdulbasah Kamil, Anton; Mustafa, Adli; Kabir Chowdhury, Md. Ahmed

2013-01-01

Pedestrian movements are the consequence of several complex and stochastic facts. The modelling of pedestrian movements and the ability to predict the travel time are useful for evaluating the performance of a pedestrian facility. However, only a few studies can be found that incorporate the design of the facility, local pedestrian body dimensions, the delay experienced by the pedestrians, and level of service to the pedestrian movements. In this paper, a queuing based analytical model is developed as a function of relevant determinants and functional factors to predict the travel time on pedestrian facilities. The model can be used to assess the overall serving rate or performance of a facility layout and correlate it to the level of service that is possible to provide the pedestrians. It has also the ability to provide a clear suggestion on the designing and sizing of pedestrian facilities. The model is empirically validated and is found to be a robust tool to understand how well a particular walking facility makes possible comfort and convenient pedestrian movements. The sensitivity analysis is also performed to see the impact of some crucial parameters of the developed model on the performance of pedestrian facilities. PMID:23691055

Status of the implementation of the World Health Organization multimodal hand hygiene strategy in United States of America health care facilities.

PubMed

Allegranzi, Benedetta; Conway, Laurie; Larson, Elaine; Pittet, Didier

2014-03-01

The World Health Organization (WHO) launched a multimodal strategy and campaign in 2009 to improve hand hygiene practices worldwide. Our objective was to evaluate the implementation of the strategy in United States health care facilities. From July through December 2011, US facilities participating in the WHO global campaign were invited to complete the Hand Hygiene Self-Assessment Framework online, a validated tool based on the WHO multimodal strategy. Of 2,238 invited facilities, 168 participated in the survey (7.5%). A detailed analysis of 129, mainly nonteaching public facilities (80.6%), showed that most had an advanced or intermediate level of hand hygiene implementation progress (48.9% and 45.0%, respectively). The total Hand Hygiene Self-Assessment Framework score was 36 points higher for facilities with staffing levels of infection preventionists > 0.75/100 beds than for those with lower ratios (P = .01) and 41 points higher for facilities participating in hand hygiene campaigns (P = .002). Despite the low response rate, the survey results are unique and allow interesting reflections. Whereas the level of progress of most participating facilities was encouraging, this may reflect reporting bias, ie, better hospitals more likely to report. However, even in respondents, further improvement can be achieved, in particular by embedding hand hygiene in a stronger institutional safety climate and optimizing staffing levels dedicated to infection prevention. These results should encourage the launch of a coordinated national campaign and higher participation in the WHO global campaign. Copyright © 2014 World Health Organization. Published by Mosby, Inc. All rights reserved.

Status of the implementation of the World Health Organization multimodal hand hygiene strategy in United States of America health care facilities

PubMed Central

Allegranzi, Benedetta; Conway, Laurie; Larson, Elaine; Pittet, Didier

2014-01-01

Background The World Health Organization (WHO) launched a multimodal strategy and campaign in 2009 to improve hand hygiene practices worldwide. Our objective was to evaluate the implementation of the strategy in United States health care facilities. Methods From July through December 2011, US facilities participating in the WHO global campaign were invited to complete the Hand Hygiene Self-Assessment Framework online, a validated tool based on the WHO multimodal strategy. Results Of 2,238 invited facilities, 168 participated in the survey (7.5%). A detailed analysis of 129, mainly nonteaching public facilities (80.6%), showed that most had an advanced or intermediate level of hand hygiene implementation progress (48.9% and 45.0%, respectively). The total Hand Hygiene Self-Assessment Framework score was 36 points higher for facilities with staffing levels of infection preventionists > 0.75/100 beds than for those with lower ratios (P = .01) and 41 points higher for facilities participating in hand hygiene campaigns (P = .002). Conclusion Despite the low response rate, the survey results are unique and allow interesting reflections. Whereas the level of progress of most participating facilities was encouraging, this may reflect reporting bias, ie, better hospitals more likely to report. However, even in respondents, further improvement can be achieved, in particular by embedding hand hygiene in a stronger institutional safety climate and optimizing staffing levels dedicated to infection prevention. These results should encourage the launch of a coordinated national campaign and higher participation in the WHO global campaign. PMID:24581011

Polychlorinated biphenyls in the surrounding of an e-waste recycling facility in North-Rhine Westphalia: Levels in plants and dusts, spatial distribution, homologue pattern and source identification using the combination of plants and wind direction data.

PubMed

Klees, Marcel; Hombrecher, Katja; Gladtke, Dieter

2017-12-15

During this study the occurrence of polychlorinated biphenyls (PCBs) in the surrounding of an e-waste recycling facility in North-Rhine Westphalia was analysed. PCB levels were analysed in curly kale, spruce needles, street dusts and dusts. Conspicuously high PCB concentrations in curly kale and spruce needles were found directly northwards of the industrial premises. Furthermore a concentration gradient originating from the industrial premises to the residential areas in direction southwest to northeast was evident. Homologue patterns of highly PCB contaminated dusts and street dusts were comparable to the homologue patterns of PCB in curly kale and spruce needles. This corroborates the suspicion that the activities at the e-waste recycling facility were responsible for the elevated PCB levels in curly kale and spruce needles. The utilization of multiple linear regression of wind direction data and analysed PCB concentrations in spruce needles proved that the e-waste recycling facility caused the PCB emissions to the surrounding. Additionally, this evaluation enabled the calculation of source specific accumulation constants for certain parts of the facility. Consequently the different facility parts contribute with different impacts to the PCB levels in bioindicators. Copyright © 2017 Elsevier B.V. All rights reserved.

Evaluation of LLNL BSL-3 Maximum Credible Event Potential Consequence to the General Population and Surrounding Environment

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

Johnson, M.

2010-08-16

The purpose of this evaluation is to establish reproducibility of the analysis and consequence results to the general population and surrounding environment in the LLNL Biosafety Level 3 Facility Environmental Assessment (LLNL 2008).

Evaluation of components, subsystems, and networks for high rate, high frequency space communications

NASA Technical Reports Server (NTRS)

Kerczewski, Robert J.; Ivancic, William D.; Zuzek, John E.

1991-01-01

The development of new space communications technologies by NASA has included both commercial applications and space science requirements. NASA's Systems Integration, Test and Evaluation (SITE) Space Communication System Simulator is a hardware based laboratory simulator for evaluating space communications technologies at the component, subsystem, system, and network level, geared toward high frequency, high data rate systems. The SITE facility is well-suited for evaluation of the new technologies required for the Space Exploration Initiative (SEI) and advanced commercial systems. Described here are the technology developments and evaluation requirements for current and planned commercial and space science programs. Also examined are the capabilities of SITE, the past, present and planned future configurations of the SITE facility, and applications of SITE to evaluation of SEI technology.

Technology evaluation, assessment, modeling, and simulation: the TEAMS capability

NASA Astrophysics Data System (ADS)

Holland, Orgal T.; Stiegler, Robert L.

1998-08-01

The United States Marine Corps' Technology Evaluation, Assessment, Modeling and Simulation (TEAMS) capability, located at the Naval Surface Warfare Center in Dahlgren Virginia, provides an environment for detailed test, evaluation, and assessment of live and simulated sensor and sensor-to-shooter systems for the joint warfare community. Frequent use of modeling and simulation allows for cost effective testing, bench-marking, and evaluation of various levels of sensors and sensor-to-shooter engagements. Interconnectivity to live, instrumented equipment operating in real battle space environments and to remote modeling and simulation facilities participating in advanced distributed simulations (ADS) exercises is available to support a wide- range of situational assessment requirements. TEAMS provides a valuable resource for a variety of users. Engineers, analysts, and other technology developers can use TEAMS to evaluate, assess and analyze tactical relevant phenomenological data on tactical situations. Expeditionary warfare and USMC concept developers can use the facility to support and execute advanced warfighting experiments (AWE) to better assess operational maneuver from the sea (OMFTS) concepts, doctrines, and technology developments. Developers can use the facility to support sensor system hardware, software and algorithm development as well as combat development, acquisition, and engineering processes. Test and evaluation specialists can use the facility to plan, assess, and augment their processes. This paper presents an overview of the TEAMS capability and focuses specifically on the technical challenges associated with the integration of live sensor hardware into a synthetic environment and how those challenges are being met. Existing sensors, recent experiments and facility specifications are featured.

Test facility for the evaluation of microwave transmission components

NASA Astrophysics Data System (ADS)

Fong, C. G.; Poole, B. R.

1985-10-01

A Low Power Test Facility (LPTF) was developed to evaluate the performance of Electron Cyclotron Resonance Heating (ECRH) microwave transmission components for the Mirror Fusion Test Facility (MFTF-B). The facility generates 26 to 60 GHz in modes of TE01, TE02, or TE03 launched at power levels of 1/2 milliwatt. The propagation of the RF as it radiates from either transmitting or secondary reflecting microwave transmission components is recorded by a discriminating crystal detector mechanically manipulated at constant radius in spherical coordinates. The facility is used to test, calibrate, and verify the design of overmoded, circular waveguide components, quasi-optical reflecting elements before high power use. The test facility consists of microwave sources and metering components, such as VSWR, power and frequency meters, a rectangular TE10 to circular TE01 mode transducer, mode filter, circular TE01 to 2.5 in. diameter overmoded waveguide with mode converters for combination of TE01 to TE03 modes. This assembly then connects to a circular waveguide launcher or the waveguide component under test.

Quality of antenatal care in Zambia: a national assessment

PubMed Central

2012-01-01

Background Antenatal care (ANC) is one of the recommended interventions to reduce maternal and neonatal mortality. Yet in most Sub-Saharan African countries, high rates of ANC coverage coexist with high maternal and neonatal mortality. This disconnect has fueled calls to focus on the quality of ANC services. However, little conceptual or empirical work exists on the measurement of ANC quality at health facilities in low-income countries. We developed a classification tool and assessed the level of ANC service provision at health facilities in Zambia on a national scale and compared this to the quality of ANC received by expectant mothers. Methods We analysed two national datasets with detailed antenatal provider and user information, the 2005 Zambia Health Facility Census and the 2007 Zambia Demographic and Health Survey (DHS), to describe the level of ANC service provision at 1,299 antenatal facilities in 2005 and the quality of ANC received by 4,148 mothers between 2002 and 2007. Results We found that only 45 antenatal facilities (3%) fulfilled our developed criteria for optimum ANC service, while 47% of facilities provided adequate service, and the remaining 50% offered inadequate service. Although 94% of mothers reported at least one ANC visit with a skilled health worker and 60% attended at least four visits, only 29% of mothers received good quality ANC, and only 8% of mothers received good quality ANC and attended in the first trimester. Conclusions DHS data can be used to monitor “effective ANC coverage” which can be far below ANC coverage as estimated by current indicators. This “quality gap” indicates missed opportunities at ANC for delivering effective interventions. Evaluating the level of ANC provision at health facilities is an efficient way to detect where deficiencies are located in the system and could serve as a monitoring tool to evaluate country progress. PMID:23237601

The drivers of facility-based immunization performance and costs. An application to Moldova.

PubMed

Maceira, Daniel; Goguadze, Ketevan; Gotsadze, George

2015-05-07

This paper identifies factors that affect the cost and performance of the routine immunization program in Moldova through an analysis of facility-based data collected as part of a multi-country costing and financing study of routine immunization (EPIC). A nationally representative sample of health care facilities (50) was selected through multi-stage, stratified random sampling. Data on inputs, unit prices and facility outputs were collected during October 3rd 2012-January 14th 2013 using a pre-tested structured questionnaire. Ordinary least square (OLS) regression analysis was performed to determine factors affecting facility outputs (number of doses administered and fully immunized children) and explaining variation in total facility costs. The study found that the number of working hours, vaccine wastage rates, and whether or not a doctor worked at a facility (among other factors) were positively and significantly associated with output levels. In addition, the level of output, price of inputs and share of the population with university education were significantly associated with higher facility costs. A 1% increase in fully immunized child would increase total cost by 0.7%. Few costing studies of primary health care services in developing countries evaluate the drivers of performance and cost. This exercise attempted to fill this knowledge gap and helped to identify organizational and managerial factors at a primary care district and national level that could be addressed by improved program management aimed at improved performance. Copyright © 2015 Elsevier Ltd. All rights reserved.

Evaluation of pharmacotherapy complexity in residents of long-term care facilities: a cross-sectional descriptive study.

PubMed

Alves-Conceição, Vanessa; Silva, Daniel Tenório da; Santana, Vanessa Lima de; Santos, Edileide Guimarães Dos; Santos, Lincoln Marques Cavalcante; Lyra, Divaldo Pereira de

2017-07-25

Polypharmacy is a reality in long-term care facilities. However, number of medications used by the patient should not be the only predictor of a complex pharmacotherapy. Although the level of complexity of pharmacotherapy is considered an important factor that may lead to side effects, there are few studies in this field. The aim of this study was to evaluate the complexity of pharmacotherapy in residents of three long-term care facilities. A cross-sectional study was performed to evaluate the complexity of pharmacotherapy using the protocols laid out in the Medication Regimen Complexity Index instrument in three long-term care facilities in northeastern Brazil. As a secondary result, potential drug interactions, potentially inappropriate medications, medication duplication, and polypharmacy were evaluated. After the assessment, the association among these variables and the Medication Regimen Complexity Index was performed. In this study, there was a higher prevalence of women (64.4%) with a high mean age among the study population of 81.8 (±9.7) years. The complexity of pharmacotherapy obtained a mean of 15.1 points (±9.8), with a minimum of 2 and a maximum of 59. The highest levels of complexity were associated with dose frequency, with a mean of 5.5 (±3.6), followed by additional instructions of use averaging 4.9 (±3.7) and by the dosage forms averaging 4.6 (±3.0). The present study evaluated some factors that complicate the pharmacotherapy of geriatric patients. Although polypharmacy was implicated as a factor directly related to complexity, other indicators such as drug interactions, potentially inappropriate medications, and therapeutic duplication can also make the use of pharmacotherapy in such patients more difficult.

Task-sharing with nurses to enhance access to HIV treatment in Côte d'Ivoire.

PubMed

McNairy, Margaret L; Bashi, Jules B; Chung, Hannah; Wemin, Louise; Lorng, Marie-Nicole Akpro; Brou, Hermann; Nioble, Cyprien; Lokossue, A; Abo, Kouame; Achi, Delphine; Ouattara, Kiyali; Sess, Daniel; Sanogo, Pongathie Adama; Ekra, Alexandre; Ettiegne-Traore, Virginie; Diabate, Conombo J; Abrams, Elaine J; El-Sadr, Wafaa M

2017-04-01

We report the first national programme in Côte d'Ivoire to evaluate the feasibility of nurse-led HIV care as a model of task-sharing with nurses to increase coverage and decentralisation of HIV services. Twenty-six public HIV facilities implemented either a nurse-with-onsite-physician or a nurse-with-visiting-physician model of HIV task-sharing. Routinely collected patient data were reviewed to analyse patient characteristics of those enrolling in care and initiating antiretroviral therapy (ART). Retention, loss to programme and death were compared across facility-level characteristics. A total of 1224 patients enrolled in HIV care, with 666 initiating ART, from January 2012 to May 2013 (median follow-up 13 months). The majority (94%) were adults ≥15 years. Fourteen facilities provided ART initiation for the first time during the pilot period; 20 facilities were primary level. Nurse-led care with a visiting physician was provided in 14 of the primary-level facilities. Nurse-led ART care with an onsite physician was provided in all secondary-level facilities and six of the primary-level facilities. During the pilot, 567 (85%) of patients were retained, 28 (4.2%) died, 47 (7.1%) were lost to follow-up, and 24 (3.6%) transferred. Five deaths (10.9%) were recorded among children as compared to 23 deaths (3.7%) among adults (P = 0.037). There were no differences in retention by model of nurse-led ART care. Task-sharing of HIV care and ART initiation with nurses in Côte d'Ivoire is feasible. This pilot illustrates two models of nurse-led HIV care and has informed national policy on nurse-led HIV care in Côte d'Ivoire. © 2017 John Wiley & Sons Ltd.

Variation in fistula use across dialysis facilities: is it explained by case-mix?

PubMed

Tangri, Navdeep; Moorthi, Ranjani; Tighiouhart, Hocine; Meyer, Klemens B; Miskulin, Dana C

2010-02-01

Arteriovenous fistulas (AVFs) remain the preferred vascular access for hemodialysis patients. Dialysis facilities that fail to meet Centers for Medicare & Medicaid Services goals cite patient case-mix as a reason for low AVF prevalence. This study aimed to determine the magnitude of the variability in AVF usage across dialysis facilities and the extent to which patient case-mix explains it. The vascular access used in 10,112 patients dialyzed at 173 Dialysis Clinic Inc. facilities from October 1 to December 31, 2004, was evaluated. The access in use was considered to be an AVF if it was used for >70% of hemodialysis treatments. Mixed-effects models with a random intercept for dialysis facilities evaluated the effect of facilities on AVF usage. Sequentially adjusted multivariate models measured the extent to which patient factors (case-mix) explain variation across facilities in AVF rates. 3787 patients (38%) were dialyzed using AVFs. There was a significant facility effect: 7.6% of variation in AVF use was attributable to facility. This was reduced to 7.1% after case-mix adjustment. There were no identified specific facility-level factors that explained the interfacility variation. AVF usage varies across dialysis facilities, and patient case-mix did not reduce this variation. In this study, 92% of the total variation in AVF usage was due to patient factors, but most were not measurable. A combination of patient factors and process indicators should be considered in adjudicating facility performance for this quality indicator.

Evaluation of the Color Me Healthy Program in Influencing Nutrition and Physical Activity in Mississippi Preschool Child Care Facilities

ERIC Educational Resources Information Center

Huye, Holly F.; Bankston, Sarah; Speed, Donna; Molaison, Elaine F.

2014-01-01

Purpose/Objectives: The purpose of this research was to determine the level of implementation and perceived value in creating knowledge and behavior change from the Color Me Healthy (CMH) training program in child care centers, family day carehomes, or Head Start facilities throughout Mississippi. Methods: A two-phase survey was used to initially…

An Evaluation of the Additional Acoustic Power Needed to Overcome the Effects of a Test-Article's Absorption During Reverberant Chamber Acoustic Testing of Spaceflight Hardware

NASA Technical Reports Server (NTRS)

Hozman, Aron D.; Hughes, William O.

2014-01-01

The exposure of a customer's aerospace test-article to a simulated acoustic launch environment is typically performed in a reverberant acoustic test chamber. The acoustic pre-test runs that will ensure that the sound pressure levels of this environment can indeed be met by a test facility are normally performed without a test-article dynamic simulator of representative acoustic absorption and size. If an acoustic test facility's available acoustic power capability becomes maximized with the test-article installed during the actual test then the customer's environment requirement may become compromised. In order to understand the risk of not achieving the customer's in-tolerance spectrum requirement with the test-article installed, an acoustic power margin evaluation as a function of frequency may be performed by the test facility. The method for this evaluation of acoustic power will be discussed in this paper. This method was recently applied at the NASA Glenn Research Center Plum Brook Station's Reverberant Acoustic Test Facility for the SpaceX Falcon 9 Payload Fairing acoustic test program.

An Evaluation of the Additional Acoustic Power Needed to Overcome the Effects of a Test-Article's Absorption during Reverberant Chamber Acoustic Testing of Spaceflight Hardware

NASA Technical Reports Server (NTRS)

Hozman, Aron D.; Hughes, William O.

2014-01-01

The exposure of a customers aerospace test-article to a simulated acoustic launch environment is typically performed in a reverberant acoustic test chamber. The acoustic pre-test runs that will ensure that the sound pressure levels of this environment can indeed be met by a test facility are normally performed without a test-article dynamic simulator of representative acoustic absorption and size. If an acoustic test facilitys available acoustic power capability becomes maximized with the test-article installed during the actual test then the customers environment requirement may become compromised. In order to understand the risk of not achieving the customers in-tolerance spectrum requirement with the test-article installed, an acoustic power margin evaluation as a function of frequency may be performed by the test facility. The method for this evaluation of acoustic power will be discussed in this paper. This method was recently applied at the NASA Glenn Research Center Plum Brook Stations Reverberant Acoustic Test Facility for the SpaceX Falcon 9 Payload Fairing acoustic test program.

Global environment facility: Independent evaluation of the pilot phase; Fonds pour l`environnement mondial: evaluation independante de la phase pilote

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

NONE

1994-12-31

This study responds to a request by participants in the Global Environment Facility (GEF) for an independent evaluation of the pilot phase. It profiles the GEF, discusses its policy framework, and reviews project development procedures and the strategies and projects in each of the GEF`s four focal areas. The study concludes that fundamental changes must occur and recommends specific reforms, such as articulating more clearly the GEF`s mandate, objectives, and strategies; addressing deficiencies in meeting its global focus; improving capacities and procedures within implementing agencies for managing the portfolio; and increasing non-government organization (NGO), country and community-level participation.

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

PubMed

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

2017-07-01

To evaluate the impact of a performance-based financing scheme on maternal and neonatal health service quality in Malawi. 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. 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. 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.

Drug Treatment in Adult Probation: An Evaluation of an Outpatient and Acupuncture Program.

ERIC Educational Resources Information Center

Moon, Melissa M.; Latessa, Edward J.

1994-01-01

The effectiveness of an innovative outpatient drug-free treatment facility serving felony drug offenders who are placed on probation is evaluated. Treatment included educational and group therapy as well as acupuncture. Background characteristics, levels of treatment, and selected outcomes are described. Principles of successful interventions are…

The effect of user fee exemption on the utilization of maternal health care at mission health facilities in Malawi.

PubMed

Manthalu, Gerald; Yi, Deokhee; Farrar, Shelley; Nkhoma, Dominic

2016-11-01

The Government of Malawi has signed contracts called service level agreements (SLAs) with mission health facilities in order to exempt their catchment populations from paying user fees. Government in turn reimburses the facilities for the services that they provide. SLAs started in 2006 with 28 out of 165 mission health facilities and increased to 74 in 2015. Most SLAs cover only maternal, neonatal and in some cases child health services due to limited resources. This study evaluated the effect of user fee exemption on the utilization of maternal health services. The difference-in-differences approach was combined with propensity score matching to evaluate the causal effect of user fee exemption. The gradual uptake of the policy provided a natural experiment with treated and control health facilities. A second control group, patients seeking non-maternal health care at CHAM health facilities with SLAs, was used to check the robustness of the results obtained using the primary control group. Health facility level panel data for 142 mission health facilities from 2003 to 2010 were used. User fee exemption led to a 15% (P <  0.01) increase in the mean proportion of women who made at least one antenatal care (ANC) visit during pregnancy, a 12% (P < 0.05) increase in average ANC visits and an 11% (P < 0.05) increase in the mean proportion of pregnant women who delivered at the facilities. No effects were found for the proportion of pregnant women who made the first ANC visit in the first trimester and the proportion of women who made postpartum care visits. We conclude that user fee exemption is an important policy for increasing maternal health care utilization. For certain maternal services, however, other determinants may be more important. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Elective surgical case cancellation in the Veterans Health Administration system: identifying areas for improvement.

PubMed

Argo, Joshua L; Vick, Catherine C; Graham, Laura A; Itani, Kamal M F; Bishop, Michael J; Hawn, Mary T

2009-11-01

This study evaluated elective surgical case cancellation (CC) rates, reasons for these cancellations, and identified areas for improvement within the Veterans Health Administration (VA) system. CC data for 2006 were collected from the scheduling software for 123 VA facilities. Surveys were distributed to 40 facilities (10 highest and 10 lowest CC rates for high- and low-volume facilities). CC reasons were standardized and piloted at 5 facilities. Of 329,784 cases scheduled by 9 surgical specialties, 40,988 (12.4%) were cancelled. CC reasons (9,528) were placed into 6 broad categories: patient (35%), work-up/medical condition change (28%), facility (20%), surgeon (8%), anesthesia (1%), and miscellaneous (8%). Survey results show areas for improvement at the facility level and a standardized list of 28 CC reasons was comprehensive. Interventions that decrease cancellations caused by patient factors, inadequate work-up, and facility factors are needed to reduce overall elective surgical case cancellations.

Examining Japanese women's preferences for a new style of postnatal care facility and its attributes.

PubMed

Shen, Junyi; Nakashima, Takako; Karasawa, Izumi; Furui, Tatsuro; Morishige, Kenichiro; Saijo, Tatsuyoshi

2018-05-21

Perinatal care in rural Japan is currently facing a crisis because of the lack of medical staff, especially obstetricians. In this study, a new style of postnatal care facility that combines both medical and nonmedical support is considered. Contrary to most postnatal care facilities in Japan, this new postnatal care facility accepts a puerperant from the cooperating maternity facility soon after birth (≤2 days). We conducted a hypothetical choice experiment to investigate whether this new postnatal care facility could be accepted by women in Gero City, Hida, Gifu Prefecture and how these women evaluate different kinds of postnatal care services. The results show that after a 2-day hospital stay, women from Gero City preferred to move to the new postnatal care facility over the other alternatives (continued hospitalization or discharge home). In addition, the estimated choice probabilities for selecting the postnatal care facility under different scenarios show a high level of acceptance for this new postnatal care facility. Copyright © 2018 John Wiley & Sons, Ltd.

Vibration criteria for transit systems in close proximity to university research activities

NASA Astrophysics Data System (ADS)

Wolf, Steven

2004-05-01

As some of the newer LRT projects get closer to research facilities the question arisesi ``how do you assess the potential impact of train operations on the activities within these types of facilities?'' There are several new LRT projects that have proposed alignments near or under university research facilities. The traditional ground vibration analysis at these locations is no longer valid but requires a more sophisticated approach to identifying both criteria and impact. APTA, ISO, IES, and FTA vibration criteria may not be adequate for the most sensitive activities involving single cell and nano technology research. The use of existing ambient vibration levels is evaluated as a potential criteria. A statistical approach is used to better understand how the train vibration would affect the ambient vibration levels.

Studies of Transgenic Mosquitoes in Disease-Endemic Countries: Preparation of Containment Facilities

PubMed Central

Mutunga, James Mutuku; Diabaté, Abdoulaye; Namountougou, Moussa; Coulibaly, Mamadou B.; Sylla, Lakamy; Kayondo, Jonathan; Balyesima, Victor; Clark, Lorna; Benedict, Mark Q.; Raymond, Peter

2018-01-01

Abstract Novel approaches to area-wide control of vector species offer promise as additional tools in the fight against vectored diseases. Evaluation of transgenic insect strains aimed at field population control in disease-endemic countries may involve international partnerships and should be done in a stepwise approach, starting with studies in containment facilities. The preparations of both new-build and renovated facilities are described, including working with local and national regulations regarding land use, construction, and biosafety requirements, as well as international guidance to fill any gaps in regulation. The examples given are for containment categorization at Arthropod Containment Level 2 for initial facility design, classification of wastes, and precautions during shipping. Specific lessons were derived from preparations to evaluate transgenic (non-gene drive) mosquitoes in West and East African countries. Documented procedures and the use of a non-transgenic training strain for trial shipments and culturing were used to develop competence and confidence among the African facility staff, and along the chain of custody for transport. This practical description is offered to support other research consortia or institutions preparing containment facilities and operating procedures in conditions where research on transgenic insects is at an early stage. PMID:29337662

Studies of Transgenic Mosquitoes in Disease-Endemic Countries: Preparation of Containment Facilities.

PubMed

Quinlan, M Megan; Mutunga, James Mutuku; Diabaté, Abdoulaye; Namountougou, Moussa; Coulibaly, Mamadou B; Sylla, Lakamy; Kayondo, Jonathan; Balyesima, Victor; Clark, Lorna; Benedict, Mark Q; Raymond, Peter

2018-01-01

Novel approaches to area-wide control of vector species offer promise as additional tools in the fight against vectored diseases. Evaluation of transgenic insect strains aimed at field population control in disease-endemic countries may involve international partnerships and should be done in a stepwise approach, starting with studies in containment facilities. The preparations of both new-build and renovated facilities are described, including working with local and national regulations regarding land use, construction, and biosafety requirements, as well as international guidance to fill any gaps in regulation. The examples given are for containment categorization at Arthropod Containment Level 2 for initial facility design, classification of wastes, and precautions during shipping. Specific lessons were derived from preparations to evaluate transgenic (non-gene drive) mosquitoes in West and East African countries. Documented procedures and the use of a non-transgenic training strain for trial shipments and culturing were used to develop competence and confidence among the African facility staff, and along the chain of custody for transport. This practical description is offered to support other research consortia or institutions preparing containment facilities and operating procedures in conditions where research on transgenic insects is at an early stage.

Impact of Glycolate Anion on Aqueous Corrosion in DWPF and Downstream Facilities

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

Mickalonis, J.

Glycolic acid is being evaluated as an alternate reductant in the preparation of high level waste for the Defense Waste Processing Facility (DWPF) at the Savannah River Site (SRS). During processing, the glycolic acid may not be completely consumed with small quantities of the glycolate anion being carried forward to other high level waste (HLW) facilities. The SRS liquid waste contractor requested an assessment of the impact of the glycolate anion on the corrosion of the materials of construction (MoC) throughout the waste processing system since this impact had not been previously evaluated. A literature review revealed that corrosion datamore » were not available for the MoCs in glycolic-bearing solutions applicable to SRS systems. Data on the material compatibility with only glycolic acid or its derivative products were identified; however, data were limited for solutions containing glycolic acid or the glycolate anion. For the proprietary coating systems applied to the DWPF concrete, glycolic acid was deemed compatible since the coatings were resistant to more aggressive chemistries than glycolic acid. Additionally, similar coating resins showed acceptable resistance to glycolic acid.« less

Impact of Glycolate Anion on Aqueous Corrosion in DWPF and Downstream Facilities

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

Mickalonis, J.

Glycolic acid is being evaluated as an alternate reductant in the preparation of high level waste for the Defense Waste Processing Facility (DWPF) at the Savannah River Site (SRS). During processing, the glycolic acid may not be completely consumed with small quantities of the glycolate anion being carried forward to other high level waste (HLW) facilities. The SRS liquid waste contractor requested an assessment of the impact of the glycolate anion on the corrosion of the materials of construction (MoC) throughout the waste processing system since this impact had not been previously evaluated. A literature review revealed that corrosion datamore » were not available for the MoCs in glycolic-bearing solutions applicable to SRS systems. Data on the material compatibility with only glycolic acid or its derivative products were identified; however, data were limited for solutions containing glycolic acid or the glycolate anion. For the proprietary coating systems applied to the DWPF concrete, glycolic acid was deemed compatible since the coatings were resistant to more aggressive chemistries than glycolic acid. Additionally similar coating resins showed acceptable resistance to glycolic acid.« less

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

Evaluation of lead levels in children living near a Los Angeles county battery recycling facility.

PubMed Central

Wohl, A R; Dominguez, A; Flessel, P

1996-01-01

This cross-sectional study examined the association between environmental lead measurements surrounding a Los Angeles County battery recycling facility and the blood lead levels of the children living nearby. Environmental lead measurements and blood lead levels of young children living in a community adjacent to a stationary lead source were compared to those living in a community without a stationary lead source. Predictors of blood lead level were identified. The blood lead levels of the children living near the secondary lead smelter were within the normal range (< 5 micrograms/dl). The absence of ground cover was associated with slightly increased blood lead levels; however, this increase was not of biological significance. Lead levels in surface soil near the stationary lead source were elevated compared to the control community; however, the soil affected community, which may be due in part to controls recently installed at the stationary lead source. PMID:8919770

Methodology for worker neutron exposure evaluation in the PDCF facility design.

PubMed

Scherpelz, R I; Traub, R J; Pryor, K H

2004-01-01

A project headed by Washington Group International is meant to design the Pit Disassembly and Conversion Facility (PDCF) to convert the plutonium pits from excessed nuclear weapons into plutonium oxide for ultimate disposition. Battelle staff are performing the shielding calculations that will determine appropriate shielding so that the facility workers will not exceed target exposure levels. The target exposure levels for workers in the facility are 5 mSv y(-1) for the whole body and 100 mSv y(-1) for the extremity, which presents a significant challenge to the designers of a facility that will process tons of radioactive material. The design effort depended on shielding calculations to determine appropriate thickness and composition for glove box walls, and concrete wall thicknesses for storage vaults. Pacific Northwest National Laboratory (PNNL) staff used ORIGEN-S and SOURCES to generate gamma and neutron source terms, and Monte Carlo (computer code for) neutron photon (transport) (MCNP-4C) to calculate the radiation transport in the facility. The shielding calculations were performed by a team of four scientists, so it was necessary to develop a consistent methodology. There was also a requirement for the study to be cost-effective, so efficient methods of evaluation were required. The calculations were subject to rigorous scrutiny by internal and external reviewers, so acceptability was a major feature of the methodology. Some of the issues addressed in the development of the methodology included selecting appropriate dose factors, developing a method for handling extremity doses, adopting an efficient method for evaluating effective dose equivalent in a non-uniform radiation field, modelling the reinforcing steel in concrete, and modularising the geometry descriptions for efficiency. The relative importance of the neutron dose equivalent compared with the gamma dose equivalent varied substantially depending on the specific shielding conditions and lessons were learned from this effect. This paper addresses these issues and the resulting methodology.

A dynamic vulnerability evaluation model to smart grid for the emergency response

NASA Astrophysics Data System (ADS)

Yu, Zhen; Wu, Xiaowei; Fang, Diange

2018-01-01

Smart grid shows more significant vulnerability to natural disasters and external destroy. According to the influence characteristics of important facilities suffered from typical kinds of natural disaster and external destroy, this paper built a vulnerability evaluation index system of important facilities in smart grid based on eight typical natural disasters, including three levels of static and dynamic indicators, totally forty indicators. Then a smart grid vulnerability evaluation method was proposed based on the index system, including determining the value range of each index, classifying the evaluation grade standard and giving the evaluation process and integrated index calculation rules. Using the proposed evaluation model, it can identify the most vulnerable parts of smart grid, and then help adopting targeted emergency response measures, developing emergency plans and increasing its capacity of disaster prevention and mitigation, which guarantee its safe and stable operation.

Tracking implementation and (un)intended consequences: a process evaluation of an innovative peripheral health facility financing mechanism in Kenya.

PubMed

Waweru, Evelyn; Goodman, Catherine; Kedenge, Sarah; Tsofa, Benjamin; Molyneux, Sassy

2016-03-01

In many African countries, user fees have failed to achieve intended access and quality of care improvements. Subsequent user fee reduction or elimination policies have often been poorly planned, without alternative sources of income for facilities. We describe early implementation of an innovative national health financing intervention in Kenya; the health sector services fund (HSSF). In HSSF, central funds are credited directly into a facility's bank account quarterly, and facility funds are managed by health facility management committees (HFMCs) including community representatives. HSSF is therefore a finance mechanism with potential to increase access to funds for peripheral facilities, support user fee reduction and improve equity in access. We conducted a process evaluation of HSSF implementation based on a theory of change underpinning the intervention. Methods included interviews at national, district and facility levels, facility record reviews, a structured exit survey and a document review. We found impressive achievements: HSSF funds were reaching facilities; funds were being overseen and used in a way that strengthened transparency and community involvement; and health workers' motivation and patient satisfaction improved. Challenges or unintended outcomes included: complex and centralized accounting requirements undermining efficiency; interactions between HSSF and user fees leading to difficulties in accessing crucial user fee funds; and some relationship problems between key players. Although user fees charged had not increased, national reduction policies were still not being adhered to. Finance mechanisms can have a strong positive impact on peripheral facilities, and HFMCs can play a valuable role in managing facilities. Although fiduciary oversight is essential, mechanisms should allow for local decision-making and ensure that unmanageable paperwork is avoided. There are also limits to what can be achieved with relatively small funds in contexts of enormous need. Process evaluations tracking (un)intended consequences of interventions can contribute to regional financing and decentralization debates. © The Author 2015. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

A technique for synergistic atomic oxygen and vacuum ultraviolet radiation durability evaluation of materials for use in LEO

NASA Technical Reports Server (NTRS)

Rutledge, Sharon K.; Banks, Bruce A.

1996-01-01

Material erosion data collected during flight experiments such as the Environmental Oxygen Interaction with Materials (EOIM)-3 and the Long Duration Exposure Facility (LDEF) have raised questions as to the sensitivity of material erosion to levels of atomic oxygen exposure and vacuum ultraviolet (VUV) radiation. The erosion sensitivity of some materials such as FEP Teflon used as a thermal control material on satellites in low Earth orbit (LEO), is particularly important but difficult to determine. This is in large part due to the inability to hold all but one exposure parameter constant during a flight experiment. This is also difficult to perform in a ground based facility, because often the variation of the level of atomic oxygen or VUV radiation also results in a change in the level of the other parameter. A facility has been developed which allows each parameter to be changed almost independently and offer broad area exposure. The resulting samples can be made large enough for mechanical testing. The facility uses an electron cyclotron resonance plasma source to provide the atomic oxygen. A series of glass plates is used to focus the atomic oxygen while filtering the VUV radiation from the plasma source. After filtering, atomic oxygen effective flux levels can still be measured which are as high as 7 x 10(exp 15) atoms/cm(exp 2)-sec which is adequate for accelerated testing. VUV radiation levels after filtering can be as low as 0.3 suns. Additional VUV suns can be added with the use of deuterium lamps which allow the VUV level to be changed while keeping the flux of atomic oxygen constant. This paper discusses the facility, and results from exposure of Kapton and FEP at pre-determined atomic oxygen flux and VUV sun levels.

Validation of cleaning method for various parts fabricated at a Beryllium facility

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

Davis, Cynthia M.

This study evaluated and documented a cleaning process that is used to clean parts that are fabricated at a beryllium facility at Los Alamos National Laboratory. The purpose of evaluating this cleaning process was to validate and approve it for future use to assure beryllium surface levels are below the Department of Energy’s release limits without the need to sample all parts leaving the facility. Inhaling or coming in contact with beryllium can cause an immune response that can result in an individual becoming sensitized to beryllium, which can then lead to a disease of the lungs called chronic berylliummore » disease, and possibly lung cancer. Thirty aluminum and thirty stainless steel parts were fabricated on a lathe in the beryllium facility, as well as thirty-two beryllium parts, for the purpose of testing a parts cleaning method that involved the use of ultrasonic cleaners. A cleaning method was created, documented, validated, and approved, to reduce beryllium contamination.« less

Earthquakes and building design: a primer for the laboratory animal professional.

PubMed

Vogelweid, Catherine M; Hill, James B; Shea, Robert A; Johnson, Daniel B

2005-01-01

Earthquakes can occur in most regions of the United States, so it might be necessary to reinforce vulnerable animal facilities to better protect research animals during these unpredictable events. A risk analysis should include an evaluation of the seismic hazard risk at the proposed building site balanced against the estimated consequences of losses. Risk analysis can help in better justifying and recommending to building owners the costs of incorporating additional seismic reinforcements. The planning team needs to specify the level of post-earthquake building function that is desired in the facility, and then design the facility to it.

Walk-through survey report: Control technology for integrated circuit fabrication, Xerox Corporation, El Segundo, California

NASA Astrophysics Data System (ADS)

Mihlan, G. J.; Ungers, L. J.; Smith, R. K.; Mitchell, R. I.; Jones, J. H.

1983-05-01

A preliminary control technology assessment survey was conducted at the facility which manufactures N-channel metal oxide semiconductor (NMOS) integrated circuits. The facility has industrial hygiene review procedures for evaluating all new and existing process equipment. Employees are trained in safety, use of personal protective equipment, and emergency response. Workers potentially exposed to arsenic are monitored for urinary arsenic levels. The facility should be considered a candidate for detailed study based on the diversity of process operations encountered and the use of state-of-the-art technology and process equipment.

The Diesel Exhaust in Miners Study: II. Exposure monitoring surveys and development of exposure groups.

PubMed

Coble, Joseph B; Stewart, Patricia A; Vermeulen, Roel; Yereb, Daniel; Stanevich, Rebecca; Blair, Aaron; Silverman, Debra T; Attfield, Michael

2010-10-01

Air monitoring surveys were conducted between 1998 and 2001 at seven non-metal mining facilities to assess exposure to respirable elemental carbon (REC), a component of diesel exhaust (DE), for an epidemiologic study of miners exposed to DE. Personal exposure measurements were taken on workers in a cross-section of jobs located underground and on the surface. Air samples taken to measure REC were also analyzed for respirable organic carbon (ROC). Concurrent measurements to assess exposure to nitric oxide (NO) and nitrogen dioxide (NO₂), two gaseous components of DE, were also taken. The REC measurements were used to develop quantitative estimates of average exposure levels by facility, department, and job title for the epidemiologic analysis. Each underground job was assigned to one of three sets of exposure groups from specific to general: (i) standardized job titles, (ii) groups of standardized job titles combined based on the percentage of time in the major underground areas, and (iii) larger groups based on similar area carbon monoxide (CO) air concentrations. Surface jobs were categorized based on their use of diesel equipment and proximity to DE. A total of 779 full-shift personal measurements were taken underground. The average REC exposure levels for underground jobs with five or more measurements ranged from 31 to 58 μg m⁻³ at the facility with the lowest average exposure levels and from 313 to 488 μg m⁻³ at the facility with the highest average exposure levels. The average REC exposure levels for surface workers ranged from 2 to 6 μg m⁻³ across the seven facilities. There was much less contrast in the ROC compared with REC exposure levels measured between surface and underground workers within each facility, as well as across the facilities. The average ROC levels underground ranged from 64 to 195 μg m⁻³, while on the surface, the average ROC levels ranged from 38 to 71 μg m⁻³ by facility, an ∼2- to 3-fold difference. The average NO and NO₂ levels underground ranged from 0.20 to 1.49 parts per million (ppm) and from 0.10 to 0.60 ppm, respectively, and were ∼10 times higher than levels on the surface, which ranged from 0.02 to 0.11 ppm and from 0.01 to 0.06 ppm, respectively. The ROC, NO, and NO₂ concentrations underground were correlated with the REC levels (r = 0.62, 0.71, and 0.62, respectively). A total of 80% of the underground jobs were assigned an exposure estimate based on measurements taken for the specific job title or for other jobs with a similar percentage of time spent in the major underground work areas. The average REC exposure levels by facility were from 15 to 64 times higher underground than on the surface. The large contrast in exposure levels measured underground versus on the surface, along with the differences between the mining facilities and between underground jobs within the facilities resulted in a wide distribution in the exposure estimates for evaluation of exposure-response relationships in the epidemiologic analyses.

The Diesel Exhaust in Miners Study: II. Exposure Monitoring Surveys and Development of Exposure Groups

PubMed Central

Coble, Joseph B.; Stewart, Patricia A.; Vermeulen, Roel; Yereb, Daniel; Stanevich, Rebecca; Blair, Aaron; Silverman, Debra T.; Attfield, Michael

2010-01-01

Air monitoring surveys were conducted between 1998 and 2001 at seven non-metal mining facilities to assess exposure to respirable elemental carbon (REC), a component of diesel exhaust (DE), for an epidemiologic study of miners exposed to DE. Personal exposure measurements were taken on workers in a cross-section of jobs located underground and on the surface. Air samples taken to measure REC were also analyzed for respirable organic carbon (ROC). Concurrent measurements to assess exposure to nitric oxide (NO) and nitrogen dioxide (NO2), two gaseous components of DE, were also taken. The REC measurements were used to develop quantitative estimates of average exposure levels by facility, department, and job title for the epidemiologic analysis. Each underground job was assigned to one of three sets of exposure groups from specific to general: (i) standardized job titles, (ii) groups of standardized job titles combined based on the percentage of time in the major underground areas, and (iii) larger groups based on similar area carbon monoxide (CO) air concentrations. Surface jobs were categorized based on their use of diesel equipment and proximity to DE. A total of 779 full-shift personal measurements were taken underground. The average REC exposure levels for underground jobs with five or more measurements ranged from 31 to 58 μg m−3 at the facility with the lowest average exposure levels and from 313 to 488 μg m−3 at the facility with the highest average exposure levels. The average REC exposure levels for surface workers ranged from 2 to 6 μg m−3 across the seven facilities. There was much less contrast in the ROC compared with REC exposure levels measured between surface and underground workers within each facility, as well as across the facilities. The average ROC levels underground ranged from 64 to 195 μg m−3, while on the surface, the average ROC levels ranged from 38 to 71 μg m−3 by facility, an ∼2- to 3-fold difference. The average NO and NO2 levels underground ranged from 0.20 to 1.49 parts per million (ppm) and from 0.10 to 0.60 ppm, respectively, and were ∼10 times higher than levels on the surface, which ranged from 0.02 to 0.11 ppm and from 0.01 to 0.06 ppm, respectively. The ROC, NO, and NO2 concentrations underground were correlated with the REC levels (r = 0.62, 0.71, and 0.62, respectively). A total of 80% of the underground jobs were assigned an exposure estimate based on measurements taken for the specific job title or for other jobs with a similar percentage of time spent in the major underground work areas. The average REC exposure levels by facility were from 15 to 64 times higher underground than on the surface. The large contrast in exposure levels measured underground versus on the surface, along with the differences between the mining facilities and between underground jobs within the facilities resulted in a wide distribution in the exposure estimates for evaluation of exposure–response relationships in the epidemiologic analyses. PMID:20876232

Preliminary assessment of the aquatic impacts of a proposed defense waste processing facility at the Savannah River Plant

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

Mackey, H.E. Jr.

1979-01-01

A review of the literature indicates that a significant body of descriptive information exists concerning the aquatic ecology of Upper Three Runs Creek and Four Mile Creek of the Savannah River Plant south of Aiken, South Carolina. This information is adequate for preparation of an environmental document evaluating these streams. These streams will be impacted by construction and operation of a proposed Defense Waste Processing Facility for solidification of high level defense waste. Potential impacts include (1) construction runoff, erosion, and siltation, (2) effluents from a chemical and industrial waste treatment facility, and (3) radionuclide releases. In order to bettermore » evaluate potential impacts, recommend mitigation methods, and comply with NEPA requirements, additional quantitative biological information should be obtained through implementation of an aquatic baseline program.« less

Patient satisfaction with the service at Menopause Clinic, Maharaj Nakorn Chiang Mai Hospital.

PubMed

Chaovisitsaree, Somsak; Sribanditmongkol, Narisa; Chandrawongse, Waraporn; Noi-um, Supranee; Sangchun, Kullaya

2010-09-01

To evaluate patient satisfaction of service at the Menopause Clinic and to identify factors affecting patient satisfaction. Cross sectional descriptive study was conducted at the Menopause Clinic, Maharaj Nakorn Chiang Mai hospital. Three hundred twenty six subjects were included. The questionnaire consists of two parts, demographic and patient satisfaction. The patient satisfaction was evaluated in five aspects. The overall patient satisfaction level was good (mean 4.2 +/- 0.71). The satisfactions about service behavior quality of care and health information were in excellent level (mean 4.29 +/- 0.69, 4.25 +/- 0.65, and 4.26 +/- 0.69, respectively). The satisfaction about clinic facilities/conveniences and medical expense were in good level (mean 3.83 +/- 0.79 and 3.87 +/- 0.75). There are three variables that could affect patient satisfaction: Occupation and level of education affected satisfaction in medical expense aspect (p < 0.001 and p < 0.05) and number of visits affected the clinic facilities/convenience aspect (p < 0.05). Some patient characteristics affected the patient satisfaction. However, system and structure of service in different setting hospitals are of concerned.

Drive-train dynamics technology - State-of-the-art and design of a test facility for advanced development

NASA Technical Reports Server (NTRS)

Badgley, R. H.; Fleming, D. P.; Smalley, A. J.

1975-01-01

A program for the development and verification of drive-train dynamic technology is described along with its basis and the results expected from it. A central feature of this program is a drive-train test facility designed for the testing and development of advanced drive-train components, including shaft systems, dampers, and couplings. Previous efforts in designing flexible dynamic drive-train systems are reviewed, and the present state of the art is briefly summarized. The design of the test facility is discussed with major attention given to the formulation of the test-rig concept, dynamic scaling of model shafts, and the specification of design parameters. Specific efforts envisioned for the test facility are briefly noted, including evaluations of supercritical test shafts, stability thresholds for various sources and types of instabilities that can exist in shaft systems, effects of structural flexibility on the dynamic performance of dampers, and methods for vibration control in two-level and three-level flexible shaft systems.

Use of personal protective equipment for respiratory protection.

PubMed

Sargent, Edward V; Gallo, Frank

2003-01-01

Management of hazards in biomedical research facilities requires the application of the traditional industrial hygiene responsibilities of anticipation, recognition, evaluation, and control to characterize the work environment, evaluate tasks and equipment, identify hazards, define exposure groups, and recommend controls. Generally, the diversity and unique characteristics of hazards faced by laboratory and animal facility employees and the short-term and low-level nature of the exposures factor into the selection of proper exposure control measures in the laboratory. The proper selection of control measures is based on a hierarchy of elimination and minimization by engineering controls, followed last by personal protective equipment when exposures cannot be eliminated. Once it is decided that personal protective equipment is needed, specific regulations and guidelines define safety standards for research facilities, including the elements of a sound respiratory protection program. These elements include respirator selection (including appropriate protection factors), medical evaluation, fit testing, training, inspection, maintenance and care, quality, quantity and flow of breathing air, and routine and emergency use procedures.

Determinants of routine immunization costing in Benin and Ghana in 2011.

PubMed

Ahanhanzo, Césaire Damien; Huang, Xiao Xian; Le Gargasson, Jean-Bernard; Sossou, Justin; Nyonator, Frank; Colombini, Anais; Gessner, Bradford D

2015-05-07

Existing tools to evaluate costs do not always capture the heterogeneity of costs at the facility level. This study seeks to address this issue through an analysis of determinants of health facility immunization costs. A statistical analysis on facility routine delivery and vaccine costs was conducted using ordinary least squares regression. Explanatory variables included the number of doses administered; proportion of time spent by facility staff on immunization; average staff wage; whether the health facility had enough staff; presence of cold chain equipment; distance to a vaccine collection point; and, facility ownership. Data were drawn from representative samples of primary care facilities in Benin and Ghana (46 and 50 facilities, respectively) collected as part of the EPIC studies. Weighted average RI immunization facility cost was US$ 16,459 in Ghana and US$ 14,994 in Benin. The regression found total doses administered to be positively and significantly associated with facility cost in both countries. A 10% increase in doses resulted in a 4% increase in cost in Ghana, and a 7.5% increase in Benin. In Ghana, the proportion of immunization time, presence of cold chain, and sufficiency of staff were positively and significantly associated with total cost. In Benin, facility cost was negatively and significantly related to distance to the vaccine collection point. In the pooled sample, facilities in capital cities were associated with significantly higher costs. This study provides evidence on the importance of the level of scale in determining facility immunization cost, as well as the role of availability of health workers and time they spend on immunization in Ghana and Benin. This type of analysis can provide insights into the costs of scaling up immunization services, and can assist with development of more efficient immunization strategies. Copyright © 2015 Elsevier Ltd. All rights reserved.

Individual and School-Level Socioeconomic Gradients in Physical Activity in Australian Schoolchildren.

PubMed

Lewis, Lucy; Maher, Carol; Katzmarzyk, Peter; Olds, Timothy

2016-02-01

We attempted to determine whether there was a socioeconomic gradient in 9- to 11-year-old Australian children's moderate-to-vigorous physical activity (MVPA), and whether school facilities or policies supporting physical activity were associated with school-level socioeconomic status (SES) and MVPA. Children (N = 528) from 26 randomly selected schools participated in the International Study of Childhood Obesity, Lifestyle and the Environment. School-level SES was determined by the Index of Community Socio-Educational Advantage. MVPA was determined from 7-day, 24-hour accelerometry. School facilities (21 items) were evaluated with an objective school ground audit. School policies related to physical activity were collected (18 items) in a school administrator survey. Relationships among SES, MVPA, school facilities, and policies were examined using bivariate regression, correlation analyses, and analysis of variance. There was a clear SES gradient in daily and in-school MVPA. School facilities or physical activity policies were not associated with SES or in-school MVPA, with the exception of presence of a sports field which was associated with lower SES schools (p = .02) and lower in-school MVPA (p = .001). School-built, policy, and resource environments are similar across different SES-level schools. Therefore, some other mechanism must be underlying the SES gradients seen in MVPA participation in Australian children. © 2016, American School Health Association.

Tracking implementation and (un)intended consequences: a process evaluation of an innovative peripheral health facility financing mechanism in Kenya

PubMed Central

Waweru, Evelyn; Goodman, Catherine; Kedenge, Sarah; Tsofa, Benjamin; Molyneux, Sassy

2016-01-01

In many African countries, user fees have failed to achieve intended access and quality of care improvements. Subsequent user fee reduction or elimination policies have often been poorly planned, without alternative sources of income for facilities. We describe early implementation of an innovative national health financing intervention in Kenya; the health sector services fund (HSSF). In HSSF, central funds are credited directly into a facility’s bank account quarterly, and facility funds are managed by health facility management committees (HFMCs) including community representatives. HSSF is therefore a finance mechanism with potential to increase access to funds for peripheral facilities, support user fee reduction and improve equity in access. We conducted a process evaluation of HSSF implementation based on a theory of change underpinning the intervention. Methods included interviews at national, district and facility levels, facility record reviews, a structured exit survey and a document review. We found impressive achievements: HSSF funds were reaching facilities; funds were being overseen and used in a way that strengthened transparency and community involvement; and health workers’ motivation and patient satisfaction improved. Challenges or unintended outcomes included: complex and centralized accounting requirements undermining efficiency; interactions between HSSF and user fees leading to difficulties in accessing crucial user fee funds; and some relationship problems between key players. Although user fees charged had not increased, national reduction policies were still not being adhered to. Finance mechanisms can have a strong positive impact on peripheral facilities, and HFMCs can play a valuable role in managing facilities. Although fiduciary oversight is essential, mechanisms should allow for local decision-making and ensure that unmanageable paperwork is avoided. There are also limits to what can be achieved with relatively small funds in contexts of enormous need. Process evaluations tracking (un)intended consequences of interventions can contribute to regional financing and decentralization debates. PMID:25920355

Evaluation of the long-term performance of six alternative disposal methods for LLRW

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

Kossik, R.; Sharp, G.; Chau, T.

1995-12-31

The State of New York has carried out a comparison of six alternative disposal methods for low-level radioactive waste (LLRW). An important part of these evaluations involved quantitatively analyzing the long-term (10,000 yr) performance of the methods with respect to dose to humans, radionuclide concentrations in the environment, and cumulative release from the facility. Four near-surface methods (covered above-grade vault, uncovered above-grade vault, below-grade vault, augered holes) and two mine methods (vertical shaft mine and drift mine) were evaluated. Each method was analyzed for several generic site conditions applicable for the state. The evaluations were carried out using RIP (Repositorymore » Integration Program), an integrated, total system performance assessment computer code which has been applied to radioactive waste disposal facilities both in the U.S. (Yucca Mountain, WIPP) and worldwide. The evaluations indicate that mines in intact low-permeability rock and near-surface facilities with engineered covers generally have a high potential to perform well (within regulatory limits). Uncovered above-grade vaults and mines in highly fractured crystalline rock, however, have a high potential to perform poorly, exceeding regulatory limits.« less

Apollo experience report: Electronic systems test program accomplishments and results

NASA Technical Reports Server (NTRS)

Ohnesorge, T. E.

1972-01-01

A chronological record is presented of the Electronic Systems Test Program from its conception in May 1963 to December 1969. The original concept of the program, which was primarily a spacecraft/Manned Space Flight Network communications system compatibility and performance evaluation, is described. The evolution of these concepts to include various levels of test detail, as well as systems level design verification testing, is discussed. Actual implementation of these concepts is presented, and the facility to support the program is described. Test results are given, and significant contributions to the lunar landing mission are underlined. Plans for modifying the facility and the concepts, based on Apollo experience, are proposed.

Expanded Quality Management Using Information Power (EQUIP): protocol for a quasi-experimental study to improve maternal and newborn health in Tanzania and Uganda

PubMed Central

2014-01-01

Background Maternal and newborn mortality remain unacceptably high in sub-Saharan Africa. Tanzania and Uganda are committed to reduce maternal and newborn mortality, but progress has been limited and many essential interventions are unavailable in primary and referral facilities. Quality management has the potential to overcome low implementation levels by assisting teams of health workers and others finding local solutions to problems in delivering quality care and the underutilization of health services by the community. Existing evidence of the effect of quality management on health worker performance in these contexts has important limitations, and the feasibility of expanding quality management to the community level is unknown. We aim to assess quality management at the district, facility, and community levels, supported by information from high-quality, continuous surveys, and report effects of the quality management intervention on the utilization and quality of services in Tanzania and Uganda. Methods In Uganda and Tanzania, the Expanded Quality Management Using Information Power (EQUIP) intervention is implemented in one intervention district and evaluated using a plausibility design with one non-randomly selected comparison district. The quality management approach is based on the collaborative model for improvement, in which groups of quality improvement teams test new implementation strategies (change ideas) and periodically meet to share results and identify the best strategies. The teams use locally-generated community and health facility data to monitor improvements. In addition, data from continuous health facility and household surveys are used to guide prioritization and decision making by quality improvement teams as well as for evaluation of the intervention. These data include input, process, output, coverage, implementation practice, and client satisfaction indicators in both intervention and comparison districts. Thus, intervention districts receive quality management and continuous surveys, and comparison districts-only continuous surveys. Discussion EQUIP is a district-scale, proof-of-concept study that evaluates a quality management approach for maternal and newborn health including communities, health facilities, and district health managers, supported by high-quality data from independent continuous household and health facility surveys. The study will generate robust evidence about the effectiveness of quality management and will inform future nationwide implementation approaches for health system strengthening in low-resource settings. Trial registration PACTR201311000681314 PMID:24690284

Expanded Quality Management Using Information Power (EQUIP): protocol for a quasi-experimental study to improve maternal and newborn health in Tanzania and Uganda.

PubMed

Hanson, Claudia; Waiswa, Peter; Marchant, Tanya; Marx, Michael; Manzi, Fatuma; Mbaruku, Godfrey; Rowe, Alex; Tomson, Göran; Schellenberg, Joanna; Peterson, Stefan

2014-04-02

Maternal and newborn mortality remain unacceptably high in sub-Saharan Africa. Tanzania and Uganda are committed to reduce maternal and newborn mortality, but progress has been limited and many essential interventions are unavailable in primary and referral facilities. Quality management has the potential to overcome low implementation levels by assisting teams of health workers and others finding local solutions to problems in delivering quality care and the underutilization of health services by the community. Existing evidence of the effect of quality management on health worker performance in these contexts has important limitations, and the feasibility of expanding quality management to the community level is unknown. We aim to assess quality management at the district, facility, and community levels, supported by information from high-quality, continuous surveys, and report effects of the quality management intervention on the utilization and quality of services in Tanzania and Uganda. In Uganda and Tanzania, the Expanded Quality Management Using Information Power (EQUIP) intervention is implemented in one intervention district and evaluated using a plausibility design with one non-randomly selected comparison district. The quality management approach is based on the collaborative model for improvement, in which groups of quality improvement teams test new implementation strategies (change ideas) and periodically meet to share results and identify the best strategies. The teams use locally-generated community and health facility data to monitor improvements. In addition, data from continuous health facility and household surveys are used to guide prioritization and decision making by quality improvement teams as well as for evaluation of the intervention. These data include input, process, output, coverage, implementation practice, and client satisfaction indicators in both intervention and comparison districts. Thus, intervention districts receive quality management and continuous surveys, and comparison districts-only continuous surveys. EQUIP is a district-scale, proof-of-concept study that evaluates a quality management approach for maternal and newborn health including communities, health facilities, and district health managers, supported by high-quality data from independent continuous household and health facility surveys. The study will generate robust evidence about the effectiveness of quality management and will inform future nationwide implementation approaches for health system strengthening in low-resource settings. PACTR201311000681314.

Exposure pathway evaluations for sites that processed asbestos-contaminated vermiculite.

PubMed

Anderson, Barbara A; Dearwent, Steve M; Durant, James T; Dyken, Jill J; Freed, Jennifer A; Moore, Susan McAfee; Wheeler, John S

2005-01-01

The Agency for Toxic Substances and Disease Registry (ATSDR) is currently evaluating the potential public health impacts associated with the processing of asbestos-contaminated vermiculite at various facilities around the country. Vermiculite ore contaminated with significant levels of asbestos was mined and milled in Libby, Montana, from the early 1920s until 1990. The majority of the Libby ore was then shipped to processing facilities for exfoliation. ATSDR initiated the National Asbestos Exposure Review (NAER) to identify and evaluate exposure pathways associated with these processing facilities. This manuscript details ATSDR's phased approach in addressing exposure potential around these sites. As this is an ongoing project, only the results from a selected set of completed site analyses are presented. Historical occupational exposures are the most significant exposure pathway for the site evaluations completed to date. Former workers also probably brought asbestos fibers home on their clothing, shoes, and hair, and their household contacts may have been exposed. Currently, most site-related worker and community exposure pathways have been eliminated. One community exposure pathway of indeterminate significance is the current exposure of individuals through direct contact with waste rock brought home for personal use as fill material, driveway surfacing, or soil amendment. Trace levels of asbestos are present in soil at many of the sites and buried waste rock has been discovered at a few sites; therefore, future worker and community exposure associated with disturbing on-site soil during construction or redevelopment at these sites is also a potential exposure pathway.

An Evaluation of Air Force Food Service Operations at Travis Air Force Base

DTIC Science & Technology

1974-06-01

food service system as represented by food service operations...was base level feeding requirements, excluding non-appropriated fund food service activities, hospital dining facilities and patient feeding, and...inflight food service . Following completion of these studies, proposed solutions to the problems were actually implemented and evaluated in a food service experiment at Travis

Filter Leaf. Operational Control Tests for Wastewater Treatment Facilities. Instructor's Manual [and] Student Workbook.

ERIC Educational Resources Information Center

Wooley, John F.

In the operation of vacuum filters and belt filters, it is desirable to evaluate the performance of different types of filter media and conditioning processes. The filter leaf test, which is used to evaluate these items, is described. Designed for individuals who have completed National Pollutant Discharge Elimination System (NPDES) level 1…

Evaluating the Impact of Sea Level Rise and Coastal Flooding on NASA Centers and Facilities by Implementing Terrestrial Laser Scanning Surveys to Improve Coastal Digital Elevation and Inundation Models

NASA Astrophysics Data System (ADS)

Bell, L. J.; Nerem, R. S.; Williams, K.; Meertens, C.; Lestak, L.; Masters, D.

2014-12-01

Sea level is rising in response to climate change. Currently the global mean rate is a little over 3 mm/year, but it is expected to accelerate significantly over this century. This will have a profound impact on coastal populations and infrastructure, including NASA centers and facilities. A detailed study proposed by the University of Colorado's Center for Astrodynamics Research on the impact of sea level rise on several of NASA's most vulnerable facilities was recently funded by NASA. Individual surveys at several high-risk NASA centers were conducted and used as case studies for a broader investigation that needs to be done for coastal infrastructure around the country. The first two years of this study included implementing and conducting a terrestrial laser scanning (TLS) and GPS survey at Kennedy Space Center, Cape Canaveral, Florida, Wallops Flight Facility, Wallops Island, Virginia, Langley Research Center, Hampton, Virginia, and Ames Research Center, Moffett Field, California. We are currently using airborne LiDAR (Light Detection and Ranging) data and TLS (Terrestrial Laser Scanning) data to construct detailed digital elevation models (DEMs) of the facilities that we have assessed. The TLS data acquired at each center provides a very dense point cloud that is being used to improve the detail and accuracy of the digital elevation models currently available. We are also using GPS data we acquired at each center to assess the rate of vertical land movement at the facilities and to tie the DEM to tide gauges and other reference points. With completed, detailed DEMs of the topography and facilities at each center, a series of simple inundation models will then be applied to each area. We will use satellite altimeter data from TOPEX, Jason-1, and Jason-2 to assess the sea level changes observed near these NASA facilities over the last 20 years along with sea level projections from global climate models (GCMs) and semi-empirical projections to make detailed maps of sea level inundation through and up to the years 2050 and 2100 for varying amounts of sea level rise. We will also work with other selected investigators to assess the effects of tidal variations and storm surge when coupled with changes in mean sea level, as storm surge is likely when initial damage due to sea level rise will occur.

