Non-utilization of public health care facilities: examining the reasons through a national study of women in India.

PubMed

Dalal, Koustuv; Dawad, Suraya

2009-01-01

This article examines women's opinions about their reasons for the non-utilization of appropriate public health care facilities, according to categories of their healthcare seeking in India. This cross-sectional article uses nationally representative samples from the Indian National Family Health Surveys NFHS-3 (2005-2006), which were generated from randomly selected households. Women of reproductive age (15-49 years) from the 29 states of India participated (n = 124 385 women). The respondents were asked why they did not utilize public health care facilities when members of their households were ill, identifying their reasons with a yes/no choice. The following five reasons were of primary interest: (1) 'there is no nearby facility'; (2) 'facility timing is not convenient'; (3) 'health personnel are often absent'; (4) 'waiting time is too long'; and (5) 'poor quality of care'. Results from logistic regression analyses indicate that respondents' education, economic status and standard of living are significant predictors for non-utilization of public health care facilities. Women who sought the services of care delivery and health check-ups indicated that health personnel were absent. Service seekers for self and child's medical treatments indicated that there were no nearby health facilities, service times were inconvenient, there were long waiting times and poor quality health care. This study concludes that improving public health care facilities with user-friendly opening times, the regular presence of staff, reduced waiting times and improved quality of care are necessary steps to reducing maternal mortality and poverty.

21 CFR 200.10 - Contract facilities (including consulting laboratories) utilized as extramural facilities by...

Code of Federal Regulations, 2010 CFR

2010-04-01

... (IND) Application, any information obtained during the inspection of an extramural facility having a... Administration does not consider results of validation studies of analytical and assay methods and control...

Accreditation status and geographic location of outpatient vascular testing facilities among Medicare beneficiaries: the VALUE (Vascular Accreditation, Location & Utilization Evaluation) study.

PubMed

Rundek, Tatjana; Brown, Scott C; Wang, Kefeng; Dong, Chuanhui; Farrell, Mary Beth; Heller, Gary V; Gornik, Heather L; Hutchisson, Marge; Needleman, Laurence; Benenati, James F; Jaff, Michael R; Meier, George H; Perese, Susana; Bendick, Phillip; Hamburg, Naomi M; Lohr, Joann M; LaPerna, Lucy; Leers, Steven A; Lilly, Michael P; Tegeler, Charles; Alexandrov, Andrei V; Katanick, Sandra L

2014-10-01

There is limited information on the accreditation status and geographic distribution of vascular testing facilities in the US. The Centers for Medicare & Medicaid Services (CMS) provide reimbursement to facilities regardless of accreditation status. The aims were to: (1) identify the proportion of Intersocietal Accreditation Commission (IAC) accredited vascular testing facilities in a 5% random national sample of Medicare beneficiaries receiving outpatient vascular testing services; (2) describe the geographic distribution of these facilities. The VALUE (Vascular Accreditation, Location & Utilization Evaluation) Study examines the proportion of IAC accredited facilities providing vascular testing procedures nationally, and the geographic distribution and utilization of these facilities. The data set containing all facilities that billed Medicare for outpatient vascular testing services in 2011 (5% CMS Outpatient Limited Data Set (LDS) file) was examined, and locations of outpatient vascular testing facilities were obtained from the 2011 CMS/Medicare Provider of Services (POS) file. Of 13,462 total vascular testing facilities billing Medicare for vascular testing procedures in a 5% random Outpatient LDS for the US in 2011, 13% (n=1730) of facilities were IAC accredited. The percentage of IAC accredited vascular testing facilities in the LDS file varied significantly by US region, p<0.0001: 26%, 12%, 11%, and 7% for the Northeast, South, Midwest, and Western regions, respectively. Findings suggest that the proportion of outpatient vascular testing facilities that are IAC accredited is low and varies by region. Increasing the number of accredited vascular testing facilities to improve test quality is a hypothesis that should be tested in future research. © The Author(s) 2014.

Teachers' Utilization of School Facilities and Academic Achievement of Student Nurses in Human Biology in Schools of Nursing in Akwa Ibom State, Nigeria

ERIC Educational Resources Information Center

Usen, Onodiong Mfreke

2016-01-01

The study examined the relationship between teachers' utilization of school facilities and academic achievement of student nurses in Human Biology in schools of Nursing in Akwa Ibom State. Four (4) specific objectives, four (4) research questions and four (4) null hypotheses were formulated to guide the study. Ex-post facto survey design was…

Facilities Inventory and Utilization Study Fall of 1988 for the State of North Carolina. Twenty-Second Edition.

ERIC Educational Resources Information Center

North Carolina State Commission on Higher Education Facilities, Raleigh.

This edition of an annual series of facilities inventory and utilization studies reflects the status of space in North Carolina institutions of higher education at the end of the drop-add period of the 1988 fall term at each college. It gives indications of the uses being made of the space and provides norms and historical information for the past…

42 CFR 488.64 - Remote facility variances for utilization review requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Remote facility variances for utilization review... PROCEDURES Special Requirements § 488.64 Remote facility variances for utilization review requirements. (a... such facility or direct responsibility for the care of the patients being reviewed or, in the case of a...

Utilization of health facilities and predictors of health-seeking behavior for under-five children with acute diarrhea in slums of Addis Ababa, Ethiopia: a community-based cross-sectional study.

PubMed

Adane, Metadel; Mengistie, Bezatu; Mulat, Worku; Kloos, Helmut; Medhin, Girmay

2017-04-04

Information on health-seeking behavior and utilization of health facilities in slums of Addis Ababa is scarce, impeding the implementation of effective interventions. The purpose of this study is to assess the status of health facilities utilization and predictors for health-seeking behavior of mothers/caregivers of under-five children with acute diarrhea in slums of Addis Ababa, Ethiopia. A community-based cross-sectional study design was employed in five rounds of surveys in seven kebeles in slums of Addis Ababa among 472 mothers/caregivers of 472 under-five children with acute diarrhea in reference to Andersen's behavioral model. Data were entered into EpiData Version 3.1 and analyzed using STATA Version 14.0. Descriptive statistics were used to examine patterns of health facilities utilization and multivariable logistic regression analysis was applied to identify predictors associated with health-seeking behavior. Most mothers/caregivers (70.8%) sought care either at home (14.2%) or health facilities (56.6%), whereas 29.2% reported that they did not seek any care. Of those who consulted health facilities, government health facilities (76.9%) were more utilized than private (18.0%) and informal (5.1%) health facilities. Nearly all (93.9%) of the mothers/caregivers using government health facilities used health centers, and of those who took their children to private health facilities (60.9%) used clinics and 26.1% used pharmacies/drug vendors. Mothers/caregivers visiting health facilities obtained mainly oral rehydration salt (ORS) (39.8%) and home-recommended fluids (HRF) (40.3%), but few of them (11.9%) obtained ORS plus zinc supplementation. Predisposing factors of literacy of mothers/caregivers (adjusted odds ratio (AOR) = 2.4; 95% CI 1.4-4.1) and occupation (AOR = 2.6; 95% CI 1.5-4.6), the enabling factors of households monthly income of 50 United States Dollars (US$) and above (AOR = 2.9; 95% CI 1.5-5.6) and availability of nearest health facilities within 15 min walking distance (AOR = 3.3; 95% CI 1.7-6.6), and the need factors of recognizing danger signs of fever (AOR = 4.3; 95% CI 2.4-7.6) and vomiting (AOR = 3.3; 95% CI 1.8-5.9) were significantly associated with health-seeking behavior. Increasing the proximity of health facilities in slums and health education and socioeconomic development programs targeting illiterate mothers/caregivers and poor households may promote and increase health-seeking behavior and the accessibility of health facilities for the treatment of acute diarrhea in under-five children in Addis Ababa slums.

Utilization of the state led public private partnership program "Chiranjeevi Yojana" to promote facility births in Gujarat, India: a cross sectional community based study.

PubMed

Yasobant, Sandul; Vora, Kranti Suresh; Shewade, Hemant Deepak; Annerstedt, Kristi Sidney; Isaakidis, Petros; Mavalankar, Dileep V; Dholakia, Nishith B; De Costa, Ayesha

2016-07-15

"Chiranjeevi Yojana (CY)", a state-led large-scale demand-side financing scheme (DSF) under public-private partnership to increase institutional delivery, has been implemented across Gujarat state, India since 2005. The scheme aims to provide free institutional childbirth services in accredited private health facilities to women from socially disadvantaged groups (eligible women). These services are paid for by the state to the private facility with the intention of service being free to the user. This community-based study estimates CY uptake among eligible women and explores factors associated with non-utilization of the CY program. This was a community-based cross sectional survey of eligible women who gave birth between January and July 2013 in 142 selected villages of three districts in Gujarat. A structured questionnaire was administered by trained research assistant to collect information on socio-demographic details, pregnancy details, details of childbirth and out-of-pocket (OOP) expenses incurred. A multivariable inferential analysis was done to explore the factors associated with non-utilization of the CY program. Out of 2,143 eligible women, 559 (26 %) gave birth under the CY program. A further 436(20 %) delivered at free public facilities, 713(33 %) at private facilities (OOP payment) and 435(20 %) at home. Eligible women who belonged to either scheduled tribe or poor [aOR = 3.1, 95 % CI:2.4 - 3.8] or having no formal education [aOR = 1.6, 95 % CI:1.1, 2.2] and who delivered by C-section [aOR = 2.1,95 % CI: 1.2, 3.8] had higher odds of not utilizing CY program. Of births at CY accredited facilities (n = 924), non-utilization was 40 % (n = 365) mostly because of lack of required official documentation that proved eligibility (72 % of eligible non-users). Women who utilized the CY program overall paid more than women who delivered in the free public facilities. Uptake of the CY among eligible women was low after almost a decade of implementation. Community level awareness programs are needed to increase participation among eligible women. OOP expense was incurred among who utilized CY program; this may be a factor associated with non-utilization in next pregnancy which needs to be studied. There is also a need to ensure financial protection of women who have C-section.

43 CFR 3272.11 - How do I describe the proposed utilization facility?

Code of Federal Regulations, 2014 CFR

2014-10-01

... rates, pressures, and temperatures; facility net and gross electrical generation; and, if applicable, interconnection with other utilization facilities. If it is a direct use facility, send us the information we need...

43 CFR 3272.11 - How do I describe the proposed utilization facility?

Code of Federal Regulations, 2013 CFR

2013-10-01

... rates, pressures, and temperatures; facility net and gross electrical generation; and, if applicable, interconnection with other utilization facilities. If it is a direct use facility, send us the information we need...

43 CFR 3272.11 - How do I describe the proposed utilization facility?

Code of Federal Regulations, 2012 CFR

2012-10-01

... rates, pressures, and temperatures; facility net and gross electrical generation; and, if applicable, interconnection with other utilization facilities. If it is a direct use facility, send us the information we need...

Using willingness to pay to investigate regressiveness of user fees in health facilities in Tanzania.

PubMed

Bonu, Sekhar; Rani, Manju; Bishai, David

2003-12-01

The study uses data from the Tanzania Human Resources Development Survey (1994) on willingness to pay (WTP) for desired quality of health care at lower-level health facilities to assess potential regressiveness of user fees - a disproportionately higher negative effect of user fees on utilization of health services among the poor compared with the rich. Despite reports of extensive bypassing of the lower-level health facilities in Tanzania, the WTP for quality health care at these health facilities is surprisingly large. WTP was lower among the poor, female and elderly respondents. Almost one-quarter of the poorest 40% of the population was not willing to pay even when the quality of services met their expectations. The results suggest that: the utilization of health services at lower-level health facilities can be increased by improving the quality of care; and the implementation of uniform user charges in the public facilities may be regressive, adversely affecting utilization among the poor, women and the elderly. An effective system of exemptions and waivers will be required for the very poor who may not be able to pay even when quality of services is improved. The findings of the study have policy implications for the Tanzanian government's recent attempts to expand cost-sharing through community health funds at lower-level health facilities, being introduced since 1998.

Utilization of retroperitoneal lymph node dissection for testicular cancer in the United States: Results from the National Cancer Database (1998-2011).

PubMed

Hugen, Cory M; Hu, Brian; Jeldres, Claudio; Burton, Claire; Nichols, Craig R; Porter, Christopher R; Daneshmand, Siamak

2016-11-01

Retroperitoneal lymph node dissection (RPLND) for the treatment of testicular cancer is a relatively rare and complex operation that may contribute to differences in utilization. We sought to characterize the use of RPLND between different categories of cancer center facilities in the United States. The National Cancer Database was queried for patients with germ cell tumors treated at different types of cancer centers between 1998 and 2011. The proportion of patients who underwent RPLND was stratified by stage and histology and then compared between treatment facilities. RPLND utilization was then compared between facility types as a function of time. A total of 59,652 patients met inclusion criteria and 5,475 (9.2%) underwent RPLND. The proportion of patients treated with RPLND for non-seminomatous germ cell tumor (NSGCT) was significantly different between cancer center types for all stages (P<0.001) and used most often in academic comprehensive cancer centers. There was no difference in the proportion of RPLND utilization for stage II and III seminoma stratified by treatment facility. There was a significantly decreased trend in the utilization of RPLND for stage I (P = 0.032) NSGCT whereas utilization was increased for stage III NSGCT (P≤0.001) over the study period. The proportion of patients undergoing RPLND for NSGCT varies significantly by the type of cancer center and is used most often in academic cancer centers. Utilization of RPLND decreased for stage I NSGCT and increased for stage III NSGCTs during the study period. Copyright © 2016 Elsevier Inc. All rights reserved.

Utility investigation best practices and effects on TxDOT highway improvement projects.

DOT National Transportation Integrated Search

2013-04-01

The lack of adequate information about the location and characteristics of utility facilities can result in a number of problems, including damages to utilities, disruptions to utility services and traffic, lost utility facilities as constructi...

An Application of a Procedures Manual for Assessing the Socioeconomic Impact of the Construction and Operation of Coal Utilization Facilities in the Old West Region.

ERIC Educational Resources Information Center

Old West Regional Commission, Billings, MT.

To evaluate and test the effectiveness of the "Procedures Manual for Assisting the Socioeconomic Impact of the Construction and Operation of Coal Utilization Facilities in the Old West Region," an impact study of a proposed electric generating station on the Laramie River near Wheatland, Wyoming, identifies difficulties encountered in…

THE COMPUTER AS A MANAGEMENT TOOL--PHYSICAL FACILITIES INVENTORIES, UTILIZATION, AND PROJECTIONS. 11TH ANNUAL MACHINE RECORDS CONFERENCE PROCEEDINGS (UNIVERSITY OF TENNESSEE, KNOXVILLE, APRIL 25-27, 1966).

ERIC Educational Resources Information Center

WITMER, DAVID R.

WISCONSIN STATE UNIVERSITIES HAVE BEEN USING THE COMPUTER AS A MANAGEMENT TOOL TO STUDY PHYSICAL FACILITIES INVENTORIES, SPACE UTILIZATION, AND ENROLLMENT AND PLANT PROJECTIONS. EXAMPLES ARE SHOWN GRAPHICALLY AND DESCRIBED FOR DIFFERENT TYPES OF ANALYSIS, SHOWING THE CARD FORMAT, CODING SYSTEMS, AND PRINTOUT. EQUATIONS ARE PROVIDED FOR DETERMINING…

Perceived barriers to utilizing maternal and neonatal health services in contracted-out versus government-managed health facilities in the rural districts of Pakistan.

PubMed

Riaz, Atif; Zaidi, Shehla; Khowaja, Asif Raza

2015-03-06

A number of developing countries have contracted out public health facilities to the Non-Government Organizations (NGOs) in order to improve service utilization. However, there is a paucity of in-depth qualitative information on barriers to access services as a result of contracting from service users' perspective. The objective of this study was to explore perceived barriers to utilizing Maternal and Neonatal Health (MNH) services, in health facilities contracted out by government to NGO for service provision versus in those which are managed by government (non-contracted). A community-based qualitative exploratory study was conducted between April to September 2012 at two contracted-out and four matched non-contracted primary healthcare facilities in Thatta and Chitral, rural districts of Pakistan. Using semi-structured guide, the data were collected through thirty-six Focus Group Discussions (FGDs) conducted with mothers and their spouses in the catchment areas of selected facilities. Thematic analysis was performed using NVivo version 10.0 in which themes and sub-themes emerged. Key barriers reported in contracted sites included physical distance, user charges and familial influences. Whereas, poor functionality of health centres was the main barrier for non-contracted sites with other issues being comparatively less salient. Decision-making patterns for participants of both catchments were largely similar. Spouses and mother-in-laws particularly influenced the decision to utilize health facilities. Contracting out of health facility reduces supply side barriers to MNH services for the community served but distance, user charges and low awareness remain significant barriers. Contracting needs to be accompanied by measures for transportation in remote settings, oversight on user fee charges by contractor, and strong community-based behavior change strategies. © 2015 by Kerman University of Medical Sciences.

Perceived barriers to utilizing maternal and neonatal health services in contracted-out versus government-managed health facilities in the rural districts of Pakistan

PubMed Central

Riaz, Atif; Zaidi, Shehla; Khowaja, Asif Raza

2015-01-01

Background: A number of developing countries have contracted out public health facilities to the Non-Government Organizations (NGOs) in order to improve service utilization. However, there is a paucity of in-depth qualitative information on barriers to access services as a result of contracting from service users’ perspective. The objective of this study was to explore perceived barriers to utilizing Maternal and Neonatal Health (MNH) services, in health facilities contracted out by government to NGO for service provision versus in those which are managed by government (non-contracted). Methods: A community-based qualitative exploratory study was conducted between April to September 2012 at two contracted-out and four matched non-contracted primary healthcare facilities in Thatta and Chitral, rural districts of Pakistan. Using semi-structured guide, the data were collected through thirty-six Focus Group Discussions (FGDs) conducted with mothers and their spouses in the catchment areas of selected facilities. Thematic analysis was performed using NVivo version 10.0 in which themes and sub-themes emerged. Results: Key barriers reported in contracted sites included physical distance, user charges and familial influences. Whereas, poor functionality of health centres was the main barrier for non-contracted sites with other issues being comparatively less salient. Decision-making patterns for participants of both catchments were largely similar. Spouses and mother-in-laws particularly influenced the decision to utilize health facilities. Conclusion: Contracting out of health facility reduces supply side barriers to MNH services for the community served but distance, user charges and low awareness remain significant barriers. Contracting needs to be accompanied by measures for transportation in remote settings, oversight on user fee charges by contractor, and strong community-based behavior change strategies. PMID:25905478

42 CFR 488.64 - Remote facility variances for utilization review requirements.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 5 2014-10-01 2014-10-01 false Remote facility variances for utilization review requirements. 488.64 Section 488.64 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... PROCEDURES Special Requirements § 488.64 Remote facility variances for utilization review requirements. (a...

42 CFR 488.64 - Remote facility variances for utilization review requirements.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 5 2012-10-01 2012-10-01 false Remote facility variances for utilization review requirements. 488.64 Section 488.64 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... PROCEDURES Special Requirements § 488.64 Remote facility variances for utilization review requirements. (a...

42 CFR 488.64 - Remote facility variances for utilization review requirements.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 5 2011-10-01 2011-10-01 false Remote facility variances for utilization review requirements. 488.64 Section 488.64 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... PROCEDURES Special Requirements § 488.64 Remote facility variances for utilization review requirements. (a...

42 CFR 488.64 - Remote facility variances for utilization review requirements.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 5 2013-10-01 2013-10-01 false Remote facility variances for utilization review requirements. 488.64 Section 488.64 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... PROCEDURES Special Requirements § 488.64 Remote facility variances for utilization review requirements. (a...

43 CFR 3270.10 - What types of geothermal operations are governed by these utilization regulations?

Code of Federal Regulations, 2011 CFR

2011-10-01

... of geothermal resources. This includes: (1) Electrical generation facilities; (2) Direct use facilities; (3) Related utilization facility operations; (4) Actual and allocated well field production and injection; and (5) Related well field operations. (b) The utilization regulations in subparts 3270 through...

Impact of geographic accessibility on utilization of the annual health check-ups by income level in Japan: A multilevel analysis.

PubMed

Fujita, Misuzu; Sato, Yasunori; Nagashima, Kengo; Takahashi, Sho; Hata, Akira

2017-01-01

Although both geographic accessibility and socioeconomic status have been indicated as being important factors for the utilization of health care services, their combined effect has not been evaluated. The aim of this study was to reveal whether an income-dependent difference in the impact of geographic accessibility on the utilization of government-led annual health check-ups exists. Existing data collected and provided by Chiba City Hall were employed and analyzed as a retrospective cohort study. The subjects were 166,966 beneficiaries of National Health Insurance in Chiba City, Japan, aged 40 to 74 years. Of all subjects, 54,748 (32.8%) had an annual health check-up in fiscal year 2012. As an optimal index of geographic accessibility has not been established, five measures were calculated: travel time to the nearest health care facility, density of health care facilities (number facilities within a 30-min walking distance from the district of residence), and three indices based on the two-step floating catchment area method. Three-level logistic regression modeling with random intercepts for household and district of residence was performed. Of the five measures, density of health care facilities was the most compatible according to Akaike's information criterion. Both low density and low income were associated with decreased utilization of the health check-ups. Furthermore, a linear relationship was observed between the density of facilities and utilization of the health check-ups in all income groups and its slope was significantly steeper among subjects with an equivalent income of 0.00 yen than among those with equivalent income of 1.01-2.00 million yen (p = 0.028) or 2.01 million yen or more (p = 0.040). This result indicated that subjects with lower incomes were more susceptible to the effects of geographic accessibility than were those with higher incomes. Thus, better geographic accessibility could increase the health check-up utilization and also decrease the income-related disparity of utilization.

Central Computational Facility CCF communications subsystem options

NASA Technical Reports Server (NTRS)

Hennigan, K. B.

1979-01-01

A MITRE study which investigated the communication options available to support both the remaining Central Computational Facility (CCF) computer systems and the proposed U1108 replacements is presented. The facilities utilized to link the remote user terminals with the CCF were analyzed and guidelines to provide more efficient communications were established.

Applications study of advanced power generation systems utilizing coal-derived fuels, volume 2

NASA Technical Reports Server (NTRS)

Robson, F. L.

1981-01-01

Technology readiness and development trends are discussed for three advanced power generation systems: combined cycle gas turbine, fuel cells, and magnetohydrodynamics. Power plants using these technologies are described and their performance either utilizing a medium-Btu coal derived fuel supplied by pipeline from a large central coal gasification facility or integrated with a gasification facility for supplying medium-Btu fuel gas is assessed.

41 CFR 102-74.310 - What measures must Federal agencies take to improve the utilization of parking facilities?

Code of Federal Regulations, 2010 CFR

2010-07-01

...) FEDERAL MANAGEMENT REGULATION REAL PROPERTY 74-FACILITY MANAGEMENT Facility Management Parking Facilities... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false What measures must Federal agencies take to improve the utilization of parking facilities? 102-74.310 Section 102-74.310...

Utilization of healthcare services in postpartum women in the Philippines who delivered at home and the effects on their health: a cross-sectional analytical study.

PubMed

Yamashita, Tadashi; Reyes Tuliao, Maria Teresa; Concel Meana, Magdalena; Suplido, Sherri Ann; Llave, Cecilia L; Tanaka, Yuko; Matsuo, Hiroya

2017-01-01

A low ratio of utilization of healthcare services in postpartum women may contribute to maternal deaths during the postpartum period. The maternal mortality ratio is high in the Philippines. The aim of this study was to examine the current utilization of healthcare services and the effects on the health of women in the Philippines who delivered at home. This was a cross-sectional analytical study, based on a self-administrated questionnaire, conducted from March 2015 to February 2016 in Muntinlupa, Philippines. Sixty-three postpartum women who delivered at home or at a facility were enrolled for this study. A questionnaire containing questions regarding characteristics, utilization of healthcare services, and abnormal symptoms during postpartum period was administered. To analyze the questionnaire data, the sample was divided into delivery at home and delivery at a facility. Chi-square test, Fisher's exact test, and Mann-Whitney U test were used. There were significant differences in the type of birth attendant, area of residence, monthly income, and maternal and child health book usage between women who delivered at home and those who delivered at a facility ( P <0.01). There was significant difference in the utilization of antenatal checkup ( P <0.01) during pregnancy, whilst there was no significant difference in utilization of healthcare services during the postpartum period. Women who delivered at home were more likely to experience feeling of irritated eyes and headaches, and continuous abdominal pain ( P <0.05). Financial and environmental barriers might hinder the utilization of healthcare services by women who deliver at home in the Philippines. Low utilization of healthcare services in women who deliver at home might result in more frequent abnormal symptoms during postpartum.

A Methodology for Conducting Space Utilization Studies within Department of Defense Medical Facilities

DTIC Science & Technology

1992-07-01

database programs, such as dBase or Microsoft Excell, to yield statistical reports that can profile the health care facility . Ladeen (1989) feels that the...service specific space status report would be beneficial to the specific service(s) under study, it would not provide sufficient data for facility -wide...change in the Master Space Plan. The revised methodology also provides a mechanism and forum for spuce management education within the facility . The

Schools and Neighborhoods Research Study: School Building Use Study.