Low levels of exposure to libby amphibole asbestos and localized pleural thickening.

PubMed

Christensen, Krista Yorita; Bateson, Thomas F; Kopylev, Leonid

2013-11-01

To explore the relationship between low levels of exposure to Libby amphibole asbestos (LAA) and pleural abnormalities, specifically localized pleural thickening (LPT). Three studies presenting the risks associated with quantitative LAA exposure estimates were reviewed, paying particular attention to lower exposure ranges. Studies reviewed were conducted among workers exposed to LAA at mining and milling operations in Libby, Montana, at a vermiculite processing facility in Marysville, Ohio, and community residents exposed to LAA from a vermiculite processing facility in Minneapolis, Minnesota. Pleural abnormalities were evaluated using radiographs. Despite differences in study populations and design, each study found that cumulative inhalation LAA exposure was associated with increased risk of LPT even at low levels of exposure. Inhalation exposure to LAA is associated with increased risk of LPT even at the lowest levels of exposure in each study.

Technical basis, supporting information, and strategy for development and implementation of DOE policy for natural phenomena hazards

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

Murray, R.C.

1991-09-01

Policy for addressing natural phenomenon comprises a hierarchy of interrelated documents. The top level of policy is contained in the code of Federal Regulations which establishes the framework and intent to ensure overall safety of DOE facilities when subjected to the effects of natural phenomena. The natural phenomena to be considered include earthquakes and tsunami, winds, hurricanes and tornadoes, floods, volcano effects and seiches. Natural phenomena criteria have been established for design of new facilities; evaluation of existing facilities; additions, modifications, and upgrades to existing facilities; and evaluation criteria for new or existing sites. Steps needed to implement these fourmore » general criteria are described. The intent of these criteria is to identify WHAT needs to be done to ensure adequate protection from natural phenomena. The commentary provides discussion of WHY this is needed for DOE facilities within the complex. Implementing procedures identifying HOW to carry out these criteria are next identified. Finally, short and long term tasks needed to identify the implementing procedure are tabulated. There is an overall need for consistency throughout the DOE complex related to natural phenomena including consistent terminology, policy, and implementation. 1 fig, 6 tabs.« less

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 bicycle safety index for evaluating urban street facilities.

PubMed

Asadi-Shekari, Zohreh; Moeinaddini, Mehdi; Zaly Shah, Muhammad

2015-01-01

The objectives of this research are to conceptualize the Bicycle Safety Index (BSI) that considers all parts of the street and to propose a universal guideline with microscale details. A point system method comparing existing safety facilities to a defined standard is proposed to estimate the BSI. Two streets in Singapore and Malaysia are chosen to examine this model. The majority of previous measurements to evaluate street conditions for cyclists usually cannot cover all parts of streets, including segments and intersections. Previous models also did not consider all safety indicators and cycling facilities at a microlevel in particular. This study introduces a new concept of a practical BSI to complete previous studies using its practical, easy-to-follow, point system-based outputs. This practical model can be used in different urban settings to estimate the level of safety for cycling and suggest some improvements based on the standards.

Survey of Emergency and Essential Surgical, Obstetric and Anaesthetic Services Available in Bangladeshi Government Health Facilities.

PubMed

Loveday, Jonathan; Sachdev, Sonal P; Cherian, Meena N; Katayama, Francisco; Akhtaruzzaman, A K M; Thomas, Joe; Huda, N; Faragher, E Brian; Johnson, Walter D

2017-07-01

Evaluate the capacity of government-run hospitals in Bangladesh to provide emergency and essential surgical, obstetric and anaesthetic services. Cross-sectional survey of 240 Bangladeshi Government healthcare facilities using the World Health Organisation Situational Analysis Tool to Assess Emergency and Essential Surgical Care (SAT). This tool evaluates the ability of a healthcare facility to provide basic surgical, obstetric and anaesthetic care based on 108 queries that detail the infrastructure and population demographics, human resources, surgical interventions and reason for referral, and available surgical equipment and supplies. For this survey, the Bangladeshi Ministry of Health sent the SAT to sub-district, district/general and teaching hospitals throughout the country in April 2013. Responses were received from 240 healthcare facilities (49.5% response rate): 218 sub-district and 22 district/general hospitals. At the sub-district level, caesarean section was offered by 55% of facilities, laparotomy by 7% and open fracture repair by 8%. At the district/general hospital level, 95% offered caesarean section, 86% offered laparotomy and 77% offered open fracture treatment. Availability of anaesthesia services, general equipment and supplies reflected this trend, where district/general hospitals were better equipped than sub-district hospitals, though equipment and infrastructure shortages persist. There has been overall impressive progress by the Bangladeshi Government in providing essential surgical services. Areas for improvement remain across all key areas, including infrastructure, human resources, surgical interventions offered and available equipment. Investment in surgical services offers a cost-effective opportunity to continue to improve the health of the Bangladeshi population and move the country towards universal healthcare coverage.

Implications of Intermodal Freight Movements for Infrastructure Access, Capacity, and Productivity

DOT National Transportation Integrated Search

1996-03-31

This report evaluates the status of intermodal freight in the U.S. with reference to infrastructure access problems such as inadequate highway connectors and facility clearance, and terminal capacity constraints affecting levels of service. Though th...

Voluntary medical male circumcision scale-up in Nyanza, Kenya: evaluating technical efficiency and productivity of service delivery.

PubMed

Omondi Aduda, Dickens S; Ouma, Collins; Onyango, Rosebella; Onyango, Mathews; Bertrand, Jane

2015-01-01

Voluntary medical male circumcision (VMMC) service delivery is complex and resource-intensive. In Kenya's context there is still paucity of information on resource use vis-à-vis outputs as programs scale up. Knowledge of technical efficiency, productivity and potential sources of constraints is desirable to improve decision-making. To evaluate technical efficiency and productivity of VMMC service delivery in Nyanza in 2011/2012 using data envelopment analysis. Comparative process evaluation of facilities providing VMMC in Nyanza in 2011/2012 using output orientated data envelopment analysis. Twenty one facilities were evaluated. Only 1 of 7 variables considered (total elapsed operation time) significantly improved from 32.8 minutes (SD 8.8) in 2011 to 30 minutes (SD 6.6) in 2012 (95%CI = 0.0350-5.2488; p = 0.047). Mean scale technical efficiency significantly improved from 91% (SD 19.8) in 2011 to 99% (SD 4.0) in 2012 particularly among outreach compared to fixed service delivery facilities (CI -31.47959-4.698508; p = 0.005). Increase in mean VRS technical efficiency from 84% (SD 25.3) in 2011 and 89% (SD 25.1) in 2012 was not statistically significant. Benchmark facilities were #119 and #125 in 2011 and #103 in 2012. Malmquist Productivity Index (MPI) at fixed facilities declined by 2.5% but gained by 4.9% at outreach ones by 2012. Total factor productivity improved by 83% (p = 0.032) in 2012, largely due to progress in technological efficiency by 79% (p = 0.008). Significant improvement in scale technical efficiency among outreach facilities in 2012 was attributable to accelerated activities. However, ongoing pure technical inefficiency requires concerted attention. Technological progress was the key driver of service productivity growth in Nyanza. Incorporating service-quality dimensions and using stepwise-multiple criteria in performance evaluation enhances comprehensiveness and validity. These findings highlight site-level resource use and sources of variations in VMMC service productivity, which are important for program planning.

Final work plan : investigation of potential contamination at the former CCC/USDA grain storage facility in Hanover, Kansas.

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

LaFreniere, L. M.; Environmental Science Division

The Commodity Credit Corporation (CCC), an agency of the U.S. Department of Agriculture (USDA), operated a grain storage facility at the northeastern edge of the city of Hanover, Kansas, from 1950 until the early 1970s. During this time, commercial grain fumigants containing carbon tetrachloride were in common use by the grain storage industry to preserve grain in their facilities. In February 1998, trace to low levels of carbon tetrachloride (below the maximum contaminant level [MCL] of 5.0 {micro}g/L) were detected in two private wells near the former grain storage facility at Hanover, as part of a statewide USDA private wellmore » sampling program that was implemented by the Kansas Department of Health and Environment (KDHE) near former CCC/USDA facilities. In April 2007, the CCC/USDA collected near-surface soil samples at 1.8-2 ft BGL (below ground level) at 61 locations across the former CCC/USDA facility. All soil samples were analyzed by the rigorous gas chromatograph-mass spectrometer analytical method (purge-and-trap method). No contamination was found in soil samples above the reporting limit of 10 {micro}g/kg. In July 2007, the CCC/USDA sampled indoor air at nine residences on or adjacent to its former facility to address the residents concerns regarding vapor intrusion. Low levels of carbon tetrachloride were detected at four of the nine homes. Because carbon tetrachloride found in private wells and indoor air at the site might be linked to historical use of fumigants containing carbon tetrachloride at its former grain storage facility, the CCC/USDA is proposing to conduct an investigation to determine the source and extent of the carbon tetrachloride contamination associated with the former facility. This investigation will be conducted in accordance with the intergovernmental agreement between the KDHE and the Farm Service Agency (FSA) of the USDA. The investigation at Hanover will be performed, on behalf of the CCC/USDA, by the Environmental Science Division of Argonne National Laboratory. Argonne is a nonprofit, multidisciplinary research center operated by UChicago Argonne, LLC, for the U.S. Department of Energy (DOE). The CCC/USDA has entered into an interagency agreement with DOE, under which Argonne provides technical assistance to the CCC/USDA with environmental site characterization and remediation at its former grain storage facilities. Seven technical objectives have been proposed for the Hanover investigation. They are as follows: (1) Identify the sources and extent of soil contamination beneath the former CCC/USDA facility; (2) Characterize groundwater contamination beneath the former CCC/USDA facility; (3) Determine groundwater flow patterns; (4) Define the vertical and lateral extent of the groundwater plume outside the former CCC/USDA facility; (5) Evaluate the aquifer and monitor the groundwater system; (6) Identify any other potential sources of contamination that are not related to activities of the CCC/USDA; and (7) Determine whether there is a vapor intrusion problem at the site attributable to the former CCC/USDA facility. The technical objectives will be accomplished in a phased approached. Data collected during each phase will be evaluated to determine whether the subsequent phase is necessary. The KDHE project manager and the CCC/USDA will be contacted during each phase and kept apprised of the results. Whether implementation of each phase of work is necessary will be discussed and mutually agreed upon by the CCC/USDA and KDHE project managers.« less

Linking household and health facility surveys to assess obstetric service availability, readiness and coverage: evidence from 17 low- and middle-income countries.

PubMed

Kanyangarara, Mufaro; Chou, Victoria B; Creanga, Andreea A; Walker, Neff

2018-06-01

Improving access and quality of obstetric service has the potential to avert preventable maternal, neonatal and stillborn deaths, yet little is known about the quality of care received. This study sought to assess obstetric service availability, readiness and coverage within and between 17 low- and middle-income countries. We linked health facility data from the Service Provision Assessments and Service Availability and Readiness Assessments, with corresponding household survey data obtained from the Demographic and Health Surveys and Multiple Indicator Cluster Surveys. Based on performance of obstetric signal functions, we defined four levels of facility emergency obstetric care (EmOC) functionality: comprehensive (CEmOC), basic (BEmOC), BEmOC-2, and low/substandard. Facility readiness was evaluated based on the direct observation of 23 essential items; facilities "ready to provide obstetric services" had ≥20 of 23 items available. Across countries, we used medians to characterize service availability and readiness, overall and by urban-rural location; analyses also adjusted for care-seeking patterns to estimate population-level coverage of obstetric services. Of the 111 500 health facilities surveyed, 7545 offered obstetric services and were included in the analysis. The median percentages of facilities offering EmOC and "ready to provide obstetric services" were 19% and 10%, respectively. There were considerable urban-rural differences, with absolute differences of 19% and 29% in the availability of facilities offering EmOC and "ready to provide obstetric services", respectively. Adjusting for care-seeking patterns, results from the linking approach indicated that among women delivering in a facility, a median of 40% delivered in facilities offering EmOC, and 28% delivered in facilities "ready to provide obstetric services". Relatively higher coverage of facility deliveries (≥65%) and coverage of deliveries in facilities "ready to provide obstetric services" (≥30% of facility deliveries) were only found in three countries. The low levels of availability, readiness and coverage of obstetric services documented represent substantial missed opportunities within health systems. Global and national efforts need to prioritize upgrading EmOC functionality and improving readiness to deliver obstetric service, particularly in rural areas. The approach of linking health facility and household surveys described here could facilitate the tracking of progress towards quality obstetric care.

Linking household and health facility surveys to assess obstetric service availability, readiness and coverage: evidence from 17 low- and middle-income countries

PubMed Central

Kanyangarara, Mufaro; Chou, Victoria B; Creanga, Andreea A; Walker, Neff

2018-01-01

Background Improving access and quality of obstetric service has the potential to avert preventable maternal, neonatal and stillborn deaths, yet little is known about the quality of care received. This study sought to assess obstetric service availability, readiness and coverage within and between 17 low- and middle-income countries. Methods We linked health facility data from the Service Provision Assessments and Service Availability and Readiness Assessments, with corresponding household survey data obtained from the Demographic and Health Surveys and Multiple Indicator Cluster Surveys. Based on performance of obstetric signal functions, we defined four levels of facility emergency obstetric care (EmOC) functionality: comprehensive (CEmOC), basic (BEmOC), BEmOC-2, and low/substandard. Facility readiness was evaluated based on the direct observation of 23 essential items; facilities “ready to provide obstetric services” had ≥20 of 23 items available. Across countries, we used medians to characterize service availability and readiness, overall and by urban-rural location; analyses also adjusted for care-seeking patterns to estimate population-level coverage of obstetric services. Results Of the 111 500 health facilities surveyed, 7545 offered obstetric services and were included in the analysis. The median percentages of facilities offering EmOC and “ready to provide obstetric services” were 19% and 10%, respectively. There were considerable urban-rural differences, with absolute differences of 19% and 29% in the availability of facilities offering EmOC and “ready to provide obstetric services”, respectively. Adjusting for care-seeking patterns, results from the linking approach indicated that among women delivering in a facility, a median of 40% delivered in facilities offering EmOC, and 28% delivered in facilities “ready to provide obstetric services”. Relatively higher coverage of facility deliveries (≥65%) and coverage of deliveries in facilities “ready to provide obstetric services” (≥30% of facility deliveries) were only found in three countries. Conclusions The low levels of availability, readiness and coverage of obstetric services documented represent substantial missed opportunities within health systems. Global and national efforts need to prioritize upgrading EmOC functionality and improving readiness to deliver obstetric service, particularly in rural areas. The approach of linking health facility and household surveys described here could facilitate the tracking of progress towards quality obstetric care. PMID:29862026

Numerical aerodynamic simulation facility feasibility study, executive summary

NASA Technical Reports Server (NTRS)

1979-01-01

There were three major issues examined in the feasibility study. First, the ability of the proposed system architecture to support the anticipated workload was evaluated. Second, the throughput of the computational engine (the flow model processor) was studied using real application programs. Third, the availability, reliability, and maintainability of the system were modeled. The evaluations were based on the baseline systems. The results show that the implementation of the Numerical Aerodynamic Simulation Facility, in the form considered, would indeed be a feasible project with an acceptable level of risk. The technology required (both hardware and software) either already exists or, in the case of a few parts, is expected to be announced this year.

Global environment facility: Independent evaluation of the pilot phase; Fondo para el medio ambiente mundial: evaluacion independiente de la etapa experimental

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

NONE

1994-06-01

This study responds to a request by participants in the Global Environment Facility (GEF) for an independent evaluation of the pilot phase. It profiles the GEF, discusses its policy framework, and reviews project development procedures and the strategies and projects in each of the GEF`s four focal areas. The study concludes that fundamental changes must occur and recommends specific reforms, such as articulating more clearly the GEF`s mandate, objectives, and strategies; addressing deficiencies in meeting its global focus; improving capacities and procedures within implementing agencies for managing the portfolio; and increasing non-government organization (NGO), country and community-level participation.

Atmospheric release model for the E-area low-level waste facility: Updates and modifications

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

None, None

The atmospheric release model (ARM) utilizes GoldSim® Monte Carlo simulation software (GTG, 2017) to evaluate the flux of gaseous radionuclides as they volatilize from E-Area disposal facility waste zones, diffuse into the air-filled soil pores surrounding the waste, and emanate at the land surface. This report documents the updates and modifications to the ARM for the next planned E-Area PA considering recommendations from the 2015 PA strategic planning team outlined by Butcher and Phifer.

Final Environmental Assessment for the Construction of a Temporary Lodging Facility, Eglin Air Force Base, FL

DTIC Science & Technology

2012-03-01

amplitude), frequency (pitch), and duration. Each of these characteristics plays a role in determining a noise’s intrusiveness and level of impact on a...1 for the Construction of a Temporary Lodging Facility Eglin Air Force Base, FL 6. LIST OF PREPARERS AND CONTRIBUTORS Name/Title Project Role ...categorized as one of the following: _ Federal As.sistAnce to Sts.te o r Local Gonrnment (IS CFR 930, Subpart F). Agtncies stre required to evaluate

EVALUATION OF THE ADULT LEARNING CENTER OF ELIZABETHPORT BY STAFF AND PARTICIPANTS, OPERATIONS FROM 2/26/68 - 4/30/68.

ERIC Educational Resources Information Center

TATUM, WILLIAM; CHASNOFF, ROBERT

ACTIVITIES, FACILITIES, AND PROGRAMED READING MATERIALS AT THE ADULT LEARNING CENTER OF ELIZABETHPORT (ELIZABETH, NEW JERSEY) WERE EVALUATED IN 1968 BY STAFF MEMBERS AND PARTICIPANTS. STAFF OPINIONS DIFFERED AS TO THE MOST SUCCESSFUL MATERIALS, AND REASONS GIVEN FOR SUCCESS VARIED BETWEEN INTEREST LEVEL, SIZE OF PRINT AND LENGTH OF STORIES, THE…

An assessment of routine primary care health information system data quality in Sofala Province, Mozambique

PubMed Central

2011-01-01

Background Primary health care is recognized as a main driver of equitable health service delivery. For it to function optimally, routine health information systems (HIS) are necessary to ensure adequate provision of health care and the development of appropriate health policies. Concerns about the quality of routine administrative data have undermined their use in resource-limited settings. This evaluation was designed to describe the availability, reliability, and validity of a sample of primary health care HIS data from nine health facilities across three districts in Sofala Province, Mozambique. HIS data were also compared with results from large community-based surveys. Methodology We used a methodology similar to the Global Fund to Fight AIDS, Tuberculosis and Malaria data verification bottom-up audit to assess primary health care HIS data availability and reliability. The quality of HIS data was validated by comparing three key indicators (antenatal care, institutional birth, and third diptheria, pertussis, and tetanus [DPT] immunization) with population-level surveys over time. Results and discussion The data concordance from facility clinical registries to monthly facility reports on five key indicators--the number of first antenatal care visits, institutional births, third DPT immunization, HIV testing, and outpatient consults--was good (80%). When two sites were excluded from the analysis, the concordance was markedly better (92%). Of monthly facility reports for immunization and maternity services, 98% were available in paper form at district health departments and 98% of immunization and maternity services monthly facility reports matched the Ministry of Health electronic database. Population-level health survey and HIS data were strongly correlated (R = 0.73), for institutional birth, first antenatal care visit, and third DPT immunization. Conclusions Our results suggest that in this setting, HIS data are both reliable and consistent, supporting their use in primary health care program monitoring and evaluation. Simple, rapid tools can be used to evaluate routine data and facilitate the rapid identification of problem areas. PMID:21569533

Treatment of men with high-risk prostate cancer based on race, insurance coverage, and access to advanced technology.

PubMed

Gerhard, Robert Steven; Patil, Dattatraya; Liu, Yuan; Ogan, Kenneth; Alemozaffar, Mehrdad; Jani, Ashesh B; Kucuk, Omer N; Master, Viraj A; Gillespie, Theresa W; Filson, Christopher P

2017-05-01

We characterized factors related to nondefinitive management (NDM) of patients with high-risk prostate cancer and assessed impact from race, insurance status, and facility-level volume of technologically advanced prostate cancer treatments (i.e., intensity-modulated radiation therapy, robotic-assisted laparoscopic radical prostatectomy) on this outcome. We identified men with high-risk localized prostate cancer (based on D׳Amico criteria) in the National Cancer Database (2010-2012). Primary outcome was NDM (i.e., delayed/no treatment with prostatectomy/radiation therapy or androgen-deprivation monotherapy). Treating facilities were classified by quartiles of proportions of patients treated with advanced technology. Multivariable regression estimated odds of primary outcome based on race, insurance status, and facility-level technology use, and evaluated for interactions between these covariates. Among 60,300 patients, 9,265 (15.4%) received NDM. This was more common among non-White men (P<0.001), Medicaid/uninsured patients (P<0.001), and those managed at facilities in the lowest quartile of technology use (25.1% vs. 11.0% highest, P<0.001). Though NDM was common among non-White men with Medicaid/no insurance treated at low-technology centers (43% vs. 10% White, private/Medicare, high-tech facility; adjusted odds ratios = 7.18, P<0.001), this was less likely if this group was managed at a high-tech hospital (22% vs. 43% low-tech, P<0.001). Technology use at a facility correlates with high-quality prostate cancer care and is associated with diminished disparities based on insurance status and patient race. More research is required to characterize other facility-level factors explaining these findings. Published by Elsevier Inc.

Treatment of men with high-risk prostate cancer based on race, insurance coverage, and access to advanced technology

PubMed Central

Gerhard, R. Steven; Patil, Dattatraya; Liu, Yuan; Ogan, Kenneth; Alemozaffar, Mehrdad; Jani, Ashesh B.; Kucuk, Omer N.; Master, Viraj A.; Gillespie, Theresa W.; Filson, Christopher P.

2017-01-01

PURPOSE We characterized factors related to non-definitive management of high-risk prostate cancer patients, and assessed impact from race, insurance status, and facility-level volume of technologically-advanced prostate cancer treatments (i.e. intensity-modulated radiation therapy, robotic-assisted laparoscopic radical prostatectomy) on this outcome. METHODS We identified men with high-risk localized prostate cancer (based on D’Amico criteria) in the National Cancer Data Base (2010–2012). Primary outcome was non-definitive management (i.e., delayed/no treatment with prostatectomy/radiation therapy or androgen deprivation therapy monotherapy). Treating facilities were classified by quartiles of proportions of patients treated with advanced technology. Multivariable regression estimated odds of primary outcome based on race, insurance status, and facility-level technology use, and evaluated for interactions between these covariates. RESULTS Among 60,300 patients, 9265 (15.4%) received non-definitive management. This was more common among non-White men (p<0.001), Medicaid/uninsured patients (p<0.001), and those managed at facilities in the lowest quartile of technology use (25.1% vs 11.0% highest, p<0.001). Though non-definitive management was common among non-White men with Medicaid/no insurance treated at low-technology centers (43% vs 10% White, private/Medicare, high-tech facility; adjusted OR 7.18, p<0.001), this was less likely if this group was managed at a high-tech hospital (22% vs 43% low-tech, p<0.001). CONCLUSIONS Technology-use at a facility correlates with high-quality prostate cancer care, and is associated with diminished disparities based on insurance status and patient race. More research is required to characterize other facility-level factors explaining these findings. PMID:28089387

Exploring the transparency mechanism and evaluating the effect of public reporting on prescription: a protocol for a cluster randomized controlled trial.

PubMed

Du, Xin; Wang, Dan; Wang, Xuan; Yang, Shiru; Zhang, Xinping

2015-03-21

The public reporting of health outcomes has become one of the most popular topics and is accepted as a quality improvement method in the healthcare field. However, little research has been conducted on the transparency mechanism, and results are mixed with regard to the evaluation of the effect of public reporting on quality improvement. The objectives of this trial are to investigate the transparency mechanism and to evaluate the effect of public reporting on prescription at the level of individual participants. This study involves a cluster randomized controlled trial conducted in 20 primary-care facilities (clusters). Eligible clusters are those facilities with excellent hospital information systems and that have agreed to participate in the trial. The 20 clusters are matched into 10 pairs according to Technique for Order Preference by Similarity to Ideal Solution score. As the unit of randomization, each pair of facilities is assigned at random to a control or an intervention group through coin flipping. Prescribed ranking information is publicly reported in the intervention group. The public materials include the posters of individuals and of facilities, the ranking lists of general practitioners, and brochures of patients, which are updated monthly. The intervention began on 13th November 2013 and lasted for one year. Specifically, participants are surveyed at five points in time (baseline, quarterly following the intervention) through questionnaires, interviews, and observations. These participants include an average of 600 patients, 300 general practitioners, 15 directors, and 6 health bureau administrators. The primary outcomes are the transparency mechanism model and the changes in medicine-prescribe. Subsequently, the modifications in the transparency mechanism constructs are evaluated. The outcomes are measured at the individual participant level, and the professional who analyzes the data is blind to the randomization status. This study protocol outlines a design that aims to examine the transparency mechanism and to evaluate the effect of public reporting on prescription. The research design is significant in the field of public policy. Furthermore, this study intends to fill the gap of the investigation of the transparency mechanism and the evaluation of public reporting on prescription.

Evaluation of cardiopulmonary factors critical to successful emergency perinatal air transport.

DOT National Transportation Integrated Search

1982-03-01

Regionalization of specialized perinatal care is a fully viable and progressing concept. The two major components of regionalized care are the level III care facility and the air transport service. In descending importance, the medical transport team...

Proposed Risk-Informed Seismic Hazard Periodic Reevaluation Methodology for Complying with DOE Order 420.1C

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

Kammerer, Annie

Department of Energy (DOE) nuclear facilities must comply with DOE Order 420.1C Facility Safety, which requires that all such facilities review their natural phenomena hazards (NPH) assessments no less frequently than every ten years. The Order points the reader to Standard DOE-STD-1020-2012. In addition to providing a discussion of the applicable evaluation criteria, the Standard references other documents, including ANSI/ANS-2.29-2008 and NUREG-2117. These documents provide supporting criteria and approaches for evaluating the need to update an existing probabilistic seismic hazard analysis (PSHA). All of the documents are consistent at a high level regarding the general conceptual criteria that should bemore » considered. However, none of the documents provides step-by-step detailed guidance on the required or recommended approach for evaluating the significance of new information and determining whether or not an existing PSHA should be updated. Further, all of the conceptual approaches and criteria given in these documents deal with changes that may have occurred in the knowledge base that might impact the inputs to the PSHA, the calculated hazard itself, or the technical basis for the hazard inputs. Given that the DOE Order is aimed at achieving and assuring the safety of nuclear facilities—which is a function not only of the level of the seismic hazard but also the capacity of the facility to withstand vibratory ground motions—the inclusion of risk information in the evaluation process would appear to be both prudent and in line with the objectives of the Order. The purpose of this white paper is to describe a risk-informed methodology for evaluating the need for an update of an existing PSHA consistent with the DOE Order. While the development of the proposed methodology was undertaken as a result of assessments for specific SDC-3 facilities at Idaho National Laboratory (INL), and it is expected that the application at INL will provide a demonstration of the methodology, there is potential for general applicability to other facilities across the DOE complex. As such, both a general methodology and a specific approach intended for INL are described in this document. The general methodology proposed in this white paper is referred to as the “seismic hazard periodic review methodology,” or SHPRM. It presents a graded approach for SDC-3, SDC-4 and SDC-5 facilities that can be applied in any risk-informed regulatory environment by once risk-objectives appropriate for the framework are developed. While the methodology was developed for seismic hazard considerations, it can also be directly applied to other types of natural hazards.« less

Proposed Risk-Informed Seismic Hazard Periodic Reevaluation Methodology for Complying with DOE Order 420.1C

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

Kammerer, Annie

Department of Energy (DOE) nuclear facilities must comply with DOE Order 420.1C Facility Safety, which requires that all such facilities review their natural phenomena hazards (NPH) assessments no less frequently than every ten years. The Order points the reader to Standard DOE-STD-1020-2012. In addition to providing a discussion of the applicable evaluation criteria, the Standard references other documents, including ANSI/ANS-2.29-2008 and NUREG-2117. These documents provide supporting criteria and approaches for evaluating the need to update an existing probabilistic seismic hazard analysis (PSHA). All of the documents are consistent at a high level regarding the general conceptual criteria that should bemore » considered. However, none of the documents provides step-by-step detailed guidance on the required or recommended approach for evaluating the significance of new information and determining whether or not an existing PSHA should be updated. Further, all of the conceptual approaches and criteria given in these documents deal with changes that may have occurred in the knowledge base that might impact the inputs to the PSHA, the calculated hazard itself, or the technical basis for the hazard inputs. Given that the DOE Order is aimed at achieving and assuring the safety of nuclear facilities—which is a function not only of the level of the seismic hazard but also the capacity of the facility to withstand vibratory ground motions—the inclusion of risk information in the evaluation process would appear to be both prudent and in line with the objectives of the Order. The purpose of this white paper is to describe a risk-informed methodology for evaluating the need for an update of an existing PSHA consistent with the DOE Order. While the development of the proposed methodology was undertaken as a result of assessments for specific SDC-3 facilities at Idaho National Laboratory (INL), and it is expected that the application at INL will provide a demonstration of the methodology, there is potential for general applicability to other facilities across the DOE complex. As such, both a general methodology and a specific approach intended for INL are described in this document. The general methodology proposed in this white paper is referred to as the “seismic hazard periodic review methodology,” or SHPRM. It presents a graded approach for SDC-3, SDC-4 and SDC-5 facilities that can be applied in any risk-informed regulatory environment once risk-objectives appropriate for the framework are developed. While the methodology was developed for seismic hazard considerations, it can also be directly applied to other types of natural hazards.« less

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

Piette, Mary Ann; Sezgen, Osman; Watson, David S.

This report describes the results of a research project to develop and evaluate the performance of new Automated Demand Response (Auto-DR) hardware and software technology in large facilities. Demand Response (DR) is a set of activities to reduce or shift electricity use to improve electric grid reliability, manage electricity costs, and ensure that customers receive signals that encourage load reduction during times when the electric grid is near its capacity. The two main drivers for widespread demand responsiveness are the prevention of future electricity crises and the reduction of electricity prices. Additional goals for price responsiveness include equity through costmore » of service pricing, and customer control of electricity usage and bills. The technology developed and evaluated in this report could be used to support numerous forms of DR programs and tariffs. For the purpose of this report, we have defined three levels of Demand Response automation. Manual Demand Response involves manually turning off lights or equipment; this can be a labor-intensive approach. Semi-Automated Response involves the use of building energy management control systems for load shedding, where a preprogrammed load shedding strategy is initiated by facilities staff. Fully-Automated Demand Response is initiated at a building or facility through receipt of an external communications signal--facility staff set up a pre-programmed load shedding strategy which is automatically initiated by the system without the need for human intervention. We have defined this approach to be Auto-DR. An important concept in Auto-DR is that a facility manager is able to ''opt out'' or ''override'' an individual DR event if it occurs at a time when the reduction in end-use services is not desirable. This project sought to improve the feasibility and nature of Auto-DR strategies in large facilities. The research focused on technology development, testing, characterization, and evaluation relating to Auto-DR. This evaluation also included the related decisionmaking perspectives of the facility owners and managers. Another goal of this project was to develop and test a real-time signal for automated demand response that provided a common communication infrastructure for diverse facilities. The six facilities recruited for this project were selected from the facilities that received CEC funds for new DR technology during California's 2000-2001 electricity crises (AB970 and SB-5X).« less

Comparative Vibration Levels Perceived Among Species in a Laboratory Animal Facility

PubMed Central

Norton, John N; Kinard, Will L; Reynolds, Randall P

2011-01-01

The current study was performed to determine the vibration levels that were generated in cages on a ventilated rack by common construction equipment in frequency ranges likely to be perceived by humans, rats, and mice. Vibration generated by the ventilated rack blower caused small but significant increases in some of the abdominal, thoracic, and head resonance frequency ranges (RFR) and sensitivity frequency ranges (SFR) in which each species is most likely to be affected by and perceive vibration, respectively. Vibration caused by various items of construction equipment at 3 ft from the cage were evaluated relative to the RFR and SFR of humans, rats, and mice in 3 anatomic locations. In addition, the vibration levels in the RFR and SFR that resulted from the use of a large jackhammer and were measured at various locations and distances in the facility and evaluated in terms of humans, rats, and mice in 3 anatomic locations. Taken together, the data indicate that a given vibration source generates vibration in frequency ranges that are more likely to affect rats and mice as compared with humans. PMID:22330711

Evaluating activation of the shielding walls of a treatment room using the Monte Carlo method

NASA Astrophysics Data System (ADS)

Lee, D.-Y.; Kim, J.-H.

2018-05-01

This study investigates the radiation activation process in a medical linear accelerator, which creates a photon beam with the energy acquired from accelerated electrons. The concrete shielding walls used in conjunction with a medical linear accelerator occupy the largest portion of facility decommissioning costs. Therefore, to evaluate the activation of the shielding wall, this study simulated the operation of a linear accelerator with high-energy photon beams (10, 15, and 20 MV). The results of the simulations showed that the high-energy photon beams produced a large number of neutrons in the areas around the linear accelerator head. Several radionuclides were identified, and their half-lives and radioactivity levels were calculated. Half-lives ranged from 2.62 hours to 3.68E+06 years, and the radioactivity levels of most of the radionuclides were found to satisfy their respective clearance requirements. These results indicate that photon beams of 15 MV or lower satisfy the clearance requirements for decommissioning a linear accelerator facility, whereas those of 20 MV or higher lie partially above the regulatory clearance levels.

Cost-effectiveness of essential newborn care training in urban first-level facilities.

PubMed

Manasyan, Albert; Chomba, Elwyn; McClure, Elizabeth M; Wright, Linda L; Krzywanski, Sara; Carlo, Waldemar A

2011-05-01

To determine the cost-effectiveness of the World Health Organization (WHO) Essential Newborn Care (ENC) training of health care providers in first-level facilities in the 2 largest cities in Zambia. Data were extracted from a study in which the effectiveness of the ENC training was evaluated (including universal precautions and cleanliness, routine neonatal care, resuscitation, thermoregulation, breastfeeding, skin-to-skin care, care of the small infant, danger signs, and common illnesses). The costs to train an ENC instructor for each first-level delivery facility and the costs of salary/benefits for 2 coordinators responsible for maintenance of the program were recorded in 2005 US dollars. The incremental costs per life gained and per disability-adjusted life-year averted were calculated. A 5-day ENC training-of-trainers was conducted in Lusaka, Zambia, to certify 18 college-trained midwives as ENC instructors. The instructors trained all clinic midwives working in their first-level facilities as part of a before-and-after study of the effect of ENC training on early neonatal mortality conducted from Oct 2004 to Nov 2006. All-cause 7-day (early) neonatal mortality decreased from 11.5 per 1000 to 6.8 per 1000 live births after ENC training of the clinic midwives (relative risk: 0.59; 95% confidence interval: 0.48-0.77; P < .001; 40 615 births). The intervention costs were $208 per life saved and $5.24 per disability-adjusted life-year averted. ENC training of clinic midwives who provide care in low-risk facilities is a low-cost intervention that can reduce early neonatal mortality in these settings.

Development of a Test Facility for Air Revitalization Technology Evaluation

NASA Technical Reports Server (NTRS)

Lu, Sao-Dung; Lin, Amy; Campbell, Melissa; Smith, Frederick; Curley, Su

2007-01-01

Development of new air revitalization system (ARS) technology can initially be performed in a subscale laboratory environment, but in order to advance the maturity level, the technology must be tested in an end-to-end integrated environment. The Air Revitalization Technology Evaluation Facility (ARTEF) at the NASA Johnson Space Center serves as a ground test bed for evaluating emerging ARS technologies in an environment representative of spacecraft atmospheres. At the center of the ARTEF is a hypobaric chamber which serves as a sealed atmospheric chamber for closed loop testing. A Human Metabolic Simulator (HMS) was custom-built to simulate the consumption of oxygen, and production of carbon dioxide, moisture and heat of up to eight persons. A multitude of gas analyzers and dew point sensors are used to monitor the chamber atmosphere upstream and downstream of a test article. A robust vacuum system is needed to simulate the vacuum of space. A reliable data acquisition and control system is required to connect all the subsystems together. This paper presents the capabilities of the integrated test facility and some of the issues encountered during the integration.

Walkyourplace - Evaluating Neighbourhood Accessibility at Street Level

NASA Astrophysics Data System (ADS)

Steiniger, S.; Poorazizi, M. E.; Hunter, A. J. S.

2013-05-01

The popularity of a neighbourhood is often explained by its perceived "higher" quality of life. Good access to shops, restaurants, parks, etc., is seen as an indicator that reflects improved quality of life. We present a web-based tool for assessment of accessibility to such services. The system evaluates in real time an area that is accessible using pedestrian, transit, and cycling infrastructure. The accessible area is evaluated using "quality of life" indicators, such as the number of grocery stores, shopping and recreation facilities, and local crime within that area. This tool sets itself apart from pre-computed and neighbourhood-level walkability indices, because it makes use of detailed street-level data, rather than block-level generalizations. It uses real network travel time, and, when transit data are provided, permits the creation and evaluation of accessibility areas for a combination of travel modes such as walking with transit use.

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

NASA Technical Reports Server (NTRS)

Morris, Robert H.; Sulfredge, C. David

2011-01-01

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

Structural Dynamic Assessment of the GN2 Piping System for NASA's New and Powerful Reverberant Acoustic Test Facility

NASA Technical Reports Server (NTRS)

McNelis, Mark E.; Staab, Lucas D.; Akers, James C.; Hughes, William O.; Chang, Li C.; Hozman, Aron D.; Henry, Michael W.

2012-01-01

The National Aeronautics and Space Administration (NASA) Glenn Research Center (GRC) has led the design and build of the new world-class vibroacoustic test capabilities at the NASA GRC's Plum Brook Station in Sandusky, Ohio, USA from 2007 to 2011. SAIC-Benham has completed construction of a new reverberant acoustic test facility to support the future testing needs of NASA's space exploration program and commercial customers. The large Reverberant Acoustic Test Facility (RATF) is approximately 101,000 cubic feet in volume and was designed to operate at a maximum empty chamber acoustic overall sound pressure level (OASPL) of 163 dB. This combination of size and acoustic power is unprecedented amongst the world s known active reverberant acoustic test facilities. Initial checkout acoustic testing was performed on March 2011 by SAIC-Benham at test levels up to 161 dB OASPL. During testing, several branches of the gaseous nitrogen (GN2) piping system, which supply the fluid to the noise generating acoustic modulators, failed at their T-junctions connecting the 12 in. supply line to their respective 4 in. branch lines. The problem was initially detected when the oxygen sensors in the horn room indicated a lower than expected oxygen level from which was inferred GN2 leaks in the piping system. In subsequent follow up inspections, cracks were identified in the failed T-junction connections through non-destructive evaluation testing. Through structural dynamic modeling of the piping system, the root cause of the T-junction connection failures was determined. The structural dynamic assessment identified several possible corrective design improvements to the horn room piping system. The effectiveness of the chosen design repairs were subsequently evaluated in September 2011 during acoustic verification testing to 161 dB OASPL.

Structural Dynamic Assessment of the GN2 Piping System for NASA's New and Powerful Reverberant Acoustic Test Facility

NASA Technical Reports Server (NTRS)

McNelis, Mark E.; Staab, Lucas D.; Akers, James C.; Hughes, WIlliam O.; Chang, Li, C.; Hozman, Aron D.; Henry, Michael W.

2012-01-01

The National Aeronautics and Space Administration (NASA) Glenn Research Center (GRC) has led the design and build of the new world-class vibroacoustic test capabilities at the NASA GRC's Plum Brook Station in Sandusky, Ohio, USA from 2007-2011. SAIC-Benham has completed construction of a new reverberant acoustic test facility to support the future testing needs of NASA's space exploration program and commercial customers. The large Reverberant Acoustic Test Facility (RATF) is approximately 101,000 cu ft in volume and was designed to operate at a maximum empty chamber acoustic overall sound pressure level (OASPL) of 163 dB. This combination of size and acoustic power is unprecedented amongst the world's known active reverberant acoustic test facilities. Initial checkout acoustic testing was performed on March 2011 by SAIC-Benham at test levels up to 161 dB OASPL. During testing, several branches of the gaseous nitrogen (GN2) piping system, which supply the fluid to the noise generating acoustic modulators, failed at their "t-junctions" connecting the 12 inch supply line to their respective 4 inch branch lines. The problem was initially detected when the oxygen sensors in the horn room indicated a lower than expected oxygen level from which was inferred GN2 leaks in the piping system. In subsequent follow up inspections, cracks were identified in the failed "t-junction" connections through non-destructive evaluation testing . Through structural dynamic modeling of the piping system, the root cause of the "t-junction" connection failures was determined. The structural dynamic assessment identified several possible corrective design improvements to the horn room piping system. The effectiveness of the chosen design repairs were subsequently evaluated in September 2011 during acoustic verification testing to 161 dB OASPL.

Emergency and trauma care in Pakistan: a cross-sectional study of healthcare levels

PubMed Central

Razzak, Junaid A; Baqir, Syed M; Khan, Uzma Rahim; Heller, David; Bhatti, Junaid; Hyder, Adnan A

2015-01-01

Background The importance of emergency medical care for the successful functioning of health systems has been increasingly recognised. This study aimed to evaluate emergency and trauma care facilities in four districts of the province of Sindh, Pakistan. Method We conducted a cross-sectional health facility survey in four districts of the province of Sindh in Pakistan using a modified version of WHO’s Guidelines for essential trauma care. 93 public health facilities (81 primary care facilities, nine secondary care hospitals, three tertiary hospitals) and 12 large private hospitals were surveyed. Interviews of healthcare providers and visual inspections of essential equipment and supplies as per guidelines were performed. A total of 141 physicians providing various levels of care were tested for their knowledge of basic emergency care using a validated instrument. Results Only 4 (44%) public secondary, 3 (25%) private secondary hospitals and all three tertiary care hospitals had designated emergency rooms. The majority of primary care health facilities had less than 60% of all essential equipments overall. Most of the secondary level public hospitals (78%) had less than 60% of essential equipments, and none had 80% or more. A fourth of private secondary care facilities and all tertiary care hospitals (n=3; 100%) had 80% or more essential equipments. The average percentage score on the physician knowledge test was 30%. None of the physicians scored above 60% correct responses. Conclusions The study findings demonstrated a gap in both essential equipment and provider knowledge necessary for effective emergency and trauma care. PMID:24157684

Accuracy of PSA Self-Reports among Low-Income Men with Prostate Cancer after a Public Health Nursing Intervention.

PubMed

Zavala, Mary Wassel; Yule, Arthur; Kwan, Lorna; Lambrechts, Sylvia; Maliski, Sally L; Litwin, Mark S

2016-11-01

To examine accuracy of patient-reported prostate-specific antigen (PSA) levels among indigent, uninsured men in a state-funded prostate cancer treatment program that provides case management, care coordination, and health education. Program evaluation. About 114 men with matched self- and lab-reported PSA levels at program enrollment and another time point within 18 months. Abstraction of self- and lab-reported PSA levels to determine self-report as "accurate" or "inaccurate," and evaluate accuracy change over time, before and after nursing interventions. Chi-square tests compared patients with accurate versus inaccurate PSA values. Nonlinear multivariate analyses explored trends in self-reported accuracy over time. Program enrollees receive prostate cancer education from a Nurse Case Manager (NCM), including significance of PSA levels. Men self-report PSA results to their NCM following lab draws and appointments. The NCM provides ongoing education about PSA levels. Of the sample, 46% (n = 53) accurately reported PSA levels. Accuracy of PSA self-reports improved with increasing time since program enrollment. Compared with men at public facilities, those treated at private facilities showed increasing accuracy in self-reported PSA (p = .038). A targeted nursing intervention may increase specific knowledge of PSA levels. Additionally, the provider/treatment setting significantly impacts a patient's disease education and knowledge. © 2016 Wiley Periodicals, Inc.

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

M. L. Abbott; K. N. Keck; R. E. Schindler

This screening level risk assessment evaluates potential adverse human health and ecological impacts resulting from continued operations of the calciner at the New Waste Calcining Facility (NWCF) at the Idaho Nuclear Technology and Engineering Center (INTEC), Idaho National Engineering and Environmental Laboratory (INEEL). The assessment was conducted in accordance with the Environmental Protection Agency (EPA) report, Guidance for Performing Screening Level Risk Analyses at Combustion Facilities Burning Hazardous Waste. This screening guidance is intended to give a conservative estimate of the potential risks to determine whether a more refined assessment is warranted. The NWCF uses a fluidized-bed combustor to solidifymore » (calcine) liquid radioactive mixed waste from the INTEC Tank Farm facility. Calciner off volatilized metal species, trace organic compounds, and low-levels of radionuclides. Conservative stack emission rates were calculated based on maximum waste solution feed samples, conservative assumptions for off gas partitioning of metals and organics, stack gas sampling for mercury, and conservative measurements of contaminant removal (decontamination factors) in the off gas treatment system. Stack emissions were modeled using the ISC3 air dispersion model to predict maximum particulate and vapor air concentrations and ground deposition rates. Results demonstrate that NWCF emissions calculated from best-available process knowledge would result in maximum onsite and offsite health and ecological impacts that are less then EPA-established criteria for operation of a combustion facility.« less

Qualitative evaluation of Rhode Island’s healthcare worker influenza vaccination regulations

PubMed Central

Lindley, Megan C.; Dube, Donna; Kalayil, Elizabeth J.; Kim, Hanna; Paiva, Kristi; Raymond, Patricia

2015-01-01

Objective To evaluate Rhode Island’s revised vaccination regulations requiring healthcare workers (HCWs) to receive annual influenza vaccination or wear a mask during patient care when influenza is widespread. Design Semi-structured telephone interviews conducted in a random sample of healthcare facilities. Setting Rhode Island healthcare facilities covered by the HCW regulations, including hospitals, nursing homes, community health centers, nursing service agencies, and home nursing care providers. Participants Staff responsible for collecting and/or reporting facility-level HCW influenza vaccination data to comply with Rhode Island HCW regulations. Methods Interviews were transcribed and individually coded by interviewers to identify themes; consensus on coding differences was reached through discussion. Common themes and illustrative quotes are presented. Results Many facilities perceived the revised regulations as extending their existing influenza vaccination policies and practices. Despite variations in implementation, nearly all facilities implemented policies that complied with the minimum requirements of the regulations. The primary barrier to implementing the HCW regulations was enforcement of masking among unvaccinated HCWs, which required timely tracking of vaccination status and additional time and effort by supervisors. Factors facilitating implementation included early and regular communication from the state health department and facilities’ ability to adapt existing influenza vaccination programs to incorporate provisions of the revised regulations. Conclusions Overall, facilities successfully implemented the revised HCW regulations during the 2012–2013 influenza season. Continued maintenance of the regulations is likely to reduce transmission of influenza and resulting morbidity and mortality in Rhode Island’s healthcare facilities. PMID:25192807

Revalidation of the NASA Ames 11-by 11-Foot Transonic Wind Tunnel with a Commercial Airplane Model

NASA Technical Reports Server (NTRS)

Kmak, Frank J.; Hudgins, M.; Hergert, D.; George, Michael W. (Technical Monitor)

2001-01-01

The 11-By 11-Foot Transonic leg of the Unitary Plan Wind Tunnel (UPWT) was modernized to improve tunnel performance, capability, productivity, and reliability. Wind tunnel tests to demonstrate the readiness of the tunnel for a return to production operations included an Integrated Systems Test (IST), calibration tests, and airplane validation tests. One of the two validation tests was a 0.037-scale Boeing 777 model that was previously tested in the 11-By 11-Foot tunnel in 1991. The objective of the validation tests was to compare pre-modernization and post-modernization results from the same airplane model in order to substantiate the operational readiness of the facility. Evaluation of within-test, test-to-test, and tunnel-to-tunnel data repeatability were made to study the effects of the tunnel modifications. Tunnel productivity was also evaluated to determine the readiness of the facility for production operations. The operation of the facility, including model installation, tunnel operations, and the performance of tunnel systems, was observed and facility deficiency findings generated. The data repeatability studies and tunnel-to-tunnel comparisons demonstrated outstanding data repeatability and a high overall level of data quality. Despite some operational and facility problems, the validation test was successful in demonstrating the readiness of the facility to perform production airplane wind tunnel%, tests.

Variation in hematologic and serum biochemical values of belugas (Delphinapterus leucas) under managed care.

PubMed

Norman, Stephanie A; Beckett, Laurel A; Miller, Woutrina A; St Leger, Judy; Hobbs, Roderick C

2013-06-01

Blood analytes are critical for evaluating the general health of cetacean populations, so it is important to understand the intrinsic variability of hematology and serum chemistry values. Previous studies have reported data for follow-up periods of several years in managed and wild populations, but studies over long periods of time (> 20 yr) have not been reported. The study objective was to identify the influences of partitioning characteristics on hematology and serum chemistry analytes of apparently healthy managed beluga (Delphinapterus leucas). Blood values from 31 managed belugas, at three facilities, collected over 22 yr, were assessed for seasonal variation and aging trends, and evaluated for biologic variation among and within individuals. Linear mixed effects models assessed the relationship between the analytes and sex, age, season, facility location, ambient air temperature, and photoperiod. Sex differences in analytes and associations with increasing age were observed. Seasonal variation was observed for hemoglobin, hematocrit, mean corpuscular volume, monocytes, alkaline phosphatase, total bilirubin, cholesterol, and triglycerides. Facilities were associated with larger effects on analyte values compared to other covariates, whereas age, sex, and ambient temperature had smaller effects compared to facility and season. Present findings provide important baseline information for future health monitoring efforts. Interpretation of blood analytes and animal health in managed and wild populations over time is aided by having available typical levels for the species and reference intervals for the degree to which individual animals vary from the species average and from their own baseline levels during long-term monitoring.

Evaluation of design ventilation requirements for enclosed parking facilities

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

Ayari, A.; Krarti, M.

2000-07-01

This paper proposes a new design approach to determine the ventilation requirements for enclosed parking garages. The design approach accounts for various factors that affect the indoor air quality within a parking facility, including the average CO emission rate, the average travel time, the number of cars, and the acceptable CO level within the parking garage. This paper first describes the results of a parametric analysis based on the design method that was developed. Then the design method is presented to explain how the ventilation flow rate can be determined for any enclosed parking facility. Finally, some suggestions are proposedmore » to save fan energy for ventilating parking garages using demand ventilation control strategies.« less

Evaluation of a Biological Pathogen Decontamination Protocol for Animal Feed Mills.

PubMed

Huss, Anne R; Cochrane, Roger A; Deliephan, Aiswariya; Stark, Charles R; Jones, Cassandra K

2015-09-01

Animal feed and ingredients are potential vectors of pathogenic bacteria. Contaminated ingredients can contaminate facility equipment, leading to cross-contamination of other products. This experiment was conducted to evaluate a standardized protocol for decontamination of an animal feed manufacturing facility using Enterococcus faecium (ATCC 31282) as an indicator. A pelleted swine diet inoculated with E. faecium was manufactured, and environmental samples (swabs, replicate organism detection and counting plates, and air samples) were collected (i) before inoculation (baseline data), (ii) after production of inoculated feed, (iii) after physical removal of organic material using pressurized air, (iv) after application of a chemical sanitizer containing a quaternary ammonium-glutaraldehyde blend, (v) after application of a chemical sanitizer containing sodium hypochlorite, (vi) after facility heat-up to 60 8 C for 24 h, (vii) for 48 h, and (viii) for 72 h. Air samples collected outside the facility confirmed pathogen containment; E. faecium levels were equal to or lower than baseline levels at each sample location. The decontamination step and its associated interactions were the only variables that affected E. faecium incidence (P < 0.0001 versus P > 0.22). After production of the inoculated diet, 85.7% of environmental samples were positive for E. faecium. Physical cleaning of equipment had no effect on contamination (P = 0.32). Chemical cleaning with a quaternary ammonium-glutaraldehyde blend and sodium hypochlorite each significantly reduced E. faecium contamination (P < 0.0001) to 28.6 and 2.4% of tested surfaces, respectively. All samples were negative for E. faecium after 48 h of heating. Both wet chemical cleaning and facility heating but not physical cleaning resulted in substantial E. faecium decontamination. These results confirmed both successful containment and decontamination of biological pathogens in the tested pilot-scale feed mill.

Evaluation of the national tuberculosis surveillance program in Haiti

PubMed Central

Salyer, S. J.; Fitter, D. L.; Milo, R.; Blanton, C.; Ho, J. L.; Geffrard, H.; Morose, W.; Marston, B. J.

2015-01-01

OBJECTIVE To assess the quality of tuberculosis (TB) surveillance in Haiti, including whether underreporting from facilities to the national level contributes to low national case registration. METHODS We collected 2010 and 2012 TB case totals, reviewed laboratory registries, and abstracted individual TB case reports from 32 of 263 anti-tuberculosis treatment facilities randomly selected after stratification/weighting toward higher-volume facilities. We compared site results to national databases maintained by a non-governmental organization partner (International Child Care [ICC]) for 2010 and 2012, and the National TB Program (Programme National de Lutte contre la Tuberculose, PNLT) for 2012 only. RESULTS Case registries were available at 30/32 facilities for 2010 and all 32 for 2012. Totals of 3711 (2010) and 4143 (2012) cases were reported at the facilities. Case totals per site were higher in site registries than in the national databases by 361 (9.7%) (ICC 2010), 28 (0.8%) (ICC 2012), and 31 (0.8%) cases (PNLT 2012). Of abstracted individual cases, respectively 11.8% and 6.8% were not recorded in national databases for 2010 (n = 323) and 2012 (n = 351). CONCLUSIONS The evaluation demonstrated an improvement in reporting registered TB cases to the PNLT in Haiti between 2010 and 2012. Further improvement in case notification will require enhanced case detection and diagnosis. PMID:26260822

Helping small babies survive: an evaluation of facility-based Kangaroo Mother Care implementation progress in Uganda

PubMed Central

Aliganyira, Patrick; Kerber, Kate; Davy, Karen; Gamache, Nathalie; Sengendo, Namaala Hanifah; Bergh, Anne-Marie

2014-01-01

Introduction Prematurity is the leading cause of newborn death in Uganda, accounting for 38% of the nation's 39,000 annual newborn deaths. Kangaroo mother care is a high-impact; cost-effective intervention that has been prioritized in policy in Uganda but implementation has been limited. Methods A standardised, cross-sectional, mixed-method evaluation design was used, employing semi-structured key-informant interviews and observations in 11 health care facilities implementing kangaroo mother care in Uganda. Results The facilities visited scored between 8.28 and 21.72 out of the possible 30 points with a median score of 14.71. Two of the 3 highest scoring hospitals were private, not-for-profit hospitals whereas the second highest scoring hospital was a central teaching hospital. Facilities with KMC services are not equally distributed throughout the country. Only 4 regions (Central 1, Central 2, East-Central and Southwest) plus the City of Kampala were identified as having facilities providing KMC services. Conclusion KMC services are not instituted with consistent levels of quality and are often dependent on private partner support. With increasing attention globally and in country, Uganda is in a unique position to accelerate access to and quality of health services for small babies across the country. PMID:25667699

Helping small babies survive: an evaluation of facility-based Kangaroo Mother Care implementation progress in Uganda.

PubMed

Aliganyira, Patrick; Kerber, Kate; Davy, Karen; Gamache, Nathalie; Sengendo, Namaala Hanifah; Bergh, Anne-Marie

2014-01-01

Prematurity is the leading cause of newborn death in Uganda, accounting for 38% of the nation's 39,000 annual newborn deaths. Kangaroo mother care is a high-impact; cost-effective intervention that has been prioritized in policy in Uganda but implementation has been limited. A standardised, cross-sectional, mixed-method evaluation design was used, employing semi-structured key-informant interviews and observations in 11 health care facilities implementing kangaroo mother care in Uganda. The facilities visited scored between 8.28 and 21.72 out of the possible 30 points with a median score of 14.71. Two of the 3 highest scoring hospitals were private, not-for-profit hospitals whereas the second highest scoring hospital was a central teaching hospital. Facilities with KMC services are not equally distributed throughout the country. Only 4 regions (Central 1, Central 2, East-Central and Southwest) plus the City of Kampala were identified as having facilities providing KMC services. KMC services are not instituted with consistent levels of quality and are often dependent on private partner support. With increasing attention globally and in country, Uganda is in a unique position to accelerate access to and quality of health services for small babies across the country.

The Diesel Exhaust in Miners Study: I. Overview of the Exposure Assessment Process

PubMed Central

Stewart, Patricia A.; Coble, Joseph B.; Vermeulen, Roel; Schleiff, Patricia; Blair, Aaron; Lubin, Jay; Attfield, Michael; Silverman, Debra T.

2010-01-01

This report provides an overview of the exposure assessment process for an epidemiologic study that investigated mortality, with a special focus on lung cancer, associated with diesel exhaust (DE) exposure among miners. Details of several components are provided in four other reports. A major challenge for this study was the development of quantitative estimates of historical exposures to DE. There is no single standard method for assessing the totality of DE, so respirable elemental carbon (REC), a component of DE, was selected as the primary surrogate in this study. Air monitoring surveys at seven of the eight study mining facilities were conducted between 1998 and 2001 and provided reference personal REC exposure levels and measurements for other agents and DE components in the mining environment. (The eighth facility had closed permanently prior to the surveys.) Exposure estimates were developed for mining facility/department/job/year combinations. A hierarchical grouping strategy was developed for assigning exposure levels to underground jobs [based on job titles, on the amount of time spent in various areas of the underground mine, and on similar carbon monoxide (CO, another DE component) concentrations] and to surface jobs (based on the use of, or proximity to, diesel-powered equipment). Time trends in air concentrations for underground jobs were estimated from mining facility-specific prediction models using diesel equipment horsepower, total air flow rates exhausted from the underground mines, and, because there were no historical REC measurements, historical measurements of CO. Exposures to potentially confounding agents, i.e. respirable dust, silica, radon, asbestos, and non-diesel sources of polycyclic aromatic hydrocarbons, also were assessed. Accuracy and reliability of the estimated REC exposures levels were evaluated by comparison with several smaller datasets and by development of alternative time trend models. During 1998–2001, the average measured REC exposure level by facility ranged from 40 to 384 μg m−3 for the underground workers and from 2 to 6 μg m−3 for the surface workers. For one prevalent underground job, ‘miner operator’, the maximum annual REC exposure estimate by facility ranged up to 685% greater than the corresponding 1998–2001 value. A comparison of the historical CO estimates from the time trend models with 1976–1977 CO measurements not used in the modeling found an overall median relative difference of 29%. Other comparisons showed similar levels of agreement. The assessment process indicated large differences in REC exposure levels over time and across the underground operations. Method evaluations indicated that the final estimates were consistent with those from alternative time trend models and demonstrated moderate to high agreement with external data. PMID:20876233

The diesel exhaust in miners study: I. Overview of the exposure assessment process.

PubMed

Stewart, Patricia A; Coble, Joseph B; Vermeulen, Roel; Schleiff, Patricia; Blair, Aaron; Lubin, Jay; Attfield, Michael; Silverman, Debra T

2010-10-01

This report provides an overview of the exposure assessment process for an epidemiologic study that investigated mortality, with a special focus on lung cancer, associated with diesel exhaust (DE) exposure among miners. Details of several components are provided in four other reports. A major challenge for this study was the development of quantitative estimates of historical exposures to DE. There is no single standard method for assessing the totality of DE, so respirable elemental carbon (REC), a component of DE, was selected as the primary surrogate in this study. Air monitoring surveys at seven of the eight study mining facilities were conducted between 1998 and 2001 and provided reference personal REC exposure levels and measurements for other agents and DE components in the mining environment. (The eighth facility had closed permanently prior to the surveys.) Exposure estimates were developed for mining facility/department/job/year combinations. A hierarchical grouping strategy was developed for assigning exposure levels to underground jobs [based on job titles, on the amount of time spent in various areas of the underground mine, and on similar carbon monoxide (CO, another DE component) concentrations] and to surface jobs (based on the use of, or proximity to, diesel-powered equipment). Time trends in air concentrations for underground jobs were estimated from mining facility-specific prediction models using diesel equipment horsepower, total air flow rates exhausted from the underground mines, and, because there were no historical REC measurements, historical measurements of CO. Exposures to potentially confounding agents, i.e. respirable dust, silica, radon, asbestos, and non-diesel sources of polycyclic aromatic hydrocarbons, also were assessed. Accuracy and reliability of the estimated REC exposures levels were evaluated by comparison with several smaller datasets and by development of alternative time trend models. During 1998-2001, the average measured REC exposure level by facility ranged from 40 to 384 μg m⁻³ for the underground workers and from 2 to 6 μg m⁻³ for the surface workers. For one prevalent underground job, 'miner operator', the maximum annual REC exposure estimate by facility ranged up to 685% greater than the corresponding 1998-2001 value. A comparison of the historical CO estimates from the time trend models with 1976-1977 CO measurements not used in the modeling found an overall median relative difference of 29%. Other comparisons showed similar levels of agreement. The assessment process indicated large differences in REC exposure levels over time and across the underground operations. Method evaluations indicated that the final estimates were consistent with those from alternative time trend models and demonstrated moderate to high agreement with external data.

Development and applications of nondestructive evaluation at Marshall Space Flight Center

NASA Technical Reports Server (NTRS)

Whitaker, Ann F.

1990-01-01

A brief description of facility design and equipment, facility usage, and typical investigations are presented for the following: Surface Inspection Facility; Advanced Computer Tomography Inspection Station (ACTIS); NDE Data Evaluation Facility; Thermographic Test Development Facility; Radiographic Test Facility; Realtime Radiographic Test Facility; Eddy Current Research Facility; Acoustic Emission Monitoring System; Advanced Ultrasonic Test Station (AUTS); Ultrasonic Test Facility; and Computer Controlled Scanning (CONSCAN) System.

NewGate Model.

ERIC Educational Resources Information Center

National Council on Crime and Delinquency, Hackensack, NJ. NewGate Resource Center.

A guide is provided for establishing a college-level education program for inmates of correctional institutions based on the NewGate concept. Necessary first steps are evaluation of current facilities, selection of the sponsoring agency, and selection of the student body. Guidelines for student selection deal with application procedure, record…

EXPERIENCES FROM THE SOURCE-TERM ANALYSIS OF A LOW AND INTERMEDIATE LEVEL RADWASTE DISPOSAL FACILITY

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

Park,Jin Beak; Park, Joo-Wan; Lee, Eun-Young

2003-02-27

Enhancement of a computer code SAGE for evaluation of the Korean concept for a LILW waste disposal facility is discussed. Several features of source term analysis are embedded into SAGE to analyze: (1) effects of degradation mode of an engineered barrier, (2) effects of dispersion phenomena in the unsaturated zone and (3) effects of time dependent sorption coefficient in the unsaturated zone. IAEA's Vault Safety Case (VSC) approach is used to demonstrate the ability of this assessment code. Results of MASCOT are used for comparison purposes. These enhancements of the safety assessment code, SAGE, can contribute to realistic evaluation ofmore » the Korean concept of the LILW disposal project in the near future.« less

Numerical aerodynamic simulation facility feasibility study

NASA Technical Reports Server (NTRS)

1979-01-01

There were three major issues examined in the feasibility study. First, the ability of the proposed system architecture to support the anticipated workload was evaluated. Second, the throughput of the computational engine (the flow model processor) was studied using real application programs. Third, the availability reliability, and maintainability of the system were modeled. The evaluations were based on the baseline systems. The results show that the implementation of the Numerical Aerodynamic Simulation Facility, in the form considered, would indeed be a feasible project with an acceptable level of risk. The technology required (both hardware and software) either already exists or, in the case of a few parts, is expected to be announced this year. Facets of the work described include the hardware configuration, software, user language, and fault tolerance.