ERIC Educational Resources Information Center

Eismann, Donald; And Others

This report documents the findings related to Objective 2 of the Schools and Neighborhoods Research Study. The task was to identify community services provided by the neighborhood school. The study staff reviewed the existing facilities use information from the Seattle Public Schools. Results from the Facilities Utilization Study Survey and the…

Study of the impacts of regulations affecting the acceptance of Integrated Community Energy Systems: public utility, energy facility siting and municipal franchising regulatory programs in Rhode Island. Preliminary background report

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

Feurer, D A; Weaver, C L; Gallagher, K C

1980-01-01

The Rhode Island statutes vest in the Public Utility Commission and the Division of Public Utilities the exclusive power and authority to regulate public utility companies in that state. Both bodies have been established within the Department of Business Regulation but are independent of the Department's director and are not under his jurisdiction. The jurisdiction to regulate utilities is shared by the Commission and the Division. The Commission serves as a quasi-judicial tribunal with jurisdiction, powers, and duties to hold investigations and hearings involving rates, sufficiency and resonableness of facilities, gas, electric, water, and pipeline public utilities. The administrator, whomore » is chief executive officer of the Division, is responsible for exercising the jurisdiction, supervision, powers, and duties not specifically assigned to the Commission. By virtue of his office, the chairman of the Commission serves also as the administrator and he supervises and directs the execution of all laws relating to public utilities and carriers and all regulations and orders of the Commission governing the conduct and charges of public utilities. Public utility regulatory statutes, energy facility siting programs, and municipal franchising authority are examined to identify how they may impact on the ability of an organization, whether or not it be a regulated utility, to construct and operate an ICES.« less

10 CFR 50.22 - Class 103 licenses; for commercial and industrial facilities.

Code of Federal Regulations, 2010 CFR

2010-01-01

... facilities. 50.22 Section 50.22 Energy NUCLEAR REGULATORY COMMISSION DOMESTIC LICENSING OF PRODUCTION AND..., transfer, acquire, possess, or use a production or utilization facility for industrial or commercial purposes; Provided, however, That in the case of a production or utilization facility which is useful in...

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

ERIC Educational Resources Information Center

Lach, Ivan J.

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

Facility fence-line monitoring using passive samplers

EPA Science Inventory

In 2009, the U.S. EPA executed a year-long field study at a refinery in Corpus Christi, Texas, to evaluate the use of passive diffusive sampling technology for assessing time-averaged benzene concentrations at the facility fence line. The study utilized 14-day time-integrated Car...

42 CFR 57.409 - Good cause for other use of completed facility.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Grants for Construction of Nurse Training Facilities § 57.409 Good cause for other use of completed... facilities not previously utilized for nurse training will be so utilized and are substantially the...

42 CFR 57.409 - Good cause for other use of completed facility.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Grants for Construction of Nurse Training Facilities § 57.409 Good cause for other use of completed... facilities not previously utilized for nurse training will be so utilized and are substantially the...

Development of a Statewide Antibiogram to Assess Regional Trends in Antibiotic-Resistant ESKAPE Organisms.

PubMed

Guarascio, Anthony J; Brickett, Laura M; Porter, Timothy J; Lee, Nancy D; Gorse, Erin E; Covvey, Jordan R

2017-01-01

Hospitals and other facilities utilize antibiograms as tools for optimal antibiotic selection. Currently, no measures compare broad trends on the regional level, despite interest for more comprehensive data, particularly for antibiotic-resistant ESKAPE organisms. To collect and compare regional health-care facility antibiogram data for ESKAPE organisms to form a cumulative antibiogram. Health-care facilities were identified using the publicly accessible Pennsylvania Department of Health web site. Facilities were contacted by phone from June 2015 to 2016 to ascertain participation/consent for the study. An electronic questionnaire ascertained baseline facility characteristics. Facilities provided quantitative antibiotic susceptibility data via antibiograms. Antibiogram data were synthesized as cumulative susceptibilities, stratified by urban/suburban versus rural location. Forty-five facilities were included in the study (n = 18 urban/suburban, n = 27 rural). The overall prevalence of methicillin-resistant S aureus was 41.5%, stratified at 40.6% and 43.3% in urban/suburban and rural facilities, respectively ( P < .001). Vancomycin-resistant Enterococcus prevalence was 18.8% overall, with 27.7% in urban/suburban and 14.0% in rural facilities ( P < .001). Generally, lower susceptibility rates were found for high-utilization beta-lactams across gram-negative organisms in urban/suburban facilities. Development of a regional cumulative antibiogram that targets key ESKAPE pathogens is feasible, while observed trends may help aid future antimicrobial stewardship efforts.

Trends in inequalities in utilization of reproductive health services from 2000 to 2011 in Vietnam.

PubMed

Duc, Nguyen Huu Chau; Nakamura, Keiko; Kizuki, Masashi; Seino, Kaoruko; Rahman, Mosiur

2015-01-01

This study aimed to examine changes in utilization of reproductive health services by wealth status from 2000 to 2011 in Vietnam. Data from the Vietnam Multiple Indicator Cluster Surveys in 2000, 2006, and 2011 were used. The subjects were 550, 1023, and 1363 women, respectively, aged between 15 and 49 years who had given birth in the previous one or two years. The wealth index, a composite measure of a household's ownership of selected assets, materials used for housing construction, and types of water access and sanitation facilities, was used as a measure of wealth status. Main utilization indicators were utilization of antenatal care services, receipt of a tetanus vaccine, receipt of blood pressure measurement, blood examination and urine examination during antenatal care, receipt of HIV testing, skilled birth attendance at delivery, health-facility-based delivery, and cesarean section delivery. Inequalities by wealth index were measured by prevalence ratios, concentration indices, and multivariable adjusted regression coefficients. Significant increase in overall utilization was observed in all indicators (all p < 0.001). The concentration indices were 0.19 in 2000 and 0.06 in 2011 for antenatal care, 0.10 in 2000 and 0.06 in 2011 for tetanus vaccination, 0.23 in 2000 and 0.08 in 2011 for skilled birth attendance, 0.29 in 2006 and 0.12 in 2011 for blood examination, and 0.18 in 2006 and 0.09 in 2011 for health-facility-based delivery. The multivariable adjusted regression coefficients of reproductive health service utilization by wealth category were 0.06 in 2000 and 0.04 in 2011 for antenatal care, 0.07 in 2000 and 0.05 in 2011 for skilled birth attendance, and 0.07 in 2006 and 0.05 in 2011 for health-facility-based delivery. More women utilized reproductive health services in 2011 than in 2000. Inequality by wealth status in utilization of antenatal care, skilled birth attendance, and health-facility-based delivery had been reduced.

Social capital, outpatient care utilization and choice between different levels of health facilities in rural and urban areas of Bhutan.

PubMed

Herberholz, Chantal; Phuntsho, Sonam

2018-06-18

This study examines the factors that explain outpatient care utilization and the choice between different levels of health facilities in Bhutan, focusing on individual social capital, given Bhutan's geography of remote and sparsely populated areas. The more isolated the living, the more important individual social capital may become. Standard factors proposed by the Andersen model of healthcare utilization serve as control variables. Data for 2526 households from the 2012 Bhutan Living Standards Survey, which contains a social capital module covering structural, cognitive and output dimensions of social capital, are used. The results from the logistic regression analysis show that individual social capital is positively related with the probability of seeking treatment when ill or injured. Informal social contacts and perceived help and support are most important in rural areas, whereas specific trust matters in urban areas. The explanatory power of the model using a subset of the data for urban areas only, however, is very low as most predisposing and enabling factors are insignificant, which is not surprising though in view of better access to health facilities in urban areas and the fact that healthcare is provided free of charge in Bhutan. Multinomial regression results further show that structural and output dimensions of social capital influence the likelihood of seeking care at secondary or tertiary care facilities relative to primary care facilities. Moreover, economic status and place of residence are significantly associated with healthcare utilization and choice of health facility. The findings with respect to social capital suggest that strategizing and organizing social capital may help improve healthcare utilization in Bhutan. Copyright © 2018 Elsevier Ltd. All rights reserved.

Shuttle orbiter storage locker system: A study

NASA Technical Reports Server (NTRS)

Butler, D. R.; Schowalter, D. T.; Weil, D. C.

1973-01-01

Study has been made to assure maximum utility of storage space and crew member facilities in planned space shuttle orbiter. Techniques discussed in this study should be of interest to designers of storage facilities in which space is at premium and vibration is severe. Manufacturers of boats, campers, house trailers, and aircraft could benefit from it.

Towards 90-90-90 Target: Factors Influencing Availability, Access, and Utilization of HIV Services—A Qualitative Study in 19 Ugandan Districts

PubMed Central

Tumwebaze, Flora; Akakimpa, Denis; Kityo, Cissy; Mugyenyi, Peter; Abongomera, George

2018-01-01

Background UNAIDS has set a new target 90-90-90 by 2020. To achieve this target, current programs need to address challenges that limit access, availability, and utilization of HIV testing and treatment services. Therefore, the aim of this study was to identify the barriers that influence access, availability, and utilization of HIV services in rural Uganda within the setting of a large donor funded program. Methods We conducted key informant interviews with stakeholders at the district level, staff of existing HIV/AIDS projects, and health facilities in 19 districts. Data were also collected from focus group discussions comprised of clients presenting for HIV care and treatment. Data were transcribed and analyzed using content analysis. Results. Barriers identified were as follows: (1) drug shortages including antiretroviral drugs at health facilities. Some patients were afraid to start ART because of worrying about shortages; (2) distance and (3) staffing shortages; (4) stigma persistence; (5) lack of social and economic support initiatives that enhance retention in treatment. Conclusions In conclusion, our study has identified several factors that influence access, availability, and utilization of HIV services. Programs need to address drug and staff shortages, HIV stigma, and long distances to health facilities to broaden access and utilization in order to realize the UNAIDS target. PMID:29750175

Viral contacts confound studies of childhood leukemia and high-voltage transmission lines.

PubMed

Sahl, J D

1994-05-01

Studies of childhood leukemia have reported a link with residential proximity to electric utility facilities. This paper elaborates on the hypothesis that residential proximity to electric utility transmission-systems is a surrogate for viral contacts, a potential confounder in these studies. While the causal implications of increased viral contacts is not established, the assumption made here is that a significant component of childhood leukemia has an infectious etiology. Increased viral contacts can result from residential mobility, being first born, or use of community childcare facilities. Re-analysis of existing studies should look specifically for the interaction between childhood leukemia, markers for viral contacts (e.g., residential mobility, birth order, use of outside childcare facilities), and residential proximity to high-voltage transmission lines. New study designs should include parameters to test directly for a virus-related infectious model for childhood leukemia.

Do resource utilization and clinical measures still vary across dialysis chains after controlling for the local practices of facilities and physicians?

PubMed

Hirth, Richard A; Turenne, Marc N; Wheeler, John R C; Ma, Yu; Messana, Joseph M

2010-08-01

Because of adverse survival effects, anemia management and financial incentives to increase doses of erythropoiesis-stimulating agents (ESAs) have been controversial. Prior studies showed more aggressive anemia management in dialysis facilities owned by for-profit chains, but have been criticized for not accounting for practices of individual physicians and facilities. To improve understanding of how dialysis practices and resource utilization are influenced by physicians, facilities, and chains. Mixed models with chain fixed effects and facility and physician random effects. Medicare hemodialysis patients in 2004. A total of 234,158 patients, 3995 facilities, 4838 physicians, and 7 chain classifications were included. Spending per session for dialysis-related services billed separately from the dialysis treatment and for ESAs. Achievement of hematocrit (HCT) and urea reduction ratio (URR) targets. Of the 4 largest for-profit chains, 3 had higher resource use than independents, with differences up to $17.92 higher ESA/session. Utilization was positively associated with achieving target HCT. Despite incurring lower costs, patients treated by a large nonprofit chain were as likely as patients of independents to achieve the HCT target. The largest chains were more likely than independents to achieve the URR target. Substantial variation occurred across physicians and facilities, and adjustment for chain only modestly decreased this variation. Chains' methods of influencing practices were not directly observed. Chains appear to have the ability to implement protocols that shift practices, but not the ability to substantially reduce local variation. Assertions that chain effects found by earlier studies were spurious are not supported.

Determinants of Utilization of Eye Care Services in a Rural Adult Population of a Developing Country

PubMed Central

Olusanya, Bolutife A.; Ashaye, Adeyinka O.; Owoaje, Eme T.; Baiyeroju, Aderonke M.; Ajayi, Benedictus G.

2016-01-01

Purpose: To describe the factors that determine the utilization of eye care services in a rural community in South-Western Nigeria. Methods: A descriptive cross-sectional survey using a multistage sampling technique was conducted. The main outcome measure was self-reported previous consultation of an orthodox medical facility for eye care. Results: The study sample included 643 participants. Only 122 (19%) respondents had previously visited orthodox facilities in search of eye care and 24% of those with presenting visual acuity <6/18 had sought eye care. Characteristics associated with previous utilization of eye care services were age of =70 years (odds ratio [OR] ≥ 1.7, P = 0.02); male gender (OR = 1.5, P = 0.04); literacy (OR = 1.7, P = 0.007); and residing close to an eye care facility (OR = 2.8, P < 0.001). Blind respondents were three times more likely to seek eye care (P < 0.001). Regression analysis revealed that factors associated with increased likelihood of utilization of eye care services included age ≥70 years; literacy; residence close to an eye facility; being diabetic or hypertensive; history of ocular symptoms, and blindness. Conclusions: These findings suggest that a significant proportion (75%) of adults in the study area are not utilizing eye care services and that blindness is an important determinant of utilization of eye care services. Health education and awareness campaigns about the importance and benefits of seeking eye care early, and the provision of community-based eye care programs are essential to boost the uptake of eye care services in this community as well as other rural areas of West Africa. PMID:26957847

A Study of Airbase Facility/Utility Energy R and D Requirements

DTIC Science & Technology

1992-04-01

facility/utility energy requirements for system implementations, modifications, or deletions were collected, entered into the database, and compared with...BASE_________ ENERGY LOS1 %) 200 MBtu TOTAL COSTS 100 Motu ELECTRIC 100 Motu THERMAL337 Motu ,, OF1FUEL 100 MBtu OF(10 11 PURCHASED S 1800.00 ELECTRIC...this page. Usage Data = *.BTU I. Correct spelling of Base name and Command 2. Macro does the following: Inserts or deletes columns or rows so that D4

Feasibility Study of Coal Gasification/Fuel Cell/Cogeneration Project. Scranton, Pennsylvania Site. Project Description,

DTIC Science & Technology

1985-11-01

arranged to maximize thermal output; - Plant will meet PURPA criteria for recognition as a "Qualifying Facility" (QF). 7587A 2 - GFC emissions will be...10. Plant must meet Public Utilities Regulatory Policies Act ( PURPA ) criteria for classification as a "Qualifying Facility" (QF). 11. Visual effect...assessments. 3 The Public Utilities Regulatory Policies Act ( PURPA ) which is administered by the Federal Energy Regulatory Commission (FERC), governs how a

Determinants of Utilization and Community Experiences with Community Health Volunteers for Treatment of Childhood Illnesses in Rural Sierra Leone.

PubMed

Yansaneh, Aisha I; George, Asha S; Sharkey, Alyssa; Brieger, William R; Moulton, Lawrence H; Yumkella, Fatu; Bangura, Peter; Kabano, Augustin; Diaz, Theresa

2016-04-01

In 2010, at the same time as the national roll out of the Free Health Care Initiative (FHCI), which removed user fees for facility based health care, trained community health volunteers (CHVs) were deployed to provide integrated community case management of diarrhea, malaria and pneumonia to children under 5 years of age (U5) in Kambia and Pujehun districts, Sierra Leone. After 2 years of implementation and in the context of FHCI, CHV utilization rate was 14.0 %. In this study, we examine the factors associated with this level of CHV utilization. A cross-sectional household-cluster survey of 1590 caregivers of 2279 children U5 was conducted in 2012; with CHV utilization assessed using a multiple logistic regression model. Focus groups and in-depth interviews were also conducted to understand communities' experiences with CHVs. Children with diarrhea (OR = 3.17, 95 % CI: 1.17-8.60), from female-headed households (OR = 4.55, 95 % CI: 1.88-11.00), and whose caregivers reported poor quality of care as a barrier to facility care-seeking (OR = 8.53, 95 % CI: 3.13-23.16) were more likely to receive treatment from a CHV. Despite low utilization, caregivers were highly familiar and appreciative of CHVs, but were concerned about the lack of financial remuneration for CHVs. CHVs remained an important source of care for children from female-headed households and whose caregivers reported poor quality of care at health facilities. CHVs are an important strategy for certain populations even when facility utilization is high or when facility services are compromised, as has happened with the recent Ebola epidemic in Sierra Leone.

Developing State Agency Facility Plans: A Guide to Planning and Implementation. Michigan Studies in Rehabilitation Utilization Series: 4.

ERIC Educational Resources Information Center

Miller, Juliet V.; Wargel, James F.

Intended for use in inservice training of vocational rehabilitation agency personnel, this facility planning guide is designed to (1) help state agencies understand the new facility planning requirements of the Rehabilitation Comprehensive Services and Developmental Disabilities Amendments of 1978, (2) provide information about a six-step planning…

ARC-1980-AC80-0512-2

NASA Image and Video Library

1980-06-05

N-231 High Reynolds Number Channel Facility (An example of a Versatile Wind Tunnel) Tunnel 1 I is a blowdown Facility that utilizes interchangeable test sections and nozzles. The facility provides experimental support for the fluid mechanics research, including experimental verification of aerodynamic computer codes and boundary-layer and airfoil studies that require high Reynolds number simulation. (Tunnel 1)

Impact of geographic accessibility on utilization of the annual health check-ups by income level in Japan: A multilevel analysis

PubMed Central

Fujita, Misuzu; Hata, Akira

2017-01-01

Although both geographic accessibility and socioeconomic status have been indicated as being important factors for the utilization of health care services, their combined effect has not been evaluated. The aim of this study was to reveal whether an income-dependent difference in the impact of geographic accessibility on the utilization of government-led annual health check-ups exists. Existing data collected and provided by Chiba City Hall were employed and analyzed as a retrospective cohort study. The subjects were 166,966 beneficiaries of National Health Insurance in Chiba City, Japan, aged 40 to 74 years. Of all subjects, 54,748 (32.8%) had an annual health check-up in fiscal year 2012. As an optimal index of geographic accessibility has not been established, five measures were calculated: travel time to the nearest health care facility, density of health care facilities (number facilities within a 30-min walking distance from the district of residence), and three indices based on the two-step floating catchment area method. Three-level logistic regression modeling with random intercepts for household and district of residence was performed. Of the five measures, density of health care facilities was the most compatible according to Akaike’s information criterion. Both low density and low income were associated with decreased utilization of the health check-ups. Furthermore, a linear relationship was observed between the density of facilities and utilization of the health check-ups in all income groups and its slope was significantly steeper among subjects with an equivalent income of 0.00 yen than among those with equivalent income of 1.01–2.00 million yen (p = 0.028) or 2.01 million yen or more (p = 0.040). This result indicated that subjects with lower incomes were more susceptible to the effects of geographic accessibility than were those with higher incomes. Thus, better geographic accessibility could increase the health check-up utilization and also decrease the income-related disparity of utilization. PMID:28486522

Monitoring agricultural processing electrical energy use and efficiency

USDA-ARS?s Scientific Manuscript database

Energy costs have become proportionately larger as cotton post-harvest processing facilities have utilized other inputs more efficiently. A discrepancy in energy consumption per unit processed between facilities suggests that energy could be utilized more efficiently. Cotton gin facilities were in...

[Business administration of PET facilities: a cost analysis of three facilities utilizing delivery FDG].

PubMed

Mitsutake, Naohiro; Oku, Shinya; Fujii, Ryo; Furui, Yuji; Yasunaga, Hideo

2008-05-01

PET (positron emission tomography) has been proved to be a powerful imaging tool in clinical oncology. The number of PET facilities in Japan has remarkably increased over the last decade. Furthermore, the approval of delivery FDG in 2005 resulted in a tremendous expansion of the PET institutions without a cyclotron facility. The aim of this study was to conduct a cost analysis of PET institutions that utilized delivery FDG. Three PET facilities using delivery FDG were investigated about the costs for PET service. Fixed costs included depreciation costs for construction and medical equipments such as positron camera. Variable costs consisted of costs for medical materials including delivery FDG. The break-even point was analyzed in each of three institutions. In the three hospitals (A, B and C), the annual number of PET scan was 1,591, 1,637 and 914, while cost per scan was accounted as yen 110,262, yen 111,091, and yen 134,192, respectively. The break-even point was calculated to be 2,583, 2,679 and 2,081, respectively. PET facilities utilizing delivery FDG seemed to have difficulty in business administration. Such a situation suggests the possibility that the current supply of PET facilities might exceed actual demand for the service. The efficiency of resource allocation should be taken into consideration in the future health service researches on PET.

Quality of life of persons with severe mental illness living in an intermediate care facility.

PubMed

Anderson, R L; Lewis, D A

2000-04-01

This study examined resident characteristics, clinical factors, and mental health service utilization associated with quality of life (QOL) for residents living in an Intermediate Care Facility (ICF). This study also utilized published literature to compare the QOL of ICF residents to persons with psychiatric disorders living in other residential settings. Chart review and interviews were used to study 100 randomly selected residents living in an ICF with a chart diagnosis of schizophrenia. Multivariate analyses suggest that higher levels of QOL are associated with reports that psychological problems did not interfere with work and activities and with lower levels of being a danger to others. Also, a comparison of the QOL scores reported by ICF residents to other published mentally ill populations suggests that residents of the ICF report somewhat higher QOL scores than state hospital patients, but lower scores as compared to other community samples. Data provide insight into the types of problems faced by residents of an intermediate care facility. These findings have implications for understanding the importance of mental health service utilization on QOL.

Does quality influence utilization of primary health care? Evidence from Haiti.

PubMed

Gage, Anna D; Leslie, Hannah H; Bitton, Asaf; Jerome, J Gregory; Joseph, Jean Paul; Thermidor, Roody; Kruk, Margaret E

2018-06-20

Expanding coverage of primary healthcare services such as antenatal care and vaccinations is a global health priority; however, many Haitians do not utilize these services. One reason may be that the population avoids low quality health facilities. We examined how facility infrastructure and the quality of primary health care service delivery were associated with community utilization of primary health care services in Haiti. We constructed two composite measures of quality for all Haitian facilities using the 2013 Service Provision Assessment survey. We geographically linked population clusters from the Demographic and Health Surveys to nearby facilities offering primary health care services. We assessed the cross-sectional association between quality and utilization of four primary care services: antenatal care, postnatal care, vaccinations and sick child care, as well as one more complex service: facility delivery. Facilities performed poorly on both measures of quality, scoring 0.55 and 0.58 out of 1 on infrastructure and service delivery quality respectively. In rural areas, utilization of several primary cares services (antenatal care, postnatal care, and vaccination) was associated with both infrastructure and quality of service delivery, with stronger associations for service delivery. Facility delivery was associated with infrastructure quality, and there was no association for sick child care. In urban areas, care utilization was not associated with either quality measure. Poor quality of care may deter utilization of beneficial primary health care services in rural areas of Haiti. Improving health service quality may offer an opportunity not only to improve health outcomes for patients, but also to expand coverage of key primary health care services.

Hadron Physics with Antiprotons

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

Wiedner, Ulrich

2005-10-26

The new FAIR facility which comes into operation at GSI in the upcoming years has a dedicated program of utilizing antiprotons for hadron physics. In particular, the planned PANDA experiment belongs to the group of core experiments at the new FAIR facility in Darmstadt/Germany. PANDA will be a universal detector to study the strong interaction by utilizing the annihilation process of antiprotons with protons and nuclear matter. The current paper gives an introduction into the hadron physics with antiprotons and part of the planned physics program with PANDA.

42 CFR 456.522 - Content of request for variance.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Review Plans: FFP, Waivers, and Variances for Hospitals and Mental Hospitals Ur Plan: Remote Facility Variances from Time... travel time between the remote facility and each facility listed in paragraph (e) of this section; (f...

CLOSED-LOOP TREATMENT OF ELECTROLYTIC AND ELECTROLESS NICKEL RINSE WATER BY POINT-OF-USE ION EXCHANGE: A CASE STUDY

EPA Science Inventory

Many recent pilot tests have demonstrated the benefits and cost effectiveness of point-of-use treatment technologies as opposed to centralized wastewater treatment for all sizes of plating facilities. A 9-month case study at a small plating facility in Cincinnati, OH utilizing po...

Utilization of health services in a resource-limited rural area in Kenya: Prevalence and associated household-level factors.

PubMed

Ngugi, Anthony K; Agoi, Felix; Mahoney, Megan R; Lakhani, Amyn; Mang'ong'o, David; Nderitu, Esther; Armstrong, Robert; Macfarlane, Sarah

2017-01-01

Knowledge of utilization of health services and associated factors is important in planning and delivery of interventions to improve health services coverage. We determined the prevalence and factors associated with health services utilization in a rural area of Kenya. Our findings inform the local health management in development of appropriately targeted interventions. We used a cluster sample survey design and interviewed household key informants on history of illness for household members and health services utilization in the preceding month. We estimated prevalence and performed random effects logistic regression to determine the influence of individual and household level factors on decisions to utilize health services. 1230/6,440 (19.1%, 95% CI: 18.3%-20.2%) household members reported an illness. Of these, 76.7% (95% CI: 74.2%-79.0%) sought healthcare in a health facility. The majority (94%) of the respondents visited dispensary-level facilities and only 60.1% attended facilities within the study sub-counties. Of those that did not seek health services, 43% self-medicated by buying non-prescription drugs, 20% thought health services were too costly, and 10% indicated that the sickness was not serious enough to necessitate visiting a health facility. In the multivariate analyses, relationship to head of household was associated with utilization of health services. Relatives other than the nuclear family of the head of household were five times less likely to seek medical help (Odds Ratio 0.21 (95% CI: 0.05-0.87)). Dispensary level health facilities are the most commonly used by members of this community, and relations at the level of the household influence utilization of health services during an illness. These data enrich the perspective of the local health management to better plan the allocation of healthcare resources according to need and demand. The findings will also contribute in the development of community-level health coverage interventions that target the disadvantaged household groups.

The relative patient costs and availability of dental services, materials and equipment in public oral care facilities in Tanzania.