Vibration and noise criteria used to evaluate environmental impacts of transportation projects on sensitive facilities

NASA Astrophysics Data System (ADS)

Busch, Todd; Gendreau, Michael; Amick, Hal

2005-08-01

The paper examines the methodologies and evaluation criteria advocated by the U.S. Federal Transit Administration (FTA) and Federal Rail Administration (FRA) used to determine whether or not a proposed alignment for a transportation project adversely impacts affected land uses, such as research & development and high-technology manufacturing. The criteria in question are applied as limits on vibration and noise at sensitive receiver locations. Both short-term construction and long-term transportation operations are typically considered, with the latter being the focus of this paper. A case study is presented of a proposed transit system that passes through four different soil zones, the operational characteristics that are required to generate a vibration level equal to the FTA/FRA advocated level of 65 VdB re: 1 micro-inch/sec, and the range of variability of the acceptability of the vibration conditions when considered in terms of third-octave bands compared to vibration criterion (VC) curves that are used as the design performance targets of vibration-sensitive facilities.

Analysis of magnetic field levels at KSC

NASA Technical Reports Server (NTRS)

Christodoulou, Christos G.

1994-01-01

The scope of this work is to evaluate the magnetic field levels of distribution systems and other equipment at Kennedy Space Center (KSC). Magnetic fields levels in several operational areas and various facilities are investigated. Three dimensional mappings and contour are provided along with the measured data. Furthermore, the portion of magnetic fields generated by the 60 Hz fundamental frequency and the portion generated by harmonics are examined. Finally, possible mitigation techniques for attenuating fields from electric panels are discussed.

Testing of YUH-61A helicopter transmission in NASA Lewis 2240-kW (3000-hp facility

NASA Technical Reports Server (NTRS)

Mitchell, A. M.; Oswald, F. B.; Schuller, F. T.

1986-01-01

A helicopter transmission that was being considered for the Army's Utility Tactical Transport Attack System (UTTAS) was tested in the NASA Lewis 2240-kW (3000-hp) test facility to obtain the transmission's operational data. The results will form a vibration and efficiency data base for evaluation similar-class helicopter transmissions. The transmission's mechanical efficiency was determined to be 98.7 percent at its rated power level of 2080 kW (2792 hp). At power levels up to 113 percent of rated the transmission displayed 56 percent higher vibration acceleration levels on the right input than on the left input. Both vibration signature analysis and final visual inspection indicated that the right input spiral-bevel gear had poor contact patterns. The highest vibration meter level was 52 g's rms at the accessory gear, which had free-wheeling gearsets. At 113 percent power and 100 percent rated speed the vibration meter levels generally ranged from 3 to 25 g's rms.

Improving postpartum care delivery and uptake by implementing context-specific interventions in four countries in Africa: a realist evaluation of the Missed Opportunities in Maternal and Infant Health (MOMI) project

PubMed Central

Djellouli, Nehla; Mann, Sue; Nambiar, Bejoy; Meireles, Paula; Miranda, Diana; Barros, Henrique; Bocoum, Fadima Y; Yaméogo, W Maurice E; Yaméogo, Clarisse; Belemkoabga, Sylvie; Tougri, Halima; Coulibaly, Abou; Kouanda, Seni; Mochache, Vernon; Mwakusema, Omar K; Irungu, Eunice; Gichangi, Peter; Dembo, Zione; Kadzakumanja, Angela; Makwenda, Charles Vidonji; Timóteo, Judite; Cossa, Misete G; de Melo, Malica; Griffin, Sally; Osman, Nafissa B; Foia, Severiano; Ogbe, Emilomo; Duysburgh, Els

2017-01-01

Postpartum care (PPC) has remained relatively neglected in many interventions designed to improve maternal and neonatal health in sub-Saharan Africa. The Missed Opportunities in Maternal and Infant Health project developed and implemented a context-specific package of health system strengthening and demand generation in four African countries, aiming to improve access and quality of PPC. A realist evaluation was conducted to enable nuanced understanding of the influence of different contextual factors on both the implementation and impacts of the interventions. Mixed methods were used to collect data and test hypothesised context–mechanism–outcome configurations: 16 case studies (including interviews, observations, monitoring data on key healthcare processes and outcomes), monitoring data for all study health facilities and communities, document analysis and participatory evaluation workshops. After evaluation in individual countries, a cross-country analysis was conducted that led to the development of four middle-range theories. Community health workers (CHWs) were key assets in shifting demand for PPC by ‘bridging’ communities and facilities. Because they were chosen from the community they served, they gained trust from the community and an intrinsic sense of responsibility. Furthermore, if a critical mass of women seek postpartum healthcare as a result of the CHWs bridging function, a ‘buzz’ for change is created, leading eventually to the acceptability and perceived value of attending for PPC that outweighs the costs of attending the health facility. On the supply side, rigid vertical hierarchies and defined roles for health facility workers (HFWs) impede integration of maternal and infant health services. Additionally, HFWs fear being judged negatively which overrides the self-efficacy that could potentially be gained from PPC training. Instead the main driver of HFWs’ motivation to provide comprehensive PPC is dependent on accountability systems for delivering PPC created by other programmes. The realist evaluation offers insights into some of the contextual factors that can be pivotal in enabling the community-level and service-level interventions to be effective. PMID:29225949

Development of a standardized transfusion ratio as a metric for evaluating dialysis facility anemia management practices.

PubMed

Liu, Jiannong; Li, Suying; Gilbertson, David T; Monda, Keri L; Bradbury, Brian D; Collins, Allan J

2014-10-01

Because transfusion avoidance has been the cornerstone of anemia treatment for patients with kidney disease, direct measurement of red blood cell transfusion use to assess dialysis facility anemia management performance is reasonable. We aimed to explore methods for estimating facility-level standardized transfusion ratios (STfRs) to assess provider anemia treatment practices. Retrospective cohort study. Point prevalent US hemodialysis patients on January 1, 2009, with Medicare as primary payer and dialysis duration of 90 days or longer were included (n = 223,901). All dialysis facilities with eligible patients were included (n = 5,345). Dialysis facility assignment. Receiving a red blood cell transfusion in the inpatient or outpatient setting. We evaluated 3 approaches for estimating STfR: ratio of observed to expected numbers of transfusions (STfR(obs)), a Bayesian approach (STfR(Bayes)), and a modified version of the Bayesian approach (STfR(modBayes)). The overall national transfusion rate in 2009 was 23.2 per 100 patient-years. Our model for predicting the expected number of transfusions performed well. For large facilities, all 3 STfRs worked well. However, for small facilities, while the STfR(modBayes) worked well, STfR(obs) values demonstrated instability and the STfR(Bayes) may produce more bias. Administration of transfusions to dialysis patients reflects medical practice both within and outside the dialysis unit. Some transfusions may be deemed unavoidable and transfusion practices are subject to considerable regional variation. Development of an STfR metric is feasible and reasonable for assessing anemia treatment at dialysis facilities. The STfR(obs) is simple to calculate and works well for larger dialysis facilities. The STfR(modBayes) is more analytically complex, but facilitates comparisons across all dialysis facilities, including small facilities. Copyright © 2014 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

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

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-12

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

Evaluation of bicycle and pedestrian facilities : user satisfaction and perceptions on three shared use trails in Texas

DOT National Transportation Integrated Search

1999-05-01

The responses to the surveys were analyzed to determine consistent themes and trends in user satisfaction and perceptions. The study found that several trail attributes contribute significantly to user satisfaction and higher levels of trail use. Ade...

Evaluating the use of crowdsourcing as a data collection method for bicycle performance measures and identification of facility improvement needs.

DOT National Transportation Integrated Search

2015-08-01

This research developed a smartphone application called ORcycle to collect cyclists routes, users, and : comfort levels. ORcycle combines GPS revealed route data collection with new questionnaires that try : to elicit cyclists attitudes as well...

An assessment of the safe delivery incentive program at a tertiary level hospital in Nepal.

PubMed

Baral, G

2012-05-01

Maternity incentive program of Nepal known as Safe Delivery Incentive Program (SDIP) was introduced nationwide in 2005 with the intention of increasing utilization of professional care at childbirth. The program provided both childbirth service as well as 'cash' to women giving birth in a health facility in addition to incentives to health provider for each delivery attended, either at home or the facility. Due to a lack of uniformity in its implementation and administrative delays, the program was reformed and even extended to many not-for-profit health institutions in early 2007, and implemented as a 'Safer Mother Program' popularly known as "Aama-Suraksha-Karyakram" since January 2009. This is a system research with observational and analytical components. Plausibility design is selected to evaluate the performance-based funding (PBF) as a system level intervention of maternity care using two instruments: Pay-For-Performance and Conditional-Cash-Transfer. It uses interrupted time-series to control for the natural trend. Research tools used are interviews, the focus group discussions and literature review. Numerical data are presented in simple graphs. While online random number generator was used partly, the purposive sampling was used for qualitative data. There is a gross discrepancy in non-targeted service delivery at the tertiary level health facility. Overflooding of maternity cases has hampered gynecological admission and surgical management delaying subspecialty care and junior physicians' training. With the same number and quality of physical facility and human resource, the additional program has put more strains to service providers and administrators. There should be adequate planning and preparation at all levels of health facilities; implementing a new program should not adversely affect another existing service delivery system. For the optional implementation, hospital organogram should be revised; and physical facilities and the low-risk birthing-centers with referral linkages should be expanded.

Voluntary Medical Male Circumcision Scale-Up in Nyanza, Kenya: Evaluating Technical Efficiency and Productivity of Service Delivery

PubMed Central

Omondi Aduda, Dickens S.; Ouma, Collins; Onyango, Rosebella; Onyango, Mathews; Bertrand, Jane

2015-01-01

Background Voluntary medical male circumcision (VMMC) service delivery is complex and resource-intensive. In Kenya’s context there is still paucity of information on resource use vis-à-vis outputs as programs scale up. Knowledge of technical efficiency, productivity and potential sources of constraints is desirable to improve decision-making. Objective To evaluate technical efficiency and productivity of VMMC service delivery in Nyanza in 2011/2012 using data envelopment analysis. Design Comparative process evaluation of facilities providing VMMC in Nyanza in 2011/2012 using output orientated data envelopment analysis. Results Twenty one facilities were evaluated. Only 1 of 7 variables considered (total elapsed operation time) significantly improved from 32.8 minutes (SD 8.8) in 2011 to 30 minutes (SD 6.6) in 2012 (95%CI = 0.0350–5.2488; p = 0.047). Mean scale technical efficiency significantly improved from 91% (SD 19.8) in 2011 to 99% (SD 4.0) in 2012 particularly among outreach compared to fixed service delivery facilities (CI -31.47959–4.698508; p = 0.005). Increase in mean VRS technical efficiency from 84% (SD 25.3) in 2011 and 89% (SD 25.1) in 2012 was not statistically significant. Benchmark facilities were #119 and #125 in 2011 and #103 in 2012. Malmquist Productivity Index (MPI) at fixed facilities declined by 2.5% but gained by 4.9% at outreach ones by 2012. Total factor productivity improved by 83% (p = 0.032) in 2012, largely due to progress in technological efficiency by 79% (p = 0.008). Conclusions Significant improvement in scale technical efficiency among outreach facilities in 2012 was attributable to accelerated activities. However, ongoing pure technical inefficiency requires concerted attention. Technological progress was the key driver of service productivity growth in Nyanza. Incorporating service-quality dimensions and using stepwise-multiple criteria in performance evaluation enhances comprehensiveness and validity. These findings highlight site-level resource use and sources of variations in VMMC service productivity, which are important for program planning. PMID:25706119

Efficiency of U.S. Dialysis Centers: An Updated Examination of Facility Characteristics That Influence Production of Dialysis Treatments

PubMed Central

Shreay, Sanatan; Ma, Martin; McCluskey, Jill; Mittelhammer, Ron C; Gitlin, Matthew; Stephens, J Mark

2014-01-01

Objective To explore the relative efficiency of dialysis facilities in the United States and identify factors that are associated with efficiency in the production of dialysis treatments. Data Sources/Study Setting Medicare cost report data from 4,343 free-standing dialysis facilities in the United States that offered in-center hemodialysis in 2010. Study Design A cross-sectional, facility-level retrospective database analysis, utilizing data envelopment analysis (DEA) to estimate facility efficiency. Data Collection/Extraction Methods Treatment data and cost and labor inputs of dialysis treatments were obtained from 2010 Medicare Renal Cost Reports. Demographic data were obtained from the 2010 U.S. Census. Principal Findings Only 26.6 percent of facilities were technically efficient. Neither the intensity of market competition nor the profit status of the facility had a significant effect on efficiency. Facilities that were members of large chains were less likely to be efficient. Cost and labor savings due to changes in drug protocols had little effect on overall dialysis center efficiency. Conclusions The majority of free-standing dialysis facilities in the United States were functioning in a technically inefficient manner. As payment systems increasingly employ capitation and bundling provisions, these institutions will need to evaluate their efficiency to remain competitive. PMID:24237043

Can motivational signs prompt increases in incidental physical activity in an Australian health-care facility?

PubMed

Marshall, A L; Bauman, A E; Patch, C; Wilson, J; Chen, J

2002-12-01

This study aimed to evaluate whether a stair-promoting signed intervention could increase the use of the stairs over the elevator in a health-care facility. A time-series design was conducted over 12 weeks. Data were collected before, during and after displaying a signed intervention during weeks 4-5 and 8-9. Evaluation included anonymous counts recorded by an objective unobtrusive motion-sensing device of people entering the elevator or the stairs. Self-report data on stair use by hospital staff were also collected. Stair use significantly increased after the first intervention phase (P = 0.02), but after the intervention was removed stair use decreased back towards baseline levels. Moreover, stair use did not significantly change after the re-introduction of the intervention. Lastly, stair use decreased below the initial baseline level during the final weeks of evaluation. Furthermore, there was no significant change in self-reported stair use by hospital staff. Therefore, the signed intervention aimed at promoting an increase in incidental physical activity produced small brief effects, which were not maintained. Further research is required to find more effective 'point of choice' interventions to increase incidental physical activity participation with more sustainable impact.

Assessment of environmental risk for red mud storage facility in China: a case study in Shandong Province.

PubMed

Wen, Zhi-Chao; Ma, Shu-Hua; Zheng, Shi-Li; Zhang, Yi; Liang, Yan

2016-06-01

Red mud storage facility (RM-SF) pollution remains a serious problem in China mainly due to the RM's huge quantity, little recyclability, and high alkalinity. And, there is also a risk of dam failure because almost all RM-SFs are processed by damming. In order to address this challenge and improve the level of risk management, it is necessary to evaluate the environmental risk of RM-SFs systematically. So, this paper firstly designs a comprehensive evaluation index system with a three-level evaluation index in the terms of RM characteristics, RM-SF characteristics, ambient environment of RM-SF, the management of RM-SF, and the application aspect of RM by the analytic hierarchy process (AHP) method. Then, a case of RM-SF from a typical alumina production enterprise is studied according to this system, as is assisted by several experts from different fields when determining the weights of all indicators. The results show that the risk of selected RM-SF primarily depends on the former factors, that is, RM and RM-SF characteristics, while the contributions of the other factors are quite smaller.

Visualizing Safeguards: Software for Conceptualizing and Communicating Safeguards Data

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

Gallucci, N.

2015-07-12

The nuclear programs of states are complex and varied, comprising a wide range of fuel cycles and facilities. Also varied are the types and terms of states’ safeguards agreements with the IAEA, each placing different limits on the inspectorate’s access to these facilities. Such nuances make it difficult to draw policy significance from the ground-level nuclear activities of states, or to attribute ground-level outcomes to the implementation of specific policies or initiatives. While acquiring a firm understanding of these relationships is critical to evaluating and formulating effective policy, doing so requires collecting and synthesizing large bodies of information. Maintaining amore » comprehensive working knowledge of the facilities comprising even a single state’s nuclear program poses a challenge, yet marrying this information with relevant safeguards and verification information is more challenging still. To facilitate this task, Brookhaven National Laboratory has developed a means of capturing the development, operation, and safeguards history of all the facilities comprising a state’s nuclear program in a single graphic. The resulting visualization offers a useful reference tool to policymakers and analysts alike, providing a chronology of states’ nuclear development and an easily digestible history of verification activities across their fuel cycles.« less

An evaluation of substance misuse treatment providers used by an employee assistance program.

PubMed

Miller, N A

1992-05-01

Structural measures of access, continuity, and quality of substance misuse treatment services were compared in 30 fee-for-service (FFS) facilities and nine health maintenance organizations (HMOs). Probit models related effects of the provider system (FFS or HMO) and the system's structural characteristics to 243 employees' access to and outcomes from treatment. Access was decreased in Independent Practice Association (IPA)/network HMOs and in all facilities which did not employ an addictionologist or provide coordinated treatment services. When bivariate correlations were examined, both use of copayments and imposing limits to the levels of treatment covered were negatively related to access, while a facility's provision of ongoing professional development was positively associated with access. These correlations did not remain significant in the multivariate probits. Receiving treatment in a staff model HMO and facing limits to the levels of treatment covered were negatively associated with attaining sufficient progress, while receiving treatment in a facility which provided ongoing professional development was positively related to progress: these effects did not remain significant in multivariate analyses. Implications for employee assistance program (EAP) staff in their role as case managers and for EAP staff and employers in their shared role as purchasers of treatment are discussed.

An update of engine system research at the Army Propulsion Directorate

NASA Technical Reports Server (NTRS)

Bobula, George A.

1990-01-01

The Small Turboshaft Engine Research (STER) program provides a vehicle for evaluating the application of emerging technologies to Army turboshaft engine systems and to investigate related phenomena. Capitalizing on the resources at hand, in the form of both the NASA facilities and the Army personnel, the program goal of developing a physical understanding of engine system dynamics and/or system interactions is being realized. STER entries investigate concepts and components developed both in-house and out-of-house. Emphasis is placed upon evaluations which evolved from on-going basic research and advanced development programs. Army aviation program managers are also encouraged to make use of STER resources, both people and facilities. The STER personnel have established their reputations as experts in the fields of engine system experimental evaluations and engine system related phenomena. The STER facility has STER program provides the Army aviation community the opportunity to perform system level investigations, and then to offer the findings to the entire engine community for their consideration in next generation propulsion systems. In this way results of the fundamental research being conducted to meet small turboshaft engine technology challenges expeditiously find their way into that next generation of propulsion systems.

Environmental Risk Factors influencing Bicycle Theft: A Spatial Analysis in London, UK.

PubMed

Mburu, Lucy Waruguru; Helbich, Marco

2016-01-01

Urban authorities are continuously drawing up policies to promote cycling among commuters. However, these initiatives are counterproductive for the targeted objectives because they increase opportunities for bicycle theft. This paper explores Inner London as a case study to address place-specific risk factors for bicycle theft at the street-segment level while controlling for seasonal variation. The presence of certain public amenities (e.g., bicycle stands, railway stations, pawnshops) was evaluated against locations of bicycle theft between 2013 and 2016 and risk effects were estimated using negative binomial regression models. Results showed that a greater level of risk stemmed from land-use facilities than from area-based socioeconomic status. The presence of facilities such as train stations, vacant houses, pawnbrokers and payday lenders increased bicycle theft, but no evidence was found that linked police stations with crime levels. The findings have significant implications for urban crime prevention with respect to non-residential land use.

Modernizing sports facilities

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

Dustin, R.

Modernization and renovation of sports facilities challenge the design team to balance a number of requirements: spectator and owner expectations, existing building and site conditions, architectural layouts, code and legislation issues, time constraints and budget issues. System alternatives are evaluated and selected based on the relative priorities of these requirements. These priorities are unique to each project. At Alexander Memorial Coliseum, project schedules, construction funds and facility usage became the priorities. The ACC basketball schedule and arrival of the Centennial Olympics dictated the construction schedule. Initiation and success of the project depended on the commitment of the design team tomore » meet coliseum funding levels established three years ago. Analysis of facility usage and system alternative capabilities drove the design team to select a system that met the project requirements and will maximize the benefits to the owner and spectators for many years to come.« less

Regulatory cross-cutting topics for fuel cycle facilities.

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

Denman, Matthew R.; Brown, Jason; Goldmann, Andrew Scott

This report overviews crosscutting regulatory topics for nuclear fuel cycle facilities for use in the Fuel Cycle Research & Development Nuclear Fuel Cycle Evaluation and Screening study. In particular, the regulatory infrastructure and analysis capability is assessed for the following topical areas: Fire Regulations (i.e., how applicable are current Nuclear Regulatory Commission (NRC) and/or International Atomic Energy Agency (IAEA) fire regulations to advance fuel cycle facilities) Consequence Assessment (i.e., how applicable are current radionuclide transportation tools to support risk-informed regulations and Level 2 and/or 3 PRA) While not addressed in detail, the following regulatory topic is also discussed: Integrated Security,more » Safeguard and Safety Requirement (i.e., how applicable are current Nuclear Regulatory Commission (NRC) regulations to future fuel cycle facilities which will likely be required to balance the sometimes conflicting Material Accountability, Security, and Safety requirements.)« less

Environmental monitoring in a laboratory animal facility.

PubMed

Wellstood-Nuesse, S; Shields, R P

1976-08-01

A study was made of the microbial environmental status of an animal facility. Cultures were made of animal and surgical room floors; the germicidal effectiveness of the phenolic disinfectant-detergent employed in the facility was tested against standard test organisms as well as against other microorganisms isolated from the facility, and killing power of the disinfectant-detergent was evaluated during various steps of the usual cleaning procedures, ie, mops and mop bucket solutions were tested before, during, and after mopping a room. It was found that colony counts for animal rooms cleaned with a chlorhexidine disinfectant were much lower than those cleaned with a phenolic disinfectant. The phenolic disinfectant killed some organisms after 10 min exposure, but no others. Pseudomonads were the most resistant organisms. Contaminated mops and mop bucket solutions appeared responsible for the high counts on floors cleaned with the phenolic disinfectant. Guidelines for achievable levels of cleanliness were suggested.

Evaluation of flow quality in two large NASA wind tunnels at transonic speeds

NASA Technical Reports Server (NTRS)

Harvey, W. D.; Stainback, P. C.; Owen, F. K.

1980-01-01

Wind tunnel testing of low drag airfoils and basic transition studies at transonic speeds are designed to provide high quality aerodynamic data at high Reynolds numbers. This requires that the flow quality in facilities used for such research be excellent. To obtain a better understanding of the characteristics of facility disturbances and identification of their sources for possible facility modification, detailed flow quality measurements were made in two prospective NASA wind tunnels. Experimental results are presented of an extensive and systematic flow quality study of the settling chamber, test section, and diffuser in the Langley 8 foot transonic pressure tunnel and the Ames 12 foot pressure wind tunnel. Results indicate that the free stream velocity and pressure fluctuation levels in both facilities are low at subsonic speeds and are so high as to make it difficult to conduct meaningful boundary layer control and transition studies at transonic speeds.

Effects of Air Pollutants on Lichens of the Idaho National Engineering Laboratory National Environmental Research Park

NASA Astrophysics Data System (ADS)

Marty, R. C.; Forman, A.; Crawford, R.; Tyler, T.

2001-12-01

The Idaho National Engineering and Environmental Laboratory is a (2300 square km) National Environmental Research Park that has been used for research and operational support of nuclear power. The Park includes scattered industrial operations and provides an ideal setting to study effects of industry on semi-arid environments. One of the facilities on the Research Park is the Idaho Nuclear Technology Center (INTEC). This facility reprocessed spent nuclear fuel from the US Navy, and its operations included heating acidic solutions to convert wastes to a solid form. The conversion released nitrogen oxides, low levels of other gases (including HF), and small amounts of solid particles through a facility stack. A fossil-fuel power plant also contributed airborne contaminants including sulfur dioxide. A 1985 study identified the effects of INTEC operations on the health of lichens Xanthoria polycarpa (quantified using electrolyte leakage), on levels of trace metals in the lichens X. polycarpa and Rhizoplaca melanophthalma, and on the levels of trace metals in higher plants and soils. The study concluded that operations impacted the physiological health of X. polycarpa southwest of the plant, and that lead was significantly higher downwind of the plant relative to other locations. Effects of the plant were re-examined in 1999 as part of an Environmental Impact Statement to evaluate the environmental effects of measures available to deal with radioactive waste at INTEC. Sulfur dioxide emissions from the facility decreased from approximately 375 tonsyear to approximately 10 tonsyear between the two studies. The re-examination of lichens showed that the measure of physiological health used in the previous study (conductivity of rinsates collected from lichen thalli) correlated well to the levels of potassium measured in rinsates collected from thalli. There, however, was no correlation between the levels of potassium/conductivity of such rinsates and the levels of total potassium in lichens or between levels of potassium/conductivity and macroscopic vigor of the lichens or between levels of potassium/conductivity in rinsates and chlorophyll ratios (another common indicator of the physiological health of lichens). This suggests that potassium levels in rinsates may not be a good indicator of physiological stress. X. polycarpa abundance varied with direction from the facility. The species was lacking from background locations at Craters of the Moon National monument. Cover on dead Artemisia tridentata twigs varied between 2 and 5% downwind and crosswind for the predominant wind direction, but approached 75% to the north and northeast (downwind) of the facility. This differential cover is striking but was not noted in the previous study and probably reflects increased abundance of the nitrogen loving X. polycarpa downwind from the facility between the two studies. Calcium levels in R. melanophthalma around INTEC were significantly higher than calcium levels in lichens from the background location at Craters of the Moon. This may reflect migration of the species to more buffered calcium carbonate substrates in response to acidified precipitation. Levels of calcium in R. melanophthalma fell between the two studies, possibly reflecting less substrate acidification during the later period. Lead was not significantly elevated during the second study, but mercury may be elevated downwind of the facility.

DETERMINING THE "MARGIN OF INCREMENTAL EXPOSURE": AN APPROACH TO ASSESSING NON-CANCER HEALTH EFFECTS OF DIOXINS

EPA Science Inventory

U.S. Environmental Protection Agency (EPA) guidance issued in April 1994 for performing screening level risk analyses of emissions from facilities that burn hazardous waste does not address the evaluation of non-cancer health effects from dioxin emissions. Historically, EPA has ...

Evaluation of interactive highway safety design model crash prediction tools for two-lane rural roads on Kansas Department of Transportation projects.

DOT National Transportation Integrated Search

2014-01-01

Historically, project-level decisions for the selection of highway features to promote safety were : based on either engineering judgment or adherence to accepted national guidance. These tools have allowed : highway designers to produce facilities t...

Evaluation of interactive highway safety design model crash prediction tools for two-lane rural roads on Kansas Department of Transportation projects : [technical summary].

DOT National Transportation Integrated Search

2014-01-01

Historically, project-level decisions for the selection of highway features to promote safety were based on either engineering judgment or adherence to accepted national guidance. These tools have allowed highway designers to produce facilities that ...

23 CFR 970.214 - Federal lands congestion management system (CMS).

Code of Federal Regulations, 2011 CFR

2011-04-01

... experiencing congestion, the NPS shall develop a separate CMS to cover those facilities. Approaches may include... congestion management strategies; (v) Determine methods to monitor and evaluate the performance of the multi... means the level at which transportation system performance is no longer acceptable due to traffic...

23 CFR 970.214 - Federal lands congestion management system (CMS).

Code of Federal Regulations, 2010 CFR

2010-04-01

... experiencing congestion, the NPS shall develop a separate CMS to cover those facilities. Approaches may include... congestion management strategies; (v) Determine methods to monitor and evaluate the performance of the multi... means the level at which transportation system performance is no longer acceptable due to traffic...

Conceptual Modeling Framework for E-Area PA HELP Infiltration Model Simulations

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

Dyer, J. A.

A conceptual modeling framework based on the proposed E-Area Low-Level Waste Facility (LLWF) closure cap design is presented for conducting Hydrologic Evaluation of Landfill Performance (HELP) model simulations of intact and subsided cap infiltration scenarios for the next E-Area Performance Assessment (PA).

Results of the air emission research study

USDA-ARS?s Scientific Manuscript database

Air quality was monitored in beef mono-slope barns. The objectives of the study were 1) to gather baseline data for the levels of gas emissions and particulate matter from beef mono-slope facilities, 2) evaluate the effect of two different manure handling systems on air quality, and 3) provide infor...

Visibility and Visual Characteristics of the Ivanpah Solar Electric Generating System Power Tower Facility

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

Sullivan, Robert; Abplanalp, Jennifer M.

2015-03-01

This report presents the results of a study conducted to document the visibility and visual characteristics of the Ivanpah Solar Electric Generating System (ISEGS), a utility-scale solar power tower facility located on land administered by the U.S. Department of the Interior Bureau of Land Management in southern California. Study activities consisted of field observations of the ISEGS facility and comparison of the observations made in the field with the visual contrast assessments and visual simulations in the ISEGS Final Environmental Impact Statement (Final EIS) and supporting documents created prior to ISEGS construction. Field observations of ISEGS were made from 19more » locations within 35 mi (56 km) of the facility in the course of one week in September 2014. The study results established that reflected sunlight from the receivers was the primary source of visual contrast from the operating ISEGS facility. The ISEGS facility was found to be a major source of visual contrast for all observations up to 20 mi (32 km), and was easily visible at 35 mi. Glare from individual heliostats was frequently visible, and often brighter than the reflected light from the receivers. Heliostat glare caused discomfort for one or more viewers at distances up to 20 mi. The ISEGS power blocks were brightly lit at night, and were conspicuous at the observation distance of approximately 6 mi (10 km). The facility is substantially brighter and is seen more clearly in the field than in photographs of the facility or in the prepared simulations, which were based on photographs. The simulations of the ISEGS facility in the Final EIS, which were evaluated as part of this study, sometimes lacked spatial accuracy and realism. The evaluated simulations generally under-represented the actual visual contrast from the project, and some of the contrast ratings in the Final EIS predicted substantially lower levels of visual contrast than were actually observed for the operating facility.« less

Health facility service availability and readiness for intrapartum and immediate postpartum care in Malawi: A cross-sectional survey

PubMed Central

Oseni, Lolade; Mtimuni, Angella; Sethi, Reena; Rashidi, Tambudzai; Kachale, Fannie; Rawlins, Barbara; Gupta, Shivam

2017-01-01

This analysis seeks to identify strengths and gaps in the existing facility capacity for intrapartum and immediate postpartum fetal and neonatal care, using data collected as a part of Malawi’s Helping Babies Breath program evaluation. From August to September 2012, the Maternal and Child Health Integrated Program (MCHIP) conducted a cross-sectional survey in 84 Malawian health facilities to capture current health facility service availability and readiness and health worker capacity and practice pertaining to labor, delivery, and immediate postpartum care. The survey collected data on availability of equipment, supplies, and medications, and health worker knowledge and performance scores on intrapartum care simulation and actual management of real clients at a subset of facilities. We ran linear regression models to identify predictors of high simulation performance of routine delivery care and management of asphyxiated newborns across all facilities surveyed. Key supplies for infection prevention and thermal care of the newborn were found to be missing in many of the surveyed facilities. At the health center level, 75% had no clinician trained in basic emergency obstetric care or newborn care and 39% had no midwife trained in the same. We observed that there were no proportional increases in available transport and staff at a facility as catchment population increased. In simulations of management of newborns with breathing problems, health workers were able to complete a median of 10 out of 16 tasks for a full-term birth case scenario and 20 out of 30 tasks for a preterm birth case scenario. Health workers who had more years of experience appeared to perform worse. Our study provides a benchmark and highlights gaps for future evaluations and studies as Malawi continues to make strides in improving facility-based care. Further progress in reducing the burden of neonatal and fetal death in Malawi will be partly predicated on guaranteeing properly equipped and staffed facilities in addition to ensuring the presence of skilled health workers. PMID:28301484

Health facility service availability and readiness for intrapartum and immediate postpartum care in Malawi: A cross-sectional survey.

PubMed

Kozuki, Naoko; Oseni, Lolade; Mtimuni, Angella; Sethi, Reena; Rashidi, Tambudzai; Kachale, Fannie; Rawlins, Barbara; Gupta, Shivam

2017-01-01

This analysis seeks to identify strengths and gaps in the existing facility capacity for intrapartum and immediate postpartum fetal and neonatal care, using data collected as a part of Malawi's Helping Babies Breath program evaluation. From August to September 2012, the Maternal and Child Health Integrated Program (MCHIP) conducted a cross-sectional survey in 84 Malawian health facilities to capture current health facility service availability and readiness and health worker capacity and practice pertaining to labor, delivery, and immediate postpartum care. The survey collected data on availability of equipment, supplies, and medications, and health worker knowledge and performance scores on intrapartum care simulation and actual management of real clients at a subset of facilities. We ran linear regression models to identify predictors of high simulation performance of routine delivery care and management of asphyxiated newborns across all facilities surveyed. Key supplies for infection prevention and thermal care of the newborn were found to be missing in many of the surveyed facilities. At the health center level, 75% had no clinician trained in basic emergency obstetric care or newborn care and 39% had no midwife trained in the same. We observed that there were no proportional increases in available transport and staff at a facility as catchment population increased. In simulations of management of newborns with breathing problems, health workers were able to complete a median of 10 out of 16 tasks for a full-term birth case scenario and 20 out of 30 tasks for a preterm birth case scenario. Health workers who had more years of experience appeared to perform worse. Our study provides a benchmark and highlights gaps for future evaluations and studies as Malawi continues to make strides in improving facility-based care. Further progress in reducing the burden of neonatal and fetal death in Malawi will be partly predicated on guaranteeing properly equipped and staffed facilities in addition to ensuring the presence of skilled health workers.

Planning Tool for Strategic Evaluation of Facility Plans - 13570

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

Magoulas, Virginia; Cercy, Michael; Hall, Irin

2013-07-01

Savannah River National Laboratory (SRNL) has developed a strategic planning tool for the evaluation of the utilization of its unique resources for processing and research and development of nuclear materials. The Planning Tool is a strategic level tool for assessing multiple missions that could be conducted utilizing the SRNL facilities and showcasing the plan. Traditional approaches using standard scheduling tools and laying out a strategy on paper tended to be labor intensive and offered either a limited or cluttered view for visualizing and communicating results. A tool that can assess the process throughput, duration, and utilization of the facility wasmore » needed. SRNL teamed with Newport News Shipbuilding (NNS), a division of Huntington Ingalls Industries, to create the next generation Planning Tool. The goal of this collaboration was to create a simulation based tool that allows for quick evaluation of strategies with respect to new or changing missions, and clearly communicates results to the decision makers. This tool has been built upon a mature modeling and simulation software previously developed by NNS. The Planning Tool provides a forum for capturing dependencies, constraints, activity flows, and variable factors. It is also a platform for quickly evaluating multiple mission scenarios, dynamically adding/updating scenarios, generating multiple views for evaluating/communicating results, and understanding where there are areas of risks and opportunities with respect to capacity. The Planning Tool that has been developed is useful in that it presents a clear visual plan for the missions at the Savannah River Site (SRS). It not only assists in communicating the plans to SRS corporate management, but also allows the area stakeholders a visual look at the future plans for SRS. The design of this tool makes it easily deployable to other facility and mission planning endeavors. (authors)« less

Case-Mix Adjustment of the Bereaved Family Survey.

PubMed

Kutney-Lee, Ann; Carpenter, Joan; Smith, Dawn; Thorpe, Joshua; Tudose, Alina; Ersek, Mary

2018-01-01

Surveys of bereaved family members are increasingly being used to evaluate end-of-life (EOL) care and to measure organizational performance in EOL care quality. The Bereaved Family Survey (BFS) is used to monitor EOL care quality and benchmark performance in the Veterans Affairs (VA) health-care system. The objective of this study was to develop a case-mix adjustment model for the BFS and to examine changes in facility-level scores following adjustment, in order to provide fair comparisons across facilities. We conducted a cross-sectional secondary analysis of medical record and survey data from veterans and their family members across 146 VA medical centers. Following adjustment using model-based propensity weighting, the mean change in the BFS-Performance Measure score across facilities was -0.6 with a range of -2.6 to 0.6. Fifty-five (38%) facilities changed within ±0.5 percentage points of their unadjusted score. On average, facilities that benefited most from adjustment cared for patients with greater comorbidity burden and were located in urban areas in the Northwest and Midwestern regions of the country. Case-mix adjustment results in minor changes to facility-level BFS scores but allows for fairer comparisons of EOL care quality. Case-mix adjustment of the BFS positions this National Quality Forum-endorsed measure for use in public reporting and internal quality dashboards for VA leadership and may inform the development and refinement of case-mix adjustment models for other surveys of bereaved family members.

Corrosion impact of reductant on DWPF and downstream facilities

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

Mickalonis, J. I.; Imrich, K. J.; Jantzen, C. M.

2014-12-01

Glycolic acid is being evaluated as an alternate reductant in the preparation of high level waste for the Defense Waste Processing Facility (DWPF) at the Savannah River Site (SRS). During processing, the glycolic acid is not completely consumed and small quantities of the glycolate anion are carried forward to other high level waste (HLW) facilities. The impact of the glycolate anion on the corrosion of the materials of construction throughout the waste processing system has not been previously evaluated. A literature review had revealed that corrosion data in glycolate-bearing solution applicable to SRS systems were not available. Therefore, testing wasmore » recommended to evaluate the materials of construction of vessels, piping and components within DWPF and downstream facilities. The testing, conducted in non-radioactive simulants, consisted of both accelerated tests (electrochemical and hot-wall) with coupons in laboratory vessels and prototypical tests with coupons immersed in scale-up and mock-up test systems. Eight waste or process streams were identified in which the glycolate anion might impact the performance of the materials of construction. These streams were 70% glycolic acid (DWPF feed vessels and piping), SRAT/SME supernate (Chemical Processing Cell (CPC) vessels and piping), DWPF acidic recycle (DWPF condenser and recycle tanks and piping), basic concentrated recycle (HLW tanks, evaporators, and transfer lines), salt processing (ARP, MCU, and Saltstone tanks and piping), boric acid (MCU separators), and dilute waste (HLW evaporator condensate tanks and transfer line and ETF components). For each stream, high temperature limits and worst-case glycolate concentrations were identified for performing the recommended tests. Test solution chemistries were generally based on analytical results of actual waste samples taken from the various process facilities or of prototypical simulants produced in the laboratory. The materials of construction for most vessels, components and piping were not impacted with the presence of glycolic acid or the impact is not expected to affect the service life. However, the presence of the glycolate anion was found to affect corrosion susceptibility of some materials of construction in the DWPF and downstream facilities, especially at elevated temperatures. The following table summarizes the results of the electrochemical and hot wall testing and indicates expected performance in service with the glycolate anion present.« less

Radiographic trends of dental offices and dental schools.

PubMed

Suleiman, O H; Spelic, D C; Conway, B; Hart, J C; Boyce, P R; Antonsen, R G

1999-07-01

A survey of private practice facilities in the United States that perform dental radiography was conducted in 1993 and repeated in dental schools in 1995-1996. Both surveys were conducted as part of the Nationwide Evaluation of X-ray Trends, or NEXT, survey program. A representative sample of dental facilities from each participating state were surveyed, and data on patient radiation exposure, radiographic technique, film-image quality, film-processing quality and darkroom fog were collected. The authors found that dental schools use E-speed film more frequently than do private practice facilities. The use of E-speed film and better film processing by dental schools resulted in lower patient radiation exposures without sacrificing image quality. The authors also found that dental school darkrooms had lower ambient fog levels than did those of private practice facilities. The distribution for the 1993 NEXT survey facilities was greater than that observed for dental schools for radiation exposure, film-processing quality and darkroom fog. Dental schools, in general, had better film quality and lower radiation exposures than did private practice facilities. Facilities need to emphasize better quality processing and the use of E-speed film to reduce patient exposure and improve image quality.

Application of the Life Safety Code to a Historic Test Stand

NASA Technical Reports Server (NTRS)

Askins, Bruce; Lemke, Paul R.; Lewis, William L.; Covell, Carol C.

2011-01-01

NASA has conducted a study to assess alternatives to refurbishing existing launch vehicle modal test facilities as opposed to developing new test facilities to meet the demands of a very fiscally constrained test and evaluation environment. The results of this study showed that Marshall Space Flight Center (MSFC) Test Stand (TS) 4550 could be made compliant, within reasonable cost and schedule impacts, if safety processes and operational limitations were put in place to meet the safety codes and concerns of the Fire Marshall. Trades were performed with key selection criteria to ensure that appropriate levels of occupant safety are incorporated into test facility design modifications. In preparation for the ground vibration tests that were to be performed on the Ares I launch vehicle, the Ares Flight and Integrated Test Office (FITO) organization evaluated the available test facility options, which included the existing mothballed structural dynamic TS4550 used by Apollo and Shuttle, alternative ground vibration test facilities at other locations, and construction of a new dynamic test stand. After an exhaustive assessment of the alternatives, the results favored modifying the TS4550 because it was the lowest cost option and presented the least schedule risk to the NASA Constellation Program for Ares Integrated Vehicle Ground Vibration Test (IVGVT). As the renovation design plans and drawings were being developed for TS4550, a safety concern was discovered the original design for the construction of the test stand, originally built for the Apollo Program and renovated for the Shuttle Program, was completed before NASA s adoption of the currently imposed safety and building codes per National Fire Protection Association Life Safety Code [NFPA 101] and International Building Codes. The initial FITO assessment of the design changes, required to make TS4550 compliant with current safety and building standards, identified a significant cost increase and schedule impact. An effort was launched to thoroughly evaluate the applicable life safety requirements, examine the context in which they were derived, and determine a means by which the TS4550 modifications could be made within budget and on schedule, while still providing the occupants with appropriate levels of safety.

Migration of Beryllium via Multiple Exposure Pathways among Work Processes in Four Different Facilities

PubMed Central

Armstrong, Jenna L.; Day, Gregory A.; Park, Ji Young; Stefaniak, Aleksandr B.; Stanton, Marcia L.; Deubner, David C.; Kent, Michael S.; Schuler, Christine R.; Virji, M. Abbas

2016-01-01

Inhalation of beryllium is associated with the development of sensitization; however, dermal exposure may also be important. The primary aim of this study was to elucidate relationships among exposure pathways in four different manufacturing and finishing facilities. Secondary aims were to identify jobs with increased levels of beryllium in air, on skin, and on surfaces; identify potential discrepancies in exposure pathways, and determine if these are related to jobs with previously identified risk. Beryllium was measured in air, on cotton gloves, and on work surfaces. Summary statistics were calculated and correlations among all three measurement types were examined at the facility and job level. Exposure ranking strategies were used to identify jobs with higher exposures. The highest air, glove, and surface measurements were observed in beryllium metal production and beryllium oxide ceramics manufacturing jobs that involved hot processes and handling powders. Two finishing and distribution facilities that handle solid alloy products had lower exposures than the primary production facilities, and there were differences observed among jobs. For all facilities combined, strong correlations were found between air-surface (rp ≥ 0.77), glove-surface (rp ≥ 0.76), and air-glove measurements (rp ≥ 0.69). In jobs where higher risk of beryllium sensitization or disease has been reported, exposure levels for all three measurement types were higher than in jobs with lower risk, though they were not the highest. Some jobs with low air concentrations had higher levels of beryllium on glove and surface wipe samples, suggesting a need to further evaluate the causes of the discrepant levels. Although such correlations provide insight on where beryllium is located throughout the workplace, they cannot identify the direction of the pathways between air, surface, or skin. Ranking strategies helped to identify jobs with the highest combined air, glove, and/or surface exposures. All previously identified high-risk jobs had high air concentrations, dermal mass loading, or both, and none had low dermal and air. We have found that both pathways are relevant. PMID:25357184

Assessing the elimination of user fees for delivery services in Laos.

PubMed

Boudreaux, Chantelle; Chanthala, Phetdara; Lindelow, Magnus

2014-01-01

A pilot eliminating user fees associated with delivery at the point of services was introduced in two districts of Laos in March 2009. Following two years of implementation, an evaluation was conducted to assess the pilot impact, as well as to document the pilot design and implementation challenges. Study results show that, even in the presence of the substantial access and cultural barriers, user fees associated with delivery at health facilities act as a serious deterrent to care seeking behavior. We find a tripling of facility-based delivery rates in the intervention areas, compared to a 40% increase in the control areas. While findings from the control region suggest that facility-based delivery rates may be on the rise across the country, the substantially higher increase in the pilot areas highlight the impact of financial burden associated with facility-based delivery fees. These fees can play an important role in rapidly increasing the uptake of facility delivery to reach the national targets and, ultimately, to improve maternal and child health outcomes. The pilot achieved important gains while relying heavily on capacity and systems already in place. However, the high cost associated with monitoring and evaluation suggest broad-scale expansion of the pilot activities is likely to necessitate targeted capacity building initiatives, especially in areas with limited district level capacity to manage funds and deliver detailed and timely reports.

Association of U.S. Dialysis Facility Neighborhood Characteristics with Facility-Level Kidney Transplantation

PubMed Central

Plantinga, Laura; Pastan, Stephen; Kramer, Michael; McClellan, Ann; Krisher, Jenna; Patzer, Rachel E.

2014-01-01

Background Improving access to optimal healthcare may depend on attributes of neighborhoods where patients receive healthcare services. We investigated whether characteristics of dialysis facility neighborhoods—where most patients with end-stage renal disease are treated—were associated with facility-level kidney transplantation. Methods We examined the association between census tract (neighborhood)-level sociodemographic factors and facility-level kidney transplantation rate in 3,983 U.S. dialysis facilities with reported kidney transplantation rates. Number of kidney transplants and total person-years contributed at the facility level in 2007-2010 were obtained from the Dialysis Facility Report and linked to census tract data on sociodemographic characteristics from the American Community Survey 2006-2010 by dialysis facility location. We used multivariable Poisson models with generalized estimating equations to estimate associations between neighborhood characteristics and transplant incidence. Results U.S. dialysis facilities were located in neighborhoods with substantially greater proportions of black and poor residents, relative to the national average. Most facility neighborhood characteristics were associated with transplant, with incidence rate ratios (95% CI) for standardized increments (in percentage) of neighborhood exposures of: living in poverty, 0.88 (0.84-0.92), black race, 0.83 (0.78-0.89); high school graduates, 1.22 (1.17-1.26); and unemployed, 0.90 (0.85-0.95). Conclusion Dialysis facility neighborhood characteristics may be modestly associated with facility rates of kidney transplantation. The success of dialysis facility interventions to improve access to kidney transplantation may partially depend on reducing neighborhood-level barriers. PMID:25196018

48 CFR 215.404-71-4 - Facilities capital employed.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., and equipment, as derived in DD Form 1861, Contract Facilities Capital Cost of Money. (i) In addition... facilities capital, the allocated facilities capital attributable to the buildings and equipment of those... Equipment 17.5 10 to 25 (g) Evaluation criteria. (1) In evaluating facilities capital employed, the...

10 CFR 62.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

.... Emergency access means access to an operating non-Federal or regional low-level radioactive waste disposal... regional low-level radioactive waste disposal facility or facilities for a period not to exceed 180 days... waste. Non-Federal disposal facility means a low-level radioactive waste disposal facility that is...

Assessing delivery practices of mothers over time and over space in Uganda, 2003-2012.

PubMed

Sprague, Daniel A; Jeffery, Caroline; Crossland, Nadine; House, Thomas; Roberts, Gareth O; Vargas, William; Ouma, Joseph; Lwanga, Stephen K; Valadez, Joseph J

2016-01-01

It is well known that safe delivery in a health facility reduces the risks of maternal and infant mortality resulting from perinatal complications. What is less understood are the factors associated with safe delivery practices. We investigate factors influencing health facility delivery practices while adjusting for multiple other factors simultaneously, spatial heterogeneity, and trends over time. We fitted a logistic regression model to Lot Quality Assurance Sampling (LQAS) data from Uganda in a framework that considered individual-level covariates, geographical features, and variations over five time points. We accounted for all two-covariate interactions and all three-covariate interactions for which two of the covariates already had a significant interaction, were able to quantify uncertainty in outputs using computationally intensive cluster bootstrap methods, and displayed outputs using a geographical information system. Finally, we investigated what information could be predicted about districts at future time-points, before the next LQAS survey is carried out. To do this, we applied the model to project a confidence interval for the district level coverage of health facility delivery at future time points, by using the lower and upper end values of known demographics to construct a confidence range for the prediction and define priority groups. We show that ease of access, maternal age and education are strongly associated with delivery in a health facility; after accounting for this, there remains a significant trend towards greater uptake over time. We use this model together with known demographics to formulate a nascent early warning system that identifies candidate districts expected to have low prevalence of facility-based delivery in the immediate future. Our results support the hypothesis that increased development, particularly related to education and access to health facilities, will act to increase facility-based deliveries, a factor associated with reducing perinatal associated mortality. We provide a statistical method for using inexpensive and routinely collected monitoring and evaluation data to answer complex epidemiology and public health questions in a resource-poor setting. We produced a model based on this data that explained the spatial distribution of facility-based delivery in Uganda. Finally, we used this model to make a prediction about the future priority of districts that was validated by monitoring and evaluation data collected in the next year.

Dialysis facility and patient characteristics associated with utilization of home dialysis.

PubMed

Walker, David R; Inglese, Gary W; Sloand, James A; Just, Paul M

2010-09-01

Nonmedical factors influencing utilization of home dialysis at the facility level are poorly quantified. Home dialysis is comparably effective and safe but less expensive to society and Medicare than in-center hemodialysis. Elimination of modifiable practice variation unrelated to medical factors could contribute to improvements in patient outcomes and use of scarce resources. Prevalent dialysis patient data by facility were collected from the 2007 ESRD Network's annual reports. Facility characteristic data were collected from Medicare's Dialysis Facility Compare file. A multivariate regression model was used to evaluate associations between the use of home dialysis and facility characteristics. The utilization of home dialysis was positively associated with facility size, percent patients employed full- or part-time, younger population, and years a facility was Medicare certified. Variables negatively associated include an increased number of hemodialysis patients per hemodialysis station, chain association, rural location, more densely populated zip code, a late dialysis work shift, and greater percent of black patients within a zip code. Improved understanding of factors affecting the frequency of use of home dialysis may help explain practice variations across the United States that result in an imbalanced use of medical resources within the ESRD population. In turn, this may improve the delivery of healthcare and extend the ability of an increasingly overburdened medical financing system to survive.

Challenges and Opportunities for Biological Mass Spectrometry Core Facilities in the Developing World.

PubMed

Bell, Liam; Calder, Bridget; Hiller, Reinhard; Klein, Ashwil; Soares, Nelson C; Stoychev, Stoyan H; Vorster, Barend C; Tabb, David L

2018-04-01

The developing world is seeing rapid growth in the availability of biological mass spectrometry (MS), particularly through core facilities. As proteomics and metabolomics becomes locally feasible for investigators in these nations, application areas associated with high burden in these nations, such as infectious disease, will see greatly increased research output. This article evaluates the rapid growth of MS in South Africa (currently approaching 20 laboratories) as a model for establishing MS core facilities in other nations of the developing world. Facilities should emphasize new services rather than new instruments. The reduction of the delays associated with reagent and other supply acquisition would benefit both facilities and the users who make use of their services. Instrument maintenance and repair, often mediated by an in-country business for an international vendor, is also likely to operate on a slower schedule than in the wealthiest nations. A key challenge to facilities in the developing world is educating potential facility users in how best to design experiments for proteomics and metabolomics, what reagents are most likely to introduce problematic artifacts, and how to interpret results from the facility. Here, we summarize the experience of 6 different institutions to raise the level of biological MS available to researchers in South Africa.

The differential associations of preexisting conditions with trauma-related outcomes in the presence of competing risks.

PubMed

Calvo, Richard Yee; Lindsay, Suzanne P; Edland, Steven D; Macera, Caroline A; Wingard, Deborah L; Ohno-Machado, Lucila; Sise, Michael J

2016-03-01

Pre-existing chronic conditions (PECs) pose a unique problem for the care of aging trauma populations. However, the relationships between specific conditions and outcomes after injury are relatively unknown. Evaluation of trauma patients is further complicated by their discharge to care facilities, where mortality risk remains high. Traditional approaches for evaluating in-hospital mortality do not account for the discharge of at-risk patients, which constitutes a competing risk event to death. The objective of this study was to evaluate associations between 40 PECs and two clinical outcomes in the context of competing risks among older trauma patients. This retrospective study evaluated blunt-injured patients aged 55 years and older admitted to a level I trauma centre in 2006-2012. Outcomes were hospital length of stay (HLOS) and in-hospital mortality. Survivors were classified as discharges home or discharges to care facilities. Competing risks regression was used to evaluate each PEC with in-hospital mortality, accounting for discharges to care facilities as competing events. Competing risk estimates were compared to Cox model estimates, for which all survivors to discharge were non-events. Analyses were stratified using injury-based mortality risk at a 50% cutpoint (high versus low). Among 4653 patients, 176 died in-hospital, 3059 were discharged home, and 1418 were discharged to a care facility. Most patients (98%) were classified with a low mortality risk. Only haemophilia and coagulopathy were consistently associated with longer HLOS. In the low-risk subgroup, in-hospital mortality was most strongly associated with liver diseases, haemophilia, and coagulopathy. In the high-risk group, Parkinson's disease, depression, and cancers showed the strongest associations. Accounting for the competing event altered estimates for 12 of 19 significant conditions. Excess mortality among patients expected to survive their injuries may be attributable to complications resulting from PECs. Discharges to care facilities constitute a bias in the evaluation of in-hospital mortality and should be considered for the accurate calculation of risk. In conjunction with injury measures, consideration of PECs provides physicians with a foundation to plan clinical decisions in older trauma patients. Copyright © 2015 Elsevier Ltd. All rights reserved.

The Role of School Environment in Physical Activity among Brazilian Adolescents.

PubMed

de Rezende, Leandro Fórnias Machado; Azeredo, Catarina Machado; Silva, Kelly Samara; Claro, Rafael Moreira; França-Junior, Ivan; Peres, Maria Fernanda Tourinho; Luiz, Olinda do Carmo; Levy, Renata Bertazzi; Eluf-Neto, José

2015-01-01

To analyze the association of physical activity facilities and extracurricular sports activities in schools with physical activity among adolescents. We used data collected for the National Survey of School Health in 2012. The national representative sample comprised 109,104 Brazilian students from 2,842 schools. We calculated the prevalence of participation in physical education classes, leisure-time physical activity, and total physical activity level. We also evaluated the following physical activity facilities: sports courts, running/athletics tracks, schoolyard with teacher-directed physical activities, swimming pools, locker rooms; and the offer of extracurricular sports activities. Schools with at least one physical activity facility had increased odds of participation in physical education (OR 1.59; 95% CI 1.20 to 2.10). However, in order to increase leisure-time physical activity (OR1.14; 95% CI 1.03 to 1.26) and total physical activity level (OR 1.15; 95% CI 1.06 to 1.24) at least four and two facilities, respectively, were necessary. Extracurricular sports activities in schools were positively associated with leisure-time physical activity and physical activity level. The number of sports courts and swimming pool in a school were associated with participation in physical education classes. Availability of sports courts, running/athletics tracks, and swimming pool in schools were associated with leisure-time physical activity. Total physical activity was associated with schools with sports courts, schoolyard with teacher-directed physical activities, and swimming pool. School-level characteristics have important potential to increase the possibility of engagement in physical activity in and out of school, and therefore have a fundamental role in promoting these practices.

Risk management study for the retired Hanford Site facilities: Qualitative risk evaluation for the retired Hanford Site facilities. Volume 3

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

Coles, G.A.; Shultz, M.V.; Taylor, W.E.

1993-09-01

This document provides a risk evaluation of the 100 and 200 Area retired, surplus facilities on the Hanford Site. Also included are the related data that were compiled by the risk evaluation team during investigations performed on the facilities. Results are the product of a major effort performed in fiscal year 1993 to produce qualitative information that characterizes certain risks associated with these facilities. The retired facilities investigated for this evaluation are located in the 100 and 200 Areas of the 1,450-km{sup 2} (570-mi{sup 2}) Hanford Site. The Hanford Site is a semiarid tract of land in southeastern Washington State.more » The nearest population center is Richland, Washington, (population 32,000) 30-km (20 mi) southeast of the 200 Area. During walkdown investigations of these facilities, data on real and potential hazards that threatened human health or safety or created potential environmental release issues were identified by the risk evaluation team. Using these findings, the team categorized the identified hazards by facility and evaluated the risk associated with each hazard. The factors contributing to each risk, and the consequence and likelihood of harm associated with each hazard also are included in this evaluation.« less

76 FR 72006 - Draft Interim Staff Guidance: Evaluations of Uranium Recovery Facility Surveys of Radon and Radon...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-21

.... Discussion Uranium recovery facility licensees, including in-situ recovery facilities and conventional... Recovery Facility Surveys of Radon and Radon Progeny in Air and Demonstrations of Compliance AGENCY... Staff Guidance, ``Evaluations of Uranium Recovery Facility Surveys of Radon and Radon Progeny in Air and...

The impact of travel time on geographic distribution of dialysis patients.

PubMed

Kashima, Saori; Matsumoto, Masatoshi; Ogawa, Takahiko; Eboshida, Akira; Takeuchi, Keisuke

2012-01-01

The geographic disparity of prevalence rates among dialysis patients is unclear. We evaluate the association between travel time to dialysis facilities and prevalence rates of dialysis patients living in 1,867 census areas of Hiroshima, Japan. Furthermore, we study the effects of geographic features (mainland or island) on the prevalence rates and assess if these effects modify the association between travel time and prevalence. The study subjects were all 7,374 people that were certified as the "renal disabled" by local governments in 2011. The travel time from each patient to the nearest available dialysis facility was calculated by incorporating both travel time and the capacity of all 98 facilities. The effect of travel time on the age- and sex-adjusted standard prevalence rate (SPR) and 95% confidence intervals (CIs) at each census area was evaluated in two-level Poisson regression models with 1,867 census areas (level 1) nested within 35 towns or cities (level 2). The results were adjusted for area-based parameters of socioeconomic status, urbanity, and land type. Furthermore, the SPR of dialysis patients was calculated in each specific subgroup of population for travel time, land type, and combination of land type and travel time. In the regression analysis, SPR decreased by 5.2% (95% CI: -7.9--2.3) per 10-min increase in travel time even after adjusting for potential confounders. The effect of travel time on prevalence was different in the mainland and island groups. There was no travel time-dependent SPR disparity on the islands. The SPR among remote residents (>30 min from facilities) in the mainland was lower (0.77, 95% CI: 0.71-0.85) than that of closer residents (≤ 30 min; 0.95, 95% CI: 0.92-0.97). The prevalence of dialysis patients was lower among remote residents. Geographic difficulties for commuting seem to decrease the prevalence rate.

Limited Effectiveness of a Skills and Drills Intervention to Improve Emergency Obstetric and Newborn Care in Karnataka, India: A Proof-of-Concept Study.

PubMed

Varghese, Beena; Krishnamurthy, Jayanna; Correia, Blaze; Panigrahi, Ruchika; Washington, Maryann; Ponnuswamy, Vinotha; Mony, Prem

2016-12-23

The majority of the maternal and perinatal deaths are preventable through improved emergency obstetric and newborn care at facilities. However, the quality of such care in India has significant gaps in terms of provider skills and in their preparedness to handle emergencies. We tested the feasibility, acceptability, and effectiveness of a "skills and drills" intervention, implemented between July 2013 and September 2014, to improve emergency obstetric and newborn care in the state of Karnataka, India. Emergency drills through role play, conducted every 2 months, combined with supportive supervision and a 2-day skills refresher session were delivered across 4 sub-district, secondary-level government facilities by an external team of obstetric and pediatric specialists and nurses. We evaluated the intervention through a quasi-experimental design with 4 intervention and 4 comparison facilities, using delivery case sheet reviews, pre- and post-knowledge tests among providers, objective structured clinical examinations (OSCEs), and qualitative in-depth interviews. Primary outcomes consisted of improved diagnosis and management of selected maternal and newborn complications (postpartum hemorrhage, pregnancy-induced hypertension, and birth asphyxia). Secondary outcomes included knowledge and skill levels of providers and acceptability and feasibility of the intervention. Knowledge scores among providers improved significantly in the intervention facilities; in obstetrics, average scores between the pre- and post-test increased from 49% to 57% (P=.006) and in newborn care, scores increased from 48% to 56% (P=.03). Knowledge scores in the comparison facilities were similar but did not improve significantly over time. Skill levels were significantly higher among providers in intervention facilities than comparison facilities (mean objective structured clinical examination scores for obstetric skills: 55% vs. 46%, respectively; for newborn skills: 58% vs. 48%, respectively; P<.001 for both obstetric and newborn), along with their confidence in managing complications. However, this did not result in significant differences in correct diagnosis and management of complications between intervention and comparison facilities. Shortage of trained nurses and doctors along with unavailability of a consistent supply chain was cited by most providers as major health systems barriers affecting provision of care. Improvements in knowledge, skills, and confidence levels of providers as a result of the skills and drills intervention was not sufficient to translate into improved diagnosis and management of maternal and newborn complications. System-level changes including adequate in-service training may also be necessary to improve maternal and newborn outcomes. © Varghese et al.

The Size and Scope of Collegiate Athletic Training Facilities and Staffing.

PubMed

Gallucci, Andrew R; Petersen, Jeffrey C

2017-08-01

  Athletic training facilities have been described in terms of general design concepts and from operational perspectives. However, the size and scope of athletic training facilities, along with staffing at different levels of intercollegiate competition, have not been quantified.   To define the size and scope of athletic training facilities and staffing levels at various levels of intercollegiate competition. To determine if differences existed in facilities (eg, number of facilities, size of facilities) and staffing (eg, full time, part time) based on the level of intercollegiate competition.   Cross-sectional study.   Web-based survey.   Athletic trainers (ATs) who were knowledgeable about the size and scope of athletic training programs.   Athletic training facility size in square footage; the AT's overall facility satisfaction; athletic training facility component spaces, including satellite facilities, game-day facilities, offices, and storage areas; and staffing levels, including full-time ATs, part-time ATs, and undergraduate students.   The survey was completed by 478 ATs (response rate = 38.7%) from all levels of competition. Sample means for facilities were 3124.7 ± 4425 ft 2 (290.3 ± 411 m 2 ) for the central athletic training facility, 1013 ± 1521 ft 2 (94 ± 141 m 2 ) for satellite athletic training facilities, 1272 ± 1334 ft 2 (118 ± 124 m 2 ) for game-day athletic training facilities, 388 ± 575 ft 2 (36 ± 53 m 2 ) for athletic training offices, and 424 ± 884 ft 2 (39 ± 82 m 2 ) for storage space. Sample staffing means were 3.8 ± 2.5 full-time ATs, 1.6 ± 2.5 part-time ATs, 25 ± 17.6 athletic training students, and 6.8 ± 7.2 work-study students. Division I schools had greater resources in multiple categories (P < .001). Differences among other levels of competition were not as well defined. Expansion or renovation of facilities in recent years was common, and almost half of ATs reported that upgrades have been approved for the near future.   This study provides benchmark descriptive data on athletic training staffing and facilities. The results (1) suggest that the ATs were satisfied with their facilities and (2) highlight the differences in resources among competition levels.

Facility-level association of preoperative stress testing and postoperative adverse cardiac events.