PubMed

Nyamuryekung'e, Kasusu K; Lahti, Satu M; Tuominen, Risto J

2015-07-01

Patient charges and availability of dental services influence utilization of dental services. There is little available information on the cost of dental services and availability of materials and equipment in public dental facilities in Africa. This study aimed to determine the relative cost and availability of dental services, materials and equipment in public oral care facilities in Tanzania. The local factors affecting availability were also studied. A survey of all district and regional dental clinics in selected regions was conducted in 2014. A total of 28/30 facilities participated in the study. A structured interview was undertaken amongst practitioners and clinic managers within the facilities. Daily resources for consumption (DRC) were used for estimation of patients' relative cost. DRC are the quantified average financial resources required for an adult Tanzanian's overall consumption per day. Tooth extractions were found to cost four times the DRC whereas restorations were 9-10 times the DRC. Studied facilities provided tooth extractions (100%), scaling (86%), fillings (79%), root canal treatment (46%) and fabrication of removable partial dentures (32%). The ratio of tooth fillings to extractions in the facilities was 1:16. Less than 50% of the facilities had any of the investigated dental materials consistently available throughout the year, and just three facilities had all the investigated equipment functional and in use. Dental materials and equipment availability, skills of the practitioners and the cost of services all play major roles in provision and utilization of comprehensive oral care. These factors are likely to be interlinked and should be taken into consideration when studying any of the factors individually.

Distance from health facility and mothers' perception of quality related to skilled delivery service utilization in northern Ethiopia.

PubMed

Fisseha, Girmatsion; Berhane, Yemane; Worku, Alemayehu; Terefe, Wondwossen

2017-01-01

Poor maternal health service utilization is one of the contributing factors to a high level of maternal and newborn mortality in Ethiopia. The factors associated with utilization of services are believed to differ from one context to another. We assessed the factors associated with skilled delivery service utilization in rural northern Ethiopia. A community-based survey was conducted among mothers who gave birth in the 12 months preceding the study period, from January to February 2015, in the Tigray region of Ethiopia. Multistage sampling technique was used to select mothers from the identified clusters. Households within a 10 km radius of the health facility were taken as a cluster for a community survey. Data were collected using face-to-face interview at the household level. We compared the mothers who reported giving birth to the index child in a health facility and those who reported delivering at home, in order to identify the predictors of skilled delivery utilization. Multivariable logistic regression model was used to determine the predictors of skilled delivery service utilization. The results are presented with odds ratio (OR) and 95% confidence interval (CI). A total of 1,796 mothers participated in the study, with a 100% response rate. Distance to health facilities (adjusted odds ratio [AOR] =0.53 [95% CI: 0.39, 0.71]), perception of mothers to the availability of adequate equipment in the delivery service in their catchment area (AOR =1.5 [95% CI: 1.11, 2.13]), experiencing any complication during childbirth, using antenatal care, lower birth order and having an educated partner were the significant predictors of skilled delivery service utilization. Implementing community-based intervention programs that will address the physical accessibility of delivery services, such as the ambulance service, road issues and waiting rooms, and improving quality maternity service will likely reduce the current problem.

Distance from health facility and mothers’ perception of quality related to skilled delivery service utilization in northern Ethiopia

PubMed Central

Fisseha, Girmatsion; Berhane, Yemane; Worku, Alemayehu; Terefe, Wondwossen

2017-01-01

Background Poor maternal health service utilization is one of the contributing factors to a high level of maternal and newborn mortality in Ethiopia. The factors associated with utilization of services are believed to differ from one context to another. We assessed the factors associated with skilled delivery service utilization in rural northern Ethiopia. Subjects and methods A community-based survey was conducted among mothers who gave birth in the 12 months preceding the study period, from January to February 2015, in the Tigray region of Ethiopia. Multistage sampling technique was used to select mothers from the identified clusters. Households within a 10 km radius of the health facility were taken as a cluster for a community survey. Data were collected using face-to-face interview at the household level. We compared the mothers who reported giving birth to the index child in a health facility and those who reported delivering at home, in order to identify the predictors of skilled delivery utilization. Multivariable logistic regression model was used to determine the predictors of skilled delivery service utilization. The results are presented with odds ratio (OR) and 95% confidence interval (CI). Results A total of 1,796 mothers participated in the study, with a 100% response rate. Distance to health facilities (adjusted odds ratio [AOR] =0.53 [95% CI: 0.39, 0.71]), perception of mothers to the availability of adequate equipment in the delivery service in their catchment area (AOR =1.5 [95% CI: 1.11, 2.13]), experiencing any complication during childbirth, using antenatal care, lower birth order and having an educated partner were the significant predictors of skilled delivery service utilization. Conclusion Implementing community-based intervention programs that will address the physical accessibility of delivery services, such as the ambulance service, road issues and waiting rooms, and improving quality maternity service will likely reduce the current problem. PMID:29042819

Utilization and expenditure at public and private facilities in 39 low-income countries.

PubMed

Saksena, Priyanka; Xu, Ke; Elovainio, Riku; Perrot, Jean

2012-01-01

To document the patterns of health service utilization and health payments at public and private facilities across countries. We used data from the World Health Surveys from 39 low- and low-middle income countries to examine differences between public and private sectors. Utilization of outpatient and inpatient services, out-of-pocket payments (OOP) at public and private facilities, and transportation costs were compared. Utilization and payments to public and private sectors differ widely. Public facilities dominated in most countries for both outpatient and inpatient services. But, whereas use of private facilities is more common among the rich, poor people also use them, to a considerable extent and in almost all the countries in the study. The majority of OOP were incurred at public providers for inpatient services. On average, this was not the case for outpatient services. Medicines accounted for the largest share of OOP for all services except inpatient services at private facilities, where consultation fees did. Transportation costs were considerable. Price competition is certainly not the only factor that guides choice of provider. The results support continued efforts by the governments to engage strategically with the private sector. However, they also highlight the importance of not generalizing conditions across countries. Governments may need to reconsider simplistic user-fee abolition strategies at public providers if they simply focus on consultation fees. Policies to make health services more accessible need to consider a comprehensive benefit package that includes a wider scope of costs related to care such as expenditures on medicines and transportation. © 2011 Blackwell Publishing Ltd.

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.

Three methods to monitor utilization of healthcare services by the poor

PubMed Central

Bhuiya, Abbas; Hanifi, SMA; Urni, Farhana; Mahmood, Shehrin Shaila

2009-01-01

Background Achieving equity by way of improving the condition of the economically poor or otherwise disadvantaged is among the core goals of contemporary development paradigm. This places importance on monitoring outcome indicators among the poor. National surveys allow disaggregation of outcomes by socioeconomic status at national level and do not have statistical adequacy to provide estimates for lower level administrative units. This limits the utility of these data for programme managers to know how well particular services are reaching the poor at the lowest level. Managers are thus left without a tool for monitoring results for the poor at lower levels. This paper demonstrates that with some extra efforts community and facility based data at the lower level can be used to monitor utilization of healthcare services by the poor. Methods Data used in this paper came from two sources- Chakaria Health and Demographic Surveillance System (HDSS) of ICDDR,B and from a special study conducted during 2006 among patients attending the public and private health facilities in Chakaria, Bangladesh. The outcome variables included use of skilled attendants for delivery and use of facilities. Rate-ratio, rate-difference, concentration index, benefit incidence ratio, sequential sampling, and Lot Quality Assurance Sampling were used to assess how pro-poor is the use of skilled attendants for delivery and healthcare facilities. Findings Poor are using skilled attendants for delivery far less than the better offs. Government health service facilities are used more than the private facilities by the poor. Benefit incidence analysis and sequential sampling techniques could assess the situation realistically which can be used for monitoring utilization of services by poor. The visual display of the findings makes both these methods attractive. LQAS, on the other hand, requires small fixed sample and always enables decision making. Conclusion With some extra efforts monitoring of the utilization of healthcare services by the poor at the facilities can be done reliably. If monitored, the findings can guide the programme and facility managers to act in a timely fashion to improve the effectiveness of the programme in reaching the poor. PMID:19650938

Analysis of Department of Defense Organic Depot Maintenance Capacity Management and Facility Utilization Factors

DTIC Science & Technology

1991-09-01

System ( CAPMS ) in lieu of using DODI 4151.15H. Facility utilization rate computation is not explicitly defined; it is merely identified as a ratio of...front of a bottleneck buffers the critical resource and protects against disruption of the system. This approach optimizes facility utilization by...run titled BUFFERED BASELINE. Three different levels of inventory were used to evaluate the effect of increasing the inventory level on critical

78 FR 9016 - Approval and Promulgation of Air Quality Implementation Plans; Massachusetts; Revisions to Fossil...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-07

... Promulgation of Air Quality Implementation Plans; Massachusetts; Revisions to Fossil Fuel Utilization and..., inspection, maintenance and testing requirements for certain fossil fuel utilization facilities, rename and... fossil fuel utilization facility regulation, source registration regulation, and new industrial...

Optimum electric utility spot price determinations for small power producing facilities operating under PURPA provisions

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

Ghoudjehbaklou, H.; Puttgen, H.B.

This paper outlines an optimum spot price determination procedure in the general context of the Public Utility Regulatory Policies Act, PURPA, provisions. PURPA stipulates that local utilities must offer to purchase all available excess electric energy from Qualifying Facilities, QF, at fair market prices. As a direct consequence of these PURPA regulations, a growing number of owners are installing power producing facilities and optimize their operational schedules to minimize their utility related costs or, in some cases, actually maximize their revenues from energy sales to the local utility. In turn, the utility strives to use spot prices which maximize itsmore » revenues from any given Small Power Producing Facility, SPPF, a schedule while respecting the general regulatory and contractual framework. the proposed optimum spot price determination procedure fully models the SPPF operation, it enforces the contractual and regulatory restrictions, and it ensures the uniqueness of the optimum SPPF schedule.« less

Optimum electric utility spot price determinations for small power producing facilities operating under PURPA provisions

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

Ghoudjehbaklou, H.; Puttgen, H.B.

The present paper outlines an optimum spot price determination procedure in the general context of the Public Utility Regulatory Policies Act, PURPA, provisions. PURPA stipulates that local utilities must offer to purchase all available excess electric energy from Qualifying Facilities, QF, at fair market prices. As a direct consequence of these PURPA regulations, a growing number of owners are installing power producing facilities and optimize their operational schedules to minimize their utility related costs or, in some cases, actually maximize their revenues from energy sales to the local utility. In turn, the utility will strive to use spot prices whichmore » maximize its revenues from any given Small Power Producing Facility, SPPF, schedule while respecting the general regulatory and contractual framework. The proposed optimum spot price determination procedure fully models the SPPF operation, it enforces the contractual and regulatory restrictions, and it ensures the uniqueness of the optimum SPPF schedule.« less

Regional health care planning: a methodology to cluster facilities using community utilization patterns

PubMed Central

2013-01-01

Background Community-based health care planning and regulation necessitates grouping facilities and areal units into regions of similar health care use. Limited research has explored the methodologies used in creating these regions. We offer a new methodology that clusters facilities based on similarities in patient utilization patterns and geographic location. Our case study focused on Hospital Groups in Michigan, the allocation units used for predicting future inpatient hospital bed demand in the state’s Bed Need Methodology. The scientific, practical, and political concerns that were considered throughout the formulation and development of the methodology are detailed. Methods The clustering methodology employs a 2-step K-means + Ward’s clustering algorithm to group hospitals. The final number of clusters is selected using a heuristic that integrates both a statistical-based measure of cluster fit and characteristics of the resulting Hospital Groups. Results Using recent hospital utilization data, the clustering methodology identified 33 Hospital Groups in Michigan. Conclusions Despite being developed within the politically charged climate of Certificate of Need regulation, we have provided an objective, replicable, and sustainable methodology to create Hospital Groups. Because the methodology is built upon theoretically sound principles of clustering analysis and health care service utilization, it is highly transferable across applications and suitable for grouping facilities or areal units. PMID:23964905

Regional health care planning: a methodology to cluster facilities using community utilization patterns.

PubMed

Delamater, Paul L; Shortridge, Ashton M; Messina, Joseph P

2013-08-22

Community-based health care planning and regulation necessitates grouping facilities and areal units into regions of similar health care use. Limited research has explored the methodologies used in creating these regions. We offer a new methodology that clusters facilities based on similarities in patient utilization patterns and geographic location. Our case study focused on Hospital Groups in Michigan, the allocation units used for predicting future inpatient hospital bed demand in the state's Bed Need Methodology. The scientific, practical, and political concerns that were considered throughout the formulation and development of the methodology are detailed. The clustering methodology employs a 2-step K-means + Ward's clustering algorithm to group hospitals. The final number of clusters is selected using a heuristic that integrates both a statistical-based measure of cluster fit and characteristics of the resulting Hospital Groups. Using recent hospital utilization data, the clustering methodology identified 33 Hospital Groups in Michigan. Despite being developed within the politically charged climate of Certificate of Need regulation, we have provided an objective, replicable, and sustainable methodology to create Hospital Groups. Because the methodology is built upon theoretically sound principles of clustering analysis and health care service utilization, it is highly transferable across applications and suitable for grouping facilities or areal units.

Perceptions of users and providers on barriers to utilizing skilled birth care in mid- and far-western Nepal: a qualitative study.