PubMed

Valle, Javier A; Graham, Laura; Thiruvoipati, Thejasvi; Grunwald, Gary; Armstrong, Ehrin J; Maddox, Thomas M; Hawn, Mary T; Bradley, Steven M

2018-06-22

Despite limited indications, preoperative stress testing is often used prior to non-cardiac surgery. Patient-level analyses of stress testing and outcomes are limited by case mix and selection bias. Therefore, we sought to describe facility-level rates of preoperative stress testing for non-cardiac surgery, and to determine the association between facility-level preoperative stress testing and postoperative major adverse cardiac events (MACE). We identified patients undergoing non-cardiac surgery within 2 years of percutaneous coronary intervention in the Veterans Affairs (VA) Health Care System, from 2004 to 2011, facility-level rates of preoperative stress testing and postoperative MACE (death, myocardial infarction (MI) or revascularisation within 30 days). We determined risk-standardised facility-level rates of stress testing and postoperative MACE, and the relationship between facility-level preoperative stress testing and postoperative MACE. Among 29 937 patients undergoing non-cardiac surgery at 131 VA facilities, the median facility rate of preoperative stress testing was 13.2% (IQR 9.7%-15.9%; range 6.0%-21.5%), and 30-day postoperative MACE was 4.0% (IQR 2.4%-5.4%). After risk standardisation, the median facility-level rate of stress testing was 12.7% (IQR 8.4%-17.4%) and postoperative MACE was 3.8% (IQR 2.3%-5.6%). There was no correlation between risk-standardised stress testing and composite MACE at the facility level (r=0.022, p=0.81), or with individual outcomes of death, MI or revascularisation. In a national cohort of veterans undergoing non-cardiac surgery, we observed substantial variation in facility-level rates of preoperative stress testing. Facilities with higher rates of preoperative stress testing were not associated with better postoperative outcomes. These findings suggest an opportunity to reduce variation in preoperative stress testing without sacrificing patient outcomes. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Association Between Facility-Level Utilization of Non-pharmacologic Chronic Pain Treatment and Subsequent Initiation of Long-Term Opioid Therapy.

PubMed

Carey, Evan P; Nolan, Charlotte; Kerns, Robert D; Ho, P Michael; Frank, Joseph W

2018-05-01

Expert guidelines recommend non-pharmacologic treatments and non-opioid medications for chronic pain and recommend against initiating long-term opioid therapy (LTOT). We examined whether veterans with incident chronic pain receiving care at facilities with greater utilization of non-pharmacologic treatments and non-opioid medications are less likely to initiate LTOT. Retrospective cohort study PARTICIPANTS: Veterans receiving primary care from a Veterans Health Administration facility with incident chronic pain between 1/1/2010 and 12/31/2015 based on either of 2 criteria: (1) persistent moderate-to-severe patient-reported pain and (2) diagnoses "likely to represent" chronic pain. The independent variable was facility-level utilization of pain-related treatment modalities (non-pharmacologic, non-opioid medications, LTOT) in the prior calendar year. The dependent variable was patient-level initiation of LTOT (≥ 90 days within 365 days) in the subsequent year, adjusting for patient characteristics. Among 1,094,569 veterans with incident chronic pain from 2010 to 2015, there was wide facility-level variation in utilization of 10 pain-related treatment modalities, including initiation of LTOT (median, 16%; range, 5-32%). Veterans receiving care at facilities with greater utilization of non-pharmacologic treatments were less likely to initiate LTOT in the year following incident chronic pain. Conversely, veterans receiving care at facilities with greater non-opioid and opioid medication utilization were more likely to initiate LTOT; this association was strongest for past year facility-level LTOT initiation (adjusted rate ratio, 2.10; 95% confidence interval, 2.06-2.15, top vs. bottom quartile of facility-level LTOT initiation in prior calendar year). Facility-level utilization patterns of non-pharmacologic, non-opioid, and opioid treatments for chronic pain are associated with subsequent patient-level initiation of LTOT among veterans with incident chronic pain. Further studies should seek to understand facility-level variation in chronic pain care and to identify facility-level utilization patterns that are associated with improved patient outcomes.

Emergency and urgent care capacity in a resource-limited setting: an assessment of health facilities in western Kenya

PubMed Central

Burke, Thomas F; Hines, Rosemary; Ahn, Roy; Walters, Michelle; Young, David; Anderson, Rachel Eleanor; Tom, Sabrina M; Clark, Rachel; Obita, Walter; Nelson, Brett D

2014-01-01

Objective Injuries, trauma and non-communicable diseases are responsible for a rising proportion of death and disability in low-income and middle-income countries. Delivering effective emergency and urgent healthcare for these and other conditions in resource-limited settings is challenging. In this study, we sought to examine and characterise emergency and urgent care capacity in a resource-limited setting. Methods We conducted an assessment within all 30 primary and secondary hospitals and within a stratified random sampling of 30 dispensaries and health centres in western Kenya. The key informants were the most senior facility healthcare provider and manager available. Emergency physician researchers utilised a semistructured assessment tool, and data were analysed using descriptive statistics and thematic coding. Results No lower level facilities and 30% of higher level facilities reported having a defined, organised approach to trauma. 43% of higher level facilities had access to an anaesthetist. The majority of lower level facilities had suture and wound care supplies and gloves but typically lacked other basic trauma supplies. For cardiac care, 50% of higher level facilities had morphine, but a minority had functioning ECG, sublingual nitroglycerine or a defibrillator. Only 20% of lower level facilities had glucometers, and only 33% of higher level facilities could care for diabetic emergencies. No facilities had sepsis clinical guidelines. Conclusions Large gaps in essential emergency care capabilities were identified at all facility levels in western Kenya. There are great opportunities for a universally deployed basic emergency care package, an advanced emergency care package and facility designation scheme, and a reliable prehospital care transportation and communications system in resource-limited settings. PMID:25260371

The Feasibility of Establishing Operational Water Hyacinth-Based Systems at the Treatment Facilities of Existing Cities. [in Florida and Texas

NASA Technical Reports Server (NTRS)

1977-01-01

The wastewater treatment facilities of three communities in southern Florida and two in southern Texas areas having populations of 20,000 or fewer persons were surveyed to determine: (1) their performance characteristics and the nature of their customers; (2) facility upgrading requirements needed to meet current and future EPA and State standards; (3) their adaptability to water hyacinth utilization and harvested plant disposal; and (4) the level of community support. Guidelines for site selection were established and applied to five cities in Texas and four in Florida. An evaluation of the prospective sites reveals that the Florida locations are generally unsuitable for implementation of water hyacinth based systems because of regulatory philosophy. All five Texas sites have excellent potential.

Nuclear data activities at the n_TOF facility at CERN

NASA Astrophysics Data System (ADS)

Gunsing, F.; Aberle, O.; Andrzejewski, J.; Audouin, L.; Bécares, V.; Bacak, M.; Balibrea-Correa, J.; Barbagallo, M.; Barros, S.; Bečvář, F.; Beinrucker, C.; Belloni, F.; Berthoumieux, E.; Billowes, J.; Bosnar, D.; Brugger, M.; Caamaño, M.; Calviño, F.; Calviani, M.; Cano-Ott, D.; Cardella, R.; Casanovas, A.; Castelluccio, D. M.; Cerutti, F.; Chen, Y. H.; Chiaveri, E.; Colonna, N.; Cortés-Giraldo, M. A.; Cortés, G.; Cosentino, L.; Damone, L. A.; Deo, K.; Diakaki, M.; Domingo-Pardo, C.; Dressler, R.; Dupont, E.; Durán, I.; Fernández-Domínguez, B.; Ferrari, A.; Ferreira, P.; Finocchiaro, P.; Frost, R. J. W.; Furman, V.; Ganesan, S.; García, A. R.; Gawlik, A.; Gheorghe, I.; Glodariu, T.; Gonçalves, I. F.; González, E.; Goverdovski, A.; Griesmayer, E.; Guerrero, C.; Göbel, K.; Harada, H.; Heftrich, T.; Heinitz, S.; Hernández-Prieto, A.; Heyse, J.; Jenkins, D. G.; Jericha, E.; Käppeler, F.; Kadi, Y.; Katabuchi, T.; Kavrigin, P.; Ketlerov, V.; Khryachkov, V.; Kimura, A.; Kivel, N.; Kokkoris, M.; Krtička, M.; Leal-Cidoncha, E.; Lederer, C.; Leeb, H.; Lerendegui, J.; Licata, M.; Lo Meo, S.; Lonsdale, S. J.; Losito, R.; Macina, D.; Marganiec, J.; Martínez, T.; Masi, A.; Massimi, C.; Mastinu, P.; Mastromarco, M.; Matteucci, F.; Maugeri, E. A.; Mazzone, A.; Mendoza, E.; Mengoni, A.; Milazzo, P. M.; Mingrone, F.; Mirea, M.; Montesano, S.; Musumarra, A.; Nolte, R.; Oprea, A.; Palomo-Pinto, F. R.; Paradela, C.; Patronis, N.; Pavlik, A.; Perkowski, J.; Porras, I.; Praena, J.; Quesada, J. M.; Rajeev, K.; Rauscher, T.; Reifarth, R.; Riego-Perez, A.; Robles, M.; Rout, P.; Radeck, D.; Rubbia, C.; Ryan, J. A.; Sabaté-Gilarte, M.; Saxena, A.; Schillebeeckx, P.; Schmidt, S.; Schumann, D.; Sedyshev, P.; Smith, A. G.; Stamatopoulos, A.; Suryanarayana, S. V.; Tagliente, G.; Tain, J. L.; Tarifeño-Saldivia, A.; Tarrío, D.; Tassan-Got, L.; Tsinganis, A.; Valenta, S.; Vannini, G.; Variale, V.; Vaz, P.; Ventura, A.; Vlachoudis, V.; Vlastou, R.; Wallner, A.; Warren, S.; Weigand, M.; Weiss, C.; Wolf, C.; Woods, P. J.; Wright, T.; Žugec, P.

2016-10-01

Nuclear data in general, and neutron-induced reaction cross sections in particular, are important for a wide variety of research fields. They play a key role in the safety and criticality assessment of nuclear technology, not only for existing power reactors but also for radiation dosimetry, medical applications, the transmutation of nuclear waste, accelerator-driven systems, fuel cycle investigations and future reactor systems as in Generation IV. Applications of nuclear data are also related to research fields as the study of nuclear level densities and stellar nucleosynthesis. Simulations and calculations of nuclear technology applications largely rely on evaluated nuclear data libraries. The evaluations in these libraries are based both on experimental data and theoretical models. Experimental nuclear reaction data are compiled on a worldwide basis by the international network of Nuclear Reaction Data Centres (NRDC) in the EXFOR database. The EXFOR database forms an important link between nuclear data measurements and the evaluated data libraries. CERN's neutron time-of-flight facility n_TOF has produced a considerable amount of experimental data since it has become fully operational with the start of the scientific measurement programme in 2001. While for a long period a single measurement station (EAR1) located at 185 m from the neutron production target was available, the construction of a second beam line at 20 m (EAR2) in 2014 has substantially increased the measurement capabilities of the facility. An outline of the experimental nuclear data activities at CERN's neutron time-of-flight facility n_TOF will be presented.

Recidivism, Disciplinary History, and Institutional Adjustment: A Quantitative Study Examining Correctional Education Programs

ERIC Educational Resources Information Center

Flamer, Eric, Sr.

2012-01-01

Establishing college-degree programs for prison inmates is an evidence-based effective instructional strategy in reducing recidivism. Evaluating academic arenas as a resource to improve behavior and levels of functioning within correctional facilities is a necessary component of inmate academic programs. The purpose of this quantitative,…

"Aprons are for Girls": Promoting Equity in Early Childhood Environments.

ERIC Educational Resources Information Center

Mullis, Ann K.; Martin, Ruth E.

1984-01-01

A 1982-83 study evaluating the level of sex equity in early childhood settings found that, while the areas of teaching behaviors and child awareness were strong, the areas of center/community, facilities and equipment, and career awareness need improvement in terms of encouraging sex equity and eliminating stereotypes. (SK)

SYNTHESIS OF METHODS FOR ESTIMATING PEDESTRIAN AND BICYCLIST EXPOSURE TO RISK AT AREAWIDE LEVELS AND ON SPECIFIC TRANSPORTATION FACILITIES

DOT National Transportation Integrated Search

2017-01-01

This report summarizes the variety of methods used to estimate and evaluate exposure to risk in pedestrian and bicyclist safety analyses. In the literature, the most common definition of risk was a measure of the probability of a crash to occur given...

75 FR 63609 - Oil and Gas and Sulphur Operations in the Outer Continental Shelf-Safety and Environmental...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-15

... safety of the offshore facility, including ensuring that all contractors and subcontractors have safety... safety analysis (task level); (3) Procedures to verify that contractors are conducting their activities in accordance with the operator's SEMS program and an evaluation to ensure that contractors have the...

Resident and facility characteristics associated with care-need level deterioration in long-term care welfare facilities in Japan.

PubMed

Jin, Xueying; Tamiya, Nanako; Jeon, Boyoung; Kawamura, Akira; Takahashi, Hideto; Noguchi, Haruko

2018-05-01

To determine the resident and facility characteristics associated with residents' care-need level deterioration in long-term care welfare facilities in Japan. A nationally representative sample of 358 886 residents who lived in 3774 long-term care welfare facilities for at least 1 year from October 2012 was obtained from long-term care insurance claims data. Facility characteristics were linked with a survey of institutions and establishments for long-term care in 2012. We used a multilevel logistic regression according to the inclusion and exclusion of lost to follow-up to define the resident and facility characteristics associated with resident care-need level deteriorations (lost to follow-up: the majority were hospitalized residents or had died; were treated as deterioration in the including loss to follow-up model). Adjusting for the covariates, at the resident level, older age and lower care-need level at baseline were more likely to show deterioration in the care-need level. At the facility level, metropolitan facilities, unit model (all private room settings) and mixed-model facilities (partly private room settings) were less likely to experience care-need level deterioration. A higher proportion of registered nurses among all nurses was negatively related to care-need level deterioration only in the model including lost to follow-up. A higher proportion of registered dietitians among all dietitians and the facilities in business for fewer years were negatively associated with care-need level deterioration only in the model excluding lost to follow-up. The present study could help identify residents who are at risk of care-need level deterioration, and could contribute to improvements in provider quality performance and enhance competence in the market. Geriatr Gerontol Int 2018; 18: 758-766. © 2018 The Authors Geriatrics & Gerontology International published by John Wiley & Sons Australia, Ltd on behalf of Japan Geriatrics Society.

EVALUATION OF PROMPT DOSE ENVIRONMENT IN THE NATIONAL IGNITION FACILITY DURING D-D AND THD SHOTS

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

Khater, H; Dauffy, L; Sitaraman, S

2009-04-28

Evaluation of the prompt dose environment expected in the National Ignition Facility (NIF) during Deuterium-Deuterium (D-D) and Tritium-Hydrogen-Deuterium (THD) shots have been completed. D-D shots resulting in the production of an annual fusion yield of up to 2.4 kJ (200 shots with 10{sup 13} neutrons per shot) are considered. During the THD shot campaign, shots generating a total of 2 x 10{sup 14} neutrons per shot are also planned. Monte Carlo simulations have been performed to estimate prompt dose values inside the facility as well as at different locations outside the facility shield walls. The Target Chamber shielding, along withmore » Target Bay and Switchyard walls, roofs, and shield doors (when needed) will reduce dose levels in occupied areas to acceptable values during these shot campaigns. The calculated dose values inside occupied areas are small, estimated at 25 and 85 {micro}rem per shot during the D-D and THD shots, respectively. Dose values outside the facility are insignificant. The nearest building to the NIF facility where co-located workers may reside is at a distance of about 100 m from the Target Chamber Center (TCC). The dose in such a building is estimated at a fraction of a ?rem during a D-D or a THD shot. Dose at the nearest site boundary location (350 m from TCC), is caused by skyshine and to a lesser extent by direct radiation. The maximum off-site dose during any of the shots considered is less than 10 nano rem.« less

Vibro-Acoustic Analysis of an Aircraft Maintenance Dock

DTIC Science & Technology

1992-08-01

evaluated. This evaluation resulted in a table of allowable number of cycles of operation to produce the same impact on the facility as the original...for 18 Gage Galvanized Steel Walls of HV Ducts 209 H13 Summary of Calculated Vibration Response Parameters at Base of HV 217 H 14 Engine Power Level...The reverberant sound field due to the acoustic energy remaining within the AMD after the first reflection of the direct sound. The direct sound field

Nevada National Security Site Environmental Report Summary 2016

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

Wills, Cathy

This document is a summary of the full 2016 Nevada National Security Site Environmental Report (NNSSER) prepared by the U.S. Department of Energy, National Nuclear Security Administration Nevada Field Office (NNSA/ NFO). This summary provides an abbreviated and more readable version of the full NNSSER. NNSA/NFO prepares the NNSSER to provide the public an understanding of the environmental monitoring and compliance activities that are conducted on the Nevada National Security Site (NNSS) to protect the public and the environment from radiation hazards and from potential nonradiological impacts. It is a comprehensive report of environmental activities performed at the NNSS andmore » offsite facilities over the previous calendar year. The NNSS is currently the nation’s unique site for ongoing national security–related missions and high-risk operations. The NNSS is located about 65 miles northwest of Las Vegas. The approximately 1,360-square-mile site is one of the largest restricted access areas in the United States. It is surrounded by federal installations with strictly controlled access as well as by lands that are open to public entry. In 2016, National Security Technologies, LLC (NSTec), was the NNSS Management and Operations Contractor accountable for ensuring work was performed in compliance with environmental regulations. NNSS activities in 2016 continued to be diverse, with the primary goal to ensure that the existing U.S. stockpile of nuclear weapons remains safe and reliable. Other activities included weapons of mass destruction first responder training; the controlled release of hazardous material at the Nonproliferation Test and Evaluation Complex (NPTEC); remediation of legacy contamination sites; characterization of waste destined for the Waste Isolation Pilot Plant in Carlsbad, New Mexico, or the Idaho National Laboratory in Idaho Falls, Idaho; disposal of low-level and mixed low-level radioactive waste; and environmental research. Facilities and centers that support the National Security/Defense mission include the U1a Facility, Big Explosives Experimental Facility (BEEF), Device Assembly Facility (DAF), National Criticality Experiments Research Center (NCERC) located in the DAF, Joint Actinide Shock Physics Experimental Research (JASPER) Facility, Dense Plasma Focus (DPF) Facility located in the Los Alamos Technical Facility (LATF), and the Radiological/ Nuclear Countermeasures Test and Evaluation Complex (RNCTEC). Facilities that support the Environmental Management mission include the Area 5 Radioactive Waste Management Complex (RWMC) and the Area 3 Radioactive Waste Management Site (RWMS), which has been in cold standby since 2006.« less

Evaluation of externally heated pulsed MPD thruster cathodes

NASA Astrophysics Data System (ADS)

Myers, Roger M.; Domonkos, Matthew; Gallimore, Alec D.

1993-12-01

Recent interest in solar electric orbit transfer vehicles (SEOTV's) has prompted a reevaluation of pulsed magnetoplasmadynamic (MPD) thruster systems due to their ease of power scaling and reduced test facility requirements. In this work the use of externally heated cathodes was examined in order to extend the lifetime of these thrusters to the 1000 to 3000 hours required for SEOTV missions. A pulsed MPD thruster test facility was assembled, including a pulse-forming network (PFN), ignitor supply and propellant feed system. Results of cold cathode tests used to validate the facility, PFN, and propellant feed system design are presented, as well as a preliminary evaluation of externally heated impregnated tungsten cathodes. The cold cathode thruster was operated on both argon and nitrogen propellants at peak discharge power levels up to 300 kW. The results confirmed proper operation of the pulsed thruster test facility, and indicated that large amounts of gas were evolved from the BaO-CaO-Al2O3 cathodes during activation. Comparison of the expected space charge limited current with the measured vacuum current when using the heated cathode indicate that either that a large temperature difference existed between the heater and the cathode or that the surface work function was higher than expected.

Factors influencing hand washing behaviour in primary schools: process evaluation within a randomised controlled trial

PubMed Central

Chittleborough, Catherine R.; Nicholson, Alexandra L.; Basker, Elaine; Bell, Sarah; Campbell, Rona

2013-01-01

This paper explores factors that may influence hand washing behaviour among pupils and staff in primary schools. A qualitative process evaluation within a cluster randomised controlled trial included pupil focus groups (n=16, ages 6 to 11, semi-structured interviews (n=16 teachers) and observations of hand washing facilities (n=57). Pupils and staff in intervention and control schools demonstrated a similar level of understanding of how, when and why they should wash their hands. Lack of time, poor adult modelling of regular hand washing and unattractive facilities were seen as important barriers to regular hand washing. Reminders and explanations for the importance of hand hygiene were thought to have a positive impact. Influencing individual choices about hand washing through education and information may be necessary, but not sufficient, for initiating and maintaining good hand washing practices. Structural factors, including having time to wash hands using accessible, clean facilities, and being encouraged through the existence of hand washing opportunities in the daily routine and hand washing being viewed as the social norm, will also influence hand washing behaviour. The effectiveness of educational interventions at improving hand hygiene in primary schools may be improved by changing priorities of staff and increasing accessibility to quality facilities. PMID:22623617

Evaluation of externally heated pulsed MPD thruster cathodes

NASA Technical Reports Server (NTRS)

Myers, Roger M.; Domonkos, Matthew; Gallimore, Alec D.

1993-01-01

Recent interest in solar electric orbit transfer vehicles (SEOTV's) has prompted a reevaluation of pulsed magnetoplasmadynamic (MPD) thruster systems due to their ease of power scaling and reduced test facility requirements. In this work the use of externally heated cathodes was examined in order to extend the lifetime of these thrusters to the 1000 to 3000 hours required for SEOTV missions. A pulsed MPD thruster test facility was assembled, including a pulse-forming network (PFN), ignitor supply and propellant feed system. Results of cold cathode tests used to validate the facility, PFN, and propellant feed system design are presented, as well as a preliminary evaluation of externally heated impregnated tungsten cathodes. The cold cathode thruster was operated on both argon and nitrogen propellants at peak discharge power levels up to 300 kW. The results confirmed proper operation of the pulsed thruster test facility, and indicated that large amounts of gas were evolved from the BaO-CaO-Al2O3 cathodes during activation. Comparison of the expected space charge limited current with the measured vacuum current when using the heated cathode indicate that either that a large temperature difference existed between the heater and the cathode or that the surface work function was higher than expected.

Factors influencing hand washing behaviour in primary schools: process evaluation within a randomized controlled trial.

PubMed

Chittleborough, Catherine R; Nicholson, Alexandra L; Basker, Elaine; Bell, Sarah; Campbell, Rona

2012-12-01

This article explores factors that may influence hand washing behaviour among pupils and staff in primary schools. A qualitative process evaluation within a cluster randomized controlled trial included pupil focus groups (n = 16, aged 6-11 years), semi-structured interviews (n = 16 teachers) and observations of hand washing facilities (n = 57). Pupils and staff in intervention and control schools demonstrated a similar level of understanding of how, when and why they should wash their hands. Lack of time, poor adult modelling of regular hand washing and unattractive facilities were seen as important barriers to regular hand washing. Reminders and explanations for the importance of hand hygiene were thought to have a positive impact. Influencing individual choices about hand washing through education and information may be necessary, but not sufficient, for initiating and maintaining good hand washing practices. Structural factors, including having time to wash hands using accessible, clean facilities, and being encouraged through the existence of hand washing opportunities in the daily routine and hand washing being viewed as the social norm, will also influence hand washing behaviour. The effectiveness of educational interventions at improving hand hygiene in primary schools may be improved by changing priorities of staff and increasing accessibility to quality facilities.

The measurement programme at the neutron time-of-flight facility n_TOF at CERN

NASA Astrophysics Data System (ADS)

Gunsing, F.; Aberle, O.; Andrzejewski, J.; Audouin, L.; Bécares, V.; Bacak, M.; Balibrea-Correa, J.; Barbagallo, M.; Barros, S.; Bečvář, F.; Beinrucker, C.; Belloni, F.; Berthoumieux, E.; Billowes, J.; Bosnar, D.; Brown, A.; Brugger, M.; Caamaño, M.; Calviño, F.; Calviani, M.; Cano-Ott, D.; Cardella, R.; Casanovas, A.; Castelluccio, D. M.; Cerutti, F.; Chen, Y. H.; Chiaveri, E.; Colonna, N.; Cortés-Giraldo, M. A.; Cortés, G.; Cosentino, L.; Damone, L. A.; Deo, K.; Diakaki, M.; Domingo-Pardo, C.; Dressler, R.; Dupont, E.; Durán, I.; Fernández-Domínguez, B.; Ferrari, A.; Ferreira, P.; Finocchiaro, P.; Frost, R. J. W.; Furman, V.; Ganesan, S.; García, A. R.; Gawlik, A.; Gheorghe, I.; Gilardoni, S.; Glodariu, T.; Gonçalves, I. F.; González, E.; Goverdovski, A.; Griesmayer, E.; Guerrero, C.; Göbel, K.; Harada, H.; Heftrich, T.; Heinitz, S.; Hernández-Prieto, A.; Heyse, J.; Jenkins, D. G.; Jericha, E.; Käppeler, F.; Kadi, Y.; Kalamara, A.; Katabuchi, T.; Kavrigin, P.; Ketlerov, V.; Khryachkov, V.; Kimura, A.; Kivel, N.; Kokkoris, M.; Krtička, M.; Kurtulgil, D.; Leal-Cidoncha, E.; Lederer, C.; Leeb, H.; Lerendegui, J.; Licata, M.; Meo, S. Lo; Lonsdale, S. J.; Losito, R.; Macina, D.; Marganiec, J.; Martínez, T.; Masi, A.; Massimi, C.; Mastinu, P.; Mastromarco, M.; Matteucci, F.; Maugeri, E. A.; Mazzone, A.; Mendoza, E.; Mengoni, A.; Milazzo, P. M.; Mingrone, F.; Mirea, M.; Montesano, S.; Musumarra, A.; Nolte, R.; Negret, A.; Oprea, A.; Palomo-Pinto, F. R.; Paradela, C.; Patronis, N.; Pavlik, A.; Perkowski, J.; Porras, I.; Praena, J.; Quesada, J. M.; Radeck, D.; Rajeev, K.; Rauscher, T.; Reifarth, R.; Riego-Perez, A.; Robles, M.; Rout, P.; Rubbia, C.; Ryan, J. A.; Sabaté-Gilarte, M.; Saxena, A.; Schillebeeckx, P.; Schmidt, S.; Schumann, D.; Sedyshev, P.; Smith, A. G.; Sosnin, N. V.; Stamatopoulos, A.; Suryanarayana, S. V.; Tagliente, G.; Tain, J. L.; Tarifeño-Saldivia, A.; Tarrío, D.; Tassan-Got, L.; Tsinganis, A.; Valenta, S.; Vannini, G.; Variale, V.; Vaz, P.; Ventura, A.; Vlachoudis, V.; Vlastou, R.; Wallner, A.; Warren, S.; Weigand, M.; Weiss, C.; Wolf, C.; Woods, P. J.; Wright, T.; Žugec, P.

2017-09-01

Neutron-induced reaction cross sections are important for a wide variety of research fields ranging from the study of nuclear level densities, nucleosynthesis to applications of nuclear technology like design, and criticality and safety assessment of existing and future nuclear reactors, radiation dosimetry, medical applications, nuclear waste transmutation, accelerator-driven systems and fuel cycle investigations. Simulations and calculations of nuclear technology applications largely rely on evaluated nuclear data libraries. The evaluations in these libraries are based both on experimental data and theoretical models. CERN's neutron time-of-flight facility n_TOF has produced a considerable amount of experimental data since it has become fully operational with the start of its scientific measurement programme in 2001. While for a long period a single measurement station (EAR1) located at 185 m from the neutron production target was available, the construction of a second beam line at 20 m (EAR2) in 2014 has substantially increased the measurement capabilities of the facility. An outline of the experimental nuclear data activities at n_TOF will be presented.

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…

Performance evaluation of the essential dimensions of the primary health care services in six localities of Bogota–Colombia: a cross-sectional study

PubMed Central

2013-01-01

Background The high segmentation and fragmentation in the provision of services are some of the main problems of the Colombian health system. In 2004 the district government of Bogota decided to implement a Primary Health Care (PHC) strategy through the Home Health program. PHC was conceived as a model for transforming health care delivery within the network of the first-level public health care facilities. This study aims to evaluate the performance of the essential dimensions of the PHC strategy in six localities geographically distributed throughout Bogotá city. Methods The rapid assessment tool to measure PHC performance, validated in Brazil, was applied. The perception of participants (users, professionals, health managers) in public health facilities where the Home Health program was implemented was compared with the perception of participants in private health facilities not implementing the program. A global performance index and specific indices for each primary care dimension were calculated. A multivariate logistic regression analysis was conducted to determine possible associations between the performance of the PHC dimensions and the self-perceived health status of users. Results The global performance index was rated as good for all participants interviewed. In general, with the exception of professionals, the differences in most of the essential dimensions seemed to favor public health care facilities where the Home Health program was implemented. The weakest dimensions were the family focus and community orientation—rated as critical by users; the distribution of financial resources—rated as critical by health managers; and, accessibility—rated as intermediate by users. Conclusions The overall findings suggest that the Home Health program could be improving the performance of the network of the first-level public health care facilities in some PHC essential dimensions, but significant efforts to achieve its objectives and raise its visibility in the community are required. PMID:23947574

An integrated approach for facilities planning by ELECTRE method

NASA Astrophysics Data System (ADS)

Elbishari, E. M. Y.; Hazza, M. H. F. Al; Adesta, E. Y. T.; Rahman, Nur Salihah Binti Abdul

2018-01-01

Facility planning is concerned with the design, layout, and accommodation of people, machines and activities of a system. Most of the researchers try to investigate the production area layout and the related facilities. However, few of them try to investigate the relationship between the production space and its relationship with service departments. The aim of this research to is to integrate different approaches in order to evaluate, analyse and select the best facilities planning method that able to explain the relationship between the production area and other supporting departments and its effect on human efforts. To achieve the objective of this research two different approaches have been integrated: Apple’s layout procedure as one of the effective tools in planning factories, ELECTRE method as one of the Multi Criteria Decision Making methods (MCDM) to minimize the risk of getting poor facilities planning. Dalia industries have been selected as a case study to implement our integration the factory have been divided two main different area: the whole facility (layout A), and the manufacturing area (layout B). This article will be concerned with the manufacturing area layout (Layout B). After analysing the data gathered, the manufacturing area was divided into 10 activities. There are five factors that the alternative were compared upon which are: Inter department satisfactory level, total distance travelled for workers, total distance travelled for the product, total time travelled for the workers, and total time travelled for the product. Three different layout alternatives have been developed in addition to the original layouts. Apple’s layout procedure was used to study and evaluate the different alternatives layouts, the study and evaluation of the layouts was done by calculating scores for each of the factors. After obtaining the scores from evaluating the layouts, ELECTRE method was used to compare the proposed alternatives with each other and with the existing layout; ELECTRE compares the alternatives based on their concordance and discordance indices. The alternatives were ranked from best to worst where regarding to the layouts concerned with the manufacturing area B.4 is the best alternative.

Drivers of facility deliveries in Africa and Asia: regional analyses using the demographic and health surveys.

PubMed

Diamond-Smith, Nadia; Sudhinaraset, May

2015-01-16

In the past few decades many countries have worked to increase the number of women delivering in facilities, with the goal of improving maternal and neonatal health outcomes. The purpose of this study is to explore the current situation of facility deliveries in Africa and Asia to understand where and with whom women deliver. Furthermore, we aim to test potential drivers of facility delivery at the individual, household, and community-level. Demographic and Health Survey data collected since 2003 from 43 countries in Africa and Asia is explored to understand the patterns of where women are delivering. We look at patterns by region and wealth quintile and urban/rural status. We then run a series of multi-level models looking at relationships between individual, household and community-level factors and the odds of a woman delivering in a facility. We explore this for Asia and Africa separately. We also look at correlates of delivery with a trained provider, in a public facility, in a private facility, with a doctor and in a hospital. The majority of women deliver in a facility and with a provider; however, about 20% of deliveries are still with no one or a friend/relative or alone. Rates of facility delivery are lower in Asia overall, and a greater proportion of deliveries take place in private facilities in Asia compared to Africa. Most of the individual level factors that have been found in past studies to be associated with delivering in a facility hold true for the multi-country-level analyses, and small differences exist between Asia and Africa. Women who deliver in private facilities differ from women who deliver in public facilities or at home. Most women in Africa and Asia are delivering in a facility, and drivers of facility delivery identified in smaller level or country specific studies hold true in multi-country national level data. More data and research is needed on other drivers, especially at the country-level and relating to the quality of care and maternal health complications.

Laboratory evaluation of the Level TROLL 100 manufactured by In-Situ Inc.: results of pressure and temperature tests

USGS Publications Warehouse

Carnley, Mark V.; Fulford, Janice M.; Brooks, Myron H.

2013-01-01

The Level TROLL 100 manufactured by In-Situ Inc. was evaluated by the U.S. Geological Survey (USGS) Hydrologic Instrumentation Facility (HIF) for conformance to the manufacturer’s accuracy specifications for measuring pressure throughout the device’s operating temperature range. The Level TROLL 100 is a submersible, sealed, water-level sensing device with an operating pressure range equivalent to 0 to 30 feet of water over a temperature range of −20 to 50 degrees Celsius (°C). The device met the manufacturer’s stated accuracy specifications for pressure within its temperature-compensated operating range of 0 to 50 °C. The device’s accuracy specifications did not meet established USGS requirements for primary water-stage sensors used in the operation of streamgages, but the Level TROLL 100 may be suitable for other hydrologic data-collection applications. As a note, the Level TROLL 100 is not designed to meet USGS accuracy requirements. Manufacturer accuracy specifications were evaluated, and the procedures followed and the results obtained are described in this report. USGS accuracy requirements are routinely examined and reported when instruments are evaluated at the HIF.

Quality of Voluntary Medical Male Circumcision Services during Scale-Up: A Comparative Process Evaluation in Kenya, South Africa, Tanzania and Zimbabwe

PubMed Central

Jennings, Larissa; Bertrand, Jane; Rech, Dino; Harvey, Steven A.; Hatzold, Karin; Samkange, Christopher A.; Omondi Aduda, Dickens S.; Fimbo, Bennett; Cherutich, Peter; Perry, Linnea; Castor, Delivette; Njeuhmeli, Emmanuel

2014-01-01

Background The rapid expansion of voluntary medical male circumcision (VMMC) has raised concerns whether health systems can deliver and sustain VMMC according to minimum quality criteria. Methods and Findings A comparative process evaluation was used to examine data from SYMMACS, the Systematic Monitoring of the Voluntary Medical Male Circumcision Scale-Up, among health facilities providing VMMC across two years of program scale-up. Site-level assessments examined the availability of guidelines, supplies and equipment, infection control, and continuity of care services. Direct observation of VMMC surgeries were used to assess care quality. Two sample tests of proportions and t-tests were used to examine differences in the percent of facilities meeting requisite preparedness standards and the mean number of directly-observed surgical tasks performed correctly. Results showed that safe, high quality VMMC can be implemented and sustained at-scale, although substantial variability was observed over time. In some settings, facility preparedness and VMMC service quality improved as the number of VMMC facilities increased. Yet, lapses in high performance and expansion of considerably deficient services were also observed. Surgical tasks had the highest quality scores, with lower performance levels in infection control, pre-operative examinations, and post-operative patient monitoring and counseling. The range of scale-up models used across countries additionally underscored the complexity of delivering high quality VMMC. Conclusions Greater efforts are needed to integrate VMMC scale-up and quality improvement processes in sub-Saharan African settings. Monitoring of service quality, not just adverse events reporting, will be essential in realizing the full health impact of VMMC for HIV prevention. PMID:24801073

The influence of facility design and human resource management on health care professionals.

PubMed

Sadatsafavi, Hessam; Walewski, John; Shepley, Mardelle M

2015-01-01

Cost control of health care services is a strategic concern for organizations. To lower costs, some organizations reduce staffing levels. However, this may not be worth the trade-off, as the quality of services will likely be reduced, morale among health care providers tends to suffer, and patient satisfaction is likely to decline. The potential synergy between human resource management and facility design and operation was investigated to achieve the goal of providing cost containment strategies without sacrificing the quality of services and the commitment of employees. About 700 health care professionals from 10 acute-care hospitals participated in this cross-sectional study. The authors used structural equation modeling to test whether employees' evaluations of their physical work environment and human resource practices were significantly associated with lower job-related anxiety, higher job satisfaction, and higher organizational commitment. The analysis found that employees' evaluations of their physical work environment and human resource practices influenced their job-related feelings and attitudes. Perceived organizational support mediated this relationship. The study also found a small but positive interaction effect between the physical work environment and human resource practices. The influence of physical work environment was small, mainly because of the high predictive value of human resource practices and strong confounding variables included in the analysis. This study specifically showed the role of facility design in reducing job-related anxiety among caregivers. Preliminary evidence is provided that facility design can be used as a managerial tool for improving job-related attitudes and feelings of employees and earning their commitment. Providing a healthy and safe work environment can be perceived by employees as an indication that the organization respects them and cares about their well-being, which might be reciprocated with higher levels of motivation and commitment toward the organization.

Walkthrough screening evaluation field guide. Natural phenomena hazards at Department of Energy facilities: Revision 2

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

Eder, S.J.; Eli, M.W.; Salmon, M.W.

1993-11-01

The US Department of Energy (DOE) has a large inventory of existing facilities. Many of these facilities were not designed and constructed to current natural phenomena hazard (NPH) criteria. The NPH events include earthquakes, extreme winds and tornadoes, and floods. DOE Order 5480.28 establishes policy and requirements for NPH mitigation for DOE facilities. DOE is conducting a multiyear project to develop evaluation guidelines for assessing the condition and determining the need for upgrades at DOE facilities. One element of the NPH evaluation guidelines` development involves the existing systems and components at DOE facilities. This effort is described in detail inmore » a cited reference. In the interim period prior to availability of the final guidelines, DOE facilities are encouraged to implement an NPH walk through screening evaluation process by which systems and components that need attention can be rapidly identified. Guidelines for conducting the walk through screening evaluations are contained herein. The result of the NPH walk through screening evaluation should be a prioritized list of systems and components that need further action. Simple and inexpensive fixes for items identified in the walk through as marginal or inadequate should be implemented without further study. By implementing an NPH walk through screening evaluation, DOE facilities may realize significant reduction in risk from NPH in the short term.« less

In-game Management of Common Joint Dislocations

PubMed Central

Skelley, Nathan W.; McCormick, Jeremy J.; Smith, Matthew V.

2014-01-01

Context: Sideline management of sports-related joint dislocations often places the treating medical professional in a challenging position. These injuries frequently require prompt evaluation, diagnosis, reduction, and postreduction management before they can be evaluated at a medical facility. Our objective is to review the mechanism, evaluation, reduction, and postreduction management of sports-related dislocations to the shoulder, elbow, finger, knee, patella, and ankle joints. Evidence Acquisition: A literature review was performed using the PubMed database to evaluate previous and current publications focused on joint dislocations. This review focused on articles published between 1980 and 2013. Study Design: Clinical review. Level of Evidence: Level 4. Results: The clinician should weigh the benefits and risks of on-field reduction based on their knowledge of the injury and the presence of associated injuries. Conclusion: When properly evaluated and diagnosed, most sports-related dislocations can be reduced and initially managed at the game. PMID:24790695

Health facilities humanisation: design guidelines supported by statistical evidence.

PubMed

Bosia, Daniela; Marino, Donatella; Peretti, Gabriella

2016-01-01

Healthcare building humanisation is currently a widely debated issue and the development of patient centered and evidence based design is growing worldwide. Many international health organizations and researchers understand the importance of Patient Centred Design and leading architects incorporate it into the design process. In Italy this design approach is still at an early stage. The article refers to research commissioned by the Italian Health Ministry and carried out by R. Del Nord (Università degli Studi di Firenze) and G. Peretti (Politecnico di Torino) with their collaborators. The scope of the research was the definition of design guidelines for healthcare facilities humanisation. The methodology framework adopted is the well established need and performance approach in architectural design. The article deals with the results of statistical investigations for the definition and ranking of users' needs and the consistent expression of their requirements. The investigations were carried out with the cooperation of psychologists of the Università degli Studi di Torino and researchers of the Università degli Studi di Cagliari. The proposed evaluation system allows ranking of health facilities according to the level of humanisation achieved. The statistical investigation evidence collected allowed the definition of humanisation design guidelines for health-care facilities and for the assessment of their specific level of humanisation.

Estimate of air carrier and air taxi crash frequencies from high altitude en route flight operations

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

Sanzo, D.; Kimura, C.Y.; Prassinos, P.G.

1996-06-03

In estimating the frequency of an aircraft crashing into a facility, it has been found convenient to break the problem down into two broad categories. One category estimates the aircraft crash frequency due to air traffic from nearby airports, the so-called near-airport environment. The other category estimates the aircraft crash frequency onto facilities due to air traffic from airways, jet routes, and other traffic flying outside the near-airport environment The total aircraft crash frequency is the summation of the crash frequencies from each airport near the facility under evaluation and from all airways, jet routes, and other traffic near themore » facility of interest. This paper will examine the problems associated with the determining the aircraft crash frequencies onto facilities outside the near-airport environment. This paper will further concentrate on the estimating the risk of aircraft crashes to ground facilities due to high altitude air carrier and air taxi traffic. High altitude air carrier and air taxi traffic will be defined as all air carrier and air taxi flights above 18,000 feet Mean Sea Level (MSL).« less

Comparison of the uncertainties of several European low-dose calibration facilities

NASA Astrophysics Data System (ADS)

Dombrowski, H.; Cornejo Díaz, N. A.; Toni, M. P.; Mihelic, M.; Röttger, A.

2018-04-01

The typical uncertainty of a low-dose rate calibration of a detector, which is calibrated in a dedicated secondary national calibration laboratory, is investigated, including measurements in the photon field of metrology institutes. Calibrations at low ambient dose equivalent rates (at the level of the natural ambient radiation) are needed when environmental radiation monitors are to be characterised. The uncertainties of calibration measurements in conventional irradiation facilities above ground are compared with those obtained in a low-dose rate irradiation facility located deep underground. Four laboratories quantitatively evaluated the uncertainties of their calibration facilities, in particular for calibrations at low dose rates (250 nSv/h and 1 μSv/h). For the first time, typical uncertainties of European calibration facilities are documented in a comparison and the main sources of uncertainty are revealed. All sources of uncertainties are analysed, including the irradiation geometry, scattering, deviations of real spectra from standardised spectra, etc. As a fundamental metrological consequence, no instrument calibrated in such a facility can have a lower total uncertainty in subsequent measurements. For the first time, the need to perform calibrations at very low dose rates (< 100 nSv/h) deep underground is underpinned on the basis of quantitative data.

Facilities Planning Conference for Community-Junior College State-Level Personnel.

ERIC Educational Resources Information Center

Florida Univ., Gainesville. Inst. of Higher Education.

This report on planning and developing facilities for community-junior colleges includes papers presented at a conference for state-level facility planners. The meeting covered the following areas: (1) development of physical facilities responsive to educational programs and community needs; (2) efficient use of existing facilities through…

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.

Assessment of the core and support functions of the Integrated Disease Surveillance system in Maharashtra, India

PubMed Central

2013-01-01

Background Monitoring the progress of the Integrated Disease Surveillance (IDS) strategy is an important component to ensure its sustainability in the state of Maharashtra in India. The purpose of the study was to document the baseline performance of the system on its core and support functions and to understand the challenges for its transition from an externally funded “project” to a state owned surveillance “program”. Methods Multi-centre, retrospective cross-sectional evaluation study to assess the structure, core and support surveillance functions using modified WHO generic questionnaires. All 34 districts in the state and randomly identified 46 facilities and 25 labs were included in the study. Results Case definitions were rarely used at the periphery. Limited laboratory capacity at all levels compromised case and outbreak confirmation. Only 53% districts could confirm all priority diseases. Stool sample processing was the weakest at the periphery. Availability of transport media, trained staff, and rapid diagnostic tests were main challenges at the periphery. Data analysis was weak at both district and facility levels. Outbreak thresholds were better understood at facility level (59%) than at the district (18%). None of the outbreak indicator targets were met and submission of final outbreak report was the weakest. Feedback and training was significantly better (p < 0.0001) at district level (65%; 76%) than at facility level (15%; 37%). Supervision was better at the facility level (37%) than at district (18%) and so were coordination, communication and logistic resources. Contractual part time positions, administrative delays in recruitment, and vacancies (30%) were main human resource issues that hampered system performance. Conclusions Significant progress has been made in the core and support surveillance functions in Maharashtra, however some challenges exist. Support functions (laboratory, transport and communication equipment, training, supervision, human and other resources) are particularly weak at the district level. Structural integration and establishing permanent state and district surveillance officer positions will ensure leadership; improve performance; support continuity; and offer sustainability to the program. Institutionalizing the integrated disease surveillance strategy through skills based personnel development and infrastructure strengthening at district levels is the only way to avoid it from ending up isolated! Improving surveillance quality should be the next on agenda for the state. PMID:23764137

47 CFR 73.7001 - Services subject to evaluation by point system.

Code of Federal Regulations, 2010 CFR

2010-10-01

... evaluate mutually exclusive applications for new radio, television, and FM translator facilities, and for... mutually exclusive applications for new radio, television, and FM translator facilities, and for major... television translator and low power television facilities, and for major changes to existing facilities, only...

Professional Development through Organizational Assessment: Using APPA's Facilities Management Evaluation Program

ERIC Educational Resources Information Center

Medlin, E. Lander; Judd, R. Holly

2013-01-01

APPA's Facilities Management Evaluation Program (FMEP) provides an integrated system to optimize organizational performance. The criteria for evaluation not only provide a tool for organizational continuous improvement, they serve as a compelling leadership development tool essential for today's facilities management professional. The senior…

Laboratory evaluation of the pressure water level data logger manufactured by Infinities USA, Inc.: results of pressure and temperature tests

USGS Publications Warehouse

Carnley, Mark V.

2015-01-01

The Pressure Water Level Data Logger manufactured by Infinities USA, Inc., was evaluated by the U.S. Geological Survey (USGS) Hydrologic Instrumentation Facility for conformance with the manufacturer’s stated accuracy specifications for measuring pressure throughout the device’s operating temperature range and with the USGS accuracy requirements for water-level measurements. The Pressure Water Level Data Logger (Infinities Logger) is a submersible, sealed, water-level sensing device with an operating pressure range of 0 to 11.5 feet of water over a temperature range of −18 to 49 degrees Celsius. For the pressure range tested, the manufacturer’s accuracy specification of 0.1 percent of full scale pressure equals an accuracy of ±0.138 inch of water. Three Infinities Loggers were evaluated, and the testing procedures followed and results obtained are described in this report. On the basis of the test results, the device is poorly compensated for temperature. For the three Infinities Loggers, the mean pressure differences varied from –4.04 to 5.32 inches of water and were not within the manufacturer’s accuracy specification for pressure measurements made within the temperature-compensated range. The device did not meet the manufacturer’s stated accuracy specifications for pressure within its temperature-compensated operating range of –18 to 49 degrees Celsius or the USGS accuracy requirements of no more than 0.12 inch of water (0.01 foot of water) or 0.10 percent of reading, whichever is larger. The USGS accuracy requirements are routinely examined and reported when instruments are evaluated at the Hydrologic Instrumentation Facility. The estimated combined measurement uncertainty for the pressure cycling test was ±0.139 inch of water, and for temperature, the cycling test was ±0.127 inch of water for the three Infinities Loggers.

An update of engine system research at the Army Propulsion Directorate

NASA Technical Reports Server (NTRS)

Bobula, George A.

1990-01-01

The Small Turboshaft Engine Research (STER) program provides a vehicle for evaluating the application of emerging technologies to Army turboshaft engine systems and to investigate related phenomena. Capitalizing on the resources at hand, in the form of both the NASA facilities and the Army personnel, the program goal of developing a physical understanding of engine system dynamics and/or system interactions is being realized. STER entries investigate concepts and components developed both in-house and out-of-house. Emphasis is placed upon evaluations which have evolved from on-going basic research and advanced development programs. Army aviation program managers are also encouraged to make use of STER resources, both people and facilities. The STER personnel have established their reputations as experts in the fields of engine system experimental evaluations and engine system related phenomena. The STER facility has demonstrated its utility in both research and development programs. The STER program provides the Army aviation community the opportunity to perform system level investigations, and then to offer the findings to the entire engine community for their consideration in next generation propulsion systems. In this way results of the fundamental research being conducted to meet small turboshaft engine technology challenges expeditiously find their way into that next generation of propulsion systems.

Ballistocraft: a novel facility for microgravity research.

PubMed

Mesland, D; Paris, D; Huijser, R; Lammertse, P; Postema, R

1995-05-01

One of ESA's aims is to provide the microgravity research community with various microgravity exposure facilities. Those facilities include drop towers, sounding rockets, and parabolic flights on board aircraft, in addition to orbital spacecraft. Microgravity flights are usually achieved using large aircraft like the French 'Caravelle' that offer a large payload volume and where a person can be present to perform the experiments and to participate as a human test-subject. However, the microgravity community is also very interested in a flexible, complementary facility that would allow frequent and repetitive exposure to microgravity for a laboratory-type of payload. ESA has therefore undertaken a study of the potential of using a 'ballistocraft', a small unmanned aircraft, to provide a low-cost facility for short-duration (30-40 seconds) microgravity experimentation. Fokker Space & Systems performed the study under an ESA contract, supported by Dutch national funding. To assess the ballistocraft, a simple breadboard of the facility was built and flight tests were performed. The ability of the on-board controller to achieve automated parabolic flights was demonstrated, and the performance of the controller in one-g level flights, and in flights with both zero-g and partial-g setpoints, was evaluated. The partial-g flights are a unique and valuable feature of the facility.

Emergency positioning system accuracy with infrared LEDs in high-security facilities

NASA Astrophysics Data System (ADS)

Knoch, Sierra N.; Nelson, Charles; Walker, Owens

2017-05-01

Instantaneous personnel location presents a challenge in Department of Defense applications where high levels of security restrict real-time tracking of crew members. During emergency situations, command and control requires immediate accountability of all personnel. Current radio frequency (RF) based indoor positioning systems can be unsuitable due to RF leakage and electromagnetic interference with sensitively calibrated machinery on variable platforms like ships, submarines and high-security facilities. Infrared light provide a possible solution to this problem. This paper proposes and evaluates an indoor line-of-sight positioning system that is comprised of IR and high-sensitivity CMOS camera receivers. In this system the movement of the LEDs is captured by the camera, uploaded and analyzed; the highest point of power is located and plotted to create a blueprint of crewmember location. Results provided evaluate accuracy as a function of both wavelength and environmental conditions. Research will further evaluate the accuracy of the LED transmitter and CMOS camera receiver system. Transmissions in both the 780 and 850nm IR are analyzed.

Evaluating Technical Efficiency of Nursing Care Using Data Envelopment Analysis and Multilevel Modeling.

PubMed

Min, Ari; Park, Chang Gi; Scott, Linda D

2016-05-23

Data envelopment analysis (DEA) is an advantageous non-parametric technique for evaluating relative efficiency of performance. This article describes use of DEA to estimate technical efficiency of nursing care and demonstrates the benefits of using multilevel modeling to identify characteristics of efficient facilities in the second stage of analysis. Data were drawn from LTCFocUS.org, a secondary database including nursing home data from the Online Survey Certification and Reporting System and Minimum Data Set. In this example, 2,267 non-hospital-based nursing homes were evaluated. Use of DEA with nurse staffing levels as inputs and quality of care as outputs allowed estimation of the relative technical efficiency of nursing care in these facilities. In the second stage, multilevel modeling was applied to identify organizational factors contributing to technical efficiency. Use of multilevel modeling avoided biased estimation of findings for nested data and provided comprehensive information on differences in technical efficiency among counties and states. © The Author(s) 2016.

Patient Care Staffing Levels and Facility Characteristics in U.S. Hemodialysis Facilities

PubMed Central

Yoder, Laura A. G.; Xin, Wenjun; Norris, Keith C.; Yan, Guofen

2013-01-01

Background Higher numbers of registered nurses per patient have been associated with improved patient outcomes in acute care facilities. Variation and associations of patient-care staffing levels and hemodialysis facility characteristics have not been previously examined. Study Design Cross-sectional study using Poisson regression to examine associations betwee patient-care staffing levels and hemodialysis facility characteristics. Setting & Participants 4,800 U.S. hemodialysis facilities in the 2009 CMS ESRD Annual Facility Survey (CMS-2744), USRDS. Predictors Facility characteristics, including profit status, freestanding status, chain affiliatio and geographic region, adjusted for facility size, capacity, functional type, and urbanicity. Outcomes Patient care staffing levels, including ratios of Registered Nurses (RN), Licensed Practical Nurses (LPN), Patient Care Technicians (PCT), composite staff (RN+LPN+PCT), Social Workers, and Dietitians to in-center hemodialysis patients. Results After adjusting for background facility characteristics, the ratios of RNs and LPNs to patients were 35% (p<0.001) and 42% (p<0.001) lower, but the PCT-to-patient ratio was 16% (p<0.001) higher in for-profit facilities than those in nonprofit facilities (Rate ratio, 0.65, 95%CI, 0.63–0.68; 0.58, 0.51–0.65; 1.16, 1.12–1.19; respectively). Regionally, compared to the Northeast, the adjusted RN-to-patient ratio was 14% (p< 0.001) lower in the Midwest, 25% (p< 0.001) lower in the South, and 18% (p< 0.001) lower in the West. Even after additional adjustments, the large for-profit chains had significantly lower RN and LPN ratios than the largest nonprofit chain, but a significantly higher PCT-to-patient ratio. The overall composite staffing levels were also lower in for-profit and chain-affiliated facilities. The patterns hold when the hospital-based units were excluded. Limitations Nursing hours were not available. Conclusions The significant variation in patient-care staffing levels and its associations with facility characteristics warrants inclusion in future large-scale hemodialysis outcomes studies. ESRD networks and hemodialysis facilities should attend to quality assurance and performance improvement initiatives that maximize licensed nurse-staffing levels in hemodialysis facilities. PMID:23810689

Are neighbourhood social capital and availability of sports facilities related to sports participation among Dutch adolescents?

PubMed Central

2012-01-01

Background The aim of this study is to explore whether availability of sports facilities, parks, and neighbourhood social capital (NSC) and their interaction are associated with leisure time sports participation among Dutch adolescents. Methods Cross-sectional analyses were conducted on complete data from the last wave of the YouRAction evaluation trial. Adolescents (n = 852) completed a questionnaire asking for sports participation, perceived NSC and demographics. Ecometric methods were used to aggregate perceived NSC to zip code level. Availability of sports facilities and parks was assessed by means of geographic information systems within the zip-code area and within a 1600 meter buffer. Multilevel logistic regression analyses, with neighborhood and individual as levels, were conducted to examine associations between physical and social environmental factors and leisure time sports participation. Simple slopes analysis was conducted to decompose interaction effects. Results NSC was significantly associated with sports participation (OR: 3.51 (95%CI: 1.18;10.41)) after adjustment for potential confounders. Availability of sports facilities and availability of parks were not associated with sports participation. A significant interaction between NSC and density of parks within the neighbourhood area (OR: 1.22 (90%CI: 1.01;1.34)) was found. Decomposition of the interaction term showed that adolescents were most likely to engage in leisure time sports when both availability of parks and NSC were highest. Conclusions The results of this study indicate that leisure time sports participation is associated with levels of NSC, but not with availability of parks or sports facilities. In addition, NSC and availability of parks in the zip code area interacted in such a way that leisure time sports participation is most likely among adolescents living in zip code areas with higher levels of NSC, and higher availability of parks. Hence, availability of parks appears only to be important for leisure time sports participation when NSC is high. PMID:22849512

Skin and surface lead contamination, hygiene programs, and work practices of bridge surface preparation and painting contractors.

PubMed

Virji, M Abbas; Woskie, Susan R; Pepper, Lewis D

2009-02-01

A 2005 regulatory review of the lead in construction standard by the Occupational Safety and Health Administration (OSHA) noted that alternative pathways of exposure can be as significant as inhalation exposure and that noncompliance with the standard pertaining to hygiene facilities and practices was the second most commonly violated section of the standard. Noncompliance with provisions of the standard and unhealthy work and hygiene practices likely increase the likelihood of take-home lead via contaminated clothing, automobiles, and skin, thus contributing to elevated blood lead levels (BLL) among construction workers and their family members. We performed a cross-sectional study of bridge painters working for small contractors in Massachusetts to investigate causes of persistent elevated BLLs and to assess lead exposures. Thirteen work sites were evaluated for a 2-week period during which surface and skin wipe samples were collected and qualitative information was obtained on personal hygiene practices, decontamination and hand wash facilities, and respiratory protection programs. Results showed lead contamination on workers' skin, respirators, personal automobiles, and the decontamination unit, indicating a significant potential for take-home lead exposure. Overall, the geometric mean (GM) skin lead levels ranged from 373 microg on workers' faces at end of shift to 814 microg on hands at break time. The overall GM lead level inside respirators was 143 microg before work and 286 microg after work. Lead contamination was also present inside workers' personal vehicles as well as on surfaces inside the clean side of the decontamination unit. Review of the respiratory protection programs, work site decontamination and hand wash facilities, and personal hygiene practices indicated that these factors had significant impact on skin and surface contamination levels and identified significant opportunities for improving work site facilities and personal practices. Elevated lead exposure and BLL can be minimized by strict adherence to the OSHA provisions for functioning decontamination and hygiene facilities and healthy personal hygiene practices.

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.

Factors affecting utilization of skilled maternal care in Northwest Ethiopia: a multilevel analysis.

PubMed

Worku, Abebaw Gebeyehu; Yalew, Alemayehu Worku; Afework, Mesganaw Fantahun

2013-04-15

The evaluation of all potential sources of low skilled maternal care utilization is crucial for Ethiopia. Previous studies have largely disregarded the contribution of different levels. This study was planned to assess the effect of individual, communal, and health facility characteristics in the utilization of antenatal, delivery, and postnatal care by a skilled provider. A linked facility and population-based survey was conducted over three months (January - March 2012) in twelve "kebeles" of North Gondar Zone, Amhara Region. A total of 1668 women who had births in the year preceding the survey were selected for analysis. Using a multilevel modelling, we examined the effect of cluster variation and a number of individual, communal (kebele), and facility-related variables for skilled maternal care utilization. About 32.3%, 13.8% and 6.3% of the women had the chance to get skilled providers for their antenatal, delivery and postnatal care, respectively. A significant heterogeneity was observed among clusters for each indicator of skilled maternal care utilization. At the individual level, variables related to awareness and perceptions were found to be much more relevant for skilled maternal service utilization. Preference for skilled providers and previous experience of antenatal care were consistently strong predictors of all indicators of skilled maternal health care utilizations. Birth order, maternal education, and awareness about health facilities to get skilled professionals were consistently strong predictors of skilled antenatal and delivery care use. Communal factors were relevant for both delivery and postnatal care, whereas the characteristics of a health facility were more relevant for use of skilled delivery care than other maternity services. Factors operating at individual and "kebele" levels play a significant role in determining utilization of skilled maternal health services. Interventions to create better community awareness and perception about skilled providers and their care, and ensuring the seamless performance of health care facilities have been considered crucial to improve skilled maternal services in the study area. Such interventions should target underprivileged women.

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.

Background noise measurements from jet exit vanes designed to reduced flow pulsations in an open-jet wind tunnel

NASA Technical Reports Server (NTRS)

Hoad, D. R.; Martin, R. M.

1985-01-01

Many open jet wind tunnels experience pulsations of the flow which are typically characterized by periodic low frequency velocity and pressure variations. One method of reducing these fluctuations is to install vanes around the perimeter of the jet exit to protrude into the flow. Although these vanes were shown to be effective in reducing the fluctuation content, they can also increase the test section background noise level. The results of an experimental acoustic program in the Langley 4- by 7-Meter Tunnel is presented which evaluates the effect on tunnel background noise of such modifications to the jet exit nozzle. Noise levels for the baseline tunnel configuration are compared with those for three jet exit nozzle modifications, including an enhanced noise reduction configuration that minimizes the effect of the vanes on the background noise. Although the noise levels for this modified vane configuration were comparable to baseline tunnel background noise levels in this facility, installation of these modified vanes in an acoustic tunnel may be of concern because the noise levels for the vanes could be well above background noise levels in a quiet facility.

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.

Evaluating Michigan commercial vehicle enforcement strategies and facilities.

DOT National Transportation Integrated Search

2015-03-01

This report documents evaluation results and recommendations for Michigan commercial vehicle : enforcement strategies and facilities. Through literature review, online survey and site visits, : enforcement strategies and facilities in other states an...

Nuclear thermal propulsion test facility requirements and development strategy

NASA Technical Reports Server (NTRS)

Allen, George C.; Warren, John; Clark, J. S.

1991-01-01

The Nuclear Thermal Propulsion (NTP) subpanel of the Space Nuclear Propulsion Test Facilities Panel evaluated facility requirements and strategies for nuclear thermal propulsion systems development. High pressure, solid core concepts were considered as the baseline for the evaluation, with low pressure concepts an alternative. The work of the NTP subpanel revealed that a wealth of facilities already exists to support NTP development, and that only a few new facilities must be constructed. Some modifications to existing facilities will be required. Present funding emphasis should be on long-lead-time items for the major new ground test facility complex and on facilities supporting nuclear fuel development, hot hydrogen flow test facilities, and low power critical facilities.

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.

Functional safety for the Advanced Technology Solar Telescope

NASA Astrophysics Data System (ADS)

Bulau, Scott; Williams, Timothy R.

2012-09-01

Since inception, the Advanced Technology Solar Telescope (ATST) has planned to implement a facility-wide functional safety system to protect personnel from harm and prevent damage to the facility or environment. The ATST will deploy an integrated safety-related control system (SRCS) to achieve functional safety throughout the facility rather than relying on individual facility subsystems to provide safety functions on an ad hoc basis. The Global Interlock System (GIS) is an independent, distributed, facility-wide, safety-related control system, comprised of commercial off-the-shelf (COTS) programmable controllers that monitor, evaluate, and control hazardous energy and conditions throughout the facility that arise during operation and maintenance. The GIS has been designed to utilize recent advances in technology for functional safety plus revised national and international standards that allow for a distributed architecture using programmable controllers over a local area network instead of traditional hard-wired safety functions, while providing an equivalent or even greater level of safety. Programmable controllers provide an ideal platform for controlling the often complex interrelationships between subsystems in a modern astronomical facility, such as the ATST. A large, complex hard-wired relay control system is no longer needed. This type of system also offers greater flexibility during development and integration in addition to providing for expanded capability into the future. The GIS features fault detection, self-diagnostics, and redundant communications that will lead to decreased maintenance time and increased availability of the facility.

Dialysis Facility and Patient Characteristics Associated with Utilization of Home Dialysis

PubMed Central

Walker, David R.; Inglese, Gary W.; Sloand, James A.

2010-01-01

Background and objectives: Nonmedical factors influencing utilization of home dialysis at the facility level are poorly quantified. Home dialysis is comparably effective and safe but less expensive to society and Medicare than in-center hemodialysis. Elimination of modifiable practice variation unrelated to medical factors could contribute to improvements in patient outcomes and use of scarce resources. Design, setting, participants, & measurements: Prevalent dialysis patient data by facility were collected from the 2007 ESRD Network’s annual reports. Facility characteristic data were collected from Medicare’s Dialysis Facility Compare file. A multivariate regression model was used to evaluate associations between the use of home dialysis and facility characteristics. Results: The utilization of home dialysis was positively associated with facility size, percent patients employed full- or part-time, younger population, and years a facility was Medicare certified. Variables negatively associated include an increased number of hemodialysis patients per hemodialysis station, chain association, rural location, more densely populated zip code, a late dialysis work shift, and greater percent of black patients within a zip code. Conclusions: Improved understanding of factors affecting the frequency of use of home dialysis may help explain practice variations across the United States that result in an imbalanced use of medical resources within the ESRD population. In turn, this may improve the delivery of healthcare and extend the ability of an increasingly overburdened medical financing system to survive. PMID:20634324

Association between social health insurance and choice of hospitals among internal migrants in China: a national cross-sectional study

PubMed Central

Wang, Haiqin; Zhang, Donglan; Hou, Zhiying; Yan, Fei; Hou, Zhiyuan

2018-01-01

Objectives There is a tendency to pursue higher-level hospitalisation services in China, especially for internal migrants. This study aims to investigate the choices of hospitalisation services among internal migrants, and evaluate the association between social health insurance and hospitalisation choices. Methods Data were from a 2014 nationally representative cross-sectional sample of internal migrants aged 15–59 years in China. Descriptive analyses were used to perform the distribution of healthcare facility levels for hospitalisation services, and multinomial logistic regression was applied to examine the association between social health insurance and hospitalisation choices. Results Of the 6121 inpatient care users, only 11.50% chose the primary healthcare facilities for hospitalisation services, 44.91% chose the secondary hospitals and 43.59% preferred the tertiary hospitals. The choices presented large regional variations across the country. Compared with the uninsured, social health insurance had no statistically significant effect on patient choices of healthcare facility levels among internal migrants in China, whereas socioeconomic status was positively associated with the choices. Conclusions Social health insurance had little influence on the hospital choice among the internal migrants. Thus, social health insurance should be consolidated and portable to enhance the proper incentive of health insurance on healthcare seeking behaviours. PMID:29440156

Leakage of radioactive materials from particle accelerator facilities by non-radiation disasters like fire and flooding and its environmental impacts

NASA Astrophysics Data System (ADS)

Lee, A.; Jung, N. S.; Mokhtari Oranj, L.; Lee, H. S.

2018-06-01

The leakage of radioactive materials generated at particle accelerator facilities is one of the important issues in the view of radiation safety. In this study, fire and flooding at particle accelerator facilities were considered as the non-radiation disasters which result in the leakage of radioactive materials. To analyse the expected effects at each disaster, the case study on fired and flooded particle accelerator facilities was carried out with the property investigation of interesting materials presented in the accelerator tunnel and the activity estimation. Five major materials in the tunnel were investigated: dust, insulators, concrete, metals and paints. The activation levels on the concerned materials were calculated using several Monte Carlo codes (MCNPX 2.7+SP-FISPACT 2007, FLUKA 2011.4c and PHITS 2.64+DCHAIN-SP 2001). The impact weight to environment was estimated for the different beam particles (electron, proton, carbon and uranium) and the different beam energies (100, 430, 600 and 1000 MeV/nucleon). With the consideration of the leakage path of radioactive materials due to fire and flooding, the activation level of selected materials, and the impacts to the environment were evaluated. In the case of flooding, dust, concrete and metal were found as a considerable object. In the case of fire event, dust, insulator and paint were the major concerns. As expected, the influence of normal fire and flooding at electron accelerator facilities would be relatively low for both cases.

Augmentor transient capability of an F100 engine equipped with a digital electronic engine control

NASA Technical Reports Server (NTRS)

Burcham, F. W., Jr.; Pai, G. D.

1984-01-01

An F100 augmented turbofan engine equipped with digital electronic engine control (DEEC) system was evaluated. The engine was equipped with a specially modified augmentor to provide improved steady state and transient augmentor capability. The combination of the DEEC and the modified augmentor was evaluated in sea level and altitude facility tests and then in four different flight phases in an F-15 aircraft. The augmentor configuration, logic, and test results are presented.

Environmental Risk Factors influencing Bicycle Theft: A Spatial Analysis in London, UK

PubMed Central

Helbich, Marco

2016-01-01

Urban authorities are continuously drawing up policies to promote cycling among commuters. However, these initiatives are counterproductive for the targeted objectives because they increase opportunities for bicycle theft. This paper explores Inner London as a case study to address place-specific risk factors for bicycle theft at the street-segment level while controlling for seasonal variation. The presence of certain public amenities (e.g., bicycle stands, railway stations, pawnshops) was evaluated against locations of bicycle theft between 2013 and 2016 and risk effects were estimated using negative binomial regression models. Results showed that a greater level of risk stemmed from land-use facilities than from area-based socioeconomic status. The presence of facilities such as train stations, vacant houses, pawnbrokers and payday lenders increased bicycle theft, but no evidence was found that linked police stations with crime levels. The findings have significant implications for urban crime prevention with respect to non-residential land use. PMID:27643788

[EVALUATION OF THE EFFECTIVENESS OF ADDITIONAL PROFESSIONAL EDUCATION ON THE BASIS OF HEALTH CARE FACILITY].

PubMed

Bohomaz, V M; Rymarenko, P V

2014-01-01

In this study we tested methods of facility learning of health care workers as part of a modern model of quality management of medical services. The statistical and qualitative analysis of the effectiveness of additional training in emergency medical care at the health facility using an adapted curriculum and special mannequins. Under the guidance of a certified instructor focus group of 53 doctors and junior medical specialists studied 22 hours. According to a survey of employees trained their level of selfassessment of knowledge and skills sigificantly increased. Also significantly increased the proportion of correct answers in a formalized testing both categories of workers. Using androgological learning model, mannequins simulators and training in small groups at work create the most favorable conditions for effective individual and group practical skills of emergency medicine.

Application of WHO ‘Near-Miss’ Tool Indicates Good Quality of Maternal Care in Rural Healthcare Setting in Uttarakhand, Northern India

PubMed Central

Roy, Debabrata; Aggarwal, Pradeep; Nautiyal, Ruchira; Chaturvedi, Jaya; Kakkar, Rakesh

2016-01-01

Introduction Women who experienced and survived a severe health condition during pregnancy, childbirth or postpartum are considered as ‘near-miss’ or severe acute maternal morbidity (SAMM) cases. Women who survive life-threatening conditions arising from complications related to pregnancy and childbirth have many common aspects with those who die of such complications. Aim To evaluate health-care facility preparedness and perfor-mance in reducing severe maternal out comes at all levels of health care. Materials and Methods The present study was carried out over a period of 12 months under the Department of Community Medicine. The cross-sectional study included all the women (937) attending health-care facilities, at all levels of health care i.e. Primary, Secondary & Tertiary level in Doiwala block of Dehradun district. This study was conducted as per the WHO criteria for ‘near-miss’ by using probability sampling for random selection of health facilities. All eligible study subjects visiting health-care facilities during the study period were included, i.e. who were pregnant, in labour, or who had delivered or aborted up to 42 days ago. Results It was found that all women delivering at the THC received oxytocin to prevent postpartum haemorrhage. Treatment of severe post-partum haemorrhage by removal of retained products was significantly associated with levels of health care. Majority (94.73%) women who had eclampsia received magnesium sulfate as primary treatment. Conclusion Application of WHO ‘near-miss’ tool indicates good quality of maternal care in rural healthcare setting in Uttarakhand, North India. The women would have otherwise died due to obstetrics complications, had proper care not been provided to them in time. PMID:26894094

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.

Surface evaluation of UV-degraded contamination

NASA Technical Reports Server (NTRS)

Connatser, Robert; Hadaway, James B.

1992-01-01

Three different areas of work were accomplished under this contract: (1) contamination testing and evaluation; (2) UV irradiation testing; and (3) surface evaluation testing. Contamination testing was generally performed in the In-Situ Contamination Effects Facility at Marshall Space Flight Center (MSFC). UV irradiation testing was also performed primarily at MSFC, utilizing facilities there. Finally, the surface evaluation was done at facilities at UAH Center for Applied Optics.

Direct facility funding as a response to user fee reduction: implementation and perceived impact among Kenyan health centres and dispensaries

PubMed Central

Opwora, Antony; Kabare, Margaret; Molyneux, Sassy; Goodman, Catherine

2010-01-01

There is increasing pressure for reduction of user fees, but this can have adverse effects by decreasing facility-level funds. To address this, direct facility funding (DFF) was piloted in Coast Province, Kenya, with health facility committees (HFCs) responsible for managing the funds. We evaluated the implementation and perceived impact 2.5 years after DFF introduction. Quantitative data collection at 30 public health centres and dispensaries included a structured interview with the in-charge, record reviews and exit interviews. In addition, in-depth interviews were conducted with the in-charge and HFC members at 12 facilities, and with district staff and other stakeholders. DFF procedures were well established: HFCs met regularly and accounting procedures were broadly followed. DFF made an important contribution to facility cash income, accounting for 47% in health centres and 62% in dispensaries. The main items of expenditure were wages for support staff (32%), travel (21%), and construction and maintenance (18%). DFF was perceived to have a highly positive impact through funding support staff such as cleaners and patient attendants, outreach activities, renovations, patient referrals and increasing HFC activity. This was perceived to have improved health worker motivation, utilization and quality of care. A number of problems were identified. HFC training was reportedly inadequate, and no DFF documentation was available at facility level, leading to confusion. Charging user fees above those specified in the national policy remained common, and understanding of DFF among the broader community was very limited. Finally, relationships between HFCs and health workers were sometimes characterized by mistrust and resentment. Relatively small increases in funding may significantly affect facility performance when the funds are managed at the periphery. Kenya plans to scale up DFF nationwide. Our findings indicate this is warranted, but should include improved training and documentation, greater emphasis on community engagement, and insistence on user fee adherence. PMID:20211967

Direct facility funding as a response to user fee reduction: implementation and perceived impact among Kenyan health centres and dispensaries.

PubMed

Opwora, Antony; Kabare, Margaret; Molyneux, Sassy; Goodman, Catherine

2010-09-01

There is increasing pressure for reduction of user fees, but this can have adverse effects by decreasing facility-level funds. To address this, direct facility funding (DFF) was piloted in Coast Province, Kenya, with health facility committees (HFCs) responsible for managing the funds. We evaluated the implementation and perceived impact 2.5 years after DFF introduction. Quantitative data collection at 30 public health centres and dispensaries included a structured interview with the in-charge, record reviews and exit interviews. In addition, in-depth interviews were conducted with the in-charge and HFC members at 12 facilities, and with district staff and other stakeholders. DFF procedures were well established: HFCs met regularly and accounting procedures were broadly followed. DFF made an important contribution to facility cash income, accounting for 47% in health centres and 62% in dispensaries. The main items of expenditure were wages for support staff (32%), travel (21%), and construction and maintenance (18%). DFF was perceived to have a highly positive impact through funding support staff such as cleaners and patient attendants, outreach activities, renovations, patient referrals and increasing HFC activity. This was perceived to have improved health worker motivation, utilization and quality of care. A number of problems were identified. HFC training was reportedly inadequate, and no DFF documentation was available at facility level, leading to confusion. Charging user fees above those specified in the national policy remained common, and understanding of DFF among the broader community was very limited. Finally, relationships between HFCs and health workers were sometimes characterized by mistrust and resentment. Relatively small increases in funding may significantly affect facility performance when the funds are managed at the periphery. Kenya plans to scale up DFF nationwide. Our findings indicate this is warranted, but should include improved training and documentation, greater emphasis on community engagement, and insistence on user fee adherence.

Design of an impact evaluation using a mixed methods model--an explanatory assessment of the effects of results-based financing mechanisms on maternal healthcare services in Malawi.

PubMed

Brenner, Stephan; Muula, Adamson S; Robyn, Paul Jacob; Bärnighausen, Till; Sarker, Malabika; Mathanga, Don P; Bossert, Thomas; De Allegri, Manuela

2014-04-22

In this article we present a study design to evaluate the causal impact of providing supply-side performance-based financing incentives in combination with a demand-side cash transfer component on equitable access to and quality of maternal and neonatal healthcare services. This intervention is introduced to selected emergency obstetric care facilities and catchment area populations in four districts in Malawi. We here describe and discuss our study protocol with regard to the research aims, the local implementation context, and our rationale for selecting a mixed methods explanatory design with a quasi-experimental quantitative component. The quantitative research component consists of a controlled pre- and post-test design with multiple post-test measurements. This allows us to quantitatively measure 'equitable access to healthcare services' at the community level and 'healthcare quality' at the health facility level. Guided by a theoretical framework of causal relationships, we determined a number of input, process, and output indicators to evaluate both intended and unintended effects of the intervention. Overall causal impact estimates will result from a difference-in-difference analysis comparing selected indicators across intervention and control facilities/catchment populations over time.To further explain heterogeneity of quantitatively observed effects and to understand the experiential dimensions of financial incentives on clients and providers, we designed a qualitative component in line with the overall explanatory mixed methods approach. This component consists of in-depth interviews and focus group discussions with providers, service user, non-users, and policy stakeholders. In this explanatory design comprehensive understanding of expected and unexpected effects of the intervention on both access and quality will emerge through careful triangulation at two levels: across multiple quantitative elements and across quantitative and qualitative elements. Combining a traditional quasi-experimental controlled pre- and post-test design with an explanatory mixed methods model permits an additional assessment of organizational and behavioral changes affecting complex processes. Through this impact evaluation approach, our design will not only create robust evidence measures for the outcome of interest, but also generate insights on how and why the investigated interventions produce certain intended and unintended effects and allows for a more in-depth evaluation approach.

Natural phenomena hazards design and evaluation criteria for Department of Energy Facilities

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

Not Available

1994-04-01

This DOE standard gives design and evaluation criteria for natural phenomena hazards (NPH) effects as guidance for implementing the NPH mitigation requirements of DOE 5480.28. Goal of the criteria is to assure that DOE facilities can withstand the effects of earthquakes, extreme winds, tornadoes, flooding, etc. They apply to the design of new facilities and the evaluation of existing facilities; they may also be used for modification and upgrading of the latter.

Migration of Beryllium via Multiple Exposure Pathways among Work Processes in Four Different Facilities.

PubMed

Armstrong, Jenna L; Day, Gregory A; Park, Ji Young; Stefaniak, Aleksandr B; Stanton, Marcia L; Deubner, David C; Kent, Michael S; Schuler, Christine R; Virji, M Abbas

2014-01-01

Inhalation of beryllium is associated with the development of sensitization; however, dermal exposure may also be important. The primary aim of this study was to elucidate relationships among exposure pathways in four different manufacturing and finishing facilities. Secondary aims were to identify jobs with increased levels of beryllium in air, on skin, and on surfaces; identify potential discrepancies in exposure pathways, and determine if these are related to jobs with previously identified risk. Beryllium was measured in air, on cotton gloves, and on work surfaces. Summary statistics were calculated and correlations among all three measurement types were examined at the facility and job level. Exposure ranking strategies were used to identify jobs with higher exposures. The highest air, glove, and surface measurements were observed in beryllium metal production and beryllium oxide ceramics manufacturing jobs that involved hot processes and handling powders. Two finishing and distribution facilities that handle solid alloy products had lower exposures than the primary production facilities, and there were differences observed among jobs. For all facilities combined, strong correlations were found between air-surface (rp ≥ 0.77), glove-surface (rp ≥ 0.76), and air-glove measurements (rp ≥ 0.69). In jobs where higher risk of beryllium sensitization or disease has been reported, exposure levels for all three measurement types were higher than in jobs with lower risk, though they were not the highest. Some jobs with low air concentrations had higher levels of beryllium on glove and surface wipe samples, suggesting a need to further evaluate the causes of the discrepant levels. Although such correlations provide insight on where beryllium is located throughout the workplace, they cannot identify the direction of the pathways between air, surface, or skin. Ranking strategies helped to identify jobs with the highest combined air, glove, and/or surface exposures. All previously identified high-risk jobs had high air concentrations, dermal mass loading, or both, and none had low dermal and air. We have found that both pathways are relevant. [Supplementary materials are available for this article. Go to the publisher's online edition of Journal of Occupational and Environmental Hygiene for the following free supplemental resource: a file describing the forms of beryllium materials encountered during production and characteristics of the aerosols by process areas.].

Gating characteristics of photomultiplier tubes for Lidar applications

NASA Technical Reports Server (NTRS)

Barrick, J. D. W.

1986-01-01

A detector test facility was developed and applied in the evaluation and characterization of lidar detectors in support of the multipurpose airborne differential absorption lidar (DIAL) system based at the Langley Research Center (LaRC). A performance data base of various detector configurations available to the DIAL system was obtained for optimum lidar detector selection. Photomultiplier tubes (PMT's) with multialkaline and bialkaline photocathodes were evaluated in voltage-divider networks (bases) by using either the focusing electrode or dynodes as a gating mechanism. Characteristics used for detector evaluation included gain stability, signal rise time, and the ability to block unwanted high light levels.

Evaluation of ceiling lifts: transfer time, patient comfort and staff perceptions.

PubMed

Alamgir, Hasanat; Li, Olivia Wei; Yu, Shicheng; Gorman, Erin; Fast, Catherine; Kidd, Catherine

2009-09-01

Mechanical lifting devices have been developed to reduce healthcare worker injuries related to patient handling. The purpose of this study was to evaluate ceiling lifts in comparison to floor lifts based on transfer time, patient comfort and staff perceptions in three long-term care facilities with varying ceiling lift coverage. The time required to transfer or reposition patients along with patient comfort levels were recorded for 119 transfers. Transfers performed with ceiling lifts required on average less time (bed to chair transfers: 156.9 seconds for ceiling lift, 273.6 seconds for floor lift) and were found to be more comfortable for patients. In the three facilities, 143 healthcare workers were surveyed on their perceptions of patient handling tasks and equipment. For both transferring and repositioning tasks, staff preferred to use ceiling lifts and also found them to be less physically demanding. Further investigation is needed on repositioning tasks to ensure safe practice.

Testing activities at the National Battery Test Laboratory

NASA Astrophysics Data System (ADS)

Hornstra, F.; Deluca, W. H.; Mulcahey, T. P.

The National Battery Test Laboratory (NBTL) is an Argonne National Laboratory facility for testing, evaluating, and studying advanced electric storage batteries. The facility tests batteries developed under Department of Energy programs and from private industry. These include batteries intended for future electric vehicle (EV) propulsion, electric utility load leveling (LL), and solar energy storage. Since becoming operational, the NBTL has evaluated well over 1400 cells (generally in the form of three- to six-cell modules, but up to 140-cell batteries) of various technologies. Performance characterization assessments are conducted under a series of charge/discharge cycles with constant current, constant power, peak power, and computer simulated dynamic load profile conditions. Flexible charging algorithms are provided to accommodate the specific needs of each battery under test. Special studies are conducted to explore and optimize charge procedures, to investigate the impact of unique load demands on battery performance, and to analyze the thermal management requirements of battery systems.

Health worker perspectives on the possible use of intramuscular artesunate for the treatment of severe malaria at lower-level health facilities in settings with poor access to referral facilities in Nigeria: a qualitative study.

PubMed

Adesoro, Olatunde; Shumba, Constance; Kpamor, John; Achan, Jane; Kivumbi, Harriet; Dada, John; Maxwell, Kolawole; Tibenderana, James; Marasciulo, Madeline; Hamade, Prudence; Oresanya, Olusola; Nankabirwa, Joanita; Baba, Ebenezer

2016-10-12

Innovative strategies are needed to reduce malaria mortality in high burden countries like Nigeria. Given that one of the important reasons for this high malaria mortality is delay in receiving effective treatment, improved access to such treatment is critical. Intramuscular artesunate could be used at lower-level facilities given its proven efficacy, ease of use and excellent safety profile. The objective of this study was therefore to explore health workers' perspectives on the possible use of intramuscular artesunate as definitive treatment for severe malaria at lower-level facilities, especially when access to referral facilities is challenging. The study was to provide insight as a formative step into the conduct of future experimental studies to ascertain the feasibility of the use of intramuscular artesunate for definitive treatment of severe malaria in lower level facilities where access to referral care is limited. This qualitative study was done across three southern States in Nigeria (Oyo, Cross River and Enugu). Key informant interviews were conducted over a period of three months between October and December 2014 among 90 purposively selected health workers with different roles in malaria case management from primary care to policy level. A thematic content analysis was used to analyse data. Overall, most of health workers and other key informant groups thought that the use of intramuscular artesunate for definitive treatment of severe malaria at lower-level facilities was possible. They however reported human resource and infrastructure constraints as factors affecting the feasibility of intramuscular artesunate use as definitive treatment for severe malaria in lower-level facilities.. Specifically identified barriers included limited numbers of skilled health workers available to manage potential complications of severe malaria and poorly equipped facilities for supportive treatment. Intramuscular artesunate was considered easy to administer and the proximity of lower-level facilities to communities was deemed important in considering the possibility of its use at lower-level facilities. Health workers also emphasised the important role of operational research to provide additional evidence to guide the implementation of existing policy recommendations and inform future policy revisions. From the perspective of health workers, use of intramuscular artesunate for definitive treatment of severe malaria at lower-level health facilities in Nigeria is possible but dependent on availability of skilled workers, well-equipped lower-level facilities to provide supportive treatment There is need for further operational research to establish feasibility and guide the implementation of such an intervention.

Distribution of Trauma Care Facilities in Oman in Relation to High-Incidence Road Traffic Injury Sites: Pilot study.

PubMed

Al-Kindi, Sara M; Naiem, Ahmed A; Taqi, Kadhim M; Al-Gheiti, Najla M; Al-Toobi, Ikhtiyar S; Al-Busaidi, Nasra Q; Al-Harthy, Ahmed Z; Taqi, Alaa M; Ba-Alawi, Sharif A; Al-Qadhi, Hani A

2017-11-01

Road traffic injuries (RTIs) are considered a major public health problem worldwide. In Oman, high numbers of RTIs and RTI-related deaths are frequently registered. This study aimed to evaluate the distribution of trauma care facilities in Oman with regards to their proximity to RTI-prevalent areas. This descriptive pilot study analysed RTI data recorded in the national Royal Oman Police registry from January to December 2014. The distribution of trauma care facilities was analysed by calculating distances between areas of peak RTI incidence and the closest trauma centre using Google Earth and Google Maps software (Google Inc., Googleplex, Mountain View, California, USA). A total of 32 trauma care facilities were identified. Four facilities (12.5%) were categorised as class V trauma centres. Of the facilities in Muscat, 42.9% were ranked as class IV or V. There were no class IV or V facilities in Musandam, Al-Wusta or Al-Buraimi. General surgery, orthopaedic surgery and neurosurgery services were available in 68.8%, 59.3% and 12.5% of the centres, respectively. Emergency services were available in 75.0% of the facilities. Intensive care units were available in 11 facilities, with four located in Muscat. The mean distance between a RTI hotspot and the nearest trauma care facility was 34.7 km; however, the mean distance to the nearest class IV or V facility was 83.3 km. The distribution and quality of trauma care facilities in Oman needs modification. It is recommended that certain centres upgrade their levels of trauma care in order to reduce RTI-associated morbidity and mortality in Oman.

33 CFR 154.1325 - Response plan development and evaluation criteria for facilities that handle, store, or transport...

Code of Federal Regulations, 2011 CFR

2011-07-01

... evaluation criteria for facilities that handle, store, or transport other non-petroleum oils. 154.1325...) POLLUTION FACILITIES TRANSFERRING OIL OR HAZARDOUS MATERIAL IN BULK Response Plans for Other Non-Petroleum..., store, or transport other non-petroleum oils. (a) An owner or operator of a facility that handles...

33 CFR 154.1325 - Response plan development and evaluation criteria for facilities that handle, store, or transport...

Code of Federal Regulations, 2010 CFR

2010-07-01

... evaluation criteria for facilities that handle, store, or transport other non-petroleum oils. 154.1325...) POLLUTION FACILITIES TRANSFERRING OIL OR HAZARDOUS MATERIAL IN BULK Response Plans for Other Non-Petroleum..., store, or transport other non-petroleum oils. (a) An owner or operator of a facility that handles...

33 CFR 154.1045 - Response plan development and evaluation criteria for facilities that handle, store, or transport...

Code of Federal Regulations, 2013 CFR

2013-07-01

... 33 Navigation and Navigable Waters 2 2013-07-01 2013-07-01 false Response plan development and... (CONTINUED) POLLUTION FACILITIES TRANSFERRING OIL OR HAZARDOUS MATERIAL IN BULK Response Plans for Oil Facilities § 154.1045 Response plan development and evaluation criteria for facilities that handle, store, or...

33 CFR 154.1045 - Response plan development and evaluation criteria for facilities that handle, store, or transport...

Code of Federal Regulations, 2011 CFR

2011-07-01

... 33 Navigation and Navigable Waters 2 2011-07-01 2011-07-01 false Response plan development and... (CONTINUED) POLLUTION FACILITIES TRANSFERRING OIL OR HAZARDOUS MATERIAL IN BULK Response Plans for Oil Facilities § 154.1045 Response plan development and evaluation criteria for facilities that handle, store, or...

33 CFR 154.1045 - Response plan development and evaluation criteria for facilities that handle, store, or transport...

Code of Federal Regulations, 2012 CFR

2012-07-01

... 33 Navigation and Navigable Waters 2 2012-07-01 2012-07-01 false Response plan development and... (CONTINUED) POLLUTION FACILITIES TRANSFERRING OIL OR HAZARDOUS MATERIAL IN BULK Response Plans for Oil Facilities § 154.1045 Response plan development and evaluation criteria for facilities that handle, store, or...

33 CFR 154.1045 - Response plan development and evaluation criteria for facilities that handle, store, or transport...

Code of Federal Regulations, 2014 CFR

2014-07-01

... 33 Navigation and Navigable Waters 2 2014-07-01 2014-07-01 false Response plan development and... (CONTINUED) POLLUTION FACILITIES TRANSFERRING OIL OR HAZARDOUS MATERIAL IN BULK Response Plans for Oil Facilities § 154.1045 Response plan development and evaluation criteria for facilities that handle, store, or...

Composite analysis E-area vaults and saltstone disposal facilities

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

Cook, J.R.

1997-09-01

This report documents the Composite Analysis (CA) performed on the two active Savannah River Site (SRS) low-level radioactive waste (LLW) disposal facilities. The facilities are the Z-Area Saltstone Disposal Facility and the E-Area Vaults (EAV) Disposal Facility. The analysis calculated potential releases to the environment from all sources of residual radioactive material expected to remain in the General Separations Area (GSA). The GSA is the central part of SRS and contains all of the waste disposal facilities, chemical separations facilities and associated high-level waste storage facilities as well as numerous other sources of radioactive material. The analysis considered 114 potentialmore » sources of radioactive material containing 115 radionuclides. The results of the CA clearly indicate that continued disposal of low-level waste in the saltstone and EAV facilities, consistent with their respective radiological performance assessments, will have no adverse impact on future members of the public.« less

Biomarkers of mercury exposure at a mercury recycling facility in Ukraine.

PubMed

Gibb, Herman Jones; Kozlov, Kostj; Buckley, Jessie Poulin; Centeno, Jose; Jurgenson, Vera; Kolker, Allan; Conko, Kathryn; Landa, Edward; Panov, Boris; Panov, Yuri; Xu, Hanna

2008-08-01

This study evaluates biomarkers of occupational mercury exposure among workers at a mercury recycling operation in Gorlovka, Ukraine. The 29 study participants were divided into three occupational categories for analysis: (1) those who worked in the mercury recycling operation (Group A, n = 8), (2) those who worked at the facility but not in the yard where the recycling was done (Group B, n = 14), and (3) those who did not work at the facility (Group C, n = 7). Urine, blood, hair, and nail samples were collected from the participants, and a questionnaire was administered to obtain data on age, gender, occupational history, smoking, alcohol consumption, fish consumption, tattoos, dental amalgams, home heating system, education, source of drinking water, and family employment in the former mercury mine/smelter located on the site of the recycling facility. Each factor was tested in a univariate regression with total mercury in urine, blood, hair, and nails. Median biomarker concentrations were 4.04 microg/g-Cr (urine), 2.58 microg/L (blood), 3.95 microg/g (hair), and 1.16 microg/g (nails). Occupational category was significantly correlated (p < 0.001) with both blood and urinary mercury concentrations but not with hair or nail mercury. Four individuals had urinary mercury concentrations in a range previously found to be associated with subtle neurological and subjective symptoms (e.g., fatigue, loss of appetite, irritability), and one worker had a urinary mercury concentration in a range associated with a high probability of neurological effects and proteinuria. Comparison of results by occupational category found that workers directly involved with the recycling operation had the highest blood and urinary mercury levels. Those who worked at the facility but were not directly involved with the recycling operation had higher levels than those who did not work at the facility.

Patient safety culture in obstetrics and gynecology and neonatology units: the nurses' and the midwives' opinion.

PubMed

Ribeliene, Janina; Blazeviciene, Aurelija; Nadisauskiene, Ruta Jolanta; Tameliene, Rasa; Kudreviciene, Ausrele; Nedzelskiene, Irena; Macijauskiene, Jurate

2018-04-22

Patients treated in health care facilities that provide services in the fields of obstetrics, gynecology, and neonatology are especially vulnerable. Large multidisciplinary teams of physicians, multiple invasive and noninvasive diagnostic and therapeutic procedures, and the use of advanced technologies increase the probability of adverse events. The evaluation of knowledge about patient safety culture among nurses and midwives working in such units and the identification of critical areas at a health care institution would reduce the number of adverse events and improve patient safety. The aim of the study was to evaluate the opinion of nurses and midwives working in clinical departments that provide services in the fields of obstetrics, gynecology, and neonatology about patient safety culture and to explore potential predictors for the overall perception of safety. We used the Hospital Survey on Patient Safety Culture (HSOPSC) to evaluate nurses' and midwives' opinion about patient safety issues. The overall response rate in the survey was 100% (n = 233). The analysis of the dimensions of safety on the unit level showed that the respondents' most positive evaluations were in the Organizational Learning - Continuous Improvement (73.2%) and Feedback and Communication about Error (66.8%) dimensions, and the most negative evaluations in the Non-punitive Response to Error (33.5%) and Staffing (44.6%) dimensions. On the hospital level, the evaluation of the safety dimensions ranged between 41.4 and 56.8%. The percentage of positive responses in the outcome dimensions Frequency of Events Reported was 82.4%. We found a significant association between the outcome dimension Frequency of Events Reported and the Hospital Management Support for Patient Safety and Feedback and Communication about Error Dimensions. On the hospital level, the critical domains in health care facilities that provide services in the fields of obstetrics, gynecology, and neonatology were Teamwork Across Hospital Units, and on the unit level - Communication Openness, Teamwork Within Units, Non-punitive Response to Error, and Staffing. The remaining domains were seen as having a potential for improvement.

Evaluation of the NASA Ames no. 1 7 by 10 foot wind tunnel as an acoustic test facility

NASA Technical Reports Server (NTRS)

Wilby, J. F.; Scharton, T. D.

1975-01-01

Measurements were made in the no. 1 7'x10' wind tunnel at NASA Ames Research Center, with the objectives of defining the acoustic characteristics and recommending minimum cost treatments so that the tunnel can be converted into an acoustic research facility. The results indicate that the noise levels in the test section are due to (a) noise generation in the test section, associated with the presence of solid bodies such as the pitot tube, and (b) propagation of acoustic energy from the fan. A criterion for noise levels in the test section is recommended, based on low-noise microphone support systems. Noise control methods required to meet the criterion include removal of hardware items for the test section and diffuser, improved design of microphone supports, and installation of acoustic treatment in the settling chamber and diffuser.

Evaluation of a microwave based reactor for the treatment of blackwater sludge

PubMed Central

Mawioo, Peter M.; Rweyemamu, Audax; Garcia, Hector A.; Hooijmans, Christine M.; Brdjanovic, Damir

2016-01-01

A laboratory-scale microwave (MW) unit was applied to treat fresh blackwater sludge that represented fecal sludge (FS) produced at heavily used toilet facilities. The sludge was exposed to MW irradiation at different power levels and for various durations. Variables such as sludge volume and pathogen reduction were observed. The results demonstrated that the MW is a rapid and efficient technology that can reduce the sludge volume by over 70% in these experimental conditions. The concentration of bacterial pathogenic indicator E. coli also decreased to below the analytical detection levels. Furthermore, the results indicated that the MW operational conditions including radiation power and contact time can be varied to achieve the desired sludge volume and pathogen reduction. MW technology can be further explored for the potential scaling-up as an option for rapid treatment of FS from intensively used sanitation facilities such as in emergency situations. PMID:26799809

Renewable Energy Feasibility Study Leading to Development of the Native Spirit Solar Energy Facility

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

Carolyn Stewart; Tracey LeBeau

2008-01-31

DOE-funded renewable energy feasibility study conducted by Red Mountain Tribal Energy on behalf of the Southwest Tribal Energy Consortium (SWTEC). During the course of the study, SWTEC members considered multiple options for the organization structure, selected a proposed organization structure, and drafted a Memorandum of Understanding for the SWTEC organization. High-level resource assessments for SWTEC members were completed; surveys were developed and completed to determine each member’s interest in multiple participation options, including on-reservation projects. With the survey inputs in mind, multiple energy project options were identified and evaluated on a high-level basis. That process led to a narrowing ofmore » the field of technology options to solar generation, specifically, utility-scale Concentrating Solar-Powered Generation projects, with a specific, tentative project location identified at the Fort Mojave Indian Reservation -- the Native Spirit Solar Energy Facility.« less

30. FLOOR PLANS OF WASTE CALCINATION FACILITY. SHOWS LEVELS ABOVE ...

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

30. FLOOR PLANS OF WASTE CALCINATION FACILITY. SHOWS LEVELS ABOVE GRADE AND AT LEVEL OF OPERATING CORRIDOR. INEEL DRAWING NUMBER 200-0633-00-287-106351. FLUOR NUMBER 5775-CPP-633-A-1. - Idaho National Engineering Laboratory, Old Waste Calcining Facility, Scoville, Butte County, ID

Dynamic EROI Assessment of the IPCC 21st Century Electricity Production Scenario

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

Neumeyer, Charles; Goldston, Robert

Abstract: The Energy Return on Investment (EROI) is an important measure of the energy gain of an electrical power generating facility that is typically evaluated based on the life cycle energy balance of a single facility. The EROI concept can be extended to cover a collection of facilities that comprise a complete power system and used to assess the expansion and evolution of a power system as it transitions from one portfolio mix of technologies to another over time. In this study we develop a dynamic EROI model that simulates the evolution of a power system and we perform anmore » EROI simulation of one of the electricity production scenarios developed under the auspices of the Intergovernmental Panel on Climate Change (IPCC) covering the global supply of electricity in the 21st century. Our analytic tool provides the means for evaluation of dynamic EROI based on arbitrary time-dependent demand scenarios by modeling the required expansion of power generation, including the plowback needed for new construction and to replace facilities as they are retired. The results provide insight into the level of installed and delivered power, above and beyond basic consumer demand, that is required to support construction during expansion, as well as the supplementary power that may be required if plowback constraints are imposed. In addition, sensitivity to EROI parameters, and the impact of energy storage efficiency are addressed.« less

Dynamic EROI Assessment of the IPCC 21st Century Electricity Production Scenario

DOE PAGES

Neumeyer, Charles; Goldston, Robert

2016-04-28

Abstract: The Energy Return on Investment (EROI) is an important measure of the energy gain of an electrical power generating facility that is typically evaluated based on the life cycle energy balance of a single facility. The EROI concept can be extended to cover a collection of facilities that comprise a complete power system and used to assess the expansion and evolution of a power system as it transitions from one portfolio mix of technologies to another over time. In this study we develop a dynamic EROI model that simulates the evolution of a power system and we perform anmore » EROI simulation of one of the electricity production scenarios developed under the auspices of the Intergovernmental Panel on Climate Change (IPCC) covering the global supply of electricity in the 21st century. Our analytic tool provides the means for evaluation of dynamic EROI based on arbitrary time-dependent demand scenarios by modeling the required expansion of power generation, including the plowback needed for new construction and to replace facilities as they are retired. The results provide insight into the level of installed and delivered power, above and beyond basic consumer demand, that is required to support construction during expansion, as well as the supplementary power that may be required if plowback constraints are imposed. In addition, sensitivity to EROI parameters, and the impact of energy storage efficiency are addressed.« less

An Approach to Industrial Stormwater Benchmarks: Establishing and Using Site-Specific Threshold Criteria at Lawrence Livermore National Laboratory

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

Campbell, C G; Mathews, S

2006-09-07

Current regulatory schemes use generic or industrial sector specific benchmarks to evaluate the quality of industrial stormwater discharges. While benchmarks can be a useful tool for facility stormwater managers in evaluating the quality stormwater runoff, benchmarks typically do not take into account site-specific conditions, such as: soil chemistry, atmospheric deposition, seasonal changes in water source, and upstream land use. Failing to account for these factors may lead to unnecessary costs to trace a source of natural variation, or potentially missing a significant local water quality problem. Site-specific water quality thresholds, established upon the statistical evaluation of historic data take intomore » account these factors, are a better tool for the direct evaluation of runoff quality, and a more cost-effective trigger to investigate anomalous results. Lawrence Livermore National Laboratory (LLNL), a federal facility, established stormwater monitoring programs to comply with the requirements of the industrial stormwater permit and Department of Energy orders, which require the evaluation of the impact of effluent discharges on the environment. LLNL recognized the need to create a tool to evaluate and manage stormwater quality that would allow analysts to identify trends in stormwater quality and recognize anomalous results so that trace-back and corrective actions could be initiated. LLNL created the site-specific water quality threshold tool to better understand the nature of the stormwater influent and effluent, to establish a technical basis for determining when facility operations might be impacting the quality of stormwater discharges, and to provide ''action levels'' to initiate follow-up to analytical results. The threshold criteria were based on a statistical analysis of the historic stormwater monitoring data and a review of relevant water quality objectives.« less

Addressing social aspects associated with wastewater treatment facilities

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

Padilla-Rivera, Alejandro; Morgan-Sagastume, Juan Manuel; Noyola, Adalberto

In wastewater treatment facilities (WWTF), technical and financial aspects have been considered a priority, while other issues, such as social aspects, have not been evaluated seriously and there is not an accepted methodology for assessing it. In this work, a methodology focused on social concerns related to WWTF is presented. The methodology proposes the use of 25 indicators as a framework for measuring social performance to evaluate the progress in moving towards sustainability. The methodology was applied to test its applicability and effectiveness in two WWTF in Mexico (urban and rural). This evaluation helped define the key elements, stakeholders andmore » barriers in the facilities. In this context, the urban facility showed a better overall performance, a result that may be explained mainly by the better socioeconomic context of the urban municipality. Finally, the evaluation of social aspects using the semi-qualitative approach proposed in this work allows for a comparison between different facilities and for the identification of strengths and weakness, and it provides an alternative tool for achieving and improving wastewater management. - Highlights: • The methodology proposes 25 indicators as a framework for measuring social performance in wastewater treatment facilities. • The evaluation helped to define the key elements, stakeholders and barriers in the wastewater treatment facilities. • The evaluation of social aspects allows the identification of strengths and weakness for improving wastewater management. • It provides a social profile of the facility that highlights the best and worst performances.« less

Rurality and Nursing Home Quality: Evidence from the 2004 National Nursing Home Survey

ERIC Educational Resources Information Center

Kang, Yu; Meng, Hongdao; Miller, Nancy A.

2011-01-01

Purpose of the Study: To evaluate the impact of rural geographic location on nursing home quality of care in the United States. Design and Methods: The study used cross-sectional observational design. We obtained resident- and facility-level data from 12,507 residents in 1,174 nursing homes from the 2004 National Nursing Home Survey. We used…

Acquisition Handbook - Update. Comprehensive Approach to Reusable Defensive Software (CARDS)

DTIC Science & Technology

1994-03-25

designs, and implementation components (source code, test plans, procedures and results, and system/software documentation). This handbook provides a...activities where software components are acquired, evaluated, tested and sometimes modified. In addition to serving as a facility for the acquisition and...systems from such components [1]. Implementation components are at the lowest level and consist of: specifications; detailed designs; code, test

Evaluating malaria case management at public health facilities in two provinces in Angola.

PubMed

Plucinski, Mateusz M; Ferreira, Manzambi; Ferreira, Carolina Miguel; Burns, Jordan; Gaparayi, Patrick; João, Lubaki; da Costa, Olinda; Gill, Parambir; Samutondo, Claudete; Quivinja, Joltim; Mbounga, Eliane; de León, Gabriel Ponce; Halsey, Eric S; Dimbu, Pedro Rafael; Fortes, Filomeno

2017-05-03

Malaria accounts for the largest portion of healthcare demand in Angola. A pillar of malaria control in Angola is the appropriate management of malaria illness, including testing of suspect cases with rapid diagnostic tests (RDTs) and treatment of confirmed cases with artemisinin-based combination therapy (ACT). Periodic systematic evaluations of malaria case management are recommended to measure health facility readiness and adherence to national case management guidelines. Cross-sectional health facility surveys were performed in low-transmission Huambo and high-transmission Uíge Provinces in early 2016. In each province, 45 health facilities were randomly selected from among all public health facilities stratified by level of care. Survey teams performed inventories of malaria commodities and conducted exit interviews and re-examinations, including RDT testing, of a random selection of all patients completing outpatient consultations. Key health facility readiness and case management indicators were calculated adjusting for the cluster sampling design and utilization. Availability of RDTs or microscopy on the day of the survey was 71% (54-83) in Huambo and 85% (67-94) in Uíge. At least one unit dose pack of one formulation of an ACT (usually artemether-lumefantrine) was available in 83% (66-92) of health facilities in Huambo and 79% (61-90) of health facilities in Uíge. Testing rates of suspect malaria cases in Huambo were 30% (23-38) versus 69% (53-81) in Uíge. Overall, 28% (13-49) of patients with uncomplicated malaria, as determined during the re-examination, were appropriately treated with an ACT with the correct dose in Huambo, compared to 60% (42-75) in Uíge. Incorrect case management of suspect malaria cases was associated with lack of healthcare worker training in Huambo and ACT stock-outs in Uíge. The results reveal important differences between provinces. Despite similar availability of testing and ACT, testing and treatment rates were lower in Huambo compared to Uíge. A majority of true malaria cases seeking care in health facilities in Huambo were not appropriately treated with anti-malarials, highlighting the importance of continued training and supervision of healthcare workers in malaria case management, particularly in areas with decreased malaria transmission.

48 CFR 836.602-2 - Evaluation boards.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Management projects. The Director, Office of Construction and Facilities Management, shall appoint an... appropriate for the particular project. The Director, Office of Construction and Facilities Management may... Evaluation boards. (a) The Director, Office of Construction and Facilities Management, shall appoint an...

Facility-level variation in diabetes and blood pressure control in patients with diabetes: Findings from the Veterans Affairs national database.

PubMed

Rehman, Hasan; Akeroyd, Julia M; Ramsey, David; Ahmed, Sarah T; Merchant, Anwar T; Navaneethan, Sankar D; Petersen, Laura A; Virani, Salim S

2017-11-01

Intensive glycemic and blood pressure (BP) control in diabetic patients is associated with improved cardiovascular outcomes. We hypothesized that there is suboptimal glycemic and BP control with significant facility-level variation in patients with diabetes. We identified patients with diabetes receiving care in 130 facilities in the Veterans Affairs Health Care System. We assessed facility-level rates of glycemic (hemoglobin [Hb]A1c <7%), BP (BP <140/90 mmHg), and combined glycemic and BP control (HbA1c <7% and BP <140/90 mmHg), and their facility-level variation in using median rate ratios (MRR). Among 1 103 302 patients with diabetes, 50.2% participants had an HbA1c <7%, 77.5% had a BP <140/90 mmHg, and 39.8% had both, HbA1c <7% and BP <140/90 mmHg. Median facility-level rates were 50.3% (interquartile range [IQR], 47.9%-52.4%) for glycemic control, 78.4% (IQR, 75.2%-80.0%) for BP control, and 39.9% (IQR, 38.14%-42.34%) for combined glycemic and BP control. Unadjusted MRR for glycemic control was 1.61 (95% confidence interval [CI]: 1.51-1.70) which decreased to 1.16 (95% CI: 1.14-1.19) after adjusting for patient and facility-level variables, indicating a 16% variation in glycemic control between 2 identical patients receiving care at 2 random facilities. Unadjusted MRR for BP control was 1.49 (95% CI: 1.41-1.56), which decreased to 1.25 (95% CI: 1.21-1.28), whereas unadjusted MRR for combined glycemic and BP control was 1.59 (95% CI: 1.50-1.68), which decreased to 1.15 (95% CI: 1.13-1.17) after adjustment. Facility-level rates for BP control and glycemic control remain low with significant facility-level variation. Much of this is explained by patient and facility-level variables although 16%, 25%, and 15% variation in glycemic, BP, and combined glycemic and BP control remains unexplained. © 2017 Wiley Periodicals, Inc.

10 CFR 62.1 - Purpose and scope.

Code of Federal Regulations, 2010 CFR

2010-01-01

... (42 U.S.C. 2021) to any non-Federal or regional low-level radioactive waste (LLW) disposal facility or... regional or non-Federal low-level radioactive waste disposal facilities and who submit a request to the... LOW-LEVEL WASTE DISPOSAL FACILITIES General Provisions § 62.1 Purpose and scope. (a) The regulations...

Educational Facility Evaluations of Primary Schools in Rural Honduras: Departments of Cortes and Meambar.

ERIC Educational Resources Information Center

Council of Educational Facility Planners, International, Scottsdale, AZ.

A team of 11 educational facility planners and architects from the United States and Canada conducted a facility evaluation of schools in the rural areas of Meambar and Cortes, Honduras. Team members were all part of the Council of Educational Facility Planners, International and traveled to Honduras under the auspices of a Christian mission…

Applications of ultraviolet germicidal irradiation disinfection in health care facilities: effective adjunct, but not stand-alone technology.

PubMed

Memarzadeh, Farhad; Olmsted, Russell N; Bartley, Judene M

2010-06-01

This review evaluates the applicability and relative contribution of ultraviolet germicidal irradiation (UVGI) to disinfection of air in health care facilities. A section addressing the use of UVGI for environmental surfaces is also included. The germicidal susceptibility of biologic agents is addressed, but with emphasis on application in health care facilities. The balance of scientific evidence indicates that UVGI should be considered as a disinfection application in a health care setting only in conjunction with other well-established elements, such as appropriate heating, ventilating, and air-conditioning (HVAC) systems; dynamic removal of contaminants from the air; and preventive maintenance in combination with through cleaning of the care environment. We conclude that although UVGI is microbiocidal, it is not "ready for prime time" as a primary intervention to kill or inactivate infectious microorganisms; rather, it should be considered an adjunct. Other factors, such as careful design of the built environment, installation and effective operation of the HVAC system, and a high level of attention to traditional cleaning and disinfection, must be assessed before a health care facility can decide to rely solely on UVGI to meet indoor air quality requirements for health care facilities. More targeted and multiparameter studies are needed to evaluate the efficacy, safety, and incremental benefit of UVGI for mitigating reservoirs of microorganisms and ultimately preventing cross-transmission of pathogens that lead to health care-associated infections. (c) 2010 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Can a quality improvement project impact maternal and child health outcomes at scale in northern Ghana?

PubMed

Singh, Kavita; Brodish, Paul; Speizer, Ilene; Barker, Pierre; Amenga-Etego, Issac; Dasoberi, Ireneous; Kanyoke, Ernest; Boadu, Eric A; Yabang, Elma; Sodzi-Tettey, Sodzi

2016-06-16

Quality improvement (QI) interventions are becoming more common in low- and middle-income countries, yet few studies have presented impact evaluations of these approaches. In this paper, we present an impact evaluation of a scale-up phase of 'Project Fives Alive!', a QI intervention in Ghana that aims to improve maternal and child health outcomes. 'Project Fives Alive!' employed a QI methodology to recognize barriers to care-seeking and care provision at the facility level and then to identify, test and implement simple and low-cost local solutions that address the barriers. A quasi-experimental design, multivariable interrupted time series analysis, with data coming from 744 health facilities and controlling for potential confounding factors, was used to study the effect of the project. The key independent variables were the change categories (interventions implemented) and implementation phase - Wave 2a (early phase) versus Wave 2b (later phase). The outcomes studied were early antenatal care (ANC), skilled delivery, facility-level under-five mortality and attendance of underweight infants at child welfare clinics. We stratified the analysis by facility type, namely health posts, health centres and hospitals. Several of the specific change categories were significantly associated with improved outcomes. For example, three of five change categories (early ANC, four or more ANC visits and skilled delivery/immediate postnatal care (PNC)) for health posts and two of five change categories (health education and triage) for hospitals were associated with increased skilled delivery. These change categories were associated with increases in skilled delivery varying from 28% to 58%. PNC changes for health posts and health centres were associated with greater attendance of underweight infants at child welfare clinics. The triage change category was associated with increased early antenatal care in hospitals. Intensity, the number of change categories tested, was associated with increased skilled delivery in health centres and reduced under-five mortality in hospitals. Using an innovative evaluation technique we determined that 'Project Fives Alive!' demonstrated impact at scale for the outcomes studied. The QI approach used by this project should be considered by other low- and middle-income countries in their efforts to improve maternal and child health.

A survey of the use of herbs among patients attending secondary-level health care facilities in southwestern Nigeria.

PubMed

Fakeye, Titilayo Oyelola; Tijani, Abu; Adebisi, O

2007-01-01

This study was carried out to evaluate the herb usage among patients attending secondary health facilities in Southwestern Nigeria. Data including allergies to drug and herbs, use of social drugs, and herbs and their perceived efficacy to herbs was collected from 265 patients (inpatients n = 65; outpatients n = 200) using structured questionnaire and patients' drug charts. A total of 15.4% of inpatients were found to be using herbs that may be potentially harmful due to drug-drug/drug-herb interactions. Nine percent experienced adverse effects with the use of herbs, whereas 2% experienced adverse reactions on coadministration with prescribed drugs. A high percent of outpatients, 38%, were using alcoholic beverages for extracting the plant materials themselves. The study showed that the use of herbs with drugs is widely practiced among patients attending secondary health care facilities in Nigeria, usually without the doctor or pharmacist's knowledge.

Evaluation of nursing manpower allocation in a nursing home.

PubMed

Chen, Chun-Hsi; Tsai, Wen-Chen; Chang, Wei-Chieh

2007-03-01

The subjects of this study encompassed the nursing staffs (nurses and nursing aids) and residents of a public hospital-based nursing home. By intensive sampling, this study explored the differences in actual times that nurses spent caring for residents. We assessed the functional status of nursing home residents of various illness severities as well as measured the actual nursing manpower needed to meet the residents' care needs using Typology of the Aged with Illustration (TAI). Results showed that current nursing manpower levels in nursing homes was adequate, although some units had excessive manpower allocation. As a result, this study suggests the establishment of a resident classification system for use in long-term care (LTC) facilities to assist with manpower allocation and reasonable utilization of resources within the facility. Adequate nurse staffing will enhance the quality and accessibility of care for the residents with severe illnesses in LTC facilities.

The role of organic complexants and microparticulates in the facilitated transport of radionuclides

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

Schilk, A.J.; Robertson, D.E.; Abel, K.H.

1996-12-01

This progress report describes the results of ongoing radiological and geochemical investigations of the mechanisms of radionuclide transport in groundwater at two low-level waste (LLW) disposal sites within the waste management area of the Chalk River Laboratories (CRL), Ontario, Canada. These sites, the Chemical Pit liquid disposal facility and the Waste Management Area C solid LLW disposal site, have provided valuable 30- to 40-year-old field locations for characterizing the migration of radionuclides and evaluating a number of recent site performance objectives for LLW disposal facilities. This information will aid the NRC and other federal, state, and local regulators, as wellmore » as LLW disposal site developers and waste generators, in maximizing the effectiveness of existing or projected LLW disposal facilities for isolating radionuclides from the general public and thereby improving the health and safety aspects of LLW disposal.« less

A heuristic approach to handle capacitated facility location problem evaluated using clustering internal evaluation

NASA Astrophysics Data System (ADS)

Sutanto, G. R.; Kim, S.; Kim, D.; Sutanto, H.

2018-03-01

One of the problems in dealing with capacitated facility location problem (CFLP) is occurred because of the difference between the capacity numbers of facilities and the number of customers that needs to be served. A facility with small capacity may result in uncovered customers. These customers need to be re-allocated to another facility that still has available capacity. Therefore, an approach is proposed to handle CFLP by using k-means clustering algorithm to handle customers’ allocation. And then, if customers’ re-allocation is needed, is decided by the overall average distance between customers and the facilities. This new approach is benchmarked to the existing approach by Liao and Guo which also use k-means clustering algorithm as a base idea to decide the facilities location and customers’ allocation. Both of these approaches are benchmarked by using three clustering evaluation methods with connectedness, compactness, and separations factors.

Evaluating the effectiveness of a strategy for teaching neonatal resuscitation in West Africa.

PubMed

Enweronu-Laryea, Christabel; Engmann, Cyril; Osafo, Alexandra; Bose, Carl

2009-11-01

To evaluate the effectiveness of a strategy for teaching neonatal resuscitation on the cognitive knowledge of health professionals who attend deliveries in Ghana, West Africa. Train-the-trainer model was used to train health professionals at 2-3 day workshops from 2003 to 2007. Obstetric Anticipatory Care and Basic Neonatal Care modules were taught as part of Neonatal Resuscitation Training package. American Neonatal Resuscitation Program was adapted to the clinical role of participants and local resources. Cognitive knowledge was evaluated by written pre- and post-training tests. The median pre-training and post-training scores were 38% and 71% for midwives, 43% and 81% for nurses, 52% and 90% for nurse anaesthetists, and 62% and 98% for physicians. All groups of the 271 professionals (18 nurse anaesthetists, 55 nurses, 68 physicians, and 130 midwives) who completed the course showed significant improvement (p<0.001) in median post-training test scores. Midwives at primary health care facilities were less likely to achieve passing post-test scores than midwives at secondary and tertiary facilities [35/53 vs. 24/26 vs. 45/51 (p=0.004)] respectively. Evidence-based neonatal resuscitation training adapted to local resources significantly improved cognitive knowledge of all groups of health professionals. Further modification of training for midwives working at primary level health facilities and incorporation of neonatal resuscitation in continuing education and professional training programs are recommended.

First Dutch Consensus of Pain Quality Indicators for Pain Treatment Facilities.

PubMed

de Meij, Nelleke; van Grotel, Marloes; Patijn, Jacob; van der Weijden, Trudy; van Kleef, Maarten

2016-01-01

There is a general consensus about the need to define and improve the quality of pain treatment facilities. Although guidelines and recommendations to improve the quality of pain practice management have been launched, provision of appropriate pain treatment is inconsistent and the quality of facilities varies widely. The aim of the study was to develop an expert-agreed list of quality indicators applicable to pain treatment facilities. The list was also intended to be used as the basis for a set of criteria for registered status of pain treatment facilities. The University Pain Center Maastricht at the Department of Anesthesiology and Pain Management of the Maastricht University Medical Center conducted a 3-round Delphi study in collaboration with the Board of the Pain Section of the Dutch Society of Anesthesiologists (NVA). Twenty-five quality indicators were selected as relevant to 2 types of pain treatment facilities, pain clinics and pain centers. The final expert-agreed list consisted of 22 quality indicators covering 7 quality domains: supervision, availability of care, staffing level and patient load, quality policy, multidisciplinarity, regionalization, and research and education. This set of quality indicators may facilitate organizational evaluation and improve insight into service quality from the perspectives of patients, pain specialists, and other healthcare professionals. Recommendations for improvements to the current set of quality indicators are made. In 2014 the process of registering pain treatment facilities in the Netherlands started; facilities can register as a pain clinic or pain center. © 2015 World Institute of Pain.

Implementing a province-wide mandatory vaccinate-or-mask policy at healthcare facilities in British Columbia, Canada.

PubMed

Nunn, Alexandra; Campbell, Audrey C; Naus, Monika; Kwong, Jeffrey C; Puddicombe, David; Quach, Susan; Henry, Bonnie

2018-01-08

In 2012, British Columbia (BC) became the first Canadian province to implement an influenza prevention policy requiring healthcare workers (HCW) to either be vaccinated annually against influenza or wear a mask in patient care areas during the influenza season. This study describes an evaluation of influenza policy implementation processes and identifies supports and challenges related to successful policy implementation at the level of healthcare facilities, during the second policy year (2013/14). Implementation leaders from 262 long-term care (LTC) and acute care facilities, mostly in three of BC's five regional Health Authorities, were invited to participate in an online survey following the 2013/14 influenza season. Descriptive quantitative and qualitative analyses identified common and effective strategies for improving vaccination coverage and policy compliance. A total of 127 respondents completed the survey on behalf of 33 acute care and 99 LTC facilities, representing 36% of acute care and 27% of LTC facilities in BC. Respondents agreed that the policy was successfully implemented at 89% of facilities, and implementation was reported to be easy at 52% of facilities. The findings elaborate on communication and leadership strategies, campaign logistics and enforcement approaches involved in policy implementation. Implementation of a vaccinate-or-mask influenza policy is complex. This study provides insight for other jurisdictions considering implementing such a policy and offers practical recommendations for facilities and health authorities. Copyright © 2017 Elsevier Ltd. All rights reserved.

Evaluation of the national surveillance system for point-prevalence of healthcare-associated infections in hospitals and in long-term care facilities for elderly in Norway, 2002-2008

PubMed Central

2011-01-01

Background Since 2002, the Norwegian Institute of Public Health has invited all hospitals and long-term care facilities for elderly (LTCFs) to participate in two annual point-prevalence surveys covering the most frequent types of healthcare-associated infections (HAIs). In a comprehensive evaluation we assessed how well the system operates to meet its objectives. Methods Surveillance protocols and the national database were reviewed. Data managers at national level, infection control practitioners and ward personnel in hospitals as well as contact persons in LTCFs involved in prevalence data collection were surveyed. Results The evaluation showed that the system was structurally simple, flexible and accepted by the key partners. On average 87% of hospitals and 32% of LTCFs participated in 2004-2008; high level of data completeness was achieved. The data collected described trends in the prevalence of reportable HAIs in Norway and informed policy makers. Local results were used in hospitals to implement targeted infection control measures and to argue for more resources to a greater extent than in LTCFs. Both the use of simplified Centers for Disease Control and Prevention (CDC) definitions and validity of data seemed problematic as compliance with the standard methodology were reportedly low. Conclusions The surveillance system provides important information on selected HAIs in Norway. The system is overall functional and well-established in hospitals, however, requires active promotion in LTCFs. Validity of data needs to be controlled in the participating institutions before reporting to the national level. PMID:22165849

Evaluation of Loss Due to Storm Surge Disasters in China Based on Econometric Model Groups.

PubMed

Jin, Xue; Shi, Xiaoxia; Gao, Jintian; Xu, Tongbin; Yin, Kedong

2018-03-27

Storm surge has become an important factor restricting the economic and social development of China's coastal regions. In order to improve the scientific judgment of future storm surge damage, a method of model groups is proposed to refine the evaluation of the loss due to storm surges. Due to the relative dispersion and poor regularity of the natural property data (login center air pressure, maximum wind speed, maximum storm water, super warning water level, etc.), storm surge disaster is divided based on eight kinds of storm surge disaster grade division methods combined with storm surge water, hypervigilance tide level, and disaster loss. The storm surge disaster loss measurement model groups consist of eight equations, and six major modules are constructed: storm surge disaster in agricultural loss, fishery loss, human resource loss, engineering facility loss, living facility loss, and direct economic loss. Finally, the support vector machine (SVM) model is used to evaluate the loss and the intra-sample prediction. It is indicated that the equations of the model groups can reflect in detail the relationship between the damage of storm surges and other related variables. Based on a comparison of the original value and the predicted value error, the model groups pass the test, providing scientific support and a decision basis for the early layout of disaster prevention and mitigation.

Within-Hospital Variation in 30-Day Adverse Events: Implications for Measuring Quality.

PubMed

Burke, Robert E; Glorioso, Thomas; Barón, Anna K; Kaboli, Peter J; Ho, P Michael

Novel measures of hospital quality are needed. Because quality improvement efforts seek to reduce variability in processes and outcomes, hospitals with higher variability in adverse events may be delivering poorer quality care. We sought to evaluate whether within-hospital variability in adverse events after a procedure might function as a quality metric that is correlated with facility-level mortality rates. We analyzed all percutaneous coronary interventions (PCIs) performed in the Veterans Health Administration (VHA) system from 2007 to 2013 to evaluate the correlation between within-hospital variability in 30-day postdischarge adverse events (readmission, emergency department visit, and repeat revascularization), and facility-level mortality rates, after adjustment for patient demographics, comorbidities, PCI indication, and PCI urgency. The study cohort included 47,567 patients at 48 VHA hospitals. The overall 30-day adverse event rate was 22.0% and 1-year mortality rate was 4.9%. The most variable sites had relative changes of 20% in 30-day rates of adverse events period-to-period. However, within-hospital variability in 30-day events was not correlated with 1-year mortality rates (correlation coefficient = .06; p = .66). Thus, measuring within-hospital variability in postdischarge adverse events may not improve identification of low-performing hospitals. Evaluation in other conditions, populations, and in relationship with other quality metrics may reveal stronger correlations with care quality.

Evaluation of Loss Due to Storm Surge Disasters in China Based on Econometric Model Groups

PubMed Central

Shi, Xiaoxia; Xu, Tongbin; Yin, Kedong

2018-01-01

Storm surge has become an important factor restricting the economic and social development of China’s coastal regions. In order to improve the scientific judgment of future storm surge damage, a method of model groups is proposed to refine the evaluation of the loss due to storm surges. Due to the relative dispersion and poor regularity of the natural property data (login center air pressure, maximum wind speed, maximum storm water, super warning water level, etc.), storm surge disaster is divided based on eight kinds of storm surge disaster grade division methods combined with storm surge water, hypervigilance tide level, and disaster loss. The storm surge disaster loss measurement model groups consist of eight equations, and six major modules are constructed: storm surge disaster in agricultural loss, fishery loss, human resource loss, engineering facility loss, living facility loss, and direct economic loss. Finally, the support vector machine (SVM) model is used to evaluate the loss and the intra-sample prediction. It is indicated that the equations of the model groups can reflect in detail the relationship between the damage of storm surges and other related variables. Based on a comparison of the original value and the predicted value error, the model groups pass the test, providing scientific support and a decision basis for the early layout of disaster prevention and mitigation. PMID:29584628

Mapping the Characteristics of Critical Care Facilities: Assessment, Distribution, and Level of Critical Care Facilities from Central India.

PubMed

Saigal, Saurabh; Sharma, Jai Prakash; Pakhare, Abhijit; Bhaskar, Santosh; Dhanuka, Sanjay; Kumar, Sanjay; Sabde, Yogesh; Bhattacharya, Pradip; Joshi, Rajnish

2017-10-01

In low- and middle-income countries such as India, where health systems are weak, the number of available Critical Care Unit (Intensive Care Unit [ICU]) beds is expected to be low. There is no study from the Indian subcontinent that has reported the characteristics and distribution of existing ICUs. We performed this study to understand the characteristics and distribution of ICUs in Madhya Pradesh (MP) state of Central India. We also aimed to develop a consensus scoring system and internally validate it to define levels of care and to improve health system planning and to strengthen referral networks in the state. We obtained a list of potential ICU facilities from various sources and then performed a cross-sectional survey by visiting each facility and determining characteristics for each facility. We collected variables with respect to infrastructure, human resources, equipment, support services, procedures performed, training courses conducted, and in-place policies or standard operating procedure documents. We identified a total of 123 ICUs in MP. Of 123 ICUs, 35 were level 1 facilities, 74 were level 2 facilities, and only 14 were level 3 facilities. Overall, there were 0.17 facilities per 100,000 population (95* confidence interval [CI] 0.14-0.20 per 100,000 populations). There were a total of 1816 ICU beds in the state, with an average of 2.5 beds per 100,000 population (95* CI 2.4-2.6 per 100,000 population). Of the total number of ICU beds, 250 are in level 1, 1141 are in level 2, and 425 are in level 3 facilities. This amounts to 0.34, 1.57, and 0.59 ICU beds per 100,000 population for levels 1, 2, and 3, respectively. This study could just be an eye opener for our healthcare authorities at both state and national levels to estimate the proportion of ICU beds per lac population. Similar mapping of intensive care services from other States will generate national data that is hitherto unknown.