PubMed

Onta, Sharad; Choulagai, Bishnu; Shrestha, Binjwala; Subedi, Narayan; Bhandari, Gajananda P; Krettek, Alexandra

2014-01-01

Although skilled birth care contributes significantly to the prevention of maternal and newborn morbidity and mortality, utilization of such care is poor in mid- and far-western Nepal. This study explored the perceptions of service users and providers regarding barriers to skilled birth care. We conducted 24 focus group discussions, 12 each with service users and service providers from different health institutions in mid- and far-western Nepal. All discussions examined the perceptions and experiences of service users and providers regarding barriers to skilled birth care and explored possible solutions to overcoming such barriers. Our results determined that major barriers to skilled birth care include inadequate knowledge of the importance of services offered by skilled birth attendants (SBAs), distance to health facilities, unavailability of transport services, and poor availability of SBAs. Other barriers included poor infrastructure, meager services, inadequate information about services/facilities, cultural practices and beliefs, and low prioritization of birth care. Moreover, the tradition of isolating women during and after childbirth decreased the likelihood that women would utilize delivery care services at health facilities. Service users and providers perceived inadequate availability and accessibility of skilled birth care in remote areas of Nepal, and overall utilization of these services was poor. Therefore, training and recruiting locally available health workers, helping community groups establish transport mechanisms, upgrading physical facilities and services at health institutions, and increasing community awareness of the importance of skilled birth care will help bridge these gaps.

Hospital-Based Outpatient Direct Access to Physical Therapist Services: Current Status in Wisconsin.

PubMed

Boissonnault, William G; Lovely, Karen

2016-11-01

Direct access to physical therapist services is available in all 50 states, with reported benefits including reduced health care costs, enhanced patient satisfaction, and no apparent compromised patient safety. Despite the benefits and legality of direct access, few data exist regarding the degree of model adoption, implementation, and utilization. The purposes of the study were: (1) to investigate the extent of implementation and utilization of direct access to outpatient physical therapist services in Wisconsin hospitals and medical centers, (2) to identify barriers to and facilitators for the provisioning of such services, and (3) to identify potential differences between facilities that do and do not provide direct access services. A descriptive survey was conducted. Eighty-nine survey questionnaires were distributed via email to the directors of rehabilitation services at Wisconsin hospitals and medical centers. The survey investigated facility adoption of the direct access model, challenges to and resources utilized during model implementation, and current barriers affecting model utilization. Forty-seven (52.8%) of the 89 survey questionnaires were completed and returned. Forty-two percent of the survey respondents (20 of 47) reported that their facility offered direct access to physical therapist services, but fewer than 10% of patients were seen via direct access at 95% of the facilities offering such services. The most frequently reported obstacles to model implementation and utilization were lack of health care provider, administrator, and patient knowledge of direct access; its legality in Wisconsin; and physical therapists' differential diagnosis and medical screening abilities. Potential respondent bias and limited generalizability of the results are limitations of the study. These findings apply to hospitals and medical centers located in Wisconsin, not to facilities located in other geographic regions. Respondents representing direct access organizations reported more timely access to physical therapist services, enhanced patient satisfaction, decreased organizational health care costs, and improved efficiency of resource utilization as benefits of model implementation. For organizations without direct access, not being an organizational priority, concerns from referral sources, and concerns that the physician-patient relationship would be negatively affected were noted as obstacles to model adoption. © 2016 American Physical Therapy Association.

A facility monitoring system: The single most valuable and cost-effective tool available to an energy manager

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

Holmes, W.A.

Energy engineering and management combines engineering problem-solving and financial management techniques to reduce utility costs. At present, substantial amounts of time and money are being spent in order to attempt to quantify energy consumption and costs and define opportunities for savings. Unfortunately, accurate verification of results is often overlooked. Advances in technology during the last few years have made the installation of a permanent, PC-based monitoring system possible for any facility, often for no more than the cost of a detailed study. By investing initially in a monitoring system rather than audits or studies, the actual consumption and cost datamore » will be available on a continuing basis and can be used to produce immediate operational savings, more accurately analyze opportunities requiring capital investments, and to verify actual savings resulting from changes. A permanent monitoring system, installed as the first step in a utility cost reduction effort, to identify where and how energy is used in a facility on a dynamic and real-time basis, can provide the most valuable and cost-effective tool available to an energy manager. The resulting data allows energy consumption patterns and utility costs to be understood and managed in the same manner as all other costs within a facility.« less

Is the closest facility the one actually used? An assessment of travel time estimation based on mammography facilities.

PubMed

Alford-Teaster, Jennifer; Lange, Jane M; Hubbard, Rebecca A; Lee, Christoph I; Haas, Jennifer S; Shi, Xun; Carlos, Heather A; Henderson, Louise; Hill, Deirdre; Tosteson, Anna N A; Onega, Tracy

2016-02-18

Characterizing geographic access depends on a broad range of methods available to researchers and the healthcare context to which the method is applied. Globally, travel time is one frequently used measure of geographic access with known limitations associated with data availability. Specifically, due to lack of available utilization data, many travel time studies assume that patients use the closest facility. To examine this assumption, an example using mammography screening data, which is considered a geographically abundant health care service in the United States, is explored. This work makes an important methodological contribution to measuring access--which is a critical component of health care planning and equity almost everywhere. We analyzed one mammogram from each of 646,553 women participating in the US based Breast Cancer Surveillance Consortium for years 2005-2012. We geocoded each record to street level address data in order to calculate travel time to the closest and to the actually used mammography facility. Travel time between the closest and the actual facility used was explored by woman-level and facility characteristics. Only 35% of women in the study population used their closest facility, but nearly three-quarters of women not using their closest facility used a facility within 5 min of the closest facility. Individuals that by-passed the closest facility tended to live in an urban core, within higher income neighborhoods, or in areas where the average travel times to work was longer. Those living in small towns or isolated rural areas had longer closer and actual median drive times. Since the majority of US women accessed a facility within a few minutes of their closest facility this suggests that distance to the closest facility may serve as an adequate proxy for utilization studies of geographically abundant services like mammography in areas where the transportation networks are well established.

Exploring health facilities' experiences in implementing the free health-care policy (FHCP) in Nepal: how did organizational factors influence the implementation of the user-fee abolition policy?

PubMed

Sato, Midori; Gilson, Lucy

2015-12-01

This article presents an Asian experience of abolishing health-care user fees: Nepal's universal free health-care policy, implemented in 2008. Based on doctoral fieldwork between August 2008 and April 2009, the paper analyses primary-care facilities' and central and district health systems' experiences with the policy. It makes a unique contribution to existing evidence because it explicitly applies organizational theory within a carefully designed, rigorous, multiple case-study analysis to deepen our understanding of the organizational and 'people' factors in the successful removal of user fees. The cases were two pairs of primary-care facilities in one district, paired for comparison of the facilities' experiences with the policy in relation to its effects on health care utilization. Data collection methods included document reviews; key informant interviews at district and central levels; in-depth, semi-structured interviews and group interviews at case facilities. (Data on indicators of utilization and quality changes over time were also collected and will be published separately). Using key elements of Nadler and Tushman's 'Organizational Congruence' model, a degree-of-fit analysis tested the study's initial propositions and yielded generalizations for contexts in and outside Nepal. The study found that Nepal's key implementation challenges were similar to Africa's: insufficient or delayed inputs of drugs and compensation; insufficient workforce and the resulting reduced quality of services that hampered facilities' relationships with their clients and health providers' attitudes. However, the Nepalese case facilities with (1) good intra- and inter-facility relationships, (2) adequate staffing, (3) well-oriented providers and (4) previously trained, better-informed and skilled health management committees experienced higher utilization and better-quality indicators over time. Through its detailed analysis of Nepal's experience in removing user fees, the study highlights the importance of addressing the 'people' and 'organizational' factors in health-policy development and implementation. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2015; all rights reserved.

Distribution and utilization of curative primary healthcare services in Lahej, Yemen.

PubMed

Bawazir, A A; Bin Hawail, T S; Al-Sakkaf, K A Z; Basaleem, H O; Muhraz, A F; Al-Shehri, A M

2013-09-01

No evidence-based data exist on the availability, accessibility and utilization of healthcare services in Lahej Governorate, Yemen. The aim of this study was to assess the distribution and utilization of curative services in primary healthcare units and centres in Lahej. Cross-sectional study (clustering sample). This study was conducted in three of the 15 districts in Lahej between December 2009 and August 2010. Household members were interviewed using a questionnaire to determine sociodemographic characteristics and types of healthcare services available in the area. The distribution of health centres, health units and hospitals did not match the size of the populations or areas of the districts included in this study. Geographical accessibility was the main obstacle to utilization. Factors associated with the utilization of curative services were significantly related to the time required to reach the nearest facility, seeking curative services during illness and awareness of the availability of health facilities (P < 0.01). There is an urgent need to look critically and scientifically at the distribution of healthcare services in the region in order to ensure accessibility and quality of services. Copyright © 2013 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Factors associated with institutional delivery service utilization in Ethiopia.

PubMed

Kebede, Alemi; Hassen, Kalkidan; Nigussie Teklehaymanot, Aderajew

2016-01-01

Most obstetric complications occur unpredictably during the time of delivery, but they can be prevented with proper medical care in the health facilities. Despite the Ethiopian government's efforts to expand health service facilities and promote health institution-based delivery service in the country, an estimated 85% of births still take place at home. The review was conducted with the aim of generating the best evidence on the determinants of institutional delivery service utilization in Ethiopia. The reviewed studies were accessed through electronic web-based search strategy from PubMed, HINARI, Mendeley reference manager, Cochrane Library for Systematic Reviews, and Google Scholar. Review Manager V5.3 software was used for meta-analysis. Mantel-Haenszel odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated. Heterogeneity of the study was assessed using I (2) test. People living in urban areas (OR =13.16, CI =1.24, 3.68), with primary and above educational level of the mother and husband (OR =4.95, CI =2.3, 4. 8, and OR =4.43, CI =1.14, 3.36, respectively), who encountered problems during pregnancy (OR =2.83, CI =4.54, 7.39), and living at a distance <5 km from nearby health facility (OR =2.6, CI =3.33, 6.57) showed significant association with institutional delivery service utilization. Women's autonomy was not significantly associated with institutional delivery service utilization. Distance to health facility and problems during pregnancy were factors positively and significantly associated with institutional delivery service utilization. Promoting couples education beyond primary education regarding the danger signs of pregnancy and benefits of institutional delivery through available communication networks such as health development army and promotion of antenatal care visits and completion of four standard visits by pregnant women were recommended.

Factors associated with institutional delivery service utilization in Ethiopia

PubMed Central

Kebede, Alemi; Hassen, Kalkidan; Nigussie Teklehaymanot, Aderajew

2016-01-01

Background Most obstetric complications occur unpredictably during the time of delivery, but they can be prevented with proper medical care in the health facilities. Despite the Ethiopian government’s efforts to expand health service facilities and promote health institution-based delivery service in the country, an estimated 85% of births still take place at home. Objective The review was conducted with the aim of generating the best evidence on the determinants of institutional delivery service utilization in Ethiopia. Methods The reviewed studies were accessed through electronic web-based search strategy from PubMed, HINARI, Mendeley reference manager, Cochrane Library for Systematic Reviews, and Google Scholar. Review Manager V5.3 software was used for meta-analysis. Mantel–Haenszel odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated. Heterogeneity of the study was assessed using I2 test. Results People living in urban areas (OR =13.16, CI =1.24, 3.68), with primary and above educational level of the mother and husband (OR =4.95, CI =2.3, 4. 8, and OR =4.43, CI =1.14, 3.36, respectively), who encountered problems during pregnancy (OR =2.83, CI =4.54, 7.39), and living at a distance <5 km from nearby health facility (OR =2.6, CI =3.33, 6.57) showed significant association with institutional delivery service utilization. Women’s autonomy was not significantly associated with institutional delivery service utilization. Conclusion and recommendation Distance to health facility and problems during pregnancy were factors positively and significantly associated with institutional delivery service utilization. Promoting couples education beyond primary education regarding the danger signs of pregnancy and benefits of institutional delivery through available communication networks such as health development army and promotion of antenatal care visits and completion of four standard visits by pregnant women were recommended. PMID:27672342

Trends in inequalities in utilization of reproductive health services from 2000 to 2011 in Vietnam

PubMed Central

Duc, Nguyen Huu Chau; Nakamura, Keiko; Kizuki, Masashi; Seino, Kaoruko; Rahman, Mosiur

2015-01-01

Objective: This study aimed to examine changes in utilization of reproductive health services by wealth status from 2000 to 2011 in Vietnam. Methods: Data from the Vietnam Multiple Indicator Cluster Surveys in 2000, 2006, and 2011 were used. The subjects were 550, 1023, and 1363 women, respectively, aged between 15 and 49 years who had given birth in the previous one or two years. The wealth index, a composite measure of a household’s ownership of selected assets, materials used for housing construction, and types of water access and sanitation facilities, was used as a measure of wealth status. Main utilization indicators were utilization of antenatal care services, receipt of a tetanus vaccine, receipt of blood pressure measurement, blood examination and urine examination during antenatal care, receipt of HIV testing, skilled birth attendance at delivery, health-facility-based delivery, and cesarean section delivery. Inequalities by wealth index were measured by prevalence ratios, concentration indices, and multivariable adjusted regression coefficients. Results: Significant increase in overall utilization was observed in all indicators (all p < 0.001). The concentration indices were 0.19 in 2000 and 0.06 in 2011 for antenatal care, 0.10 in 2000 and 0.06 in 2011 for tetanus vaccination, 0.23 in 2000 and 0.08 in 2011 for skilled birth attendance, 0.29 in 2006 and 0.12 in 2011 for blood examination, and 0.18 in 2006 and 0.09 in 2011 for health-facility-based delivery. The multivariable adjusted regression coefficients of reproductive health service utilization by wealth category were 0.06 in 2000 and 0.04 in 2011 for antenatal care, 0.07 in 2000 and 0.05 in 2011 for skilled birth attendance, and 0.07 in 2006 and 0.05 in 2011 for health-facility-based delivery. Conclusions: More women utilized reproductive health services in 2011 than in 2000. Inequality by wealth status in utilization of antenatal care, skilled birth attendance, and health-facility-based delivery had been reduced. PMID:26705431

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

Experience of socioeconomic-related inequality in dental care utilization among Thai elderly under universal coverage.