Summary of the effects of engine throttle response on airplane formation-flying qualities

NASA Technical Reports Server (NTRS)

Walsh, Kevin R.

1992-01-01

A flight evaluation as conducted to determine the effect of engine throttle response characteristics on precision formation-flying qualities. A variable electronic throttle control system was developed and flight-tested on a TF-104G airplane with a J79-11B engine at the NASA Dryden Flight Research Facility. Ten research flights were flown to evaluate the effects of throttle gain, time delay, and fuel control rate limiting on engine handling qualities during a demanding precision wing formation task. Handling quality effects of lag filters and lead compensation time delays were also evaluated. Data from pilot ratings and comments indicate that throttle control system time delays and rate limits cause significant degradations in handling qualities. Threshold values for satisfactory (level 1) and adequate (level 2) handling qualities of these key variables are presented.

Special Analysis for Disposal of High-Concentration I-129 Waste in the Intermediate-Level Vaults at the E-Area Low-Level Waste Facility

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

Collard, L.B.

2000-09-26

This revision was prepared to address comments from DOE-SR that arose following publication of revision 0. This Special Analysis (SA) addresses disposal of wastes with high concentrations of I-129 in the Intermediate-Level (IL) Vaults at the operating, low-level radioactive waste disposal facility (the E-Area Low-Level Waste Facility or LLWF) on the Savannah River Site (SRS). This SA provides limits for disposal in the IL Vaults of high-concentration I-129 wastes, including activated carbon beds from the Effluent Treatment Facility (ETF), based on their measured, waste-specific Kds.

10 CFR 62.13 - Contents of a request for emergency access: Alternatives.

Code of Federal Regulations, 2010 CFR

2010-01-01

... radioactive waste in a licensed storage facility; (3) Obtaining access to a disposal facility by voluntary... disposal at a Federal low-level radioactive waste disposal facility in the case of a Federal or defense... EMERGENCY ACCESS TO NON-FEDERAL AND REGIONAL LOW-LEVEL WASTE DISPOSAL FACILITIES Request for a Commission...

Solving the competitive facility location problem considering the reactions of competitor with a hybrid algorithm including Tabu Search and exact method

NASA Astrophysics Data System (ADS)

Bagherinejad, Jafar; Niknam, Azar

2018-03-01

In this paper, a leader-follower competitive facility location problem considering the reactions of the competitors is studied. A model for locating new facilities and determining levels of quality for the facilities of the leader firm is proposed. Moreover, changes in the location and quality of existing facilities in a competitive market where a competitor offers the same goods or services are taken into account. The competitor could react by opening new facilities, closing existing ones, and adjusting the quality levels of its existing facilities. The market share, captured by each facility, depends on its distance to customer and its quality that is calculated based on the probabilistic Huff's model. Each firm aims to maximize its profit subject to constraints on quality levels and budget of setting up new facilities. This problem is formulated as a bi-level mixed integer non-linear model. The model is solved using a combination of Tabu Search with an exact method. The performance of the proposed algorithm is compared with an upper bound that is achieved by applying Karush-Kuhn-Tucker conditions. Computational results show that our algorithm finds near the upper bound solutions in a reasonable time.

How to Improve Engineering Competencies for Students with Special Needs?

NASA Astrophysics Data System (ADS)

Maknun, J.; Barliana, M. S.; Cahyani, D.

2018-02-01

The problem of vocational education for Children with Special Needs (CSN) is not only about the service profile, spectrum relevance and competency level, but also the carrying capacity of educational facilities. In this regard, two important things are highlighted. First, the different characteristics of the design of educational facilities between regular and exceptional schools. Second, the distinctive characteristics of the design of the school facilities are extraordinary for general education (academic) and vocational education. The purpose of this study is to describe the level of suitability of the architectural design of educational facilities with the needs of vocational learning behavior for children with special needs in West Java, Indonesia. The entire research used the Education Research and Development (R & D) method of Developing the Architectural Facility Design Guide to Support the Vocational Competence of Crew Competence in accordance with the stages developed by Thiagarajan (1974) known as Four-D Model. To achieve the above objectives, then the stages of the R & D method that is done is the define, design and develop stage. Evaluation results show the infrastructure of education of Special School (SLB) Cicendo, Indonesia has met the standards set by the government, especially on aspects of land and building areas have met the standards. Most aspects of accessibility such as the basic size of space, pedestrian pathways, and doors have been met. But other aspects such as guiding lines, ram, ladders, toilets, showers, sinks, furniture and signs do not meet accessibility requirements. The conclusion is the educational infrastructure of the school in general has met the standards set by the government.

Distribution of physical activity facilities in Scotland by small area measures of deprivation and urbanicity

PubMed Central

2010-01-01

Background The aim of this study was to examine the distribution of physical activity facilities by area-level deprivation in Scotland, adjusting for differences in urbanicity, and exploring differences between and within the four largest Scottish cities. Methods We obtained a list of all recreational physical activity facilities in Scotland. These were mapped and assigned to datazones. Poisson and negative binomial regression models were used to investigate associations between the number of physical activity facilities relative to population size and quintile of area-level deprivation. Results The results showed that prior to adjustment for urbanicity, the density of all facilities lessened with increasing deprivation from quintiles 2 to 5. After adjustment for urbanicity and local authority, the effect of deprivation remained significant but the pattern altered, with datazones in quintile 3 having the highest estimated mean density of facilities. Within-city associations were identified between the number of physical activity facilities and area-level deprivation in Aberdeen and Dundee, but not in Edinburgh or Glasgow. Conclusions In conclusion, area-level deprivation appears to have a significant association with the density of physical activity facilities and although overall no clear pattern was observed, affluent areas had fewer publicly owned facilities than more deprived areas but a greater number of privately owned facilities. PMID:20955548

The University of Tokyo Atacama Observatory 6.5m Telescope: enclosure design and wind analysis

NASA Astrophysics Data System (ADS)

Konishi, Masahiro; Sako, Shigeyuki; Uchida, Takanori; Araya, Ryou; Kim, Koui; Yoshii, Yuzuru; Doi, Mamoru; Kohno, Kotaro; Miyata, Takashi; Motohara, Kentaro; Tanaka, Masuo; Minezaki, Takeo; Morokuma, Tomoki; Tamura, Yoichi; Tanabé, Toshihiko; Kato, Natsuko; Kamizuka, Takafumi; Takahashi, Hidenori; Aoki, Tsutomu; Soyano, Takao; Tarusawa, Ken'ichi

2016-07-01

We present results on the computational fluid dynamics (CFD) numerical simulations as well as the wind tunnel experiments for the observation facilities of the University of Tokyo Atacama Observatory 6.5m Telescope being constructed at the summit of Co. Chajnantor in northern Chile. Main purpose of this study starting with the baseline design reported in 2014 is to analyze topographic effect on the wind behavior, and to evaluate the wind pressure, the air turbulence, and the air change (ventilation) efficiency in the enclosure. The wind velocity is found to be accelerated by a factor of 1.2 to reach the summit (78 m sec-1 expected at a maximum), and the resulting wind pressure (3,750 N m-2) is used for the framework design of the facilities. The CFD data reveals that the open space below the floor of the facilities works efficiently to drift away the air turbulence near the ground level which could significantly affect the dome seeing. From comparisons of the wind velocity field obtained from the CFD simulation for three configurations of the ventilation windows, we find that the windows at a level of the telescope secondary mirror have less efficiency of the air change than those at lower levels. Considering the construction and maintenance costs, and operation procedures, we finally decide to allocate 13 windows at a level of the observing floor, 12 at a level of the primary mirror, and 2 at the level of the secondary mirror. The opening area by those windows accounts for about 14% of the total interior surface of the enclosure. Typical air change rate of 20-30 per hour is expected at the wind velocity of 1 m sec-1.

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.

Removal site evaluation report for the Isotope Facilities at Oak Ridge National Laboratory, Oak Ridge, Tennessee

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

NONE

This removal site evaluation (RmSE) report of the Isotope Facilities at Oak Ridge National Laboratory (ORNL) was prepared to provide the Environmental Restoration Program with information necessary to evaluate whether hazardous and/or radiological contaminants in and around the Isotopes Facility pose a substantial risk to human health or the environment and if remedial site evaluations (RSEs) or removal actions are required. The scope of the project included: (1) a review of historical evidence regarding operations and use of the facility; (2) interviews with facility personnel concerning current and past operating practices; (3) a site inspection; and (4) identification of hazardmore » areas requiring maintenance, removal, or remedial actions. The results of RmSE indicate that no substantial risks exist from contaminants present in the Isotope Facilities because adequate controls and practices exist to protect human health and the environment. The recommended correction from the RmSE are being conducted as maintenance actions; accordingly, this RmSE is considered complete and terminated.« less

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.

Filmless Radiology: The Design, Integration, Implementation, and Evaluation of a Digital Imaging Network. Potential Investigations to Be Conducted in Conjunction with the Digital Imaging Network System (DINS) evaluation Project. Revision 1

DTIC Science & Technology

1988-06-01

INSTRUMENT IDENTIFICATION NUMBERORGANIZATION U.S. Army Medical (if aplicable ) Research & Development Command Contract No. DAMDI7-86-C-6145 8c. ADDRESS (City...three echelon levels is delivered from mobile facilities located up to 10, 40, and 150 kilometers from the forward edge of the battle area (FEBA...respectively. There are seven types of Army hospitals used in wartime theaters of operation. They range from Mobile Army Surgical Hospital (MASH) units in

Shielding evaluation and acceptance testing of a prefabricated, modular, temporary radiation therapy treatment facility

PubMed Central

Ezzell, Gary A.

2004-01-01

We have recently commissioned a temporary radiation therapy facility that is novel in two aspects: it was constructed using modular components, and the LINAC was installed in one of the modular sections before it was lifted into position. Additional steel and granular fill was added to the modular sections on‐site during construction. The building will be disassembled and removed when no longer needed. This paper describes the radiation shielding specifications and survey of the facility, as well as the ramifications for acceptance testing occasioned by the novel installation procedure. The LINAC is a Varian 21EX operating at 6 MV and 18 MV. The radiation levels outside the vault satisfied the design criteria, and no anomalous leakage was detected along the joints of the modular structure. At 18 MV and 600 monitor units (MU) per minute, the radiation level outside the primary barrier walls was 8.5μSv/h of photons; there were no detectable neutrons. Outside the direct‐shielded door, the levels were 0.4μSv/h of photons and 3.0μSv/h of neutrons. The isocentricity of the accelerator met the acceptance criteria and was not affected by its preinstallation into an integrated baseframe and subsequent transport to the building site. PACS numbers: 87.52.Df, 87.52.Ga PMID:15738926

Overview of NASA Electrified Aircraft Propulsion Research for Large Subsonic Transports

NASA Technical Reports Server (NTRS)

Jansen, Ralph H.; Bowman, Cheryl; Jankovsky, Amy; Dyson, Rodger; Felder, James L.

2017-01-01

NASA is investing in Electrified Aircraft Propulsion (EAP) research as part of the portfolio to improve the fuel efficiency, emissions, and noise levels in commercial transport aircraft. Turboelectric, partially turboelectric, and hybrid electric propulsion systems are the primary EAP configurations being evaluated for regional jet and larger aircraft. The goal is to show that one or more viable EAP concepts exist for narrow body aircraft and mature tall-pole technologies related to those concepts. A summary of the aircraft system studies, technology development, and facility development is provided. The leading concept for mid-term (2035) introduction of EAP for a single aisle aircraft is a tube and wing, partially turbo electric configuration (STARC-ABL), however other viable configurations exist. Investments are being made to raise the TRL (Technology Readiness Level) level of light weight, high efficiency motors, generators, and electrical power distribution systems as well as to define the optimal turbine and boundary layer ingestion systems for a mid-term tube and wing configuration. An electric aircraft power system test facility (NEAT - NASA’s Electric Aircraft Testbed) is under construction at NASA Glenn and an electric aircraft control system test facility (HEIST - Hybrid-Electric Integrated Systems Testbed) is under construction at NASA Armstrong. The correct building blocks are in place to have a viable, large plane EAP configuration tested by 2025 leading to entry into service in 2035 if the community chooses to pursue that goal.

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 characteristics of referring facilities and transferred hand surgery patients: factors associated with emergency patient transfers.

PubMed

Kuo, Phoebe; Hartzell, Tristan L; Eberlin, Kyle R; Miao, Diana; Zurakowski, David; Winograd, Jonathan M; Day, Charles S

2014-03-19

As emergency departments (EDs) become increasingly overwhelmed and specialist coverage in some EDs decreases, patients may be transferred to tertiary or quaternary facilities for specialized care to decrease patient load at transferring facilities. Our objective was to determine whether facilities that transferred patients for hand surgery had hand surgery coverage and to evaluate any nonmedical factors that might have been associated with transfer. A retrospective review was conducted for 1167 visits of hand and wrist patients seen in the EDs of two urban level-I trauma centers. The hand surgery capacity of referring facilities was determined by phone calls to the EDs. Univariate and multivariable analyses were conducted to identify nonmedical factors that could potentially affect the decision to transfer. A total of 155 (13.3%) of 1167 patients arrived from other facilities for specialized hand care. These patients were significantly more likely to be male (p = 0.02), have noncommercial insurance (p = 0.04), require an interpreter (p = 0.01), and arrive between 6:00 p.m. and midnight (p = 0.03). In a multivariable analysis, sex and insurance status were significantly associated with transfer (p < 0.05). The subset of ninety-five patients who were transferred from other EDs was significantly more likely to be male (p < 0.01) and arrive on weekends (p < 0.01) or between 6:00 p.m. and midnight (p < 0.01). Of these patients, seventy-seven (81%) were transferred from an ED that reported partial or full hand surgery coverage. However, only eight (10.4%) received a hand surgery evaluation prior to transfer. The low percentage of patients receiving hand surgery evaluations prior to transfer suggests that referring hospitals are not using their own hand surgeon resources. Nonmedical factors, including noncommercial insurance and off-hour time of initial arrival, may be associated with the decision to transfer patients. Identifying nonmedical factors associated with patient transfers and referrals can enlighten efforts to improve the quality and appropriate use of transfers for specialty care.

A psychometric evaluation of the Chinese version of the nursing home survey on patient safety culture.

PubMed

Lin, Shu-Yuan; Tseng, Wei Ting; Hsu, Miao-Ju; Chiang, Hui-Ying; Tseng, Hui-Chen

2017-12-01

To test the psychometric properties of the Chinese version of the Nursing Home Survey on Patient Safety Culture scale among staff in long-term care facilities. The Nursing Home Survey on Patient Safety Culture scale is a standard tool for safety culture assessment in nursing homes. Extending its application to different types of long-term care facilities and varied ethnic populations is worth pursuing. A national random survey. A total of 306 managers and staff completed the Chinese version of the Nursing Home Survey on Patient Safety Culture scale among 30 long-term care facilities in Taiwan. Content validity and construct validity were tested by content validity index (CVI) and principal axis factor analysis (PAF) with Promax rotation. Concurrent validity was tested through correlations between the scale and two overall rating items. Reliability was computed by intraclass correlation coefficient and Cronbach's α coefficients. Statistical analyses such as descriptive, Pearson's and Spearman's rho correlations and PAF were completed. Scale-level and item-level CVIs (0.91-0.98) of the Chinese version of the Nursing Home Survey on Patient Safety Culture scale were satisfactory. Four-factor construct and merged item composition differed from the Nursing Home Survey on Patient Safety Culture scale, and it accounted for 53% of variance. Concurrent validity was evident by existing positive correlations between the scale and two overall ratings of resident safety. Cronbach's α coefficients of the subscales and the Chinese version of the Nursing Home Survey on Patient Safety Culture scale ranged from .76-.94. The Chinese version of the Nursing Home Survey on Patient Safety Culture scale identified essential dimensions to reflect the important features of a patient safety culture in long-term care facilities. The researchers introduced the Chinese version of the Nursing Home Survey on Patient Safety Culture for safety culture assessment in long-term care facilities, but further testing of the reliability of the scale in a large Chinese sample and in different long-term care facilities was recommended. The Chinese version of the Nursing Home Survey on Patient Safety Culture scale was developed to increase the users' intention towards safety culture assessment. It can identify areas for improvement, understand safety culture changes over time and evaluate the effectiveness of interventions. © 2017 John Wiley & Sons Ltd.

Compensation for risks: host community benefits in siting locally unwanted facilities

NASA Astrophysics Data System (ADS)

Himmelberger, Jeffery J.; Ratick, Samuel J.; White, Allen L.

1991-09-01

This article analyzes the recent negotiations connected with siting 24 solid-waste landfills in Wisconsin. We examine the association between the type and amount of compensation paid to host communities by facility developers and the size of facilities, certain facility characteristics, the timing of negotiated agreements, the size of the host community, and the socioeconomic status of the host area. Our findings suggest that the level of compensation after adjusting for landfill capacity is positively associated with the percentage of total facility capacity dedicated to host community use, positively associated with the percentage of people of the host area who are in poverty, and larger for public facilities that accept municipal wastes. Other explanatory variables we examined, whose association with levels of compensation proved statistically insignificant, were facility size, facility status (new vs expansion), facility use (countyonly vs multicounty), timing of negotiation, host community size, and the host area education level, population density, and per capita income. We discuss the policy implications of our principal findings and future research questions in light of the persistent opposition surrounding the siting of solid-waste and other waste-management facilities.

6 CFR 27.205 - Determination that a chemical facility “presents a high level of security risk.”

Code of Federal Regulations, 2010 CFR

2010-01-01

... 6 Domestic Security 1 2010-01-01 2010-01-01 false Determination that a chemical facility âpresents a high level of security risk.â 27.205 Section 27.205 Domestic Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY CHEMICAL FACILITY ANTI-TERRORISM STANDARDS Chemical Facility Security...

HiRadMat at CERN SPS - A test facility with high intensity beam pulses to material samples

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

Charitonidis, N.; Fabich, A.; Efthymiopoulos, I.

2015-07-01

HiRadMat (High Irradiation to Materials) is a facility at CERN designed to provide high-intensity pulsed beams to an irradiation area where material samples as well as accelerator component assemblies (e.g. vacuum windows, shock tests on high power targets, collimators) can be tested. The beam parameters (SPS 440 GeV protons with a pulse energy of up to 3.4 MJ, or alternatively lead/argon ions at the proton equivalent energy) can be tuned to match the needs of each experiment. It is a test area designed to perform single pulse experiments to evaluate the effect of high-intensity pulsed beams on materials in amore » dedicated environment, excluding long-time irradiation studies. The facility is designed for a 10{sup 16} maximum number of protons per year, in order to limit the activation to acceptable levels for human intervention. This paper will demonstrate the possibilities for research using this facility and showing examples of upcoming experiments scheduled in the beam period 2014/2015. (authors)« less

Status and Planned Experiments of the Hiradmat Pulsed Beam Material Test Facility at CERN SPS

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

Charitonidis, Nikolaos; Efthymiopoulos, Ilias; Fabich, Adrian

2015-06-01

HiRadMat (High Irradiation to Materials) is a facility at CERN designed to provide high-intensity pulsed beams to an irradiation area where material samples as well as accelerator component assemblies (e.g. vacuum windows, shock tests on high power targets, collimators) can be tested. The beam parameters (SPS 440 GeV protons with a pulse energy of up to 3.4 MJ, or alternatively lead/argon ions at the proton equivalent energy) can be tuned to match the needs of each experiment. It is a test area designed to perform single pulse experiments to evaluate the effect of high-intensity pulsed beams on materials in amore » dedicated environment, excluding long-time irradiation studies. The facility is designed for a maximum number of 1016 protons per year, in order to limit the activation of the irradiated samples to acceptable levels for human intervention. This paper will demonstrate the possibilities for research using this facility and go through examples of upcoming experiments scheduled in the beam period 2015/2016.« less

Polymer materials and component evaluation in acidic-radiation environments

NASA Astrophysics Data System (ADS)

Celina, M.; Gillen, K. T.; Malone, G. M.; Clough, R. L.; Nelson, W. H.

2001-07-01

Polymeric materials used for cable/wire insulation, electrical connectors, O-rings, seals, and in critical components such as motors, level switches and resistive thermo-devices were evaluated under accelerated degradation conditions in combined radiation-oxidative elevated-temperature acidic-vapor (nitric/oxalic) environments relevant to conditions in isotope processing facilities. Experiments included the assessment of individual materials such as PEEK, polyimides, polyolefin based cable insulation, EPDM rubbers, various epoxy systems, commercial caulking materials as well as some functional testing of components. We discuss how to conduct laboratory experiments to simulate such complex hostile environments, describe some degradation effects encountered, and evaluate the impact on appropriate material and component selection.

The development of fire evaluation system for detention and correctional occupancies

NASA Astrophysics Data System (ADS)

Nelson, H. E.; Shibe, A. J.

1984-12-01

A fire safety evaluation system for detention and correctional occupancies was developed. It can be used for determining if a facility has fire safety equivalent to that obtained by meeting the requirement of a given code. The system was calibrated for use with proposed chapters for detention and correctional occupancies of the Life Safety Code (1985). There are separate sets of requirements for each of four use conditions: one for zoned egress, one for zoned impeded egress, one for impeded egress, and one for contained. Within each set, there are two levels of evaluation: one for partially sprinklered and nonsprinklered buildings, and one for totally sprinklered buildings.

SSHAC Level 1 Probabilistic Seismic Hazard Analysis for the Idaho National Laboratory

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

Payne, Suzette; Coppersmith, Ryan; Coppersmith, Kevin

A Probabilistic Seismic Hazard Analysis (PSHA) was completed for the Materials and Fuels Complex (MFC), Naval Reactors Facility (NRF), and the Advanced Test Reactor (ATR) at Idaho National Laboratory (INL) (Figure 1-1). The PSHA followed the approaches and procedures appropriate for a Study Level 1 provided in the guidance advanced by the Senior Seismic Hazard Analysis Committee (SSHAC) in U.S. Nuclear Regulatory Commission (NRC) NUREG/CR-6372 and NUREG-2117 (NRC, 1997; 2012a). The SSHAC Level 1 PSHAs for MFC and ATR were conducted as part of the Seismic Risk Assessment (SRA) project (INL Project number 31287) to develop and apply a new-riskmore » informed methodology, respectively. The SSHAC Level 1 PSHA was conducted for NRF to provide guidance on the potential use of a design margin above rock hazard levels. The SRA project is developing a new risk-informed methodology that will provide a systematic approach for evaluating the need for an update of an existing PSHA. The new methodology proposes criteria to be employed at specific analysis, decision, or comparison points in its evaluation process. The first four of seven criteria address changes in inputs and results of the PSHA and are given in U.S. Department of Energy (DOE) Standard, DOE-STD-1020-2012 (DOE, 2012a) and American National Standards Institute/American Nuclear Society (ANSI/ANS) 2.29 (ANS, 2008a). The last three criteria address evaluation of quantitative hazard and risk-focused information of an existing nuclear facility. The seven criteria and decision points are applied to Seismic Design Category (SDC) 3, 4, and 5, which are defined in American Society of Civil Engineers/Structural Engineers Institute (ASCE/SEI) 43-05 (ASCE, 2005). The application of the criteria and decision points could lead to an update or could determine that such update is not necessary.« less

Measuring governance at health facility level: developing and validation of simple governance tool in Zambia.

PubMed

Mutale, Wilbroad; Mwanamwenge, Margaret Tembo; Balabanova, Dina; Spicer, Neil; Ayles, Helen

2013-08-09

Governance has been cited as a key determinant of economic growth, social advancement and overall development. Achievement of millennium development goals is partly dependant on governance practices. In 2007, Health Systems 20/20 conducted an Internet-based survey on the practice of good governance. The survey posed a set of good practices related to health governance and asked respondents to indicate whether their experience confirmed or disconfirmed those practices. We applied the 17 governance statements in rural health facilities of Zambia. The aim was to establish whether the statements were reliable and valid for assessing governance practices at primary care level. Both quantitative and qualitative methods were used. We first applied the governance statements developed by the health system 20/20 and then conducted focus group discussion and In-depth interviews to explore some elements of governance including accountability and community participation. The target respondents were the health facility management team and community members. The sample size include 42 health facilities. Data was analyzed using SPSS version 17 and Nvivo version 9. The 95% one-sided confidence interval for Cronbach's alpha was between 0.69 and 0.74 for the 16 items.The mean score for most of the items was above 3. Factor analysis yielded five principle components: Transparency, community participation, Intelligence & vision, Accountability and Regulation & oversight. Most of the items (6) clustered around the transparency latent factor. Chongwe district performed poorly in overall mean governance score and across the five domains of governance. The overall scores in Chongwe ranged between 51 and 94% with the mean of 80%. Kafue and Luangwa districts had similar overall mean governance scores (88%). Community participation was generally low. Generally, it was noted that community members lacked capacity to hold health workers accountable for drugs and medical supplies. The study successfully validated and applied the new tool for evaluating health system governance at health facility level. The results have shown that it is feasible to measure governance practices at health facility level and that the adapted tool is fairly reliable with the 95% one-sided confidence interval for Cronbach's alpha laying between 0.69 and 0.74 for the 16 items. Caution should be taken when interpreting overall scores as they tended to mask domain specific variations.

Comparing State- Versus Facility-Level Effects on Crowding in U.S. Correctional Facilities

ERIC Educational Resources Information Center

Steiner, Benjamin; Wooldredge, John

2008-01-01

The literature on prison crowding underscores the potential importance of both state- and facility-level effects on crowding, although empirical research has not assessed these relative effects because of the sole focus on states as units of analysis. This article describes findings from bi-level analyses of crowding across 459 state-operated…

Facility Energy Performance Benchmarking in a Data-Scarce Environment

DTIC Science & Technology

2017-08-01

environment, and analyze occupant-, system-, and component-level faults contributing to energy in- efficiency. A methodology for developing DoD-specific...Research, Development, Test, and Evaluation (RDTE) Program to develop an intelligent framework, encompassing methodology and model- ing, that...energy performers by installation, climate zone, and other criteria. A methodology for creating the DoD-specific EUIs would be an important part of a

Liquid Rocket Engine Testing Overview

NASA Technical Reports Server (NTRS)

Rahman, Shamim

2005-01-01

Contents include the following: Objectives and motivation for testing. Technology, Research and Development Test and Evaluation (RDT&E), evolutionary. Representative Liquid Rocket Engine (LRE) test compaigns. Apollo, shuttle, Expandable Launch Vehicles (ELV) propulsion. Overview of test facilities for liquid rocket engines. Boost, upper stage (sea-level and altitude). Statistics (historical) of Liquid Rocket Engine Testing. LOX/LH, LOX/RP, other development. Test project enablers: engineering tools, operations, processes, infrastructure.

Assessment of Surgical and Trauma Capacity in Potosí, Bolivia.

PubMed

Blair, Kevin J; Boeck, Marissa A; Gallardo Barrientos, José Luis; Hidalgo López, José Luis; Helenowski, Irene B; Nwomeh, Benedict C; Shapiro, Michael B; Swaroop, Mamta

Scaling up surgical and trauma care in low- and middle-income countries could prevent nearly 2 million annual deaths. Various survey instruments exist to measure surgical and trauma capacity, including Personnel, Infrastructure, Procedures, Equipment, and Supplies (PIPES) and International Assessment of Capacity for Trauma (INTACT). We sought to evaluate surgical and trauma capacity in the Bolivian department of Potosí using a combined PIPES and INTACT tool, with additional questions to further inform intervention targets. In June and July 2014 a combined PIPES and INTACT survey was administered to 20 government facilities in Potosí with a minimum of 1 operating room: 2 third-level, 10 second-level, and 8 first-level facilities. A surgeon, head physician, director, or obstetrician-gynecologist completed the survey. Additional personnel responded to 4 short-answer questions. Survey items were divided into subsections, and PIPES and INTACT indices calculated. Medians were compared via Wilcoxon rank sum and Kruskal-Wallis tests. Six of 20 facilities were located in the capital city and designated urban. Urban establishments had higher median PIPES (8.5 vs 6.7, P = .11) and INTACT (8.5 vs 6.9, P = .16) indices compared with rural. More than half of surgeons and anesthesiologists worked in urban hospitals. Urban facilities had higher median infrastructure and procedure scores compared with rural. Fifty-three individuals completed short-answer questions. Training was most desired in laparoscopic surgery and trauma management; less than half of establishments reported staff with trauma training. Surgical and trauma capacity in Potosí was most limited in personnel, infrastructure, and procedures at rural facilities, with greater personnel deficiencies than previously reported. Interventions should focus on increasing the number of surgical and anesthesia personnel in rural areas, with a particular focus on the reported desire for trauma management training. Results have been made available to key stakeholders in Potosí to inform targeted quality improvement interventions. Copyright © 2017 Icahn School of Medicine at Mount Sinai. Published by Elsevier Inc. All rights reserved.

Costs and financing of routine immunization: Approach and selected findings of a multi-country study (EPIC).

PubMed

Brenzel, Logan; Young, Darwin; Walker, Damian G

2015-05-07

Few detailed facility-based costing studies of routine immunization (RI) programs have been conducted in recent years, with planners, managers and donors relying on older information or data from planning tools. To fill gaps and improve quality of information, a multi-country study on costing and financing of routine immunization and new vaccines (EPIC) was conducted in Benin, Ghana, Honduras, Moldova, Uganda and Zambia. This paper provides the rationale for the launch of the EPIC study, as well as outlines methods used in a Common Approach on facility sampling, data collection, cost and financial flow estimation for both the routine program and new vaccine introduction. Costing relied on an ingredients-based approach from a government perspective. Estimating incremental economic costs of new vaccine introduction in contexts with excess capacity are highlighted. The use of more disaggregated System of Health Accounts (SHA) coding to evaluate financial flows is presented. The EPIC studies resulted in a sample of 319 primary health care facilities, with 65% of facilities in rural areas. The EPIC studies found wide variation in total and unit costs within each country, as well as between countries. Costs increased with level of scale and socio-economic status of the country. Governments are financing an increasing share of total RI financing. This study provides a wealth of high quality information on total and unit costs and financing for RI, and demonstrates the value of in-depth facility approaches. The paper discusses the lessons learned from using a standardized approach, as well as proposes further areas of methodology development. The paper discusses how results can be used for resource mobilization and allocation, improved efficiency of services at the country level, and to inform policies at the global level. Efforts at routinizing cost analysis to support sustainability efforts would be beneficial. Copyright © 2015 Elsevier Ltd. All rights reserved.

Apollo experience report: Real-time auxiliary computing facility development

NASA Technical Reports Server (NTRS)

Allday, C. E.

1972-01-01

The Apollo real time auxiliary computing function and facility were an extension of the facility used during the Gemini Program. The facility was expanded to include support of all areas of flight control, and computer programs were developed for mission and mission-simulation support. The scope of the function was expanded to include prime mission support functions in addition to engineering evaluations, and the facility became a mandatory mission support facility. The facility functioned as a full scale mission support activity until after the first manned lunar landing mission. After the Apollo 11 mission, the function and facility gradually reverted to a nonmandatory, offline, on-call operation because the real time program flexibility was increased and verified sufficiently to eliminate the need for redundant computations. The evaluation of the facility and function and recommendations for future programs are discussed in this report.

The Impact of Local Environmental Health Capacity on Foodborne Illness Morbidity in Maryland

PubMed Central

Resnick, Beth A.; Fox, Mary A.; McGready, John; Yager, James P.; Burke, Thomas A.

2011-01-01

Objectives. We evaluated the relationship between local food protection capacity and service provision in Maryland's 24 local food protection programs (FPPs) and incidence of foodborne illness at the county level. Methods. We conducted regression analyses to determine the relationship between foodborne illness and local FPP characteristics. We used the Centers for Disease Control and Prevention's FoodNet and Maryland Department of Health and Mental Hygiene outbreak data set, along with data on Maryland's local FPP capacity (workforce size and experience levels, budget) and service provision (food service facility inspections, public notification programs). Results. Counties with higher capacity, such as larger workforce, higher budget, and greater employee experience, had fewer foodborne illnesses. Counties with better performance and county-level regulations, such as high food service facility inspection rates and requiring certified food manager programs, respectively, had lower rates of illness. Conclusions. Counties with strong local food protection capacity and services can protect the public from foodborne illness. Research on public health services can enhance our understanding of the food protection infrastructure, and the effectiveness of food protection programs in preventing foodborne illness. PMID:21750282

Factors affecting utilization of skilled maternal care in Northwest Ethiopia: a multilevel analysis

PubMed Central

2013-01-01

Background The evaluation of all potential sources of low skilled maternal care utilization is crucial for Ethiopia. Previous studies have largely disregarded the contribution of different levels. This study was planned to assess the effect of individual, communal, and health facility characteristics in the utilization of antenatal, delivery, and postnatal care by a skilled provider. Methods A linked facility and population-based survey was conducted over three months (January - March 2012) in twelve “kebeles” of North Gondar Zone, Amhara Region. A total of 1668 women who had births in the year preceding the survey were selected for analysis. Using a multilevel modelling, we examined the effect of cluster variation and a number of individual, communal (kebele), and facility-related variables for skilled maternal care utilization. Result About 32.3%, 13.8% and 6.3% of the women had the chance to get skilled providers for their antenatal, delivery and postnatal care, respectively. A significant heterogeneity was observed among clusters for each indicator of skilled maternal care utilization. At the individual level, variables related to awareness and perceptions were found to be much more relevant for skilled maternal service utilization. Preference for skilled providers and previous experience of antenatal care were consistently strong predictors of all indicators of skilled maternal health care utilizations. Birth order, maternal education, and awareness about health facilities to get skilled professionals were consistently strong predictors of skilled antenatal and delivery care use. Communal factors were relevant for both delivery and postnatal care, whereas the characteristics of a health facility were more relevant for use of skilled delivery care than other maternity services. Conclusion Factors operating at individual and “kebele” levels play a significant role in determining utilization of skilled maternal health services. Interventions to create better community awareness and perception about skilled providers and their care, and ensuring the seamless performance of health care facilities have been considered crucial to improve skilled maternal services in the study area. Such interventions should target underprivileged women. PMID:23587369

Evaluation of a TB infection control implementation initiative in out-patient HIV clinics in Zambia and Botswana.

PubMed

Emerson, C; Lipke, V; Kapata, N; Mwananyambe, N; Mwinga, A; Garekwe, M; Lanje, S; Moshe, Y; Pals, S L; Nakashima, A K; Miller, B

2016-07-01

Out-patient human immunodeficiency virus (HIV) care and treatment clinics in Zambia and Botswana, countries with a high burden of HIV and TB infection. To develop a tuberculosis infection control (TB IC) training and implementation package and evaluate the implementation of TB IC activities in facilities implementing the package. Prospective program evaluation of a TB IC training and implementation package using a standardized facility risk assessment tool, qualitative interviews with facility health care workers and measures of pre- and post-test performance. A composite measure of facility performance in TB IC improved from 32% at baseline to 50% at 1 year among eight facilities in Zambia, and from 27% to 80% at 6 months among 10 facilities in Botswana. Although there was marked improvement in indicators of managerial, administrative and environmental controls, key ongoing challenges remained in ensuring access to personal protective equipment and implementing TB screening in health care workers. TB IC activities at out-patient HIV clinics in Zambia and Botswana improved after training using the implementation package. Continued infrastructure support, as well as monitoring and evaluation, are needed to support the scale-up and sustainability of TB IC programs in facilities in low-resource countries.

Assessing the feasibility of mobile phones for follow-up of acutely unwell children presenting to village clinics in rural northern Malawi.

PubMed

Hardy, Victoria; Hsieh, Jenny; Chirambo, Baxter; Wu, Tsung-Shu Joseph; O'Donoghue, John; Muula, Adamson S; Thompson, Matthew

2017-03-01

Patient follow-up is a routine component of clinical practice and valuable for evaluating the effectiveness of interventions, but because of the broad dispersion of health facilities and lack of standardised medical reporting in Malawi, collecting patient outcome data can be challenging. Increasing accessibility and affordability of mobile technology in resource-poor settings may facilitate patient follow-up in the community. The objective of this study was to evaluate the potential utility of mobile phones for collecting follow-up clinical data from parents or caregivers of acutely unwell under-5 children, for intervention evaluation purposes. Parents' or caregivers' mobile phone numbers were obtained by health surveillance assistants (HSAs) during study enrollment. Guardians who provided a telephone number were contacted by the study team to establish re-consultations or hospitalisations of their child(ren) within 14 days of recruitment. Health records at village clinics and higher-level health facilities were hand-searched to identify or confirm presentations and abstract clinical data. 87 out of 149 (58.4%) guardians provided a mobile telephone number, of whom the study team could contact 44 (29.5%). Seven guardians stated they took their child for further treatment: three of these returned to village clinics and four presented to secondary care facilities; attendance could only be confirmed from health records for one child. With continued expansion of cellular network coverage and mobile ownership in Malawi, mobile phones may facilitate collection of patient outcomes for intervention evaluation purposes. Future consideration should also be given to integrating mobile technologies into HSA clinical practice.

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.

SU-E-T-400: Evaluation of Shielding and Activation at Two Pencil Beam Scanning Proton Facilities

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

Remmes, N; Mundy, D; Classic, K

2015-06-15

Purpose: To verify acceptably low dose levels around two newly constructed identical pencil beam scanning proton therapy facilities and to evaluate accuracy of pre-construction shielding calculations. Methods: Dose measurements were taken at select points of interest using a WENDI-2 style wide-energy neutron detector. Measurements were compared to pre-construction shielding calculations. Radiation badges with neutron dose measurement capabilities were worn by personnel and also placed at points throughout the facilities. Seven neutron and gamma detectors were permanently installed throughout the facility, continuously logging data. Potential activation hazards have also been investigated. Dose rates near water tanks immediately after prolonged irradiation havemore » been measured. Equipment inside the treatment room and accelerator vault has been surveyed and/or wipe tested. Air filters from air handling units, sticky mats placed outside of the accelerator vault, and water samples from the magnet cooling water loops have also been tested. Results: All radiation badges have been returned with readings below the reporting minimum. Measurements of mats, air filters, cooling water, wipe tests and surveys of equipment that has not been placed in the beam have all come back at background levels. All survey measurements show the analytical shielding calculations to be conservative by at least a factor of 2. No anomalous events have been identified by the building radiation monitoring system. Measurements of dose rates close to scanning water tanks have shown dose rates of approximately 10 mrem/hr with a half-life less than 5 minutes. Measurements around the accelerator show some areas with dose rates slightly higher than 10 mrem/hr. Conclusion: The shielding design is shown to be adequate. Measured dose rates are below those predicted by shielding calculations. Activation hazards are minimal except in certain very well defined areas within the accelerator vault and for objects placed directly in the path of the beam.« less

Strengthening primary eye care in South Africa: An assessment of services and prospective evaluation of a health systems support package

PubMed Central

Lilian, Rivka R.; Railton, Jean; Schaftenaar, Erik; Mabitsi, Moyahabo; Grobbelaar, Cornelis J.; Khosa, N. Sellina; Maluleke, Babra H.; Struthers, Helen E.; McIntyre, James A.

2018-01-01

Visual impairment is a significant public health concern, particularly in low- and middle-income countries where eye care is predominantly provided at the primary healthcare (PHC) level, known as primary eye care. This study aimed to perform an evaluation of primary eye care services in three districts of South Africa and to assess whether an ophthalmic health system strengthening (HSS) package could improve these services. Baseline surveys were conducted in Cape Winelands District, Johannesburg Health District and Mopani District at 14, 25 and 36 PHC facilities, respectively. Thereafter, the HSS package, comprising group training, individual mentoring, stakeholder engagement and resource provision, was implemented in 20 intervention sites in Mopani District, with the remaining 16 Mopani facilities serving as control sites. At baseline, less than half the facilities in Johannesburg and Mopani had dedicated eye care personnel or sufficient space to measure visual acuity. Although visual acuity charts were available in most facilities, <50% assessed patients at the correct distance. Median score for availability of nine essential drugs was <70%. Referral criteria knowledge was highest in Cape Winelands and Johannesburg, with poor clinical knowledge across all districts. Several HSS interventions produced successful outcomes: compared to control sites there was a significant increase in the proportion of intervention sites with eye care personnel and resources such as visual acuity charts (p = 0.02 and <0.01, respectively). However, engaging with district pharmacists did not improve availability of essential drugs (p = 0.47). Referral criteria knowledge improved significantly in intervention sites (p<0.01) but there was no improvement in clinical knowledge (p = 0.76). Primary eye care in South Africa faces multiple challenges with regard to organisation of care, resource availability and clinical competence. The HSS package successfully improved some aspects of this care, but further development is warranted together with debate regarding the positioning of eye services at PHC level. PMID:29758069

Bridging the gaps in the Health Management Information System in the context of a changing health sector

PubMed Central

2010-01-01

Background The Health Management Information System (HMIS) is crucial for evidence-based policy-making, informed decision-making during planning, implementation and evaluation of health programs; and for appropriate use of resources at all levels of the health system. This study explored the gaps and factors influencing HMIS in the context of a changing health sector in Tanzania. Methods A cross sectional descriptive study was conducted in 11 heath facilities in Kilombero district between January and February 2008. A semi-structured questionnaire was used to interview 43 health workers on their knowledge, attitude, practice and factors for change on HMIS and HMIS booklets from these facilities were reviewed for completeness. Results Of all respondents, 81% had never been trained on HMIS, 65% did not properly define this system, 54% didn't know who is supposed to use the information collected and 42% did not use the collected data for planning, budgeting and evaluation of services provision. Although the attitude towards the system was positive among 91%, the reviewed HMIS booklets were never completed in 25% - 55% of the facilities. There were no significant differences in knowledge, attitude and practice on HMIS between clinicians and nurses. The most common type of HMIS booklets which were never filled were those for deliveries (55%). The gaps in the current HMIS were linked to lack of training, inactive supervision, staff workload pressure and the lengthy and laborious nature of the system. Conclusions This research has revealed a state of poor health data collection, lack of informed decision-making at the facility level and the factors for change in the country's HMIS. It suggests need for new innovations including incorporation of HMIS in the ongoing reviews of the curricula for all cadres of health care providers, development of more user-friendly system and use of evidence-based John Kotter's eight-step process for implementing successful changes in this system. PMID:20579336

Factors Associated with the Use of Helicopter Inter-facility Transport of Trauma Patients to Tertiary Trauma Centers within an Organized Rural Trauma System

PubMed Central

Stewart, Kenneth; Garwe, Tabitha; Bhandari, Naresh; Danford, Brandon; Albrecht, Roxie

2016-01-01

Objective A review of the literature yielded little information regarding factors associated with the decision to use ground (GEMS) or helicopter (HEMS) emergency medical services for trauma patients transferred inter-facility. Furthermore, studies evaluating the impact of inter-facility transport mode on mortality have reported mixed findings. Since HEMS transport is generally reserved for more severely injured patients, this introduces indication bias, which may explain the mixed findings. Our objective was to identify factors at referring non-tertiary trauma centers (NTC) influencing transport mode decision. Methods This was a case-control study of trauma patients transferred from a Level III or IV NTC to a tertiary trauma center (TTC) within 24-hours reported to the Oklahoma State Trauma Registry between 2005 and 2012. Multivariable logistic regression was used to determine clinical and non-clinical factors associated with the decision to use HEMS. Results A total of 7380 patients met the study eligibility. Of these, 2803(38%) were transported inter-facility by HEMS. Penetrating injury, prehospital EMS transport, severe torso injury, hypovolemic shock, and TBI were significant predictors (p<0.05) of HEMS use regardless of distance to a TTC. Association between HEMS use and male gender, Level IV NTC, and local ground EMS resources varied by distance from the TTC. Many HEMS transported patients had minor injuries and normal vital signs. Conclusions Our results suggest that while distance remains the most influential factor associated with HEMS use, significant differences exist in clinical and non-clinical factors between patients transported by HEMS versus GEMS. To ensure comparability of study groups, studies evaluating outcome differences between HEMS and GEMS should take factors determining transport mode into account. The findings will be used to develop propensity scores to balance baseline risk between GEMS and HEMS patients for use in subsequent studies of outcomes. PMID:26986053

Bridging the gaps in the Health Management Information System in the context of a changing health sector.

PubMed

Nyamtema, Angelo S

2010-06-25

The Health Management Information System (HMIS) is crucial for evidence-based policy-making, informed decision-making during planning, implementation and evaluation of health programs; and for appropriate use of resources at all levels of the health system. This study explored the gaps and factors influencing HMIS in the context of a changing health sector in Tanzania. A cross sectional descriptive study was conducted in 11 heath facilities in Kilombero district between January and February 2008. A semi-structured questionnaire was used to interview 43 health workers on their knowledge, attitude, practice and factors for change on HMIS and HMIS booklets from these facilities were reviewed for completeness. Of all respondents, 81% had never been trained on HMIS, 65% did not properly define this system, 54% didn't know who is supposed to use the information collected and 42% did not use the collected data for planning, budgeting and evaluation of services provision. Although the attitude towards the system was positive among 91%, the reviewed HMIS booklets were never completed in 25% - 55% of the facilities. There were no significant differences in knowledge, attitude and practice on HMIS between clinicians and nurses. The most common type of HMIS booklets which were never filled were those for deliveries (55%). The gaps in the current HMIS were linked to lack of training, inactive supervision, staff workload pressure and the lengthy and laborious nature of the system. This research has revealed a state of poor health data collection, lack of informed decision-making at the facility level and the factors for change in the country's HMIS. It suggests need for new innovations including incorporation of HMIS in the ongoing reviews of the curricula for all cadres of health care providers, development of more user-friendly system and use of evidence-based John Kotter's eight-step process for implementing successful changes in this system.

Summary Report of Ecological Risk Assessment for the Operation of the Explosives Waste Treatment Facility at Site 300 of the Lawrence Livermore National Laboratory.

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

Gallegos, Gretchen M.; Terusaki, Stan H.

2013-12-01

An ecological risk assessment is required as part of the Resource Recovery and Conservation Act (RCRA) permit renewal process for Miscellaneous Units subject to 22 CCR 66270.23. This risk assessment is prepared in support of the RCRA permit renewal for the Explosives Waste Treatment Facility (EWTF) at Site 300 of the Lawrence Livermore National Laboratory (LLNL). LLNL collected soil samples and used the resulting data to produce a scoping-level ecological risk assessment pursuant to the Department of Toxic Substances Control, Guidance for Ecological Risk Assessment at Hazardous Waste Sites and Permitted Facilities, Part A: Overview, July 4, 1996. The scoping-levelmore » ecological risk assessment provides a framework to determine the potential interaction between ecological receptors and chemicals of concern from hazardous waste treatment operations in the area of EWTF. A scoping-level ecological risk assessment includes the step of conducting soil sampling in the area of the treatment units. The Sampling Plan in Support of the Human Health and Ecological Risk Assessment for the Operation of the Explosives Waste Treatment Facility at Site 300 of the Lawrence Livermore National Laboratory, (Terusaki, 2007), outlines the EWTF project-specific soil sampling requirements. Soil samples were obtained and analyzed for constituents from four chemical groups: furans, explosives, semi-volatiles and metals. Analytical results showed that furans, explosives and semi-volatiles were not detected; therefore, no further analysis was conducted. The soil samples did show the presence of metals. Soil samples analyzed for metals were compared to site-wide background levels, which had been developed for site -wide cleanup activities pursuant to the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA). Total metal concentrations from 28 discrete soil samples obtained in the EWTF area were all below CERCLA-developed background levels. Therefore, following DTSC 1996 guidance, the EWTF hazardous waste treatment units exit the ecological risk evaluation process upon completion of the requirements of a scoping-level assessment report. This summary report documents that the requirements of a scoping-level assessment have been met.« less

A model for evaluating the environmental benefits of elementary school facilities.

PubMed

Ji, Changyoon; Hong, Taehoon; Jeong, Kwangbok; Leigh, Seung-Bok

2014-01-01

In this study, a model that is capable of evaluating the environmental benefits of a new elementary school facility was developed. The model is composed of three steps: (i) retrieval of elementary school facilities having similar characteristics as the new elementary school facility using case-based reasoning; (ii) creation of energy consumption and material data for the benchmark elementary school facility using the retrieved similar elementary school facilities; and (iii) evaluation of the environmental benefits of the new elementary school facility by assessing and comparing the environmental impact of the new and created benchmark elementary school facility using life cycle assessment. The developed model can present the environmental benefits of a new elementary school facility in terms of monetary values using Environmental Priority Strategy 2000, a damage-oriented life cycle impact assessment method. The developed model can be used for the following: (i) as criteria for a green-building rating system; (ii) as criteria for setting the support plan and size, such as the government's incentives for promoting green-building projects; and (iii) as criteria for determining the feasibility of green building projects in key business sectors. Copyright © 2013 Elsevier Ltd. All rights reserved.

Lessons Learned from Radioactive Waste Storage and Disposal Facilities

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

Esh, David W.; Bradford, Anna H.

2008-01-15

The safety of radioactive waste disposal facilities and the decommissioning of complex sites may be predicated on the performance of engineered and natural barriers. For assessing the safety of a waste disposal facility or a decommissioned site, a performance assessment or similar analysis is often completed. The analysis is typically based on a site conceptual model that is developed from site characterization information, observations, and, in many cases, expert judgment. Because waste disposal facilities are sited, constructed, monitored, and maintained, a fair amount of data has been generated at a variety of sites in a variety of natural systems. Thismore » paper provides select examples of lessons learned from the observations developed from the monitoring of various radioactive waste facilities (storage and disposal), and discusses the implications for modeling of future waste disposal facilities that are yet to be constructed or for the development of dose assessments for the release of decommissioning sites. Monitoring has been and continues to be performed at a variety of different facilities for the disposal of radioactive waste. These include facilities for the disposal of commercial low-level waste (LLW), reprocessing wastes, and uranium mill tailings. Many of the lessons learned and problems encountered provide a unique opportunity to improve future designs of waste disposal facilities, to improve dose modeling for decommissioning sites, and to be proactive in identifying future problems. Typically, an initial conceptual model was developed and the siting and design of the disposal facility was based on the conceptual model. After facility construction and operation, monitoring data was collected and evaluated. In many cases the monitoring data did not comport with the original site conceptual model, leading to additional investigation and changes to the site conceptual model and modifications to the design of the facility. The following cases are discussed: commercial LLW disposal facilities; uranium mill tailings disposal facilities; and reprocessing waste storage and disposal facilities. The observations developed from the monitoring and maintenance of waste disposal and storage facilities provide valuable lessons learned for the design and modeling of future waste disposal facilities and the decommissioning of complex sites.« less

Facility-level outcome performance measures for nursing homes.

PubMed

Porell, F; Caro, F G

1998-12-01

Risk-adjusted nursing home performance scores were developed for four health outcomes and five quality indicators from resident-level longitudinal case-mix reimbursement data for Medicaid residents of more than 500 nursing homes in Massachusetts. Facility performance was measured by comparing actual resident outcomes with expected outcomes derived from quarterly predictions of resident-level econometric models over a 3-year period (1991-1994). Performance measures were tightly distributed among facilities in the state. The intercorrelations among the nine outcome performance measures were relatively low and not uniformly positive. Performance measures were not highly associated with various structural facility attributes. For most outcomes, longitudinal analyses revealed only modest correlations between a facility's performance score from one time period to the next. Relatively few facilities exhibited consistent superior or inferior performance over time. The findings have implications toward the practical use of facility outcome performance measures for quality assurance and reimbursement purposes in the near future.

Central Facilities Area Sewage Lagoon Evaluation

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

Cole, Mark R.

2013-12-01

The Central Facilities Area (CFA), located in Butte County, Idaho, at the Idaho National Laboratory has an existing wastewater system to collect and treat sanitary wastewater and non-contact cooling water from the facility. The existing treatment facility consists of three cells: Cell #1 has a surface area of 1.7 acres, Cell #2 has a surface area of 10.3 acres, and Cell #3 has a surface area of 0.5 acres. If flows exceed the evaporative capacity of the cells, wastewater is discharged to a 73.5-acre land application site that uses a center-pivot irrigation sprinkler system. As flows at CFA have decreasedmore » in recent years, the amount of wastewater discharged to the land application site has decreased from 13.64 million gallons in 2004 to no discharge in 2012 and 2013. In addition to the decreasing need for land application, approximately 7.7 MG of supplemental water was added to the system in 2013 to maintain a water level and prevent the clay soil liners in the cells from drying out and “cracking.” The Idaho National Laboratory is concerned that the sewage lagoons and land application site may be oversized for current and future flows. A further concern is the sustainability of the large volumes of supplemental water that are added to the system according to current operational practices. Therefore, this study was initiated to evaluate the system capacity, operational practices, and potential improvement alternatives, as warranted.« less

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.

SPRT Calibration Uncertainties and Internal Quality Control at a Commercial SPRT Calibration Facility

NASA Astrophysics Data System (ADS)

Wiandt, T. J.

2008-06-01

The Hart Scientific Division of the Fluke Corporation operates two accredited standard platinum resistance thermometer (SPRT) calibration facilities, one at the Hart Scientific factory in Utah, USA, and the other at a service facility in Norwich, UK. The US facility is accredited through National Voluntary Laboratory Accreditation Program (NVLAP), and the UK facility is accredited through UKAS. Both provide SPRT calibrations using similar equipment and procedures, and at similar levels of uncertainty. These uncertainties are among the lowest available commercially. To achieve and maintain low uncertainties, it is required that the calibration procedures be thorough and optimized. However, to minimize customer downtime, it is also important that the instruments be calibrated in a timely manner and returned to the customer. Consequently, subjecting the instrument to repeated calibrations or extensive repeated measurements is not a viable approach. Additionally, these laboratories provide SPRT calibration services involving a wide variety of SPRT designs. These designs behave differently, yet predictably, when subjected to calibration measurements. To this end, an evaluation strategy involving both statistical process control and internal consistency measures is utilized to provide confidence in both the instrument calibration and the calibration process. This article describes the calibration facilities, procedure, uncertainty analysis, and internal quality assurance measures employed in the calibration of SPRTs. Data will be reviewed and generalities will be presented. Finally, challenges and considerations for future improvements will be discussed.

Stock-outs of essential health products in Mozambique - longitudinal analyses from 2011 to 2013.

PubMed

Wagenaar, Bradley H; Gimbel, Sarah; Hoek, Roxanne; Pfeiffer, James; Michel, Cathy; Manuel, João Luis; Cuembelo, Fatima; Quembo, Titos; Afonso, Pires; Gloyd, Stephen; Sherr, Kenneth

2014-07-01

To assess the relationship between health system factors and facility-level EHP stock-outs in Mozambique. Service provisions were assessed in 26 health facilities and 13 district warehouses in Sofala Province, Mozambique, from July to August in 2011-2013. Generalised estimating equations were used to model factors associated with facility-level availability of essential drugs, supplies and equipment. Stock-out rates for drugs ranged from 1.3% for oral rehydration solution to 20.5% for Depo-Provera and condoms, with a mean stock-out rate of 9.1%; mean stock-out rates were 15.4% for supplies and 4.1% for equipment. Stock-outs at the district level accounted for 27.1% (29/107) of facility-level drug stock-outs and 44.0% (37/84) of supply stock-outs. Each 10-km increase in the distance from district distribution warehouses was associated with a 31% (CI: 22-42%), 28% (CI: 17-40%) or 27% (CI: 7-50%) increase in rates of drug, supply or equipment stock-outs, respectively. The number of heath facility staff was consistently negatively associated with the occurrence of stock-outs. Facility-level stock-outs of EHPs in Mozambique are common and appear to disproportionately affect those living far from district capitals and near facilities with few health staff. The majority of facility-level EHP stock-outs in Mozambique occur when stock exists at the district distribution centre. Innovative methods are urgently needed to improve EHP supply chains, requesting and ordering of drugs, facility and district communication, and forecasting of future EHP needs in Mozambique. Increased investments in public-sector human resources for health could potentially decrease the occurrence of EHP stock-outs. © 2014 John Wiley & Sons Ltd.

Stock-outs of essential health products in Mozambique-longitudinal analyses from 2011 to 2013

PubMed Central

Wagenaar, Bradley H.; Gimbel, Sarah; Hoek, Roxanne; Pfeiffer, James; Michel, Cathy; Manuel, João Luis; Cuembelo, Fatima; Quembo, Titos; Afonso, Pires; Gloyd, Stephen; Sherr, Kenneth

2015-01-01

objectives To assess the relationship between health system factors and facility-level EHP stock-outs in Mozambique. methods Service provisions were assessed in 26 health facilities and 13 district warehouses in Sofala Province, Mozambique, from July to August in 2011–2013. Generalised estimating equations were used to model factors associated with facility-level availability of essential drugs, supplies and equipment. results Stock-out rates for drugs ranged from 1.3% for oral rehydration solution to 20.5% for Depo-Provera and condoms, with a mean stock-out rate of 9.1%; mean stock-out rates were 15.4% for supplies and 4.1% for equipment. Stock-outs at the district level accounted for 27.1% (29/107) of facility-level drug stock-outs and 44.0% (37/84) of supply stock-outs. Each 10-km increase in the distance from district distribution warehouses was associated with a 31% (CI: 22–42%), 28% (CI: 17–40%) or 27% (CI: 7–50%) increase in rates of drug, supply or equipment stock-outs, respectively. The number of heath facility staff was consistently negatively associated with the occurrence of stock-outs. conclusions Facility-level stock-outs of EHPs in Mozambique are common and appear to disproportionately affect those living far from district capitals and near facilities with few health staff. The majority of facility-level EHP stock-outs in Mozambique occur when stock exists at the district distribution centre. Innovative methods are urgently needed to improve EHP supply chains, requesting and ordering of drugs, facility and district communication, and forecasting of future EHP needs in Mozambique. Increased investments in public-sector human resources for health could potentially decrease the occurrence of EHP stock-outs. PMID:24724617

Costs of facility-based HIV testing in Malawi, Zambia and Zimbabwe

PubMed Central

Mwenge, Lawrence; Sande, Linda; Mangenah, Collin; Ahmed, Nurilign; Kanema, Sarah; d’Elbée, Marc; Sibanda, Euphemia; Kalua, Thokozani; Ncube, Gertrude; Johnson, Cheryl C.; Hatzold, Karin; Cowan, Frances M.; Corbett, Elizabeth L.; Ayles, Helen; Maheswaran, Hendramoorthy

2017-01-01

Background Providing HIV testing at health facilities remains the most common approach to ensuring access to HIV treatment and prevention services for the millions of undiagnosed HIV-infected individuals in sub-Saharan Africa. We sought to explore the costs of providing these services across three southern African countries with high HIV burden. Methods Primary costing studies were undertaken in 54 health facilities providing HIV testing services (HTS) in Malawi, Zambia and Zimbabwe. Routinely collected monitoring and evaluation data for the health facilities were extracted to estimate the costs per individual tested and costs per HIV-positive individual identified. Costs are presented in 2016 US dollars. Sensitivity analysis explored key drivers of costs. Results Health facilities were testing on average 2290 individuals annually, albeit with wide variations. The mean cost per individual tested was US$5.03.9 in Malawi, US$4.24 in Zambia and US$8.79 in Zimbabwe. The mean cost per HIV-positive individual identified was US$79.58, US$73.63 and US$178.92 in Malawi, Zambia and Zimbabwe respectively. Both cost estimates were sensitive to scale of testing, facility staffing levels and the costs of HIV test kits. Conclusions Health facility based HIV testing remains an essential service to meet HIV universal access goals. The low costs and potential for economies of scale suggests an opportunity for further scale-up. However low uptake in many settings suggests that demand creation or alternative testing models may be needed to achieve economies of scale and reach populations less willing to attend facility based services. PMID:29036171

Study of emergency setting for urban facility using microsimulation tool

NASA Astrophysics Data System (ADS)

Campisi, Tiziana; Canale, Antonino; Tesoriere, Giovanni

2017-11-01

Today Public transport is growing not only in terms of high passenger capacity but also considering high efficiency and it has become one of the preferred alternatives to automobile travel. This is evident, as for example, in the case of airport terminal working and management. The same could be for Bus Transport station considering roadway. As a result, many railway stations experience high levels of pedestrian congestion especially during the morning and afternoon peak periods. Traditional design and evaluation procedures for pedestrian transit facilities aim to maintain a desirable Pedestrian Level-Of-Service (PLOS) for the individual pedestrian areas or sub precincts. More in general, transit facilities and their sub-precincts interact with one another so that pedestrian circulation might be better assessed from a broader systems perspective. Microsimulation packages that can model pedestrians (e.g. VISSIM-VISWALK) can be employed to assess these interactions. This research outlines a procedure for the potential implementation of pedestrian flow analysis in a bus/rail transit station using micro-simulation. Base model data requirements are identified which include static (facility layout and locations of temporary equipment) and dynamic data (pedestrian demand and public transport services). Possible model calibration criteria would be also identified. A VISSIM micro-simulation base model would be developed for one of the main Airport terminal in Sicily (Italy) for investigating proposed station operational and infrastructure changes. This case study provided a good example for the potential implementation of micro-simulation models in the analysis of pedestrian circulation.

Informal caregiving burden and perceived social support in an acute stroke care facility.

PubMed

Akosile, Christopher Olusanjo; Banjo, Tosin Olamilekan; Okoye, Emmanuel Chiebuka; Ibikunle, Peter Olanrewaju; Odole, Adesola Christiana

2018-04-05

Providing informal caregiving in the acute in-patient and post-hospital discharge phases places enormous burden on the caregivers who often require some form of social support. However, it appears there are few published studies about informal caregiving in the acute in-patient phase of individuals with stroke particularly in poor-resource countries. This study was designed to evaluate the prevalence of caregiving burden and its association with patient and caregiver-related variables and also level of perceived social support in a sample of informal caregivers of stroke survivors at an acute stroke-care facility in Nigeria. Ethical approval was sought and obtained. Fifty-six (21 males, 35 females) consecutively recruited informal caregivers of stroke survivors at the medical ward of a tertiary health facility in South-Southern Nigeria participated in this cross-sectional survey. Participants' level of care-giving strain/burden and perceived social support were assessed using the Caregiver Strain Index and the Multidimensional Scale of Perceived Social Support respectively. Caregivers' and stroke survivors' socio-demographics were also obtained. Data was analysed using frequency count and percentages, independent t-test, analysis of variance (ANOVA) and partial correlation at α =0.05. The prevalence of care-giving burden among caregivers is 96.7% with a high level of strain while 17.9% perceived social support as low. No significant association was found between caregiver burden and any of the caregiver- or survivor-related socio-demographics aside primary level education. Only the family domain of the Multidimensional Scale of Perceived Social Support was significantly correlated with burden (r = - 0.295). Informal care-giving burden was highly prevalent in this acute stroke caregiver sample and about one in every five of these caregivers rated social support low. This is a single center study. Healthcare managers and professionals in acute care facilities should device strategies to minimize caregiver burden and these may include family education and involvement.

LLNL Contribution to Sandia Used Fuel Disposition - Security March 2011 Deliverable

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

Blink, J A

2011-03-23

Cleary [2007] divides the proliferation pathway into stages: diversion, facility misuse, transportation, transformation, and weapons fabrication. King [2010], using Cleary's methodology, compares a deepburn fusion-driven blanket containing weapons-grade plutonium with a PWR burning MOX fuel enrichments of 5-9%. King considers the stages of theft, transportation, transformation, and nuclear explosive fabrication. In the current study of used fuel storage security, a similar approach is appropriate. First, one must consider the adversary's objective, which can be categorized as on-site radionuclide dispersion, theft of material for later radionuclide dispersion, and theft of material for later processing and fabrication into a nuclear explosive. Formore » on-site radionuclide dispersion, only a single proliferation pathway stage is appropriate: dispersion. That situation will be addressed in future reports. For later radionuclide dispersion, the stages are theft, transportation, and transformation (from oxide spent fuel containing both fission products and actinides to a material size and shape suitable for dispersion). For later processing and fabrication into a nuclear explosive, the stages are theft (by an outsider or by facility misuse by an insider), transportation, transformation (from oxide spent fuel containing both fission products and actinides to a metal alloy), and fabrication (of the alloy into a weapon). It should be noted that the theft and transportation stages are similar, and possibly identical, for later radionuclide dispersion and later processing and fabrication into a nuclear explosive. Each stage can be evaluated separately, and the methodology can vary for each stage. For example, King starts with the methodology of Cleary for the theft, transportation, transformation, and fabrication stages. Then, for each stage, King assembles and modifies the attributes and inputs suggested by Cleary. In the theft (also known as diversion) stage, Cleary has five high-level categories (material handling during diversion, difficulty of evading detection by the accounting system, difficulty of evading detection by the material control system, difficulty of conducting undeclared facility modifications for the purpose of diverting nuclear material, and difficulty of evading detection of the facility modifications for the purposes of diverting nuclear material). Each category has one or more subcategories. For example, the first category includes mass per significant quantity (SQ) of nuclear material, volume/SQ of nuclear material, number of items/SQ, material form (solid, liquid, powder, gas), radiation level in terms of dose, chemical reactivity, heat load, and process temperature. King adds the following two subcategories to that list: SQs available for theft, and interruptions/changes (normal and unexpected) in material stocks and flows. For the situation of an orphaned surface storage facility, this approach is applicable, with some of the categories and subcategories being modified to reflect the static situation (no additions or removals of fuel or containers). In addition, theft would require opening a large overpack and either removing a full container or opening that sealed container and then removing one or more spent nuclear fuel assemblies. These activities would require time without observation (detection), heavy-duty equipment, and some degree of protection of the thieves from radiological dose. In the transportation stage, Cleary has two high-level categories (difficulty of handling material during transportation, and difficulty of evading detection during transport). Each category has a number of subcategories. For the situation of an orphaned surface storage facility, these categories are applicable. The transformation stage of Cleary has three high-level categories (facilities and equipment needed to process diverted materials; knowledge, skills, and workforce needed to process diverted materials; and difficulty of evading detection of transformation activities). Again, there are subcategories. King [2007] adds a fourth high-level category: time required to transform the materials. For the situation of an orphaned surface storage facility, the categories are applicable, but the evaluations of each category and subcategory will be significantly different for later radionuclide dispersion than for later processing and fabrication into a nuclear explosive. The fabrication stage of Cleary has three high-level categories (difficulty associated with design, handling difficulties, and knowledge and skills needed to design and fabricate). King replaces the first two high-level categories with the Figure of Merit for Nuclear Explosives Utility (FOM), with subcategories of bare critical mass, heat content of transformed material, dose rate of transformed material, and SQs available for theft. The next section of this report describes the FOM in more detail.« less

Further assessment of houseflies (Musca domestica) as vectors for the mechanical transport and transmission of porcine reproductive and respiratory syndrome virus under field conditions.

PubMed

Pitkin, Andrea; Deen, John; Otake, Satoshi; Moon, Roger; Dee, Scott

2009-04-01

The purpose of this study was to evaluate the potential for houseflies (Musca domestica) to mechanically transport and transmit porcine reproductive and respiratory syndrome virus (PRRSV) between pig populations under controlled field conditions. The study employed swine housed in commercial livestock facilities and a release-recapture protocol involving marked (ochre-eyed) houseflies. To assess whether transport of PRRSV by insects occurred, ochre-eyed houseflies were released and collected from a facility housing an experimentally PRRSV-inoculated population of pigs (facility A) and collected from a neighboring facility located 120 m to the northwest that housed a naïve pig population (facility B). All samples were tested for PRRSV RNA by polymerase chain reaction (PCR). To assess transmission between the 2 populations, blood samples were collected from naïve pigs in facility B at designated intervals and tested by PCR. A total of 7 replicates were conducted. During 2 of 7 replicates (1 and 5), PCR-positive ochre-eyed houseflies were recovered in facility B and pigs in this facility became infected with PRRSV. Chi-squared analysis indicated that the presence of PRRSV in an insect sample was significantly (P = 0.0004) associated with infection of facility B pigs. Porcine reproductive and respiratory syndrome virus was not recovered from other reported routes of transmission during the study period, including air, fomites, and personnel. In conclusion, while an insufficient number of replicates were conducted to predict the frequency of the event, houseflies may pose some level of risk for the transport and transmission of PRRSV between pig populations under field conditions.

Further assessment of houseflies (Musca domestica) as vectors for the mechanical transport and transmission of porcine reproductive and respiratory syndrome virus under field conditions

PubMed Central

Pitkin, Andrea; Deen, John; Otake, Satoshi; Moon, Roger; Dee, Scott

2009-01-01

The purpose of this study was to evaluate the potential for houseflies (Musca domestica) to mechanically transport and transmit porcine reproductive and respiratory syndrome virus (PRRSV) between pig populations under controlled field conditions. The study employed swine housed in commercial livestock facilities and a release-recapture protocol involving marked (ochre-eyed) houseflies. To assess whether transport of PRRSV by insects occurred, ochre-eyed houseflies were released and collected from a facility housing an experimentally PRRSV-inoculated population of pigs (facility A) and collected from a neighboring facility located 120 m to the northwest that housed a naïve pig population (facility B). All samples were tested for PRRSV RNA by polymerase chain reaction (PCR). To assess transmission between the 2 populations, blood samples were collected from naïve pigs in facility B at designated intervals and tested by PCR. A total of 7 replicates were conducted. During 2 of 7 replicates (1 and 5), PCR-positive ochre-eyed houseflies were recovered in facility B and pigs in this facility became infected with PRRSV. Chi-squared analysis indicated that the presence of PRRSV in an insect sample was significantly (P = 0.0004) associated with infection of facility B pigs. Porcine reproductive and respiratory syndrome virus was not recovered from other reported routes of transmission during the study period, including air, fomites, and personnel. In conclusion, while an insufficient number of replicates were conducted to predict the frequency of the event, houseflies may pose some level of risk for the transport and transmission of PRRSV between pig populations under field conditions. PMID:19436589

Evaluation of the Revolver Ignition Design at the National Ignition Facility Using Polar-Direct-Drive Illumination

NASA Astrophysics Data System (ADS)

McKenty, P. W.; Collins, T. J. B.; Marozas, J. A.; Campbell, E. M.; Molvig, K.; Schmitt, M.

2017-10-01

The direct-drive ignition design Revolver employs a triple-shell target using a beryllium ablator, a copper driver, and an eventual gold pusher. Symmetric numerical calculations indicate that each of the three shells exhibit low convergence ( 3to 5) resulting in a modest gain (G 4) for 1.7 MJ of incident laser energy. Studies are now underway to evaluate the robustness of this design employing polar direct drive (PDD) at the National Ignition Facility. Integral to these calculations is the leveraging of illumination conditioning afforded by research done to demonstrate ignition for a traditional PDD hot-spot target design. Two-dimensional simulation results, employing nonlocal electron-thermal transport and cross-beam energy transport, will be presented that indicate ignition using PDD. A study of the allowed levels of long-wavelength perturbations (target offset and power imbalance) not precluding ignition will also be examined. This material is based upon work supported by the Department of Energy National Nuclear Security Administration under Award Number DE-NA0001944.

Technology evaluation report: SITE (Superfund Innovative Technology Evaluation) program demonstration test. The American Combustion Pyretron Thermal Destruction System at the US EPA's (Environmental Protection Agency's) combustion research facility

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

Waterland, L.; Lee, J.W.

1989-04-01

A series of demonstration tests of the American Combustion, Inc., Thermal Destruction System was performed under the SITE program. This oxygen-enhanced combustion system was retrofit to the rotary-kiln incinerator at EPA's Combustion Research Facility. The system's performance was tested firing contaminated soil from the Stringfellow Superfund Site, both alone and mixed with a coal tar waste (KO87). Comparative performance with conventional incinerator operation was also tested. Compliance with the incinerator performance standards of 99.99% principal organic hazardous constituents (POHC) destruction and removal efficiency and particulate emissions of less than 180 mg/dscm at 7% O2 was measured for all tests. Themore » Pyretron system was capable of in-compliance performance at double the mixed waste feedrate and at a 60% increase in batch waste charge mass than possible with conventional incineration. Scrubber blowdown and kiln ash contained no detectable levels of any of the POHCs chosen.« less

Special Analysis: 2017-001 Disposal of Drums Containing Enriched Uranium in Pit 38 at Technical Area 54, Area G

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

Birdsell, Kay Hanson; Stauffer, Philip H.; French, Sean B.

Los Alamos National Laboratory (LANL) generates radioactive waste as a result of various activities. Operational waste is generated from a wide variety of research and development activities including nuclear weapons development, energy production, and medical research. Environmental restoration (ER), and decontamination and decommissioning (D&D) waste is generated as contaminated sites and facilities at LANL undergo cleanup or remediation. The majority of this waste is low-level radioactive waste (LLW) and is disposed of at the Technical Area 54 (TA-54), Area G disposal facility. This special analysis, SA 2017-001, evaluates the potential impacts of disposing of this waste in Pit 38 atmore » Area G based on the assumptions that form the basis of the Area G PA/CA. Section 2 describes the methods used to conduct the analysis; the results of the evaluation are provided in Section 3; and conclusions and recommendations are provided in Section 4.« less

RELEASE OF DRIED RADIOACTIVE WASTE MATERIALS TECHNICAL BASIS DOCUMENT

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

KOZLOWSKI, S.D.

2007-05-30

This technical basis document was developed to support RPP-23429, Preliminary Documented Safety Analysis for the Demonstration Bulk Vitrification System (PDSA) and RPP-23479, Preliminary Documented Safety Analysis for the Contact-Handled Transuranic Mixed (CH-TRUM) Waste Facility. The main document describes the risk binning process and the technical basis for assigning risk bins to the representative accidents involving the release of dried radioactive waste materials from the Demonstration Bulk Vitrification System (DBVS) and to the associated represented hazardous conditions. Appendices D through F provide the technical basis for assigning risk bins to the representative dried waste release accident and associated represented hazardous conditionsmore » for the Contact-Handled Transuranic Mixed (CH-TRUM) Waste Packaging Unit (WPU). The risk binning process uses an evaluation of the frequency and consequence of a given representative accident or represented hazardous condition to determine the need for safety structures, systems, and components (SSC) and technical safety requirement (TSR)-level controls. A representative accident or a represented hazardous condition is assigned to a risk bin based on the potential radiological and toxicological consequences to the public and the collocated worker. Note that the risk binning process is not applied to facility workers because credible hazardous conditions with the potential for significant facility worker consequences are considered for safety-significant SSCs and/or TSR-level controls regardless of their estimated frequency. The controls for protection of the facility workers are described in RPP-23429 and RPP-23479. Determination of the need for safety-class SSCs was performed in accordance with DOE-STD-3009-94, Preparation Guide for US. Department of Energy Nonreactor Nuclear Facility Documented Safety Analyses, as described below.« less

Improving quality of care through payment for performance: examining effects on the availability and stock-out of essential medical commodities in Tanzania.

PubMed

Binyaruka, Peter; Borghi, Josephine

2017-01-01

To evaluate the effects of payment for performance (P4P) on the availability and stock-out rate of reproductive, maternal, newborn and child health (RMNCH) medical commodities in Tanzania and assess the distributional effects. The availability of RMNCH commodities (medicines, supplies and equipment) on the day of the survey, and stock-outs for at least one day in the 90 days prior to the survey, was measured in 75 intervention and 75 comparison facilities in January 2012 and 13 months later. Composite scores for each subgroup of commodities were generated. A difference-in-differences linear regression was used to estimate the effect of P4P on outcomes and differential effects by facility location, level of care, ownership and socio-economic status of the catchment population. We estimated a significant increase in the availability of medicines by 8.4 percentage points (P = 0.002) and an 8.3 percentage point increase (P = 0.050) in the availability of medical supplies. P4P had no effect on the availability of functioning equipment. Most items with a significant increase in availability also showed a significant reduction in stock-outs. Effects were generally equally distributed across facilities, with effects on stock-outs of many medicines being pro-poor, and greater effects in facilities in rural compared to urban districts. P4P can improve the availability of medicines and medical supplies, especially in poor, rural areas, when these commodities are incentivised at both facility and district levels, making services more acceptable, effective and affordable, enhancing progress towards universal health coverage. © 2016 John Wiley & Sons Ltd.

Timeliness of abnormal screening and diagnostic mammography follow-up at facilities serving vulnerable women.

PubMed

Goldman, L Elizabeth; Walker, Rod; Hubbard, Rebecca; Kerlikowske, Karla

2013-04-01

Whether timeliness of follow-up after abnormal mammography differs at facilities serving vulnerable populations, such as women with limited education or income, in rural areas, and racial/ethnic minorities is unknown. We examined receipt of diagnostic evaluation after abnormal mammography using 1998-2006 Breast Cancer Surveillance Consortium-linked Medicare claims. We compared whether time to recommended breast imaging or biopsy depended on whether women attended facilities serving vulnerable populations. We characterized a facility by the proportion of mammograms performed on women with limited education or income, in rural areas, or racial/ethnic minorities. We analyzed 30,874 abnormal screening examinations recommended for follow-up imaging across 142 facilities and 10,049 abnormal diagnostic examinations recommended for biopsy across 114 facilities. Women at facilities serving populations with less education or more racial/ethnic minorities had lower rates of follow-up imaging (4%-5% difference, P<0.05), and women at facilities serving more rural and low-income populations had lower rates of biopsy (4%-5% difference, P<0.05). Women undergoing biopsy at facilities serving vulnerable populations had longer times until biopsy than those at facilities serving nonvulnerable populations (21.6 vs. 15.6 d; 95% confidence interval for mean difference 4.1-7.7). The proportion of women receiving recommended imaging within 11 months and biopsy within 3 months varied across facilities (interquartile range, 85.5%-96.5% for imaging and 79.4%-87.3% for biopsy). Among Medicare recipients, follow-up rates were slightly lower at facilities serving vulnerable populations, and among those women who returned for diagnostic evaluation, time to follow-up was slightly longer at facilities that served vulnerable population. Interventions should target variability in follow-up rates across facilities, and evaluate effectiveness particularly at facilities serving vulnerable populations.

Nursing home consumer complaints and their potential role in assessing quality of care.

PubMed

Stevenson, David G

2005-02-01

State survey agencies collect and investigate consumer complaints for care in nursing homes and other health care settings. Complaint investigations play a key role in quality assurance, because they can respond to concerns of consumers and families. This study uses 5 years of nursing home complaints data from Massachusetts (1998-2002) to investigate whether complaints might be used to assess nursing home quality of care. The investigator matches facility-level complaints data with On-Line Survey Certification and Reporting (OSCAR) data and Minimum Data Set Quality Indicator (MDS QI) data to evaluate the association between consumer complaints, facility and resident characteristics, and other nursing home quality measures. Consumer complaints varied across facility characteristics in ways consistent with the nursing home quality literature. Complaints were consistently and significantly associated with survey deficiencies, the presence of a serious survey deficiency, and nurse aide staffing. Complaints were not significantly associated with nurse staffing, and associations with 6 MDS QIs were mixed. The number of complaints was significantly predictive of survey deficiencies identified at the subsequent inspection. Nursing home consumer complaints provide a supplemental tool with which to differentiate nursing homes on quality. Despite limitations, complaints data have potential strengths when used in combination with other quality measures. The potential of using consumer complaints to assess nursing home quality of care should be evaluated in states beyond Massachusetts. Evaluating consumer complaints also might be a productive area of inquiry for other health care settings such as hospitals and home health agencies.

Evaluating the Maturity of Cybersecurity Programs for Building Control Systems

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

Glantz, Clifford S.; Somasundaram, Sriram; Mylrea, Michael E.

The cyber-physical security threat to buildings is complex, non-linear, and rapidly evolving as operational and information technologies converge and connect buildings to cyberspace. Cyberattacks on buildings can exploit smart building controls and breach corporate networks, causing financial and reputational damage. This may result in the loss of sensitive building information or the disruption of, or damage to, the systems necessary for the safe and efficient operation of buildings. For the buildings and facility infrastructure, there is a need for a robust national cybersecurity strategy for buildings, guidance on the selection and implementation of appropriate cybersecurity controls for buildings, an approachmore » to evaluate the maturity and adequacy of the cybersecurity programs. To provide an approach for evaluating the maturity of the cybersecurity programs for building control systems, the US Department of Energy’s widely used Cybersecurity Capability and Maturity Model (C2M2) has been adapted into a building control systems version. The revised model, the Buildings-C2M2 (B-C2M2) provides maturity level indicators for cybersecurity programmatic domains. A “B-C2M2 Lite” version allows facility managers and building control system engineers, or information technology personnel to perform rapid self-assessments of their cybersecurity program. Both tools have been pilot tested on several facilities. This paper outlines the concept of a maturity model, describes the B-C2M2 tools, presents results and observations from the pilot assessments, and lays out plans for future work.« less

Implementation of tuberculosis infection prevention and control in Mozambican health care facilities.

PubMed

Brouwer, M; Coelho, E; das Dores Mosse, C; van Leth, F

2015-01-01

District and urban health care facilities in three provinces (Manica, Sofala, Tete) in central Mozambique. To assess the level of implementation of selected tuberculosis infection prevention and control (TB-IPC) measures. In a cross-sectional study of TB-IPC implementation in 29 health care facilities, we assessed TB clinics, laboratories, out-patient departments and medical and TB wards. Assessment included selected managerial, administrative and environmental measures and the availability and use of respiratory protective equipment (N95 respirators). Guidelines for diagnosis and treatment of (presumptive) TB patients were not present in all facilities. Staff instructed patients on sputum collection in 91%, but only 4% observed it. Using a pragmatic '20% rule', 52% of the rooms assessed had adequate ventilation. Potentially, this could be increased to 76%. Three quarters of the health care workers had N95 respirators. Only 36% knew how to use it correctly. Implementation of TB-IPC measures showed wide variations within health care facilities. Relatively simple measures to improve TB-IPC include the availability of guidelines, opening doors and windows to improve ventilation, and training and support on correct N95 respirator use. However, even relatively simple measures are challenging to implement, and require careful attention in and evaluation of the implementation process.

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

Integration of Biosafety into Core Facility Management

PubMed Central

Fontes, Benjamin

2013-01-01

This presentation will discuss the implementation of biosafety policies for small, medium and large core laboratories with primary shared objectives of ensuring the control of biohazards to protect core facility operators and assure conformity with applicable state and federal policies, standards and guidelines. Of paramount importance is the educational process to inform core laboratories of biosafety principles and policies and to illustrate the technology and process pathways of the core laboratory for biosafety professionals. Elevating awareness of biohazards and the biosafety regulatory landscape among core facility operators is essential for the establishment of a framework for both project and material risk assessment. The goal of the biohazard risk assessment process is to identify the biohazard risk management parameters to conduct the procedure safely and in compliance with applicable regulations. An evaluation of the containment, protective equipment and work practices for the procedure for the level of risk identified is facilitated by the establishment of a core facility registration form for work with biohazards and other biological materials with potential risk. The final step in the biocontainment process is the assumption of Principal Investigator role with full responsibility for the structure of the site-specific biosafety program plan by core facility leadership. The presentation will provide example biohazard protocol reviews and accompanying containment measures for core laboratories at Yale University.

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.

Effects of Long-Term Low-Level Radiofrequency Radiation Exposure on Rats. Volume 1. Design, Facilities, and Procedures.

DTIC Science & Technology

1983-09-01

uncovering unsuspected organ system malfunctions. In animals with subclinical or undiagnosed abnormalities, the emphasis is placed on the correct...normochromic, normocytic anemia are suggestive of hypothyroidism , although they do not occur in all hypothyroid animals. The thyroid hormones, thyroxine (T4...evaluation increased the opportunity to detect subclinical abnormalities and follow their pathophysiological course. Open-field assessment was conducted

Health-hazard evaluation report no. HETA-87-404-1893, Park County Courthouse, Fairplay, Colorado

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

Lee, S.A.

1988-05-01

In response to a request from employees at the Park County Courthouse, Fairplay, Colorado, an evaluation was made of indoor air quality at the facility, with specific reference to symptoms of headaches, ringing in the ears, worsening eyesight, and sinus problems. Six people worked at the building which had been constructed 2 years earlier. Air samples were taken at the facility and analyzed for formaldehyde by visible spectroscopy. Formaldehyde levels were measured at 0.03 to 0.06 parts per million (ppm), with a mean of 0.05ppm in the offices and courtrooms. As a result of recommendations, the building was made amore » no smoking area, and outside air vents were connected to the furnaces. At a followup visit, carbon dioxide levels were about 250ppm throughout the building, reaching a maximum of 400ppm at 9:30 in the morning, when 29 people were present in the building. Relative humidity ranged from 14 to 18%. The author concludes that there was no hazard due to exposure to formaldehyde, and that adequate amounts of fresh air were supplied throughout the building. The author recommends increasing the relative humidity to about 40% to alleviate upper respiratory irritation caused by dry air during the heating season.« less

Evaluation of the 183-D Water Filtration Facility for Bat Roosts and Development of a Mitigation Strategy, 100-D Area, Hanford Site

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

Lindsey, C. T.; Gano, K. A.; Lucas, J. G.

The 183-D Water Filtration Facility is located in the 100-D Area of the Hanford Site, north of Richland, Washington. It was used to provide filtered water for cooling the 105-D Reactor and supplying fire-protection and drinking water for all facilities in the 100-D Area. The facility has been inactive since the 1980s and is now scheduled for demolition. Therefore, an evaluation was conducted to determine if any part of the facility was being used as roosting habitat by bats.

Final Work Plan: Phase I Investigation at Bladen, Nebraska

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

LaFreniere, Lorraine M.; Yan, Eugene

The village of Bladen is a town of population approximately 237 in the northwest part of Webster County, Nebraska, 30 mi southwest of Hastings and 140 mi southwest of Lincoln, Nebraska. In 2000, the fumigant-related compound carbon tetrachloride was detected in public water supply well PWS 68-1, at a trace level. Low-level contamination, below the maximum contamination level (MCL) of 5.0 μg/L, has been detected intermittently in well PWS 68-1 since 2000, including in the last sample taken in July 2013. In 2006, the village installed a new well, PWS 2006-1, that remains free of contamination. Because the carbon tetrachloridemore » found in well PWS 68-1 might be linked to historical use of fumigants containing carbon tetrachloride at grain storage facilities, including its former facility in Bladen, the CCC/USDA is proposing an investigation to (1) delineate the source and extent of the carbon tetrachloride contamination potentially associated with its former facility, (2) characterize pathways and controlling factors for contaminant migration in the subsurface, and (3) establish a basis for estimating potential health and environmental risks. The work will be performed in accordance with the Intergovernmental Agreement established between the NDEQ and the Farm Service Agency of the USDA. The site investigation at Bladen will be implemented in phases, so that data collected and interpretations developed during each phase can be evaluated to determine if a subsequent phase of investigation is warranted and, if warranted, to provide effective guidance for the subsequent investigation activities. This Work Plan identifies the specific technical objectives and defines the scope of work proposed for the Phase I investigation by compiling and evaluating historical data. The proposed investigation activities will be performed on behalf of the CCC/USDA by the Environmental Science Division of Argonne National Laboratory. Argonne is a nonprofit, multidisciplinary research institute operated by UChicago Argonne, LLC, for the U.S. Department of Energy.« less

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.

10 CFR 62.11 - Filing and distribution of a determination request.

Code of Federal Regulations, 2010 CFR

2010-01-01

... radioactive waste disposal facilities, to the Compact Commissions with operating regional low-level radioactive waste disposal facilities, and to the Governors of the States in the Compact Commissions with... ACCESS TO NON-FEDERAL AND REGIONAL LOW-LEVEL WASTE DISPOSAL FACILITIES Request for a Commission...

Strategic need for a multi-purpose thermal hydraulic loop for support of advanced reactor technologies

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

O'Brien, James E.; Sabharwall, Piyush; Yoon, Su -Jong

2014-09-01

This report presents a conceptual design for a new high-temperature multi fluid, multi loop test facility for the INL to support thermal hydraulic, materials, and thermal energy storage research for nuclear and nuclear-hybrid applications. In its initial configuration, the facility will include a high-temperature helium loop, a liquid salt loop, and a hot water/steam loop. The three loops will be thermally coupled through an intermediate heat exchanger (IHX) and a secondary heat exchanger (SHX). Research topics to be addressed with this facility include the characterization and performance evaluation of candidate compact heat exchangers such as printed circuit heat exchangers (PCHEs)more » at prototypical operating conditions, flow and heat transfer issues related to core thermal hydraulics in advanced helium-cooled and salt-cooled reactors, and evaluation of corrosion behavior of new cladding materials and accident-tolerant fuels for LWRs at prototypical conditions. Based on its relevance to advanced reactor systems, the new facility has been named the Advanced Reactor Technology Integral System Test (ARTIST) facility. Research performed in this facility will advance the state of the art and technology readiness level of high temperature intermediate heat exchangers (IHXs) for nuclear applications while establishing the INL as a center of excellence for the development and certification of this technology. The thermal energy storage capability will support research and demonstration activities related to process heat delivery for a variety of hybrid energy systems and grid stabilization strategies. Experimental results obtained from this research will assist in development of reliable predictive models for thermal hydraulic design and safety codes over the range of expected advanced reactor operating conditions. Proposed/existing IHX heat transfer and friction correlations and criteria will be assessed with information on materials compatibility and instrumentation needs. The experimental database will guide development of appropriate predictive methods and be available for code verification and validation (V&V) related to these systems.« less

Communities, birth attendants and health facilities: a continuum of emergency maternal and newborn care (the Global Network's EmONC trial).

PubMed

Pasha, Omrana; Goldenberg, Robert L; McClure, Elizabeth M; Saleem, Sarah; Goudar, Shivaprasad S; Althabe, Fernando; Patel, Archana; Esamai, Fabian; Garces, Ana; Chomba, Elwyn; Mazariegos, Manolo; Kodkany, Bhala; Belizan, Jose M; Derman, Richard J; Hibberd, Patricia L; Carlo, Waldemar A; Liechty, Edward A; Hambidge, K Michael; Buekens, Pierre; Wallace, Dennis; Howard-Grabman, Lisa; Stalls, Suzanne; Koso-Thomas, Marion; Jobe, Alan H; Wright, Linda L

2010-12-14

Maternal and newborn mortality rates remain unacceptably high, especially where the majority of births occur in home settings or in facilities with inadequate resources. The introduction of emergency obstetric and newborn care services has been proposed by several organizations in order to improve pregnancy outcomes. However, the effectiveness of emergency obstetric and neonatal care services has never been proven. Also unproven is the effectiveness of community mobilization and community birth attendant training to improve pregnancy outcomes. We have developed a cluster-randomized controlled trial to evaluate the impact of a comprehensive intervention of community mobilization, birth attendant training and improvement of quality of care in health facilities on perinatal mortality in low and middle-income countries where the majority of births take place in homes or first level care facilities. This trial will take place in 106 clusters (300-500 deliveries per year each) across 7 sites of the Global Network for Women's and Children's Health Research in Argentina, Guatemala, India, Kenya, Pakistan and Zambia. The trial intervention has three key elements, community mobilization, home-based life saving skills for communities and birth attendants, and training of providers at obstetric facilities to improve quality of care. The primary outcome of the trial is perinatal mortality. Secondary outcomes include rates of stillbirth, 7-day neonatal mortality, maternal death or severe morbidity (including obstetric fistula, eclampsia and obstetrical sepsis) and 28-day neonatal mortality. In this trial, we are evaluating a combination of interventions including community mobilization and facility training in an attempt to improve pregnancy outcomes. If successful, the results of this trial will provide important information for policy makers and clinicians as they attempt to improve delivery services for pregnant women and newborns in low-income countries. ClinicalTrials.gov NCT01073488.

An analysis of workplace exposures to benzene over four decades at a petrochemical processing and manufacturing facility (1962-1999).

PubMed

Sahmel, J; Devlin, K; Burns, A; Ferracini, T; Ground, M; Paustenbach, D

2013-01-01

Benzene, a known carcinogen, can be generated as a by-product during the use of petroleum-based raw materials in chemical manufacturing. The aim of this study was to analyze a large data set of benzene air concentration measurements collected over nearly 40 years during routine employee exposure monitoring at a petrochemical manufacturing facility. The facility used ethane, propane, and natural gas as raw materials in the production of common commercial materials such as polyethylene, polypropylene, waxes, adhesives, alcohols, and aldehydes. In total, 3607 benzene air samples were collected at the facility from 1962 to 1999. Of these, in total 2359 long-term (>1 h) personal exposure samples for benzene were collected during routine operations at the facility between 1974 and 1999. These samples were analyzed by division, department, and job title to establish employee benzene exposures in different areas of the facility over time. Sampling data were also analyzed by key events over time, including changes in the occupational exposure limits (OELs) for benzene and key equipment process changes at the facility. Although mean benzene concentrations varied according to operation, in nearly all cases measured benzene quantities were below the OEL in place at the time for benzene (10 ppm for 1974-1986 and 1 ppm for 1987-1999). Decreases in mean benzene air concentrations were also found when data were evaluated according to 7- to 10-yr periods following key equipment process changes. Further, an evaluation of mortality rates for a retrospective employee cohort (n = 3938) demonstrated that the average personal benzene exposures at this facility (0.89 ppm for the period 1974-1986 and 0.125 ppm for the period 1987-1999) did not result in increased standardized mortality ratio (SMRs) for diseases or malignancies of the lymphatic system. The robust nature of this data set provides comprehensive exposure information that may be useful for assessing human benzene exposures at similar facilities. The data also provide a basis for comparable measured exposure levels and the potential for adverse health effects. These data may also prove beneficial for comparing relative exposure potential for production versus nonproduction operations and the relationship between area and personal breathing zone samples.

Optimizing Characterization of Site Hydrology in Support of New Reactor Licensing at the U.S. Nuclear Regulatory Commission (Invited)

NASA Astrophysics Data System (ADS)

Nicholson, T. J.; Raione, R.; Ahn, H.; Barnhurst, D.; Giacinto, J.; McBride, M.; Tiruneh, N. D.

2009-12-01

The NRC regulates the civilian use of radioactive materials and facilities in an open and transparent manner. The NRC regulatory criteria are designed to protect human health and safety, and the environment by regulating nuclear facilities. During review of new reactor licensing applications, NRC staff reviews and independently verifies hydrogeologic information submitted by the applicant in several topical areas such as development and testing of Conceptual Site Models (CSM) which may involve perched aquifers; engineered water level fluctuations of surface-water reservoirs; ground-water collector wells and local ground-water uses; design-basis ground-water levels for structural analysis; analysis of scenarios for potential release of radionuclides to the subsurface; deep well injection of effluents; and monitoring to detect radionuclide releases. This information is reviewed in a systematic manner in accordance with NRC requirements and guidance to evaluate safety and environmental impacts and reduce the uncertainties for these impacts. NRC licensing staff is reviewing 14 applications for siting new reactors. Experience gained through these licensing activities has shown the value of using site-specific data to evaluate the CSM and its use to assess design and operational issues. Optimizing the information flow process through a systemically and thorough review process creates efficiencies. Through an iterative process of evaluating various geographical settings and associated ground-water conditions, NRC staff has developed methods to minimize prediction uncertainty through the use of confirmatory analyses performed under conservative, hierarchal approaches.

An evaluation of negative-emission transportation-energy systems for the US

NASA Astrophysics Data System (ADS)

Larson, E. D.; Meerman, J. C.

2017-12-01

We present technical, economic, and carbon footprint evaluations of alternative technological pathways for negative emissions transportation energy from sustainably-sourced lignocellulosic biomass in the U.S. We combine the understanding of alternative technological pathways with spatially-resolved projections of the sustainable supply of lignocellulosic biomass and with future demands for transportation services to provide insights on the extent to which biomass-based energy might be able to help meet mid-century U.S. transportation energy needs and carbon mitigation targets. Biomass conversion routes included in our evaluations are biochemical, biocatalytic, thermocatalytic hydropyrolysis, and thermochemical gasification/synthesis to produce liquid fuels fungible with petroleum-derived fuels, and thermochemical conversion to hydrogen (for fuel cell vehicles) or electricity (for battery electric vehicles). Lifecycle net negative emissions are achieved for each system via soil carbon buildup during biomass production and/or capture of CO2 at the conversion facility and underground storage. Co-processing of some fossil fuel is considered in some cases to improve economics. For self-consistency in the analysis across systems, a common set of technical, economic and carbon footprint input parameters are adopted. Capital cost estimates are harmonized by taking into account scale of facilities, level of engineering details available in generating a cost estimate, and the technology readiness level (TRL) of components and the process as a whole. Implications for economics of future commercial plants are investigated, considering alternative prospective reductions in capital and operating costs (via "learning by doing") and alternative carbon mitigation policies.

Electrical characterization of a Mapham inverter using pulse testing techniques

NASA Technical Reports Server (NTRS)

Baumann, E. D.; Myers, I. T.; Hammond, A. N.

1990-01-01

Electric power requirements for aerospace missions have reached megawatt power levels. Within the next few decades, it is anticipated that a manned lunar base, interplanetary travel, and surface exploration of the Martian surface will become reality. Several research and development projects aimed at demonstrating megawatt power level converters for space applications are currently underway at the NASA Lewis Research Center. Innovative testing techniques will be required to evaluate the components and converters, when developed, at their rated power in the absence of costly power sources, loads, and cooling systems. Facilities capable of testing these components and systems at full power are available, but their use may be cost prohibitive. The use of a multiple pulse testing technique is proposed to determine the electrical characteristics of large megawatt level power systems. Characterization of a Mapham inverter is made using the proposed technique and conclusions are drawn concerning its suitability as an experimental tool to evaluate megawatt level power systems.

Comprehensive and integrated district health systems strengthening: the Rwanda Population Health Implementation and Training (PHIT) Partnership

PubMed Central

2013-01-01

Background Nationally, health in Rwanda has been improving since 2000, with considerable improvement since 2005. Despite improvements, rural areas continue to lag behind urban sectors with regard to key health outcomes. Partners In Health (PIH) has been supporting the Rwanda Ministry of Health (MOH) in two rural districts in Rwanda since 2005. Since 2009, the MOH and PIH have spearheaded a health systems strengthening (HSS) intervention in these districts as part of the Rwanda Population Health Implementation and Training (PHIT) Partnership. The partnership is guided by the belief that HSS interventions should be comprehensive, integrated, responsive to local conditions, and address health care access, cost, and quality. The PHIT Partnership represents a collaboration between the MOH and PIH, with support from the National University of Rwanda School of Public Health, the National Institute of Statistics, Harvard Medical School, and Brigham and Women’s Hospital. Description of intervention The PHIT Partnership’s health systems support aligns with the World Health Organization’s six health systems building blocks. HSS activities focus across all levels of the health system — community, health center, hospital, and district leadership — to improve health care access, quality, delivery, and health outcomes. Interventions are concentrated on three main areas: targeted support for health facilities, quality improvement initiatives, and a strengthened network of community health workers. Evaluation design The impact of activities will be assessed using population-level outcomes data collected through oversampling of the demographic and health survey (DHS) in the intervention districts. The overall impact evaluation is complemented by an analysis of trends in facility health care utilization. A comprehensive costing project captures the total expenditures and financial inputs of the health care system to determine the cost of systems improvement. Targeted evaluations and operational research pieces focus on specific programmatic components, supported by partnership-supported work to build in-country research capacity. Discussion Building on early successes, the work of the Rwanda PHIT Partnership approach to HSS has already seen noticeable increases in facility capacity and quality of care. The rigorous planned evaluation of the Partnership’s HSS activities will contribute to global knowledge about intervention methodology, cost, and population health impact. PMID:23819573

Management support and perceived consumer satisfaction in skilled nursing facilities.

PubMed

Metlen, Scott; Eveleth, Daniel; Bailey, Jeffrey J

2005-08-01

How managers 'manage' employees influences important firm outcomes. Heskett, Sasser, and Schlesinger contend that the level of internal support for service workers will influence consumer satisfaction. This study empirically explores how skilled nursing facility (SNF) managers affect consumer satisfaction by encouraging employee effectiveness and listening to employees to determine how to improve employee effectiveness. We extend previous research by proposing management as a form of internal support and demonstrating its relationship to service process integration, as a distinct form of internal support. The results of our individual-level investigation of 630 nursing assistants from 45 SNFs provide support for our two-part hypothesis. First, active management support and process integration, as elements of internal support, do lead to increased employee satisfaction and employee effectiveness. Second, the increased employee satisfaction and effectiveness was positively related to consumer satisfaction, as evaluated by the service workers. Thus, there is a positive influence of management's internal support of nursing assistants on perceived consumer satisfaction.

SPECIAL ANALYSIS AIR PATHWAY MODELING OF E-AREA LOW-LEVEL WASTE FACILITY

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

Hiergesell, R.; Taylor, G.

This Special Analysis (SA) was initiated to address a concern expressed by the Department of Energy's Low Level Waste Disposal Facility Federal Review Group (LFRG) Review Team during their review of the 2008 E-Area Performance Assessment (PA) (WSRC, 2008). Their concern was the potential for overlapping of atmospheric plumes, emanating from the soil surface above SRS LLW disposal facilities within the E-Area, to contribute to the dose received by a member of the public during the Institutional Control (IC) period. The implication of this concern was that the dose to the maximally-exposed individual (MEI) located at the SRS boundary mightmore » be underestimated during this time interval. To address this concern a re-analysis of the atmospheric pathway releases from E-Area was required. In the process of developing a new atmospheric release model (ARM) capable of addressing the LFRG plume overlap concern, it became obvious that new and better atmospheric pathway disposal limits should be developed for each of the E-Area disposal facilities using the new ARM. The scope of the SA was therefore expanded to include the generation of these new limits. The initial work conducted in this SA was to develop a new ARM using the GoldSim{reg_sign} program (GTG, 2009). The model simulates the subsurface vapor diffusion of volatile radionuclides as they release from E-Area disposal facility waste zones and migrate to the land surface. In the process of this work, many new features, including several new physical and chemical transport mechanisms, were incorporated into the model. One of the most important improvements was to incorporate a mechanism to partition volatile contaminants across the water-air interface within the partially saturated pore space of the engineered and natural materials through which vapor phase transport occurs. A second mechanism that was equally important was to incorporate a maximum concentration of 1.9E-07 Ci/m{sup 3} of {sup 14}CO{sub 2} in the air-filled pores of cementitious materials. The ARM also combines the individual transport models constructed for each E-Area disposal facility into a single model, and was ultimately used to analyze the LFRG concern regarding the potential for atmospheric plume overlap at the SRS boundary during the IC period. To evaluate the plume overlap issue, a conservative approach was adopted whereby the MEI at the SRS boundary was exposed to the releases from all E-Area disposal facilities simultaneously. This is equivalent to a 100% overlap of all atmospheric plumes emanating from E-Area. Should the dose received from this level of atmospheric plume overlap still fall below the permissible exposure level of 10 mrem/yr, then the LFRG concern would be alleviated. The structuring of the ARM enables this evaluation to be easily performed. During the IC period, the peak of the 'total plume overlap dose' was computed to be 1.9E-05 mrem/yr, which is five orders of magnitude lower than the 10 mrem/yr PA performance objective for the atmospheric release pathway. The main conclusion of this study is that for atmospheric releases from the E-Area disposal facilities, plume overlap does not cause the total dose to the MEI at the SRS boundary during the IC to exceed the Performance Assessment (PA) performance objective. Additionally, the potential for plume overlap was assessed in the post-Institutional Control period. Atmospheric plume overlap is less likely to occur during this period but conceivably could occur if the prevailing wind direction shifted so as to pass directly over all EArea disposal facilities and transport airborne radionuclides to the MEI at the 100 m point of compliance (POC). This concern was also demonstrated of little concern, as the maximum plume overlap dose was found to be 1.45E+00 mrem/yr (or {approx}15% of the performance measure) during this period and under these unlikely conditions.« less

Computer-implemented security evaluation methods, security evaluation systems, and articles of manufacture

DOEpatents

Muller, George; Perkins, Casey J.; Lancaster, Mary J.; MacDonald, Douglas G.; Clements, Samuel L.; Hutton, William J.; Patrick, Scott W.; Key, Bradley Robert

2015-07-28

Computer-implemented security evaluation methods, security evaluation systems, and articles of manufacture are described. According to one aspect, a computer-implemented security evaluation method includes accessing information regarding a physical architecture and a cyber architecture of a facility, building a model of the facility comprising a plurality of physical areas of the physical architecture, a plurality of cyber areas of the cyber architecture, and a plurality of pathways between the physical areas and the cyber areas, identifying a target within the facility, executing the model a plurality of times to simulate a plurality of attacks against the target by an adversary traversing at least one of the areas in the physical domain and at least one of the areas in the cyber domain, and using results of the executing, providing information regarding a security risk of the facility with respect to the target.

Biological intrusion of low-level-waste trench covers

NASA Astrophysics Data System (ADS)

Hakonson, T. E.; Gladney, E. S.

The long-term integrity of low-level waste shallow land burialsites is dependent on the interaction of physical, chemical, and biological factors that modify the waste containment system. The need to consider biological processes as being potentially important in reducing the integrity of waste burial site cover treatment is demonstrated. One approach to limiting biological intrusion through the waste cover is to apply a barrier within the profile to limit root and animal penetration with depth. Experiments in the Los Alamos Experimental Engineered Test Facility were initiated to develop and evaluate biological barriers that are effective in minimizing intrusion into waste trenches. The experiments that are described employ four different candidate barrier materials of geologic origin. Experimental variables that will be evaluated, in addition to barrier type, are barrier depth and sil overburden depth.

Cross-cultural validation of the St. Louis Inventory of Community Living Skills for Chinese patients with schizophrenia in Hong Kong.

PubMed

Au, Raymond Wing Cheong; Tam, Peter Wai Chung; Tam, Gladys Wai Chi; Ungvari, Gabor Sander

2005-01-01

The study validated a culturally sensitive community living skills rating scale for Chinese patients by adapting the St. Louis Inventory of Community Living Skills (SLICLS). The Chinese version (SLICLS-C) was produced by forward and backward translation. An expert panel evaluated its content validity. Its internal consistency, inter-rater reliability, construct and concurrent validity were tested on 80 DSM-IV schizophrenia inpatients in a long-term facility. For predictive validity, the above sample was extended to ensure at least 20 subjects discharged to each of three levels of community care were included in the study sample. The SLICLS-C was psychometrically sound and could be used for predicting level of community care, program evaluation and measuring outcome.

Performance assessment methodology and preliminary results for low-level radioactive waste disposal in Taiwan.

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

Arnold, Bill Walter; Chang, Fu-lin; Mattie, Patrick D.

2006-02-01

Sandia National Laboratories (SNL) and Taiwan's Institute for Nuclear Energy Research (INER) have teamed together to evaluate several candidate sites for Low-Level Radioactive Waste (LLW) disposal in Taiwan. Taiwan currently has three nuclear power plants, with another under construction. Taiwan also has a research reactor, as well as medical and industrial wastes to contend with. Eventually the reactors will be decomissioned. Operational and decommissioning wastes will need to be disposed in a licensed disposal facility starting in 2014. Taiwan has adopted regulations similar to the US Nuclear Regulatory Commission's (NRC's) low-level radioactive waste rules (10 CFR 61) to govern themore » disposal of LLW. Taiwan has proposed several potential sites for the final disposal of LLW that is now in temporary storage on Lanyu Island and on-site at operating nuclear power plants, and for waste generated in the future through 2045. The planned final disposal facility will have a capacity of approximately 966,000 55-gallon drums. Taiwan is in the process of evaluating the best candidate site to pursue for licensing. Among these proposed sites there are basically two disposal concepts: shallow land burial and cavern disposal. A representative potential site for shallow land burial is located on a small island in the Taiwan Strait with basalt bedrock and interbedded sedimentary rocks. An engineered cover system would be constructed to limit infiltration for shallow land burial. A representative potential site for cavern disposal is located along the southeastern coast of Taiwan in a tunnel system that would be about 500 to 800 m below the surface. Bedrock at this site consists of argillite and meta-sedimentary rocks. Performance assessment analyses will be performed to evaluate future performance of the facility and the potential dose/risk to exposed populations. Preliminary performance assessment analyses will be used in the site-selection process and to aid in design of the disposal system. Final performance assessment analyses will be used in the regulatory process of licensing a site. The SNL/INER team has developed a performance assessment methodology that is used to simulate processes associated with the potential release of radionuclides to evaluate these sites. The following software codes are utilized in the performance assessment methodology: GoldSim (to implement a probabilistic analysis that will explicitly address uncertainties); the NRC's Breach, Leach, and Transport - Multiple Species (BLT-MS) code (to simulate waste-container degradation, waste-form leaching, and transport through the host rock); the Finite Element Heat and Mass Transfer code (FEHM) (to simulate groundwater flow and estimate flow velocities); the Hydrologic Evaluation of Landfill performance Model (HELP) code (to evaluate infiltration through the disposal cover); the AMBER code (to evaluate human health exposures); and the NRC's Disposal Unit Source Term -- Multiple Species (DUST-MS) code (to screen applicable radionuclides). Preliminary results of the evaluations of the two disposal concept sites are presented.« less

Impact of decentralization on health services in Uganda: a look at facility utilization, prescribing and availability of essential drugs.

PubMed

Anokbonggo, W W; Ogwal-Okeng, J W; Obua, C; Aupont, O; Ross-Degnan, D

2004-02-01

Uganda began implementation of a structural adjustment programme (SAP) in July 1994 in order to improve social services. The decentralization of health services administration to district level was intended to improve the quality of health services and pharmaceutical supplies in the hospitals, with resultant increase in the level of utilization of health facilities. This study evaluated the impact of the decentralization policy on health facility utilization; availability of essential drugs, and prescribing patterns for acute respiratory infections (ARI), diarrhoea, and malaria in two district hospitals in Uganda. Mixed method evaluation design, involving both quantitative and qualitative methods. Time series analyses of data from utilization, pharmacy stock, and prescription records before and after the policy change. Key informant interviews and focus group discussions to obtain information on perceptions and attitude of stakeholders on the process of the policy implementation. STUDY SETTING AND POPULATION: The study was conducted in two district hospitals in northern Uganda. A total of seven years of utilization and pharmacy stock data including 5040 patient records from the hospitals were analysed retrospectively. In-depth interviews were conducted among 11 politicians from each district; 100 open-ended questionnaires were administered to patients in each hospital; 86 health care workers were interviewed using semi-structured questionnaires; and focus group discussions were conducted with 23 health care providers. Facility utilization was evaluated by average monthly attendance in the outpatient department and paediatric ward admissions. Availability was assessed as average number of drugs per month. Prescribing indicator outcomes included: for malaria, percent chloroquine tablets and percent chloroquine injection; for ARI, percent receiving antibiotics or injections; for diarrhoea, use of oral rehydration salts (ORS), antidiarrhoeal mixtures, and antibiotics. The average number of drugs prescribed assessed polypharmacy. There was a general increase in patient attendance in both hospitals, although the initial increase later declined in Apac. Drug availability was erratic and not always adequate. The situation was better in Lira where funding for drug procurement was more accessible. Prescribing patterns varied, with improvement in some indicators, while others showed no change or even worsened. The decentralization policy led to increased utilization of health facilities. The perception was that the policy was good because it "empowered the community in terms of creating a sense of responsibility in the stakeholders, and a sense of ownership that facilitated sustainability" of public institutions. In spite of the views expressed by the stakeholders, the policy failed to improve drug shortages, inefficient utilization of resources, and low morale among hospital staff. Staff should be re-trained and better remunerated in order to cope with the implementation of the policy. Local politicians should clearly understand their roles and responsibility under the new policy. Efficient utilization of funds at all levels of the district administrative structures should be ensured.

Strategic avionics technology definition studies. Subtask 3-1A3: Electrical Actuation (ELA) Systems Test Facility

NASA Technical Reports Server (NTRS)

Rogers, J. P.; Cureton, K. L.; Olsen, J. R.

1994-01-01

Future aerospace vehicles will require use of the Electrical Actuator systems for flight control elements. This report presents a proposed ELA Test Facility for dynamic evaluation of high power linear Electrical Actuators with primary emphasis on Thrust Vector Control actuators. Details of the mechanical design, power and control systems, and data acquisition capability of the test facility are presented. A test procedure for evaluating the performance of the ELA Test Facility is also included.

The dietitian in community home programs.

PubMed

Oller, J A

1980-03-01

The dietitian is an important member of the health care team in the community and must be competent in the areas of administration, clinical nutrition, patient education, and human relations. Dietary follow-up care is essential in the community to evaluate existing facilities, assess economic levels, disseminate information to residents and sponsors, and ultimately provide good nutritional care to the patients. Responsibilities of the community care dietitian include participation in the initial evaluation of community homes under consideration for veteran placement and in determining the appropriateness of home placement for individual patients. Also, she/he makes follow-up visits to patients living in community residences.

Transistor screening evaluation SJ6708H

NASA Technical Reports Server (NTRS)

Barton, J. L.

1978-01-01

A manufacturer was contracted to screen 125 transistors capable of withstanding the high level inductive voltages obtained when switching inductive loads. Planned differences included a change in die bonding to comply with NASA's desire for hard solder die attachment which further necessitated a change in package to conform to the required die mounting system. Evaluation of the electrical performance and recommended changes were made during the preliminary build phase of the program. The following sections are outlined: (1) narrative outline; (2) customer data summary and X-ray reports; (3) device specification; (4) failure analysis reports; (5) test facilities list; and (6) test measurement data.

Random Access Frame (RAF) System Neutral Buoyancy Evaluations

NASA Technical Reports Server (NTRS)

Howe, A. Scott; Polit-Casillas, Raul; Akin, David L.; McBryan, Katherine; Carlsen, Christopher

2015-01-01

The Random Access Frame (RAF) concept is a system for organizing internal layouts of space habitats, vehicles, and outposts. The RAF system is designed as a more efficient improvement over the current International Standard Payload Rack (ISPR) used on the International Space Station (ISS), which was originally designed to allow for swapping and resupply by the Space Shuttle. The RAF system is intended to be applied in variable gravity or microgravity environments. This paper discusses evaluations and results of testing the RAF system in a neutral buoyancy facility simulating low levels of gravity that might be encountered in a deep space environment.

42 CFR 435.622 - Individuals in institutions who are eligible under a special income level.

Code of Federal Regulations, 2010 CFR

2010-10-01

... THE STATES, DISTRICT OF COLUMBIA, THE NORTHERN MARIANA ISLANDS, AND AMERICAN SAMOA General Financial..., nursing facilities, and intermediate care facilities for the mentally retarded who would not be eligible... (hospital, nursing facility, or intermediate level care for the mentally retarded), or by other factors...

Fads, Fancies and Fantasies: An Educator's Perspective on Current Educational Facility Issues.

ERIC Educational Resources Information Center

Ryland, James

2003-01-01

Explores educational facilities issues from the personal perspective of being both an educator and an owner. Topics discussed include aligning curriculum and instruction with facilities design, green school rating systems, the relationship between facilities and achievement, longitudinal facilities research, post-occupancy evaluation, and…

Biomarkers of mercury exposure at a mercury recycling facility in Ukraine

USGS Publications Warehouse

Gibb, H.J.; Kozlov, K.; Buckley, J.P.; Centeno, J.; Jurgenson, V.; Kolker, A.; Conko, K.; Landa, E.; Panov, B.; Panov, Y.; Xu, H.

2008-01-01

This study evaluates biomarkers of occupational mercury exposure among workers at a mercury recycling operation in Gorlovka, Ukraine. The 29 study participants were divided into three occupational categories for analysis: (1) those who worked in the mercury recycling operation (Group A, n = 8), (2) those who worked at the facility but not in the yard where the recycling was done (Group B, n = 14), and (3) those who did not work at the facility (Group C, n = 7). Urine, blood, hair, and nail samples were collected from the participants, and a questionnaire was administered to obtain data on age, gender, occupational history, smoking, alcohol consumption, fish consumption, tattoos, dental amalgams, home heating system, education, source of drinking water, and family employment in the former mercury mine/smelter located on the site of the recycling facility. Each factor was tested in a univariate regression with total mercury in urine, blood, hair, and nails. Median biomarker concentrations were 4.04 ??g/g-Cr (urine), 2.58 ??g/L (blood), 3.95 ??g/g (hair), and 1.16 ??g/g (nails). Occupational category was significantly correlated (p < 0.001) with both blood and urinary mercury concentrations but not with hair or nail mercury. Four individuals had urinary mercury concentrations in a range previously found to be associated with subtle neurological and subjective symptoms (e.g., fatigue, loss of appetite, irritability), and one worker had a urinary mercury concentration in a range associated with a high probability of neurological effects and proteinuria. Comparison of results by occupational category found that workers directly involved with the recycling operation had the highest blood and urinary mercury levels. Those who worked at the facility but were not directly involved with the recycling operation had higher levels than those who did not work at the facility. Copyright ?? 2008 JOEH, LLC.

ENVIRONMENTAL, ECONOMIC AND ENERGY IMPACTS OF MATERIAL RECOVERY FACILITIES - A MITE PROGRAM EVALUATION

EPA Science Inventory

This report documents an evaluation of the environmental, economic, and energy impacts of material recovery facilities (MRFS) conducted under the Municipal Solid Waste Innovative Technology Evaluation (MITE) Program. he MITE Program is sponsored by the U.S. Environmental Protecti...

Rights of people with mental disorders: Realities in healthcare facilities in Tunisia.

PubMed

Rekhis, Mayssa; Ben Hamouda, Abir; Ouanes, Sami; Rafrafi, Rym

2017-08-01

Mental disorders have been associated worldwide with human rights' violations. Controversially, many occur in mental health facilities. This work aimed to assess the rights of people with mental disorders in healthcare facilities in Tunisia. A cross-sectional study, using the World Health Organization (WHO) quality-rights toolkit, assessed the human rights levels of achievement in Elrazi Hospital, the only psychiatric hospital in Tunisia, in comparison with the National Institute of Nutrition (NIN). The framework was the Convention on the Rights of Persons with Disabilities (CRPD). The assessment was carried through observation, documentation review, and interviews with service users, staff, and family members. The sample was composed of 113 interviewees. In Elrazi Hospital, three out of the five evaluated rights were assessed as only initiated: the right to an adequate standard of living, to exercise legal capacity and to be free from inhuman treatment. By comparison, these rights were partially achieved in the NIN. The right to enjoyment of the highest attainable standard of health was partially achieved and the right to live independently and to be included in the community was not even initiated. These last two rights were at the same level of achievement in the NIN. Significant improvements are needed to adapt the practice in Elrazi Hospital to comply with human rights, especially since the achievement level of these rights is lower than in a non-psychiatric hospital. Our study emphasizes the importance of spreading the CRPD as a standardized framework.

Costing analysis and anthropological assessment of the vaccine supply chain system redesign in the Comé District (Benin).

PubMed

Huang, Xiao Xian; Guillermet, Elise; Le Gargasson, Jean-Bernard; Alfa, Daleb Abdoulaye; Gbodja, Romule; Sossou, Adanmavokin Justin; Jaillard, Phillippe

2017-04-19

At the end of 2013, a pilot experiment was carried out in Comé health zone (HZ) in an attempt to optimize the vaccine supply chain. Four commune vaccine storage facilities were replaced by one central HZ facility. This study evaluated the incremental financial needs for the establishment of the new system; compared the economic cost of the supply chain in the Comé HZ before and after the system redesign; and analyzed the changes induced by the pilot project in immunization logistics management. The purposive sampling method was used to draw a sample from 37 health facilities in the zone for costing evaluation. Data on inputs and prices were collected retrospectively for 2013 and 2014. The analysis used an ingredient-based approach. In addition, 44 semi-structured interviews with health workers for anthropological analysis were completed in 2014. The incremental financial costs amounted to US$55,148, including US$50,605 for upfront capital investment and US$4543 for ongoing recurrent costs. Annual economic cost per dose administered (including all vaccines distributed through the Expanded Program on Immunization (EPI)) in the Comé HZ increased from US$0.09 before system redesign to US$0.15 after implementation, mainly due to a high initial investment and the operational cost of HZ mobile warehouse. Interviews with health workers suggested that the redesigned system was associated with improvements in motivation and professional awareness due to training, supportive supervision, and improved work conditions. The system redesign involved a considerable investment at HZ level. Benefits were found in the reduction of transportation costs to health posts (HP) and commune health center (CHC) levels, and the strengthening of health workers professional skills at all levels in Comé. The redesigned system contributed to a decrease in funding needs at HP and CHC levels. The benefits of the investment need to be examined after the introduction of new vaccines and after a longer period. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Rainfall simulation in education

NASA Astrophysics Data System (ADS)

Peters, Piet; Baartman, Jantiene; Gooren, Harm; Keesstra, Saskia

2016-04-01

Rainfall simulation has become an important method for the assessment of soil erosion and soil hydrological processes. For students, rainfall simulation offers an year-round, attractive and active way of experiencing water erosion, while not being dependent on (outdoors) weather conditions. Moreover, using rainfall simulation devices, they can play around with different conditions, including rainfall duration, intensity, soil type, soil cover, soil and water conservation measures, etc. and evaluate their effect on erosion and sediment transport. Rainfall simulators differ in design and scale. At Wageningen University, both BSc and MSc student of the curriculum 'International Land and Water Management' work with different types of rainfall simulation devices in three courses: - A mini rainfall simulator (0.0625m2) is used in the BSc level course 'Introduction to Land Degradation and Remediation'. Groups of students take the mini rainfall simulator with them to a nearby field location and test it for different soil types, varying from clay to more sandy, slope angles and vegetation or litter cover. The groups decide among themselves which factors they want to test and they compare their results and discuss advantage and disadvantage of the mini-rainfall simulator. - A medium sized rainfall simulator (0.238 m2) is used in the MSc level course 'Sustainable Land and Water Management', which is a field practical in Eastern Spain. In this course, a group of students has to develop their own research project and design their field measurement campaign using the transportable rainfall simulator. - Wageningen University has its own large rainfall simulation laboratory, in which a 15 m2 rainfall simulation facility is available for research. In the BSc level course 'Land and Water Engineering' Student groups will build slopes in the rainfall simulator in specially prepared containers. Aim is to experience the behaviour of different soil types or slope angles when (heavy) rain occurs. The MSc level course 'Fundamentals of Land Management' students carry out a hands-on practical in which they compare soil type and design and evaluate the effect of soil and water conservation measures. Also, MSc thesis research is being carried out using this facility. For instance, the distribution and movement of pesticide Glyphosate with sediment transportation was being quantified using the rainfall simulation facility.

Annual INTEC Groundwater Monitoring Report for Group 5 - Snake River Plain Aquifer (2001)

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

Roddy, Michael Scott

2002-02-01

This report describes the monitoring activities conducted and presents the results of groundwater sampling and water-level measurements from October 2000 to September 2001. Groundwater samples were initially collected from 41 wells from the Idaho Nuclear Technology and Engineering Center and the Central Facilities Area and analyzed for iodine-129, strontium-90, tritium, gross alpha, gross beta, technetium-99, uranium isotopes, plutonium isotopes, neptunium-237, americium-241, gamma spectrometry, and mercury. Samples from 41 wells were collected in April and May 2001. Additional sampling was conducted in August 2001 and included the two CFA production wells, the CFA point of compliance for the production wells, onemore » well that was previously sampled and five additional monitoring wells. Iodine-129 and strontium-90 were the only analytes above their respective maximum contaminant levels. Iodine-129 was detected just above its maximum contaminant level of 1 pCi/L at two of the Central Facilities Area landfill wells. Iodine-129 was detected in the CFA production wells at 0.35±0.083 pCi/L in CFA-1, but was below detectable activity in CFA-2. Strontium-90 was above its maximum contaminant level of 8 pCi/L in several wells near the Idaho Nuclear Technology and Engineering Center but was below its maximum contaminant level in the downgradient wells at the Central Facilities Area landfills. Sr-90 was not detected in the CFA production wells. Gross beta results generally mirrored the results for strontium-90 and technetium-99. Plutonium isotopes and neptunium-237 were not detected. Uranium-233/234 and uranium-238 isotopes were detected in all samples. Concentrations of background and site wells were similar and are within background limits for total uranium determined by the USGS, suggesting that the concentrations are background. Uranium-235/236 was detected in 11 samples, but all the detected concentrations were similar and near the minimum detectable activity. Americium-241 was detected at three locations near the minimum detectable activity of approximately 0.07 pCi/L. The gamma spectrometry results detected cesium-137 in three samples, potassium-40 at eight locations, and radium-226 at one location. Mercury was below its maximum contaminant level of 2 µg/L in all samples. Gamma spectrometry results for the CFA production wells did not detect any analytes. Water-level measurements were taken from wells in the Idaho Nuclear Technology and Engineering Center, Central Facilities Area, and the area south of Central Facilities Area to evaluate groundwater flow directions. Water-level measurements indicated groundwater flow to the south-southwest from the Idaho Nuclear Technology and Engineering Center.« less

New CPT codes: hospital, consultation, emergency and nursing facility services.

PubMed

Zuber, T J; Henley, D E

1992-03-01

New evaluation and management codes were created by the Current Procedural Terminology (CPT) Editorial Panel to ensure more accurate and consistent reporting of physician services. The new hospital inpatient codes describe three levels of service for both initial and subsequent care. Critical care services are reported according to the total time spent by a physician providing constant attention to a critically ill patient. Consultation codes are divided into four categories: office/outpatient, initial inpatient, follow-up inpatient and confirmatory. Emergency department services for both new and established patients are limited to five codes. In 1992, nursing facility services are described with either comprehensive-assessment codes or subsequent-care codes. Hospital discharge services may be reported in addition to the comprehensive nursing facility assessment. Since the 1992 CPT book will list only the new codes, and since all insurance carriers will not be using these codes in 1992, physicians are encouraged to keep their 1991 code books and contact their local insurance carriers to determine which codes will be used.

Staffing levels in not-for-profit and for-profit long-term care facilities: Does type of ownership matter?

PubMed Central

McGregor, Margaret J.; Cohen, Marcy; McGrail, Kimberlyn; Broemeling, Anne Marie; Adler, Reva N.; Schulzer, Michael; Ronald, Lisa; Cvitkovich, Yuri; Beck, Mary

2005-01-01

Background Currently there is a lot of debate about the advantages and disadvantages of for-profit health care delivery. We examined staffing ratios for direct-care and support staff in publicly funded not-for-profit and for-profit nursing homes in British Columbia. Methods We obtained staffing data for 167 long-term care facilities and linked these to the type of facility and ownership of the facility. All staff were members of the same bargaining association and received identical wages in both not-for-profit and for-profit facilities. Similar public funding is provided to both types of facilities, although the amounts vary by the level of functional dependence of the residents. We compared the mean number of hours per resident-day provided by direct-care staff (registered nurses, licensed practical nurses and resident care aides) and support staff (housekeeping, dietary and laundry staff) in not-for-profit versus for-profit facilities, after adjusting for facility size (number of beds) and level of care. Results The nursing homes included in our study comprised 76% of all such facilities in the province. Of the 167 nursing homes examined, 109 (65%) were not-for-profit and 58 (35%) were for-profit; 24% of the for-profit homes were part of a chain, and the remaining homes were owned by a single operator. The mean number of hours per resident-day was higher in the not-for-profit facilities than in the for-profit facilities for both direct-care and support staff and for all facility levels of care. Compared with for-profit ownership, not-for-profit status was associated with an estimated 0.34 more hours per resident-day (95% confidence interval [CI] 0.18–0.49, p < 0.001) provided by direct-care staff and 0.23 more hours per resident-day (95% CI 0.15–0.30, p < 0.001) provided by support staff. Interpretation Not-for-profit facility ownership is associated with higher staffing levels. This finding suggests that public money used to provide care to frail eldery people purchases significantly fewer direct-care and support staff hours per resident-day in for-profit long-term care facilities than in not-for-profit facilities. PMID:15738489

Materials and Nondestructive Evaluation Laboratoriers: User Test Planning Guide

NASA Technical Reports Server (NTRS)

Schaschl, Leslie

2011-01-01

The Materials and Nondestructive Evaluation Laboratory process, milestones and inputs are unknowns to first-time users. The Materials and Nondestructive Evaluation Laboratory Planning Guide aids in establishing expectations for both NASA and non- NASA facility customers. The potential audience for this guide includes both internal and commercial spaceflight hardware developers. It is intended to assist their project engineering personnel in materials analysis planning and execution. Material covered includes a roadmap of the analysis process, roles and responsibilities of facility and user, major milestones, facility capabilities, and inputs required by the facility. Samples of deliverables, products, and inputs necessary to define scope of analysis, cost, and schedule are included as an appendix to the guide.