PubMed

Somkotra, Tewarit

2013-04-01

To assess the socioeconomic-related inequality in dental care utilization among Thai elderly and to determine factors associated with the observed inequality after the country achieved universal coverage. The data were taken from the nationally representative Thailand Health & Welfare Survey 2007. Data of 10,096 Thai elderly (aged over 60 years) were selected. Descriptive analyses of the features of dental care utilization among Thai elderly were carried out, in addition to the concentration index (Cindex ) being used to quantify the extent of socioeconomic-related inequality in dental care utilization. Logistic regression was used to determine factors associated with inequality in dental care. Socioeconomic-related inequality in dental care utilization among Thai elderly was shown. Also, utilization was more concentrated among wealthier older adults, as shown by the positive value of Cindex (equals 0.244). The poor elderly, however, were more likely to utilize dental care at public facilities, particularly primary care facilities. Multivariate analysis showed that certain demographic, socioeconomic and geographic characteristics were particularly associated with poor-rich differences in dental care utilization among Thai elderly. Although socioeconomic-related inequality in dental care utilization among Thai elderly exists, the pro-poor utilization at public facilities, particularly primary care facilities, substantiates the concerted effort to reducing inequality in dental care utilization for Thai elderly. © 2012 Japan Geriatrics Society.

The ICCB MIS Facility Inventory & Utilization Users Handbook.

ERIC Educational Resources Information Center

Illinois Community Coll. Board, Springfield.

This handbook is designed to assist community college administrators in using the various reports generated by the facility inventory and utilization subsystem of the Illinois Community College Board management information system. Among the reports generated by the subsystem are: room utilization report, campus classroom usage report, room use…

Instructional Facility Utilization.

ERIC Educational Resources Information Center

Kalamazoo Valley Community Coll., MI.

Data describing campus facility use for instructional and related purposes for one week of activity in Fall 1978 were collected and evaluated at Kalamazoo Valley Community College. Four measures of space utilization were used: (1) percent of available time used; (2) percent of available space used; (3) percent of scheduled space utilized; and (4)…

Short-term residential care for dementia patients: predictors for utilization and expected quality from a family caregiver's point of view.

PubMed

Donath, Carolin; Winkler, Angelika; Grässel, Elmar

2009-08-01

Short-term residential care (SRC) has proved to be effective in reducing the burden on family caregivers of dementia patients. Nevertheless, little is known about the factors which influence its usage or the expectations of family caregivers regarding quality. In this paper we address the following questions: (i) which variables of the care situation, the caregivers and their attitudes act as predictors for the utilization of SRC facilities? (ii) What are the views of caregivers about the quality of SRC? The cross-sectional study was carried out as an anonymous written survey of family caregivers of dementia patients in four regions of Germany. With a 20% response it was possible to analyze the quantitative and qualitative data from 404 and 254 family caregivers respectively. Predictors for utilization were evaluated using binary logistic regression analysis. The answers to questions of quality were evaluated using qualitative content analysis. Significant predictors for the utilization of SRC are the assessment of the helpfulness of SRC and the caregiver's knowledge of the accessibility of SRC facilities. Family caregivers who had already used SRC most frequently expressed the wish for "good care" in SRC facilities, followed by a program of suitable activities for dementia patients. In order to increase the rate of utilization, family caregivers must be convinced of the relevant advantages of using SRC facilities. The staff should be trained in caring for dementia patients and appropriate activities should be available.

Variation in Older Adult Characteristics by Residence Type and Use of Home- and Community-Based Services.

PubMed

Ewen, Heidi H; Washington, Tiffany R; Emerson, Kerstin G; Carswell, Andrew T; Smith, Matthew Lee

2017-03-22

Background: The majority of older adults prefer to remain in their homes, or to "age-in-place." To accomplish this goal, many older adults will rely upon home- and community-based services (HCBS) for support. However, the availability and accessibility of HCBS may differ based on whether the older adult lives in the community or in a senior housing apartment facility. Methods: This paper reports findings from the Pathways to Life Quality study of residential change and stability among seniors in upstate New York. Data were analyzed from 663 older adults living in one of three housing types: service-rich facilities, service-poor facilities, and community-dwelling in single-family homes. A multinomial logistic regression model was used to examine factors associated with residence type. A linear regression model was fitted to examine factors associated with HCBS utilization. Results : When compared to community-dwelling older adults, those residing in service-rich and service-poor facilities were more likely to be older, report more activity limitations, and provide less instrumental assistance to others. Those in service-poor facilities were more likely to have poorer mental health and lower perceived purpose in life. The three leading HCBS utilized were senior centers (20%), homemaker services (19%), and transportation services (18%). More HCBS utilization was associated with participants who resided in service-poor housing, were older, were female, and had more activity limitations. More HCBS utilization was also associated with those who received instrumental support, had higher perceived purpose in life, and poorer mental health. Conclusions : Findings suggest that older adults' residential environment is associated with their health status and HCBS utilization. Building upon the Person-Environment Fit theories, dedicated efforts are needed to introduce and expand upon existing HCBS available to facility residents to address physical and mental health needs as well as facilitate aging-in-place.

Variation in Older Adult Characteristics by Residence Type and Use of Home- and Community-Based Services

PubMed Central

Ewen, Heidi H.; Washington, Tiffany R.; Emerson, Kerstin G.; Carswell, Andrew T.; Smith, Matthew Lee

2017-01-01

Background: The majority of older adults prefer to remain in their homes, or to “age-in-place.” To accomplish this goal, many older adults will rely upon home- and community-based services (HCBS) for support. However, the availability and accessibility of HCBS may differ based on whether the older adult lives in the community or in a senior housing apartment facility. Methods: This paper reports findings from the Pathways to Life Quality study of residential change and stability among seniors in upstate New York. Data were analyzed from 663 older adults living in one of three housing types: service-rich facilities, service-poor facilities, and community-dwelling in single-family homes. A multinomial logistic regression model was used to examine factors associated with residence type. A linear regression model was fitted to examine factors associated with HCBS utilization. Results: When compared to community-dwelling older adults, those residing in service-rich and service-poor facilities were more likely to be older, report more activity limitations, and provide less instrumental assistance to others. Those in service-poor facilities were more likely to have poorer mental health and lower perceived purpose in life. The three leading HCBS utilized were senior centers (20%), homemaker services (19%), and transportation services (18%). More HCBS utilization was associated with participants who resided in service-poor housing, were older, were female, and had more activity limitations. More HCBS utilization was also associated with those who received instrumental support, had higher perceived purpose in life, and poorer mental health. Conclusions: Findings suggest that older adults’ residential environment is associated with their health status and HCBS utilization. Building upon the Person–Environment Fit theories, dedicated efforts are needed to introduce and expand upon existing HCBS available to facility residents to address physical and mental health needs as well as facilitate aging-in-place. PMID:28327507

Facilities Inventory and Utilization Study, Fall of 1994; For the State of North Carolina. Twenty-Eighth Edition.

ERIC Educational Resources Information Center

North Carolina Univ., Chapel Hill. Commission on Higher Education Facilities.

This study presents the results of the 28th annual inventory and utilization study concerning space in North Carolina institutions of higher education during the 1994 fall term. The study provides information on 113 institutions of higher education including the 16 public senior institutions which comprise the University of North Carolina (UNC),…

Facilities Inventory and Utilization Study. Fall of 1995 for the State of North Carolina. Twenty-Ninth Edition.

ERIC Educational Resources Information Center

North Carolina Univ., Chapel Hill. Commission on Higher Education Facilities.

This study presents the results of the 29th annual inventory and utilization study concerning space in North Carolina institutions of higher education during the 1995 fall term. The study provides information on 113 institutions of higher education including the 16 public senior institutions which comprise the University of North Carolina (UNC),…

The LMOP Locator

EPA Pesticide Factsheets

This page contains the LMOP Locator, a tool that allows a user to geographically search for facilities that can potentially utilize LFG, or for landfills located near a facility that is interested in utilizing LFG.

The impact of nonreferral outpatient co-payment on medical care utilization and expenditures in Taiwan.

PubMed

Chen, Li-Chia; Schafheutle, Ellen I; Noyce, Peter R

2009-09-01

Taiwan's National Health Insurance's (NHI) generous coverage and patients' freedom to access different tiers of medical facilities have resulted in accelerating outpatient care utilization and costs. To deter nonessential visits and encourage initial contact in primary care (physician clinics), a differential co-payment was introduced on 15th July 2005. Under this, patients pay more for outpatient consultations at "higher tiers" of medical facilities (local community hospitals, regional hospitals, medical centers), particularly if accessed without referral. This study explored the impact of this policy on outpatient medical activities and expenditures, different co-payment groups, and tiers of medical facilities. A segmented time-series analysis on regional weekly outpatient medical claims (January 2004 to July 2006) was conducted. Outcome variables (number of visits, number of outpatients, total cost of outpatient care) and variables for cost structure were stratified by tiers of medical facilities and co-payment groups. Analysis used the auto-regressive integrated moving-average model in STATA 9.0. The overall number of outpatient visits significantly decreased after policy implementation due to a reduction in the number of patients using outpatient facilities, but total costs of care remained unchanged. The policy had its greatest impact on the number of visits to regional and local community hospitals but had no influence on those to the medical centers. Medical utilization in physician clinics decreased due to an audit of reimbursement declarations. Overall, the policy failed to encourage referrals from primary care to higher tiers because there was no obvious shifting of medical utilization and costs reversely. Differential co-payment policy decreased total medication utilization but not costs to NHI. The results suggest that the increased level of co-payment charge and the strategy of a single cost-sharing policy are not sufficient to promote referrals within the system. To achieve an effective co-payment policy, further research is needed to explore how patients' out-of-pocket payment affects medical utilization and which forces (not susceptible to co-payment) act in tertiary facilities.

Utilization of Healthcare in the Typhoid Fever Surveillance in Africa Program.

PubMed

Panzner, Ursula; Pak, Gi Deok; Aaby, Peter; Adu-Sarkodie, Yaw; Ali, Mohammad; Aseffa, Abraham; Baker, Stephen; Bjerregaard-Andersen, Morten; Crump, John A; Deerin, Jessica; Cruz Espinoza, Ligia Maria; Gasmelseed, Nagla; Heriniaina, Jean Noël; Hertz, Julian T; Im, Justin; von Kalckreuth, Vera; Keddy, Karen H; Lankoande, Bruno; Løfberg, Sandra; Meyer, Christian G; Oresto, Michael Munishi; Park, Jin Kyung; Park, Se Eun; Rakotozandrindrainy, Raphaël; Sarpong, Nimako; Soura, Abdramane Bassiahi; Gassama Sow, Amy; Tall, Adama; Teferi, Mekonnen; Worku, Alemayehu; Yeshitela, Biruk; Wierzba, Thomas F; Marks, Florian

2016-03-15

Assessing healthcare utilization is important to identify weaknesses of healthcare systems, to outline action points for preventive measures and interventions, and to more accurately estimate the disease burden in a population. A healthcare utilization survey was developed for the Typhoid Fever Surveillance in Africa Program (TSAP) to adjust incidences of salmonellosis determined through passive, healthcare facility-based surveillance. This cross-sectional survey was conducted at 11 sites in 9 sub-Saharan African countries. Demographic data and healthcare-seeking behavior were assessed at selected households. Overall and age-stratified percentages of each study population that sought healthcare at a TSAP healthcare facility and elsewhere were determined. Overall, 88% (1007/1145) and 81% (1811/2238) of the population in Polesgo and Nioko 2, Burkina Faso, respectively, and 63% (1636/2590) in Butajira, Ethiopia, sought healthcare for fever at any TSAP healthcare facility. A far smaller proportion-namely, 20%-45% of the population in Bissau, Guinea-Bissau (1743/3885), Pikine, Senegal (1473/4659), Wad-Medani, Sudan (861/3169), and Pietermaritzburg, South Africa (667/2819); 18% (483/2622) and 9% (197/2293) in Imerintsiatosika and Isotry, Madagascar, respectively; and 4% (127/3089) in Moshi, Tanzania-sought healthcare at a TSAP healthcare facility. Patients with fever preferred to visit pharmacies in Imerintsiatosika and Isotry, and favored self-management of fever in Moshi. Age-dependent differences in healthcare utilization were also observed within and across sites. Healthcare utilization for fever varied greatly across sites, and revealed that not all studied populations were under optimal surveillance. This demonstrates the importance of assessing healthcare utilization. Survey data were pivotal for the adjustment of the program's estimates of salmonellosis and other conditions associated with fever. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

21 CFR 200.10 - Contract facilities (including consulting laboratories) utilized as extramural facilities by...

Code of Federal Regulations, 2014 CFR

2014-04-01

... Cosmetic Act specifically authorizes inspection of consulting laboratories as well as any factory... Federal Food, Drug, and Cosmetic Act. The Food and Drug Administration's position is that by the... Administration does not consider results of validation studies of analytical and assay methods and control...