Summary of findings from the evaluation of a pilot medically supervised safer injecting facility

PubMed Central

Wood, Evan; Tyndall, Mark W.; Montaner, Julio S.; Kerr, Thomas

2006-01-01

In many cities, infectious disease and overdose epidemics are occurring among illicit injection drug users (IDUs). To reduce these concerns, Vancouver opened a supervised safer injecting facility in September 2003. Within the facility, people inject pre-obtained illicit drugs under the supervision of medical staff. The program was granted a legal exemption by the Canadian government on the condition that a 3-year scientific evaluation of its impacts be conducted. In this review, we summarize the findings from evaluations in those 3 years, including characteristics of IDUs at the facility, public injection drug use and publicly discarded syringes, HIV risk behaviour, use of addiction treatment services and other community resources, and drug-related crime rates. Vancouver's safer injecting facility has been associated with an array of community and public health benefits without evidence of adverse impacts. These findings should be useful to other cities considering supervised injecting facilities and to governments considering regulating their use. PMID:17116909

Actual use of and satisfaction associated with rollators and "shopping carts" among frail elderly Japanese people using day-service facilities.

PubMed

Kitajima, Eiji; Moriuchi, Takefumi; Iso, Naoki; Sagari, Akira; Kikuchi, Yasuyuki; Higashi, Toshio

2017-07-01

Purpose This study aimed at clarifying the actual use of and satisfaction with rollators and "shopping carts" (wheeled walkers with storage) among frail elderly people, who were certified by a long-term care insurance system as users of facilities that provide day-service nursing care and rehabilitation. Methods We identified 1247 frail elderly people who used day-service facilities, and evaluated their actual use of, and satisfaction with, rollators and shopping carts. Results Forty-four (3.5%) individuals used rollators, and 53 (4.3%) used shopping carts. The shopping cart group contained more individuals who were certified as care level 1 (26.4%), than the rollator group (20.5%), and 52.8% of the shopping cart group was certified as care levels 1-3. The scores for "repairs and services" and "follow-up" from the Quebec User Evaluation of Satisfaction with assistive Technology second version (QUEST 2.0) survey were significantly higher in the rollator group than in the shopping cart group. Conclusions The QUEST 2.0 scores revealed that shopping cart users exhibit insufficient "repairs and services" and "follow-up" scores. As frail elderly people with poor care status accounted for >50% of the shopping cart group, these individuals urgently need walking aids that are tailored to their care status. Implications for Rehabilitation We conclude that walking aid fitting must be tailored to each persons care status, and suggest that a system should be established to allow occupational or physical therapists to provide this fitting Moreover, our analysis of the QUEST2.0 service scores revealed that repairs, services, and follow-up are insufficient to meet the needs of shopping cart users.

The neighborhood recreational environment and physical activity among urban youth: an examination of public and private recreational facilities.

PubMed

Ries, Amy V; Yan, Alice F; Voorhees, Carolyn C

2011-08-01

Recreational facility availability has been shown to associate positively with youth physical activity levels. Nonetheless, little is known about additional facility characteristics affecting their use for physical activity as well as differences between private and public facilities. This study examines (1) perceptions and use of public and private recreational facilities and (2) environmental and individual-level correlates of both facility use and physical activity among urban adolescents. Physical activity was assessed using accelerometry, objective measures of facility availability were obtained using Geographical Information Systems data, and facility use and perceptions were measured with a survey (N = 327). Adolescents were more likely to use public than private facilities despite perceiving that private facilities were of higher quality. Adolescents' use of both public and private facilities was associated with perceived (but not objective) availability, perceived quality, and use by friends and family. Public, but not private, facility use was associated with physical activity. This study reveals the importance of public facilities to the physical activity of urban youth.

Corrosion behaviour of steel rebars embedded in a concrete designed for the construction of an intermediate-level radioactive waste disposal facility

NASA Astrophysics Data System (ADS)

Duffó, G. S.; Arva, E. A.; Schulz, F. M.; Vazquez, D. R.

2013-07-01

The National Atomic Energy Commission of the Argentine Republic is developing a nuclear waste disposal management programme that contemplates the design and construction of a facility for the final disposal of intermediate-level radioactive wastes. The repository is based on the use of multiple, independent and redundant barriers. The major components are made in reinforced concrete so, the durability of these structures is an important aspect for the facility integrity. This work presents an investigation performed on an instrumented reinforced concrete prototype specifically designed for this purpose, to study the behaviour of an intermediate level radioactive waste disposal facility from the rebar corrosion point of view. The information obtained will be used for the final design of the facility in order to guarantee a service life more or equal than the foreseen durability for this type of facilities.

Rates of trauma-informed counseling at substance abuse treatment facilities: reports from over 10,000 programs.

PubMed

Capezza, Nicole M; Najavits, Lisa M

2012-04-01

Trauma-informed treatment increasingly is recognized as an important component of service delivery. This study examined differences in treatment-related characteristics of facilities that offer moderate or high levels of trauma-informed counseling versus those that offer no or low levels of such counseling. Responses from 13,223 substance abuse treatment facilities surveyed in 2009 by the National Survey of Substance Abuse Treatment Services (NSSATS) were used. A majority (66.6%) of facilities reported using trauma counseling sometimes or always or often. Facilities that provided moderate or high levels of trauma counseling were more likely to provide additional treatment services, such as disease testing and specialized group therapy, as well as child care, employment counseling, and other ancillary services. A majority of facilities reported provision of trauma counseling. Additional training and resources may be needed for programs that reported low rates of trauma counseling.

Durability of a reinforced concrete designed for the construction of an intermediate-level radioactive waste disposal facility

NASA Astrophysics Data System (ADS)

Duffó, G. S.; Arva, E. A.; Schulz, F. M.; Vazquez, D. R.

2012-01-01

The National Atomic Energy Commission of the Argentine Republic is developing a nuclear waste disposal management programme that contemplates the design and construction of a facility for the final disposal of intermediate-level radioactive wastes. The repository is based on the use of multiple, independent and redundant barriers. The major components are made in reinforced concrete so, the durability of these structures is an important aspect for the facility integrity. This work presents an investigation performed on a reinforced concrete specifically designed for this purpose, to predict the service life of the intermediate level radioactive waste disposal facility from data obtained with several techniques. Results obtained with corrosion sensors embedded in a concrete prototype are also included. The information obtained will be used for the final design of the facility in order to guarantee a service life more or equal than the foreseen durability for this type of facilities.

EnergySolution's Clive Disposal Facility Operational Research Model - 13475

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

Nissley, Paul; Berry, Joanne

2013-07-01

EnergySolutions owns and operates a licensed, commercial low-level radioactive waste disposal facility located in Clive, Utah. The Clive site receives low-level radioactive waste from various locations within the United States via bulk truck, containerised truck, enclosed truck, bulk rail-cars, rail boxcars, and rail inter-modals. Waste packages are unloaded, characterized, processed, and disposed of at the Clive site. Examples of low-level radioactive waste arriving at Clive include, but are not limited to, contaminated soil/debris, spent nuclear power plant components, and medical waste. Generators of low-level radioactive waste typically include nuclear power plants, hospitals, national laboratories, and various United States government operatedmore » waste sites. Over the past few years, poor economic conditions have significantly reduced the number of shipments to Clive. With less revenue coming in from processing shipments, Clive needed to keep its expenses down if it was going to maintain past levels of profitability. The Operational Research group of EnergySolutions were asked to develop a simulation model to help identify any improvement opportunities that would increase overall operating efficiency and reduce costs at the Clive Facility. The Clive operations research model simulates the receipt, movement, and processing requirements of shipments arriving at the facility. The model includes shipment schedules, processing times of various waste types, labor requirements, shift schedules, and site equipment availability. The Clive operations research model has been developed using the WITNESS{sup TM} process simulation software, which is developed by the Lanner Group. The major goals of this project were to: - identify processing bottlenecks that could reduce the turnaround time from shipment arrival to disposal; - evaluate the use (or idle time) of labor and equipment; - project future operational requirements under different forecasted scenarios. By identifying processing bottlenecks and unused equipment and/or labor, improvements to operating efficiency could be determined and appropriate cost saving measures implemented. Model runs forecasting various scenarios helped illustrate potential impacts of certain conditions (e.g. 20% decrease in shipments arrived), variables (e.g. 20% decrease in labor), or other possible situations. (authors)« less

33 CFR 154.1047 - Response plan development and evaluation criteria for facilities that handle, store, or transport...

Code of Federal Regulations, 2011 CFR

2011-07-01

... evaluation criteria for facilities that handle, store, or transport Group V petroleum oils. 154.1047 Section... Group V petroleum oils. (a) An owner or operator of a facility that handles, stores, or transports Group...) Procedures and strategies for responding to a worst case discharge of Group V petroleum oils to the maximum...

33 CFR 154.1047 - Response plan development and evaluation criteria for facilities that handle, store, or transport...

Code of Federal Regulations, 2013 CFR

2013-07-01

... evaluation criteria for facilities that handle, store, or transport Group V petroleum oils. 154.1047 Section... Group V petroleum oils. (a) An owner or operator of a facility that handles, stores, or transports Group...) Procedures and strategies for responding to a worst case discharge of Group V petroleum oils to the maximum...

33 CFR 154.1047 - Response plan development and evaluation criteria for facilities that handle, store, or transport...

Code of Federal Regulations, 2010 CFR

2010-07-01

... evaluation criteria for facilities that handle, store, or transport Group V petroleum oils. 154.1047 Section... Group V petroleum oils. (a) An owner or operator of a facility that handles, stores, or transports Group...) Procedures and strategies for responding to a worst case discharge of Group V petroleum oils to the maximum...

33 CFR 154.1047 - Response plan development and evaluation criteria for facilities that handle, store, or transport...

Code of Federal Regulations, 2014 CFR

2014-07-01

... evaluation criteria for facilities that handle, store, or transport Group V petroleum oils. 154.1047 Section... Group V petroleum oils. (a) An owner or operator of a facility that handles, stores, or transports Group...) Procedures and strategies for responding to a worst case discharge of Group V petroleum oils to the maximum...

33 CFR 154.1047 - Response plan development and evaluation criteria for facilities that handle, store, or transport...

Code of Federal Regulations, 2012 CFR

2012-07-01

... evaluation criteria for facilities that handle, store, or transport Group V petroleum oils. 154.1047 Section... Group V petroleum oils. (a) An owner or operator of a facility that handles, stores, or transports Group...) Procedures and strategies for responding to a worst case discharge of Group V petroleum oils to the maximum...

General service and child immunization-specific readiness assessment of healthcare facilities in two selected divisions in Bangladesh.

PubMed

Shawon, Md Shajedur Rahman; Adhikary, Gourab; Ali, Md Wazed; Shamsuzzaman, Md; Ahmed, Shahabuddin; Alam, Nurul; Shackelford, Katya A; Woldeab, Alexander; Lim, Stephen S; Levine, Aubrey; Gakidou, Emmanuela; Uddin, Md Jasim

2018-01-25

Service readiness of health facilities is an integral part of providing comprehensive quality healthcare to the community. Comprehensive assessment of general and service-specific (i.e. child immunization) readiness will help to identify the bottlenecks in healthcare service delivery and gaps in equitable service provision. Assessing healthcare facilities readiness also helps in optimal policymaking and resource allocation. A health facility survey was conducted between March 2015 and December 2015 in two purposively selected divisions in Bangladesh; i.e. Rajshahi division (high performing) and Sylhet division (low performing). A total of 123 health facilities were randomly selected from different levels of service, both public and private, with variation in sizes and patient loads from the list of facilities. Data on various aspects of healthcare facility were collected by interviewing key personnel. General service and child immunization specific service readiness were assessed using the Service Availability and Readiness Assessment (SARA) manual developed by World Health Organization (WHO). The analyses were stratified by division and level of healthcare facilities. The general service readiness index for pharmacies, community clinics, primary care facilities and higher care facilities were 40.6%, 60.5%, 59.8% and 69.5%, respectively in Rajshahi division and 44.3%, 57.8%, 57.5% and 73.4%, respectively in Sylhet division. Facilities at all levels had the highest scores for basic equipment (ranged between 51.7% and 93.7%) and the lowest scores for diagnostic capacity (ranged between 0.0% and 53.7%). Though facilities with vaccine storage capacity had very high levels of service readiness for child immunization, facilities without vaccine storage capacity lacked availability of many tracer items. Regarding readiness for newly introduced pneumococcal conjugate vaccine (PCV) and inactivated polio vaccine (IPV), most of the surveyed facilities reported lack of sufficient funding and resources (antigen) for training programs. Our study suggested that health facilities suffered from lack of readiness in various aspects, most notably in diagnostic capacity. Conversely, with very few challenges, nearly all the health facilities designated to provide immunization services were ready to deliver routine childhood immunization services as well as newly introduced PCV and IPV.

Universal definition of loss to follow-up in HIV treatment programs: a statistical analysis of 111 facilities in Africa, Asia, and Latin America.

PubMed

Chi, Benjamin H; Yiannoutsos, Constantin T; Westfall, Andrew O; Newman, Jamie E; Zhou, Jialun; Cesar, Carina; Brinkhof, Martin W G; Mwango, Albert; Balestre, Eric; Carriquiry, Gabriela; Sirisanthana, Thira; Mukumbi, Henri; Martin, Jeffrey N; Grimsrud, Anna; Bacon, Melanie; Thiebaut, Rodolphe

2011-10-01

Although patient attrition is recognized as a threat to the long-term success of antiretroviral therapy programs worldwide, there is no universal definition for classifying patients as lost to follow-up (LTFU). We analyzed data from health facilities across Africa, Asia, and Latin America to empirically determine a standard LTFU definition. At a set "status classification" date, patients were categorized as either "active" or "LTFU" according to different intervals from time of last clinic encounter. For each threshold, we looked forward 365 d to assess the performance and accuracy of this initial classification. The best-performing definition for LTFU had the lowest proportion of patients misclassified as active or LTFU. Observational data from 111 health facilities-representing 180,718 patients from 19 countries-were included in this study. In the primary analysis, for which data from all facilities were pooled, an interval of 180 d (95% confidence interval [CI]: 173-181 d) since last patient encounter resulted in the fewest misclassifications (7.7%, 95% CI: 7.6%-7.8%). A secondary analysis that gave equal weight to cohorts and to regions generated a similar result (175 d); however, an alternate approach that used inverse weighting for cohorts based on variance and equal weighting for regions produced a slightly lower summary measure (150 d). When examined at the facility level, the best-performing definition varied from 58 to 383 d (mean=150 d), but when a standard definition of 180 d was applied to each facility, only slight increases in misclassification (mean=1.2%, 95% CI: 1.0%-1.5%) were observed. Using this definition, the proportion of patients classified as LTFU by facility ranged from 3.1% to 45.1% (mean=19.9%, 95% CI: 19.1%-21.7%). Based on this evaluation, we recommend the adoption of ≥180 d since the last clinic visit as a standard LTFU definition. Such standardization is an important step to understanding the reasons that underlie patient attrition and establishing more reliable and comparable program evaluation worldwide. Please see later in the article for the Editors' Summary.

Discriminative facility and its role in the perceived quality of interactional experiences.

PubMed

Cheng, C; Chiu, C Y; Hong, Y Y; Cheung, J S

2001-10-01

Discriminative facility refers to an individual's sensitivity to subtle cues about the psychological meaning of a situation. This research aimed at examining (a) the conceptual distinctiveness of discriminative facility, (b) the situation-appropriate aspect of this construct, and (c) the relationship between discriminative facility and interpersonal experiences. Discriminative facility was assessed by a new measure of situation-appropriate behaviors across a variety of novel stressful situations. Results from study 1 showed that discriminative facility had weak positive relationships with cognitive complexity and nonsignificant relationships with self-monitoring and social desirability, indicating that discriminative facility is a unique construct. Results from Study 2 revealed that higher levels of discriminative facility were associated with higher levels of perceived social support and a greater number of pleasant interpersonal events experienced, thus providing support for the theoretical proposition that discriminative facility is an aspect of social intelligence.

Use of a Balanced Scorecard in strengthening health systems in developing countries: an analysis based on nationally representative Bangladesh Health Facility Survey.

PubMed

Khan, M Mahmud; Hotchkiss, David R; Dmytraczenko, Tania; Zunaid Ahsan, Karar

2013-01-01

This paper illustrates the importance of collecting facility-based data through regular surveys to supplement the administrative data, especially for developing countries of the world. In Bangladesh, measures based on facility survey indicate that only 70% of very basic medical instruments and 35% of essential drugs were available in health facilities. Less than 2% of officially designated obstetric care facilities actually had required drugs, injections and personnel on-site. Majority of (80%) referral hospitals at the district level were not ready to provide comprehensive emergency obstetric care. Even though the Management Information System reports availability of diagnostic machines in all district-level and sub-district-level facilities, it fails to indicate that 50% of these machines are not functional. In terms of human resources, both physicians and nurses are in short supply at all levels of the healthcare system. The physician-nurse ratio also remains lower than the desirable level of 3.0. Overall job satisfaction index was less than 50 for physicians and 66 for nurses. Patient satisfaction score, however, was high (86) despite the fact that process indicators of service quality were poor. Facility surveys can help strengthen not only the management decision-making process but also the quality of administrative data. Copyright © 2012 John Wiley & Sons, Ltd.

Evaluation of intermodal passenger transfer facilities

DOT National Transportation Integrated Search

1994-09-01

The Wisconsin Department of Transportation has initiated a study into the feasibility of locating an intermodal passenger transportation facility in downtown Milwaukee. That feasibilty study requires an evaluation of a very wide range of alternatives...

Adolescents’ Use of Indoor Tanning: A Large-Scale Evaluation of Psychosocial, Environmental, and Policy-Level Correlates

PubMed Central

Woodruff, Susan I.; Slymen, Donald J.; Sallis, James F.; Forster, Jean L.; Clapp, Elizabeth J.; Hoerster, Katherine D.; Pichon, Latrice C.; Weeks, John R.; Belch, George E.; Weinstock, Martin A.; Gilmer, Todd

2011-01-01

Objectives. We evaluated psychosocial, built-environmental, and policy-related correlates of adolescents’ indoor tanning use. Methods. We developed 5 discrete data sets in the 100 most populous US cities, based on interviews of 6125 adolescents (aged 14–17 years) and their parents, analysis of state indoor tanning laws, interviews with enforcement experts, computed density of tanning facilities, and evaluations of these 3399 facilities’ practices regarding access by youths. After univariate analyses, we constructed multilevel models with generalized linear mixed models (GLMMs). Results. In the past year, 17.1% of girls and 3.2% of boys had used indoor tanning. The GLMMs indicated that several psychosocial or demographic variables significantly predicted use, including being female, older, and White; having a larger allowance and a parent who used indoor tanning and allowed their adolescent to use it; and holding certain beliefs about indoor tanning's consequences. Living within 2 miles of a tanning facility also was a significant predictor. Residing in a state with youth-access legislation was not significantly associated with use. Conclusions. Current laws appear ineffective in reducing indoor tanning; bans likely are needed. Parents have an important role in prevention efforts. PMID:21421947

The evaluation of stack metal emissions from hazardous waste incinerators: assessing human exposure through noninhalation pathways.

PubMed Central

Sedman, R M; Polisini, J M; Esparza, J R

1994-01-01

Potential public health effects associated with exposure to metal emissions from hazardous waste incinerators through noninhalation pathways were evaluated. Instead of relying on modeling the movement of toxicants through various environmental media, an approach based on estimating changes from baseline levels of exposure was employed. Changes in soil and water As, Cd, Hg, Pb, Cr, and Be concentrations that result from incinerator emissions were first determined. Estimates of changes in human exposure due to direct contact with shallow soil or the ingestion of surface water were then ascertained. Projected changes in dietary intakes of metals due to incinerator emissions were estimated based on changes from baseline dietary intakes that are monitored in U.S. Food and Drug Administration total diet studies. Changes from baseline intake were deemed to be proportional to the projected changes in soil or surface water metal concentrations. Human exposure to metals emitted from nine hazardous waste incinerators were then evaluated. Metal emissions from certain facilities resulted in tangible human exposure through noninhalation pathways. However, the analysis indicated that the deposition of metals from ambient air would result in substantially greater human exposure through noninhalation pathways than the emissions from most of the facilities. PMID:7925180

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

PubMed

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

2014-01-01

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

10 CFR 62.12 - Contents of a request for emergency access: General information.

Code of Federal Regulations, 2014 CFR

2014-01-01

... EMERGENCY ACCESS TO NON-FEDERAL AND REGIONAL LOW-LEVEL WASTE DISPOSAL FACILITIES Request for a Commission... the disposal facility or facilities which had been receiving the waste stream of concern before the... the person(s) or company(ies) generating the low-level radioactive waste for which the determination...

10 CFR 62.12 - Contents of a request for emergency access: General information.

Code of Federal Regulations, 2011 CFR

2011-01-01

... EMERGENCY ACCESS TO NON-FEDERAL AND REGIONAL LOW-LEVEL WASTE DISPOSAL FACILITIES Request for a Commission... the disposal facility or facilities which had been receiving the waste stream of concern before the... the person(s) or company(ies) generating the low-level radioactive waste for which the determination...

10 CFR 62.12 - Contents of a request for emergency access: General information.

Code of Federal Regulations, 2012 CFR

2012-01-01

... EMERGENCY ACCESS TO NON-FEDERAL AND REGIONAL LOW-LEVEL WASTE DISPOSAL FACILITIES Request for a Commission... the disposal facility or facilities which had been receiving the waste stream of concern before the... the person(s) or company(ies) generating the low-level radioactive waste for which the determination...

10 CFR 62.12 - Contents of a request for emergency access: General information.

Code of Federal Regulations, 2013 CFR

2013-01-01

... EMERGENCY ACCESS TO NON-FEDERAL AND REGIONAL LOW-LEVEL WASTE DISPOSAL FACILITIES Request for a Commission... the disposal facility or facilities which had been receiving the waste stream of concern before the... the person(s) or company(ies) generating the low-level radioactive waste for which the determination...

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.

Review of hardware-in-the-loop simulation and its prospects in the automotive area

NASA Astrophysics Data System (ADS)

Fathy, Hosam K.; Filipi, Zoran S.; Hagena, Jonathan; Stein, Jeffrey L.

2006-05-01

Hardware-in-the-loop (HIL) simulation is rapidly evolving from a control prototyping tool to a system modeling, simulation, and synthesis paradigm synergistically combining many advantages of both physical and virtual prototyping. This paper provides a brief overview of the key enablers and numerous applications of HIL simulation, focusing on its metamorphosis from a control validation tool into a system development paradigm. It then describes a state-of-the art engine-in-the-loop (EIL) simulation facility that highlights the use of HIL simulation for the system-level experimental evaluation of powertrain interactions and development of strategies for clean and efficient propulsion. The facility comprises a real diesel engine coupled to accurate real-time driver, driveline, and vehicle models through a highly responsive dynamometer. This enables the verification of both performance and fuel economy predictions of different conventional and hybrid powertrains. Furthermore, the facility can both replicate the highly dynamic interactions occurring within a real powertrain and measure their influence on transient emissions and visual signature through state-of-the-art instruments. The viability of this facility for integrated powertrain system development is demonstrated through a case study exploring the development of advanced High Mobility Multipurpose Wheeled Vehicle (HMMWV) powertrains.

Operationalising emergency care delivery in sub-Saharan Africa: consensus-based recommendations for healthcare facilities.

PubMed

Calvello, Emilie J B; Tenner, Andrea G; Broccoli, Morgan C; Skog, Alexander P; Muck, Andrew E; Tupesis, Janis P; Brysiewicz, Petra; Teklu, Sisay; Wallis, Lee; Reynolds, Teri

2016-08-01

A major barrier to successful integration of acute care into health systems is the lack of consensus on the essential components of emergency care within resource-limited environments. The 2013 African Federation of Emergency Medicine Consensus Conference was convened to address the growing need for practical solutions to further implementation of emergency care in sub-Saharan Africa. Over 40 participants from 15 countries participated in the working group that focused on emergency care delivery at health facilities. Using the well-established approach developed in the WHO's Monitoring Emergency Obstetric Care, the workgroup identified the essential services delivered-signal functions-associated with each emergency care sentinel condition. Levels of emergency care were assigned based on the expected capacity of the facility to perform signal functions, and the necessary human, equipment and infrastructure resources identified. These consensus-based recommendations provide the foundation for objective facility capacity assessment in developing emergency health systems that can bolster strategic planning as well as facilitate monitoring and evaluation of service delivery. 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/

Implementing a psycho-educational intervention for care assistants working with people with dementia in aged-care facilities: facilitators and barriers.

PubMed

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

2017-06-01

Many intervention studies lack an investigation and description of the factors that are relevant to its success or failure, despite its relevance to inform future interventions. This study aimed to explore the facilitators and barriers to the implementation of a psycho-educational intervention for care assistants caring for people with dementia in aged-care facilities. A process evaluation was carried out alongside a pretest/post-test controlled study conducted in aged-care facilities. Seven focus-group interviews involving 21 care assistants (female; mean age 43.37 ± 10.0) and individual semi-structured interviews with two managers (female; mean age 45.5 ± 10.26) were conducted 2 weeks and 6 months after the intervention, in two aged-care facilities. Interviews were recorded, transcribed and submitted to content analysis by two independent researchers. Results were organised into implementer, participant and organisation level hindered and facilitator factors. Findings enable the interpretation of the experimental results and underscore the importance of collecting the perception of different grades of staff to obtain information relevant to plan effective interventions. © 2016 Nordic College of Caring Science.

An assessment of drinking-water supplies on the Hanford site: an evaluation conducted at a federal nuclear facility in southeastern Washington state.

PubMed

Hanf, R William; Kelly, Lynn M

2005-03-01

Drinking water is supplied to most U.S. Department of Energy (DOE) facilities on the Hanford Site by DOE-owned, contractor-operated pumping and distribution systems. Water is primarily obtained from the Columbia River, but some facilities use water from on-site groundwater wells. Because of the large amount of radioactive and chemical waste produced, stored, and disposed of at Hanford, some people are concerned that waste materials are contaminating on-site drinking-water supplies. This paper describes the drinking-water facilities and treatment requirements on the Hanford Site and summarizes radiological and non-radiological water quality data obtained from water samples collected from each drinking-water system in use during 2001 and 2002. Monitoring data show that Hanford-produced radionuclides are measurable in some drinking-water samples. The only non-radiological contaminants detected either were by-products of the chlorination process or came from off-site agricultural activities. Contaminant level values were, in all cases, below state and federal drinking-water limits. This information will provide assurance to current employees and future site developers that drinking water on the Hanford Site is safe for public consumption.

Summary of the effects of engine throttle response on airplane formation-flying qualities

NASA Technical Reports Server (NTRS)

Walsh, Kevin R.

1993-01-01

A flight evaluation was conducted to determine the effect of engine throttle response characteristics on precision formation-flying qualities. A variable electronic throttle control system was developed and flight-tested on a TF-104G airplane with a J79-11B engine at the NASA Dryden Flight Research Facility. This airplane was chosen because of its known, very favorable thrust response characteristics. Ten research flights were flown to evaluate the effects of throttle gain, time delay, and fuel control rate limiting on engine handling qualities during a demanding precision wing formation task. Handling quality effects of lag filters and lead compensation time delays were also evaluated. The Cooper and Harper Pilot Rating Scale was used to assign levels of handling quality. Data from pilot ratings and comments indicate that throttle control system time delays and rate limits cause significant degradations in handling qualities. Threshold values for satisfactory (level 1) and adequate (level 2) handling qualities of these key variables are presented. These results may provide engine manufacturers with guidelines to assure satisfactory handling qualities in future engine designs.

The status of LILW disposal facility construction in Korea

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

Kim, Min-Seok; Chung, Myung-Sub; Park, Kyu-Wan

2013-07-01

In this paper, we discuss the experiences during the construction of the first LILW disposal facility in South Korea. In December 2005, the South Korean Government designated Gyeongju-city as a host city of Low- and Intermediate-Level Radioactive Waste(LILW) disposal site through local referendums held in regions whose local governments had applied to host disposal facility in accordance with the site selection procedures. The LILW disposal facility is being constructed in Bongilri, Yangbuk-myeon, Gyeongju. The official name of the disposal facility is called 'Wolsong Low and Intermediate Level Radioactive Waste Disposal Center (LILW Disposal Center)'. It can dispose of 800,000 drumsmore » of radioactive wastes in a site of 2,100,000 square meters. At the first stage, LILW repository of underground silo type with disposal capacity of 100,000 drums is under construction expected to be completed by June of 2014. The Wolsong Low and Intermediate Level Radioactive Waste Disposal Center consists of surface facilities and underground facilities. The surface facilities include a reception and inspection facility, an interim storage facility, a radioactive waste treatment building, and supporting facilities such as main control center, equipment and maintenance shop. The underground facilities consist of a construction tunnel for transport of construction equipment and materials, an operation tunnel for transport of radioactive waste, an entrance shaft for workers, and six silos for final disposal of radioactive waste. As of Dec. 2012, the overall project progress rate is 93.8%. (authors)« less

Field evaluations of the VD max approach for substantiation of a 25 kGy sterilization dose and its application to other preselected doses

NASA Astrophysics Data System (ADS)

Kowalski, John B.; Herring, Craig; Baryschpolec, Lisa; Reger, John; Patel, Jay; Feeney, Mary; Tallentire, Alan

2002-08-01

The International and European standards for radiation sterilization require evidence of the effectiveness of a minimum sterilization dose of 25 kGy but do not provide detailed guidance on how this evidence can be generated. An approach, designated VD max, has recently been described and computer evaluated to provide safe and unambiguous substantiation of a 25 kGy sterilization dose. The approach has been further developed into a practical method, which has been subjected to field evaluations at three manufacturing facilities which produce different types of medical devices. The three facilities each used a different overall evaluation strategy: Facility A used VD max for quarterly dose audits; Facility B compared VD max and Method 1 in side-by-side parallel experiments; and Facility C, a new facility at start-up, used VD max for initial substantiation of 25 kGy and subsequent quarterly dose audits. A common element at all three facilities was the use of 10 product units for irradiation in the verification dose experiment. The field evaluations of the VD max method were successful at all three facilities; they included many different types of medical devices/product families with a wide range of average bioburden and sample item portion values used in the verification dose experiments. Overall, around 500 verification dose experiments were performed and no failures were observed. In the side-by-side parallel experiments, the outcomes of the VD max experiments were consistent with the outcomes observed with Method 1. The VD max approach has been extended to sterilization doses >25 and <25 kGy; verification doses have been derived for sterilization doses of 15, 20, 30, and 35 kGy. Widespread application of the VD max method for doses other than 25 kGy must await controlled field evaluations and the development of appropriate specifications/standards.

A Manual for Evaluating School Facilities.

ERIC Educational Resources Information Center

Reida, G.W.

This survey manual evaluates the important points of functionality of school facilities in logical order. Instructions are given for the use of the manual, and separate sections present guidelines for evaluation of the following--(1) site, (2) building structure, (3) administrative spaces, (4) classrooms, (5) special rooms, (6) general service…

An Analytical and Experimental Analysis of Factors Affecting Exhaust System Performance in Sea Level Static Jet Engine Test Facilities.

DTIC Science & Technology

1972-12-01

include filtering devices, venturi scrubbers , and electrostatic precipitators. These have been evaluated as unsatisfactory from considerations of...Early studies of pollution abatement systems have resulted in the selection and development of a nucleation scrubber [Ref. 47]. Other devices analyzed...the venturi system is its inability to operate efficiently over greater than a 10 percent interval away from its design point, which is an

A Study of the System Safety Concept as it Relates to the New Walter Reed Army Medical Center, Washington, DC.

DTIC Science & Technology

1978-03-31

established the safety level of the% * originally designed facility and the extent of current safety * modifications. The objectives evaluated the...Program could identify many safety hazards thus leading to design improvements. The study provided several recommendations to formalize the Systems Safety... design , construction, and proposed systems management of the new Walter Reed Army Medical Center (WRAMC), Washington, D.C., was conducted during the

Space station systems analysis study. Part 3: Documentation. Volume 7: SCB alternate EPS evaluation, task 10

NASA Technical Reports Server (NTRS)

1977-01-01

Power levels up to 100 kWe average were baselined for the electrical power system of the space construction base, a long-duration manned facility capable of supporting manufacturing and large scale construction projects in space. Alternatives to the solar array battery systems discussed include: (1) solar concentrator/brayton; (2) solar concentrator/thermionic; (3) isotope/brayton; (4) nuclear/brayton; (5) nuclear thermoelectric; and (6) nuclear thermionic.

An Evaluation of the Implementation of Two-Levels of Maintenance at Strategic Air Command Intercontinental Ballistic Missile Bases

DTIC Science & Technology

1991-09-01

34excellent results in the conservation of technical skills, tools, facilities and materials" (18:9). The pioneering efforts of SAC and the subsequent...to the weapon systems successes through recent decades and concepts which were pioneering in the business of system acquisition. According to Sanks...Minuteman system has undergone major physical modifications to enhance its effectiveness. Its longevity continues to be sustained through modifications

The Testing Behind The Test Facility: The Acoustic Design of the NASA Glenn Research Center's World-Class Reverberant Acoustic Test Facility

NASA Technical Reports Server (NTRS)

Hozman, Aron D.; Hughes, William O.; McNelis, Mark E.; McNelis, Anne M.

2011-01-01

The National Aeronautics and Space Administration (NASA) Glenn Research Center (GRC) is leading the design and build of the new world-class vibroacoustic test capabilities at the NASA GRC's Plum Brook Station in Sandusky, Ohio, USA. Benham Companies, LLC is currently constructing modal, base-shake sine and reverberant acoustic test facilities to support the future testing needs of NASA's space exploration program. The large Reverberant Acoustic Test Facility (RATF) will be approximately 101,000 cu ft in volume and capable of achieving an empty chamber acoustic overall sound pressure level (OASPL) of 163 dB. This combination of size and acoustic power is unprecedented amongst the world's known active reverberant acoustic test facilities. The key to achieving the expected acoustic test spectra for a range of many NASA space flight environments in the RATF is the knowledge gained from a series of ground acoustic tests. Data was obtained from several NASA-sponsored test programs, including testing performed at the National Research Council of Canada's acoustic test facility in Ottawa, Ontario, Canada, and at the Redstone Technical Test Center acoustic test facility in Huntsville, Alabama, USA. The majority of these tests were performed to characterize the acoustic performance of the modulators (noise generators) and representative horns that would be required to meet the desired spectra, as well as to evaluate possible supplemental gas jet noise sources. The knowledge obtained in each of these test programs enabled the design of the RATF sound generation system to confidently advance to its final acoustic design and subsequent on-going construction.

Which organizational characteristics are associated with increased management of depression using antidepressants in US nursing homes?

PubMed

Lapane, Kate L; Hughes, Carmel M

2004-10-01

There is universal agreement that organizational characteristics of nursing facilities can and do influence the quality of care and resident outcomes. This study evaluated the relation between organizational characteristics and management of depression using antidepressants. This was a cross-sectional study of Medicare/Medicaid certified nursing homes in 6 states in 2000. We studied 87,907 residents with depression in 2,128 facilities. Minimum Data Set (MDS) provided information regarding use of antidepressants and resident factors. On-line Survey and Certification of Automated Records (OSCAR) provided facility characteristics information including structural, resource, and staffing levels. Adjusted estimates of organizational effects on antidepressant drug use were derived from generalized estimating equations. Increased treatment of depression with antidepressants was associated with facilities with a higher percentage of residents from payer sources other than Medicare/Medicaid (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.02-1.06) and more professional nursing staff (OR, 1.15; 95% CI, 1.05-1.26). Decreased treatment tended to be related to larger homes (OR, 0.76; 95% CI, 0.68-0.84) or if the home employed full-time physicians (OR, 0.87; 95% CI, 0.78-0.96). Once the decision to treat was made, treatment with tricyclics tended to be inversely related to larger homes, for-profit facilities, and homes with more Medicare residents. Facilities that are required to be more fiscally conservative, be it larger facilities with fewer private pay patients or for profit facilities, have lower rates of pharmacologic treatment. Resource and structural characteristics influence the type of antidepressant being prescribed; resident characteristics may not be the over-riding factor in prescribing.

Using a qualitative approach for understanding hospital-affiliated integrated clinical and fitness facilities: characteristics and members' experiences.

PubMed

Yang, Jingzhen; Kingsbury, Diana; Nichols, Matthew; Grimm, Kristin; Ding, Kele; Hallam, Jeffrey

2015-06-19

With health care shifting away from the traditional sick care model, many hospitals are integrating fitness facilities and programs into their clinical services in order to support health promotion and disease prevention at the community level. Through a series of focus groups, the present study assessed characteristics of hospital-affiliated integrated facilities located in Northeast Ohio, United States and members' experiences with respect to these facilities. Adult members were invited to participate in a focus group using a recruitment flyer. A total of 6 focus groups were conducted in 2013, each lasting one hour, ranging from 5 to 12 participants per group. The responses and discussions were recorded and transcribed verbatim, then analyzed independently by research team members. Major themes were identified after consensus was reached. The participants' average age was 57, with 56.8% currently under a doctor's care. Four major themes associated with integrated facilities and members' experiences emerged across the six focus groups: 1) facility/program, 2) social atmosphere, 3) provider, and 4) member. Within each theme, several sub-themes were also identified. A key feature of integrated facilities is the availability of clinical and fitness services "under one roof". Many participants remarked that they initially attended physical therapy, becoming members of the fitness facility afterwards, or vice versa. The participants had favorable views of and experiences with the superior physical environment and atmosphere, personal attention, tailored programs, and knowledgeable, friendly, and attentive staff. In particular, participants favored the emphasis on preventive care and the promotion of holistic health and wellness. These results support the integration of wellness promotion and programming with traditional medical care and call for the further evaluation of such a model with regard to participants' health outcomes.

Urban Watershed Research Facility at Edison Environmental Center

EPA Science Inventory

The Urban Watershed Research Facility (UWRF) is an isolated, 20-acre open space within EPA’s 200 acre Edison facility established to develop and evaluate the performance of stormwater management practices under controlled conditions. The facility includes greenhouses that allow ...

Aeronautical facilities assessment

NASA Technical Reports Server (NTRS)

Penaranda, F. E. (Compiler)

1985-01-01

A survey of the free world's aeronautical facilities was undertaken and an evaluation made on where the relative strengths and weaknesses exist. Special emphasis is given to NASA's own capabilities and needs. The types of facilities surveyed are: Wind Tunnels; Airbreathing Propulsion Facilities; and Flight Simulators

An Investment Level Decision Method to Secure Long-term Reliability

NASA Astrophysics Data System (ADS)

Bamba, Satoshi; Yabe, Kuniaki; Seki, Tomomichi; Shibaya, Tetsuji

The slowdown in power demand increase and facility replacement causes the aging and lower reliability in power facility. And the aging is followed by the rapid increase of repair and replacement when many facilities reach their lifetime in future. This paper describes a method to estimate the repair and replacement costs in future by applying the life-cycle cost model and renewal theory to the historical data. This paper also describes a method to decide the optimum investment plan, which replaces facilities in the order of cost-effectiveness by setting replacement priority formula, and the minimum investment level to keep the reliability. Estimation examples applied to substation facilities show that the reasonable and leveled future cash-out can keep the reliability by lowering the percentage of replacements caused by fatal failures.

Diagnostic issues and capabilities in 48 isolation facilities in 16 European countries: data from EuroNHID surveys.

PubMed

Thiberville, Simon-Djamel; Schilling, Stefan; De Iaco, Giuseppina; Fusco, Francesco Maria; Thomson, Gail; Maltezou, Helen C; Gottschalk, Rene; Brodt, Reinhard H; Bannister, Barbara; Puro, Vincenzo; Ippolito, Giuseppe; Brouqui, Philippe

2012-09-25

Highly infectious diseases (HIDs) are defined as being transmissible from person to person, causing life-threatening illnesses and presenting a serious public health hazard. The sampling, handling and transport of specimens from patients with HIDs present specific bio-safety concerns. The European Network for HID project aimed to record, in a cross-sectional study, the infection control capabilities of referral centers for HIDs across Europe and assesses the level of achievement to previously published guidelines. In this paper, we report the current diagnostic capabilities and bio-safety measures applied to diagnostic procedures in these referral centers. Overall, 48 isolation facilities in 16 European countries were evaluated. Although 81% of these referral centers are located near a biosafety level 3 laboratory, 11% and 31% of them still performed their microbiological and routine diagnostic analyses, respectively, without bio-safety measures. The discrepancies among the referral centers surveyed between the level of practices and the European Network of Infectious Diseases (EUNID) recommendations have multiple reasons of which the interest of the individuals in charge and the investment they put in preparedness to emerging outbreaks. Despite the fact that the less prepared centers can improve by just updating their practice and policies any support to help them to achieve an acceptable level of biosecurity is welcome.

Evaluation of mobile phone addiction level and sleep quality in university students.

PubMed

Sahin, Sevil; Ozdemir, Kevser; Unsal, Alaattin; Temiz, Nazen

2013-07-01

To determine the mobile phone addiction level in university students, to examine several associated factors and to evaluate the relation between the addiction level and sleep quality. The study is a cross-sectional research conducted on the students of the Sakarya University between 01 November 2012 and 01 February 2013. The study group included 576 students. The Problematic Mobile Phone Use Scale was used for evaluating the mobile phone addiction level and the Pittsburgh Sleep Quality Index for assessing the sleep quality. Mann-Whitney U test, Kruskal-Wallis test and Spearman's Correlation Analysis were used for analyzing the data. The study group consisted of 296 (51.4%) females and 208 (48.6%) males. The mean age was 20.83 ± 1.90 years (min:17, max:28). The addiction level was determined to be higher in the second-year students, those with poor family income, those with type A personality, those whose age for first mobile phone is 13 and below and those whose duration of daily mobile phone use is above 5 hours (p < 0.05 for each). The sleep quality worsens with increasing mobile phone addiction level (p < 0.05). The sleep quality worsens with increasing addiction level. It was concluded that referring the students with suspected addiction to advanced healthcare facilities, performing occasional scans for early diagnosis and informing the students about controlled mobile phone use would be useful.

Trends in Facility Management Technology: The Emergence of the Internet, GIS, and Facility Assessment Decision Support.

ERIC Educational Resources Information Center

Teicholz, Eric

1997-01-01

Reports research on trends in computer-aided facilities management using the Internet and geographic information system (GIS) technology for space utilization research. Proposes that facility assessment software holds promise for supporting facility management decision making, and outlines four areas for its use: inventory; evaluation; reporting;…

Protocol for the evaluation of a quality-based pay for performance scheme in Liberia.

PubMed

Bawo, Luke; Leonard, Kenneth L; Mohammed, Rianna

2015-01-13

Improving the quality of care at hospitals is a key next step in rebuilding Liberia's health system. In order to improve the efficiency, effectiveness, and quality of care at the secondary hospital level, the country is developing a system to upgrade health worker skills and competencies, and shifting towards improved provider accountability for results, including a Graduate Medical Residency Program (GMRP) and provider accountability for improvements in quality through performance-based financing (PBF) at the hospital level. This document outlines the protocol for the impact evaluation of the hospital improvement program. The evaluation will provide an estimate of the impact of the project and investigate the mechanism for success in a way that can provide general lessons about the quality of health care in low-income countries. The evaluation aims 1) to provide the best possible estimate of program impact and 2) to quantitatively describe the changes that took place within facilities as a result of the program. In particular, the impact evaluation focuses on the changes in human resources within the hospitals. As such, we use a three-period intensive evaluation of treated and matched comparison hospitals to see how services change in treated hospitals as well as a continuous data collection effort to track the activities of individual health workers within treated hospitals. We are particularly interested in understanding how facilities met quality targets. Did they bring in new health workers with higher qualifications? Did they improve the knowledge or competence of their existing staff? Did they improve the availability of medicines and equipment so that the capacities of existing health workers were improved? Did they address the motivation of health workers so that individuals with the same competence and capacity were able to provide higher quality? And, if they did improve quality, did patients notice?

The emergence of care facilities in Thailand for older German-speaking people: structural backgrounds and facility operators as transnational actors.

PubMed

Bender, Désirée; Hollstein, Tina; Schweppe, Cornelia

2017-12-01

This paper presents findings from an ethnographic study of old age care facilities for German-speaking people in Thailand. It analyses the conditions and processes behind the development and specific designs of such facilities. It first looks at the intertwinement, at the socio-structural level, of different transborder developments in which the facilities' emergence is embedded. Second, it analyses the processes that accompany the emergence, development and organisation of these facilities at the local level. In this regard, it points out the central role of the facility operators as transnational actors who mediate between different frames of reference and groups of actors involved in these facilities. It concludes that the processes of mediation and intertwining are an important and distinctive feature of the emergence of these facilities, necessitated by the fact that, although the facilities are located in Thailand, their 'markets' are in the German-speaking countries of their target groups.

The cold chain and the expanded program on immunization in Chile: an evaluation exercise.

PubMed

Carrasco, R; Dinstrans, R; Montaldo, I; Medina, E; Reyes, M; Vergara, I; Piwonka, A; Thomas, E R

1982-01-01

It was decided that a study of the cold chain should be conducted in Chile in an effort to identify situations that could be corrected and to improve the technical and administrative development of the program. Specifically, study objectives were as follows: to determine the degree to which the EPI standards for procurement, receipt, transfer, control, maintenance, and distribution of vaccines were being met; to assess the turnover, knowledge, and training of auxiliary vaccination personnel against the relevant standards established for vaccine and cold chain management; to determine the antigenic potency of measles vaccine samples available at the time visits were made to local clinics, regional health storage sites, and the central supply facility; and to test a written instrument designed for the express purpose of assessing achievement of the first 2 objectives cited. The study sought to provide a descriptive assessment of work being performed at the central, regional, and local levels in the Metropolitan Region. The operating units involved included the airport and main supply center at the central level; the 7 storage facilities of the Metropolitan Region's 78 local clinics providing maternal and child health care. 40 clinics, selected by lot, represented 51% of the region's 78 clinics and provided coverage for 49% of the population assigned to the region's health services. The units studied failed to satisfy half the investigated Expanded Program for Immunization (EPI) standards, i.e., the average achievement rating of the 3 levels combined (49.3%) fell short of half the desired 100%. The airport unit met very few of the EPI implementation standards, scoring only 20% in this area. Deficiencies were found in systems for shipping vaccine in cold boxes, for making cold rooms permanently available, and for providing adequate vaccine transportation. The central supply facility, responsible for the purchase, storage, distribution, and maintenance of an adequate vaccine stock, had an achievement score of only 41%. The regional level, represented by the 7 storage facilities studied, obtained a lower overall achievement score than the other 2 levels and appears to be a high-risk link in the cold chain. The local level, represented by the 40 clinics studied, attained the highest average achievement score of any level (57%). Yet, serious deficiencies also emerged at this level, particularly regarding implementation and control activities. These deficiencies were aggravated by the fact that vaccines undoubtedly encounter a larger number of potentially damaging contingencies at the local level than they do elsewhere. Suggestions are made for overcoming these difficulties.

The Diesel Exhaust in Miners Study: V. Evaluation of the Exposure Assessment Methods

PubMed Central

Stewart, Patricia A.; Vermeulen, Roel; Coble, Joseph B.; Blair, Aaron; Schleiff, Patricia; Lubin, Jay H.; Attfield, Mike; Silverman, Debra T.

2012-01-01

Exposure to respirable elemental carbon (REC), a component of diesel exhaust (DE), was assessed for an epidemiologic study investigating the association between DE and mortality, particularly from lung cancer, among miners at eight mining facilities from the date of dieselization (1947–1967) through 1997. To provide insight into the quality of the estimates for use in the epidemiologic analyses, several approaches were taken to evaluate the exposure assessment process and the quality of the estimates. An analysis of variance was conducted to evaluate the variability of 1998–2001 REC measurements within and between exposure groups of underground jobs. Estimates for the surface exposure groups were evaluated to determine if the arithmetic means (AMs) of the REC measurements increased with increased proximity to, or use of, diesel-powered equipment, which was the basis on which the surface groups were formed. Estimates of carbon monoxide (CO) (another component of DE) air concentrations in 1976–1977, derived from models developed to predict estimated historical exposures, were compared to 1976–1977 CO measurement data that had not been used in the model development. Alternative sets of estimates were developed to investigate the robustness of various model assumptions. These estimates were based on prediction models using: (i) REC medians rather AMs, (ii) a different CO:REC proportionality than a 1:1 relation, and (iii) 5-year averages of historical CO measurements rather than modeled historical CO measurements and DE-related determinants. The analysis of variance found that in three of the facilities, most of the between-group variability in the underground measurements was explained by the use of job titles. There was relatively little between-group variability in the other facilities. The estimated REC AMs for the surface exposure groups rose overall from 1 to 5 μg m−3 as proximity to, and use of, diesel equipment increased. The alternative estimates overall were highly correlated (∼0.9) with the primary set of estimates. The median of the relative differences between the 1976–1977 CO measurement means and the 1976–1977 estimates for six facilities was 29%. Comparison of estimated CO air concentrations from the facility-specific prediction models with historical CO measurement data found an overall agreement similar to that observed in other epidemiologic studies. Other evaluations of components of the exposure assessment process found moderate to excellent agreement. Thus, the overall evidence suggests that the estimates were likely accurate representations of historical personal exposure levels to DE and are useful for epidemiologic analyses. PMID:22383674

Facility Practice Variation to Help Understand the Effects of Public Policy: Insights from the Dialysis Outcomes and Practice Patterns Study (DOPPS).

PubMed

Fuller, Douglas S; Robinson, Bruce M

2017-01-06

Recent Centers for Medicare & Medicaid Services policies have used dialysis facility practice variation to develop public ratings and adjust payments. In the Dialysis Facility Compare star rating system (DFC SRS), facility-relative rates of performance-based clinical measures varied nearly two-fold for mortality (standardized mortality ratio; 10th/90th percentiles: 0.71, 1.34) and hospitalization (standardized hospitalization ratio; 10th/90th percentiles: 0.64, 1.37), and nearly four-fold for transfusion (standardized transfusion ratio; 10th/90th percentiles: 0.43, 1.65). Medicare claims data (from July of 2014) demonstrate that facility variation for the proportions of patients on hemodialysis hospitalized (10th/90th percentiles: 27%, 50%) and transfused (10th/90th percentiles: 3%, 17%) within 6 months that far exceeds relatively modest recent overall longitudinal trends. DFC SRS-rated facility variation is also substantial for fistula (10th/90th percentiles: 50%, 78%) and catheter use >90 days (10th/90th percentiles: 3%, 19%). By contrast, DFC SRS-rated facility distributions for adult hemodialysis Kt/V>1.2 (10th/90th percentiles: 84%, 97%) and total serum calcium >10.2 mg/dl (median, 1%; 75th/90th percentiles: 3%, 5%) are quite narrow and may be of questionable value. Likewise, variation in the US Dialysis Outcomes and Practice Patterns Study is over two-fold for facility median serum parathyroid hormone (10th/90th percentiles: 290 pg/ml, 629 pg/ml) and ferritin (10th/90th percentiles: 469 ng/ml, 1143 ng/ml) levels, and facility mean treatment time varies by 30 minutes (10th/90th percentiles: 204 minutes, 234 minutes). Rising serum parathyroid hormone and ferritin levels, and generally short dialysis treatment time, represent areas unchecked by existing policy; both overall trends and facility variation in these values may reflect unintended consequences of policy or reimbursement pressures and therefore raise concern. Additionally, outcomes in the transition period from advanced CKD to dialysis remain poor, and policy initiatives and performance accountability in this area remain insufficient. Innovative models of comprehensive care in advanced CKD and the early dialysis period which are more amenable to policy oversight are needed. In summary, facility variation is typically larger than prevailing longitudinal trends, and should not be overlooked. The combination of nationally representative observational databases (e.g., the Dialysis Outcomes and Practice Patterns Study) and ESRD registries can provide policy makers with additional tools to evaluate facility variation, develop policies, and monitor unintended effects. Copyright © 2016 by the American Society of Nephrology.

An exploratory study on equity in funding allocation for essential medicines and health supplies in Uganda's public sector.

PubMed

Kusemererwa, Donna; Alban, Anita; Obua, Ocwa Thomas; Trap, Birna

2016-08-30

To ascertain equity in financing for essential medicines and health supplies (EMHS) in Uganda, this paper explores the relationships among government funding allocations for EMHS, patient load, and medicines availability across facilities at different levels of care. We collected data on EMHS allocations and availability of selected vital medicines from 43 purposively sampled hospitals and the highest level health centers (HC IV), 44 randomly selected lower-level health facilities (HC II, III), and from over 400 facility health information system records and National Medical Stores records. The data were analyzed to determine allocations per patient within and across levels of care and the effects of allocations on product availability. EMHS funding allocations per patient varied widely within facilities at the same level, and allocations per patient between levels overlapped considerably. For example, HC IV allocations per patient ranged from US$0.25 to US$2.14 (1:9 ratio of lowest to highest allocation), and over 75 % of HC IV facilities had the same or lower average allocation per patient than HC III facilities. Overall, 43 % of all the facilities had optimal stock levels, 27 % were understocked, and 30 % were overstocked. Using simulations, we reduced the ratio between the highest and lowest allocations per patient within a level of care to less than two and eliminated the overlap in allocation per patient between levels. Inequity in EMHS allocation is demonstrated by the wide range of funding allocations per patient and the corresponding disparities in medicines availability. We show that using patient load to calculate EMHS allocations has the potential to improve equity significantly. However, more research in this area is urgently needed. The article does not report any results of human participants. It is implemented in collaboration with the Uganda's Ministry of Health, Pharmacy Division.

Timeliness of abnormal screening and diagnostic mammography follow-up at facilities serving vulnerable women

PubMed Central

Goldman, L. Elizabeth; Walker, Rod; Hubbard, Rebecca; Kerlikowske, Karla

2013-01-01

Background Whether timeliness of follow-up after abnormal mammography differs at facilities serving vulnerable populations such as women with limited education or income, in rural areas, and racial/ethnic minorities is unknown. Methods We examined receipt of diagnostic evaluation following abnormal mammography using 1998-2006 Breast Cancer Surveillance Consortium-linked Medicare claims. We compared whether time to recommended breast imaging or biopsy depended on whether women attended facilities serving vulnerable populations. We characterized a facility by the proportion of mammograms performed on women with limited education or income, in rural areas, or racial/ethnic minorities. Results We analyzed 30,874 abnormal screening examinations recommended for follow-up imaging across 142 facilities and 10,049 abnormal diagnostic examinations recommended for biopsy across 114 facilities. Women at facilities serving populations with less education or more racial/ethnic minorities had lower rates of follow-up imaging (4-5% difference, p<0.05), and women at facilities serving more rural and low income populations had lower rates of biopsy (4-5% difference, p<0.05). Women undergoing biopsy at facilities serving vulnerable populations had longer times until biopsy than those at facilities serving non-vulnerable populations (21.6 days vs. 15.6 days; 95% CI for mean difference 4.1-7.7). The proportion of women receiving recommended imaging within 11 months and biopsy within 3 months varied across facilities (interquartile range 85.5%-96.5% for imaging and 79.4%-87.3% for biopsy). Conclusions Among Medicare recipients, follow-up rates were slightly lower at facilities serving vulnerable populations, and among those women who returned for diagnostic evaluation, time to follow-up was slightly longer at facilities that served vulnerable population. Interventions should target variability in follow-up rates across facilities, and evaluate effectiveness particularly at facilities serving vulnerable populations. PMID:23358386

An Application of the SSHAC Level 3 Process to the Probabilistic Seismic Hazard Analysis for Nuclear Facilities at the Hanford Site, Eastern Washington, USA

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

Coppersmith , Kevin J.; Bommer, Julian J.; Bryce, Robert W.

Under the sponsorship of the US Department of Energy (DOE) and the electric utility Energy Northwest, the Pacific Northwest National Laboratory (PNNL) is conducting a probabilistic seismic hazard analysis (PSHA) within the framework of a SSHAC Level 3 procedure (Senior Seismic Hazard Analysis Committee; Budnitz et al., 1997). Specifically, the project is being conducted following the guidelines and requirements specified in NUREG-2117 (USNRC, 2012b) and consistent with approach given in the American Nuclear Standard ANSI/ANS-2.29-2008 Probabilistic Seismic Hazard Analysis. The collaboration between DOE and Energy Northwest is spawned by the needs of both organizations for an accepted PSHA with highmore » levels of regulatory assurance that can be used for the design and safety evaluation of nuclear facilities. DOE committed to this study after performing a ten-year review of the existing PSHA, as required by DOE Order 420.1C. The study will also be used by Energy Northwest as a basis for fulfilling the NRC’s 10CFR50.54(f) requirement that the western US nuclear power plants conduct PSHAs in conformance with SSHAC Level 3 procedures. The study was planned and is being carried out in conjunction with a project Work Plan, which identifies the purpose of the study, the roles and responsibilities of all participants, tasks and their associated schedules, Quality Assurance (QA) requirements, and project deliverables. New data collection and analysis activities are being conducted as a means of reducing the uncertainties in key inputs to the PSHA. It is anticipated that the results of the study will provide inputs to the site response analyses at multiple nuclear facility sites within the Hanford Site and at the Columbia Generating Station.« less

Policy for Promotion of Women's Mental Health: Insight from Analysis of Policy on Postnatal Depression in Mexico.

PubMed

Place, Jean Marie S; Billings, Deborah L; Frongillo, Edward A; Blake, Christine E; Mann, Joshua R; deCastro, Filipa

2016-03-01

This article critically examines federal, state and facility-level policies, as well as clinical practice guidelines regarding postnatal depression in Mexico. Thirteen documents including national health plans, national action plans, federal and state laws and regulations, clinical practice guidelines, and public-sector healthcare facility policies were collected and evaluated according to whether they included a statement of intent and/or actions related to the care of women at risk for or experiencing postnatal depression. While postnatal depression is included in several policies in Mexico, it is not addressed in ways that guide actions to manage postnatal depression. Specific direction on postnatal depression in policies would bridge a gap in maternal mental healthcare given that medication, treatment, and timing of interventions is unique in the postpartum context.

Variations in hospitalization rates among nursing home residents: the role of facility and market attributes.

PubMed

Carter, Mary W; Porell, Frank W

2003-04-01

This study examined the contribution of facility-level and area market-level attributes to variations in hospitalization rates among nursing home residents. Three years (1991-1994) of state quarterly Medicaid case-mix reimbursement data from 527 nursing homes (NH) in Massachusetts were linked with Medicare Provider Analysis and Review hospital claims and nursing facility attribute data to produce a longitudinal, analytical file containing 72,319 person-quarter observations. Logistic regression models were used to estimate the influence of facility-level and market-level factors on hospital use, after controlling for individual-level resident attributes, including: NH diagnoses, resident-level quality of care indicators, and diagnostic cost grouping classification from previous hospital stays. Multivariate findings suggest that resident heterogeneity alone does not account for the wide variations in hospitalization rates across nursing homes. Instead, facility characteristics such as profit status, nurse staffing patterns, NH size, chain affiliation, and percentage of Medicaid and Medicare reimbursed days significantly influence NH residents' risk of hospitalization. Broader area market factors also appear to contribute to variations in hospitalization rates. Variations in hospitalization rates may reflect underutilization, as well as overutilization. Continued efforts toward identifying medically necessary hospitalizations are needed.

Infection prevention and control practice for Crimean-Congo hemorrhagic fever-A multi-center cross-sectional survey in Eurasia.

PubMed

Fletcher, Tom E; Gulzhan, Abuova; Ahmeti, Salih; Al-Abri, Seif S; Asik, Zahide; Atilla, Aynur; Beeching, Nick J; Bilek, Heval; Bozkurt, Ilkay; Christova, Iva; Duygu, Fazilet; Esen, Saban; Khanna, Arjun; Kader, Çiğdem; Mardani, Masoud; Mahmood, Faisal; Mamuchishvili, Nana; Pshenichnaya, Natalia; Sunbul, Mustafa; Yalcin, Tuğba Y; Leblebicioglu, Hakan

2017-01-01

Crimean Congo Hemorrhagic Fever (CCHF) is a life threatening acute viral infection that presents significant risk of nosocomial transmission to healthcare workers. Evaluation of CCHF infection prevention and control (IP&C) practices in healthcare facilities that routinely manage CCHF cases in Eurasia. A cross-sectional CCHF IP&C survey was designed and distributed to CCHF centers in 10 endemic Eurasian countries in 2016. Twenty-three responses were received from centers in Turkey, Pakistan, Russia, Georgia, Kosovo, Bulgaria, Oman, Iran, India and Kazakhstan. All units had dedicated isolation rooms for CCHF, with cohorting of confirmed cases in 15/23 centers and cohorting of suspect and confirmed cases in 9/23 centers. There was adequate personal protective equipment (PPE) in 22/23 facilities, with 21/23 facilities reporting routine use of PPE for CCHF patients. Adequate staffing levels to provide care reported in 14/23 locations. All centers reported having a high risk CCHFV nosocomial exposure in last five years, with 5 centers reporting more than 5 exposures. Education was provided annually in most centers (13/23), with additional training requested in PPE use (11/23), PPE donning/doffing (12/23), environmental disinfection (12/23) and waste management (14/23). Staff and patient safety must be improved and healthcare associated CCHF exposure and transmission eliminated. Improvements are recommended in isolation capacity in healthcare facilities, use of PPE and maintenance of adequate staffing levels. We recommend further audit of IP&C practice at individual units in endemic areas, as part of national quality assurance programs.

The Impact of Inventory Management on Stock-Outs of Essential Drugs in Sub-Saharan Africa: Secondary Analysis of a Field Experiment in Zambia.

PubMed

Leung, Ngai-Hang Z; Chen, Ana; Yadav, Prashant; Gallien, Jérémie

2016-01-01

To characterize the impact of widespread inventory management policies on stock-outs of essential drugs in Zambia's health clinics and develop related recommendations. Daily clinic storeroom stock levels of artemether-lumefantrine (AL) products in 2009-2010 were captured in 145 facilities through photography and manual transcription of paper forms, then used to determine historical stock-out levels and estimate demand patterns. Delivery lead-times and estimates of monthly facility accessibility were obtained through worker surveys. A simulation model was constructed and validated for predictive accuracy against historical stock-outs, then used to evaluate various changes potentially affecting product availability. While almost no stock-outs of AL products were observed during Q4 2009 consistent with primary analysis, up to 30% of surveyed facilities stocked out of some AL product during Q1 2010 despite ample inventory being simultaneously available at the national warehouse. Simulation experiments closely reproduced these results and linked them to the use of average past monthly issues and failure to capture lead-time variability in current inventory control policies. Several inventory policy enhancements currently recommended by USAID | DELIVER were found to have limited impact on product availability. Inventory control policies widely recommended and used for distributing medicines in sub-Saharan Africa directly account for a substantial fraction of stock-outs observed in common situations involving demand seasonality and facility access interruptions. Developing central capabilities in peripheral demand forecasting and inventory control is critical. More rigorous independent peer-reviewed research on pharmaceutical supply chain management in low-income countries is needed.