21 CFR 200.10 - Contract facilities (including consulting laboratories) utilized as extramural facilities by...

Code of Federal Regulations, 2011 CFR

2011-04-01

... Cosmetic Act specifically authorizes inspection of consulting laboratories as well as any factory... Federal Food, Drug, and Cosmetic Act. The Food and Drug Administration's position is that by the... Administration does not consider results of validation studies of analytical and assay methods and control...

21 CFR 200.10 - Contract facilities (including consulting laboratories) utilized as extramural facilities by...

Code of Federal Regulations, 2013 CFR

2013-04-01

... Cosmetic Act specifically authorizes inspection of consulting laboratories as well as any factory... Federal Food, Drug, and Cosmetic Act. The Food and Drug Administration's position is that by the... Administration does not consider results of validation studies of analytical and assay methods and control...

21 CFR 200.10 - Contract facilities (including consulting laboratories) utilized as extramural facilities by...

Code of Federal Regulations, 2012 CFR

2012-04-01

... Cosmetic Act specifically authorizes inspection of consulting laboratories as well as any factory... Federal Food, Drug, and Cosmetic Act. The Food and Drug Administration's position is that by the... Administration does not consider results of validation studies of analytical and assay methods and control...

Can contracted out health facilities improve access, equity, and quality of maternal and newborn health services? Evidence from Pakistan.

PubMed

Zaidi, Shehla; Riaz, Atif; Rabbani, Fauziah; Azam, Syed Iqbal; Imran, Syeda Nida; Pradhan, Nouhseen Akber; Khan, Gul Nawaz

2015-11-25

The case of contracting out government health services to non-governmental organizations (NGOs) has been weak for maternal, newborn, and child health (MNCH) services, with documented gains being mainly in curative services. We present an in-depth assessment of the comparative advantages of contracting out on MNCH access, quality, and equity, using a case study from Pakistan. An end-line, cross-sectional assessment was conducted of government facilities contracted out to a large national NGO and government-managed centres serving as controls, in two remote rural districts of Pakistan. Contracting out was specific for augmenting MNCH services but without contractual performance incentives. A household survey, a health facility survey, and focus group discussions with client and spouses were used for assessment. Contracted out facilities had a significantly higher utilization as compared to control facilities for antenatal care, delivery, postnatal care, emergency obstetric care, and neonatal illness. Contracted facilities had comparatively better quality of MNCH services but not in all aspects. Better household practices were also seen in the district where contracting involved administrative control over outreach programs. Contracting was also faced with certain drawbacks. Facility utilization was inequitably higher amongst more educated and affluent clients. Contracted out catchments had higher out-of-pocket expenses on MNCH services, driven by steeper transport costs and user charges for additional diagnostics. Contracting out did not influence higher MNCH service coverage rates across the catchment. Physical distances, inadequate transport, and low demand for facility-based care in non-emergency settings were key client-reported barriers. Contracting out MNCH services at government health facilities can improve facility utilization and bring some improvement in  quality of services. However, contracting out of health facilities is insufficient to increase service access across the catchment in remote rural contexts and requires accompanying measures for demand enhancement, transportation access, and targeting of the more disadvantaged clientele.

UTILIZATION OF MOBILE FACILITIES FOR DEVELOPMENT OF ENTRY WORK SKILLS FOR ARKANSAS' RURAL UNEMPLOYED AND LOW INCOME EARNERS, A FEASIBILITY STUDY.

ERIC Educational Resources Information Center

Nevada Univ., Reno. School Planning Lab.

THE FEASIBILITY AND METHODS OF USING MOBILE FACILITIES IN UPGRADING THE WORK SKILLS OF RURAL LOW INCOME WAGE EARNERS ARE EXPLORED. SUCH MOBILE FACILITIES WOULD BE DIRECTED TOWARD 3 SPECIFIC GROUPS OF PEOPLE--SMALL ACREAGE FARMERS WHO PRODUCED ONLY A MINIMAL INCOME, THE RURAL LOW-INCOME NEGRO POPULATION, AND YOUNG RURAL SCHOOL DROPOUTS WITH LITTLE…

Bypassing health facilities for childbirth in the context of the JSY cash transfer program to promote institutional birth: A cross-sectional study from Madhya Pradesh, India

PubMed Central

Sabde, Yogesh; Chaturvedi, Sarika; Randive, Bharat; Sidney, Kristi; Salazar, Mariano; De Costa, Ayesha; Diwan, Vishal

2018-01-01

Bypassing health facilities for childbirth can be costly both for women and health systems. There have been some reports on this from Sub-Saharan African and from Nepal but none from India. India has implemented the Janani Suraksha Yojana (JSY), a large national conditional cash transfer program which has successfully increased the number of institutional births in India. This paper aims to study the extent of bypassing the nearest health facility offering intrapartum care in three districts of Madhya Pradesh, India, and to identify individual and facility determinants of bypassing in the context of the JSY program. Our results provide information to support the optimal utilization of facilities at different levels of the healthcare system for childbirth. Data was collected from 96 facilities (74 public) and 720 rural mothers who delivered at these facilities were interviewed. Multilevel logistic regression was used to analyze the data. Facility obstetric care functionality was assessed by the number of emergency obstetric care (EmOC) signal functions performed in the last three months. Thirty eighth percent of the mothers bypassed the nearest public facility for their current delivery. Primiparity, higher education, arriving by hired transport and a longer distance from home to the nearest facility increased the odds of bypassing a public facility for childbirth. The variance partition coefficient showed that 37% of the variation in bypassing the nearest public facility can be attributed to difference between facilities. The number of basic emergency obstetric care signal functions (AOR = 0.59, 95% CI 0.37–0.93), and the availability of free transportation at the nearest facility (AOR = 0.11, 95% CI 0.03–0.31) were protective factors against bypassing. The variation between facilities (MOR = 3.85) was more important than an individual’s characteristics to explain bypassing in MP. This multilevel study indicates that in this setting, a focus on increasing the level of emergency obstetric care functionality in public obstetric care facilities will allow more optimal utilization of facilities for childbirth under the JSY program thereby leading to better outcomes for mothers. PMID:29385135

Bypassing health facilities for childbirth in the context of the JSY cash transfer program to promote institutional birth: A cross-sectional study from Madhya Pradesh, India.

PubMed

Sabde, Yogesh; Chaturvedi, Sarika; Randive, Bharat; Sidney, Kristi; Salazar, Mariano; De Costa, Ayesha; Diwan, Vishal

2018-01-01

Bypassing health facilities for childbirth can be costly both for women and health systems. There have been some reports on this from Sub-Saharan African and from Nepal but none from India. India has implemented the Janani Suraksha Yojana (JSY), a large national conditional cash transfer program which has successfully increased the number of institutional births in India. This paper aims to study the extent of bypassing the nearest health facility offering intrapartum care in three districts of Madhya Pradesh, India, and to identify individual and facility determinants of bypassing in the context of the JSY program. Our results provide information to support the optimal utilization of facilities at different levels of the healthcare system for childbirth. Data was collected from 96 facilities (74 public) and 720 rural mothers who delivered at these facilities were interviewed. Multilevel logistic regression was used to analyze the data. Facility obstetric care functionality was assessed by the number of emergency obstetric care (EmOC) signal functions performed in the last three months. Thirty eighth percent of the mothers bypassed the nearest public facility for their current delivery. Primiparity, higher education, arriving by hired transport and a longer distance from home to the nearest facility increased the odds of bypassing a public facility for childbirth. The variance partition coefficient showed that 37% of the variation in bypassing the nearest public facility can be attributed to difference between facilities. The number of basic emergency obstetric care signal functions (AOR = 0.59, 95% CI 0.37-0.93), and the availability of free transportation at the nearest facility (AOR = 0.11, 95% CI 0.03-0.31) were protective factors against bypassing. The variation between facilities (MOR = 3.85) was more important than an individual's characteristics to explain bypassing in MP. This multilevel study indicates that in this setting, a focus on increasing the level of emergency obstetric care functionality in public obstetric care facilities will allow more optimal utilization of facilities for childbirth under the JSY program thereby leading to better outcomes for mothers.

Sarcopenia and Health Care Utilization in Older Women

PubMed Central

Lui, Li-Yung; McCulloch, Charles E.; Cauley, Jane A.; Paudel, Misti L.; Taylor, Brent; Schousboe, John T.; Ensrud, Kristine E.

2017-01-01

Background: Although there are several consensus definitions of sarcopenia, their association with health care utilization has not been studied. Methods: We included women from the prospective Study of Osteoporotic Fractures with complete assessment of sarcopenia by several definitions at the Study of Osteoporotic Fractures Year 10 (Y10) exam (1997–1998) who also had available data from Medicare Fee- For-Service Claims (N = 566) or Kaiser Encounter data (N = 194). Sarcopenia definitions evaluated were: International Working Group, European Working Group for Sarcopenia in Older Persons, Foundation for the NIH Sarcopenia Project, Baumgartner, and Newman. Hurdle models and logistic regression were used to assess the relation between sarcopenia status (the summary definition and the components of slowness, weakness and/or lean mass) and outcomes that included hospitalizations, cumulative inpatient days/year, short-term (part A paid) skilled nursing facility stay in the 3 years following the Y10 visit. Results: None of the consensus definitions, nor the definition components of weakness or low lean mass, was associated with increased risk of hospitalization or greater likelihood of short-term skilled nursing facility stay. Women with slowness by any criterion definition were about 50% more likely to be hospitalized; had a greater rate of hospitalization days amongst those hospitalized; and had 1.8 to 2.1 times greater likelihood of a short-term skilled nursing facility stay than women without slowness. There was the suggestion of a protective association of low lean mass by the various criterion definitions on short-term skilled nursing facility stay. Conclusion: Estimated effects of sarcopenia on health care utilization were negligible. However, slowness was associated with greater health care utilization. PMID:27402050

Institutional Delivery Service Utilization among Women from Rural Districts of Wolaita and Dawro Zones, Southern Ethiopia; a Community Based Cross-Sectional Study

PubMed Central

Arba, Mihiretu Alemayehu; Darebo, Tadele Dana; Koyira, Mengistu Meskele

2016-01-01

Introduction The highest number of maternal deaths occur during labour, delivery and the first day after delivery highlighting the critical need for good quality care during this period. Therefore, for the strategies of institutional delivery to be effective, it is essential to understand the factors that influence individual and household factors to utilize skilled birth attendance and institutions for delivery. This study was aimed to assess factors affecting the utilization of institutional delivery service of women in rural districts of Wolaita and Dawro Zones. Methods A community based cross-sectional study was done among mothers who gave birth within the past one year preceding the survey in Wolaita and Dawro Zones, from February 01 –April 30, 2015 by using a three stage sampling technique. Initially, 6 districts were selected randomly from the total of 17 eligible districts. Then, 2 kebele from each district was selected randomly cumulating a total of 12 clusters. Finally, study participants were selected from each cluster by using systematic sampling technique. Accordingly, 957 mothers were included in the survey. Data was collected by using a pretested interviewer administered structured questionnaire. The questionnaire was prepared by including socio-demographic variables and variables of maternal health service utilization factors. Data was entered using Epi-data version 1.4.4.0 and exported to SPSS version 20 for analysis. Bivariate and multiple logistic regressions were applied to identify candidate and predictor variables respectively. Result Only 38% of study participants delivered the index child at health facility. Husband’s educational status, wealth index, average distance from nearest health facility, wanted pregnancy, agreement to follow post-natal care, problem faced during delivery, birth order, preference of health professional for ante-natal care and maternity care were predictors of institutional delivery. Conclusion The use of institutional delivery service is low in the study community. Eventhough antenatal care service is high; nearly two in every three mothers delivered their index child out of health facility. Improving socio-economic status of mothers as well as availing modern health facilities to the nearest locality will have a good impact to improve institutional delivery service utilization. Similarly, education is also a tool to improve awareness of mothers and their husbands for the improvement of health care service utilization. PMID:26986563

Institutional Delivery Service Utilization among Women from Rural Districts of Wolaita and Dawro Zones, Southern Ethiopia; a Community Based Cross-Sectional Study.

PubMed

Arba, Mihiretu Alemayehu; Darebo, Tadele Dana; Koyira, Mengistu Meskele

2016-01-01

The highest number of maternal deaths occur during labour, delivery and the first day after delivery highlighting the critical need for good quality care during this period. Therefore, for the strategies of institutional delivery to be effective, it is essential to understand the factors that influence individual and household factors to utilize skilled birth attendance and institutions for delivery. This study was aimed to assess factors affecting the utilization of institutional delivery service of women in rural districts of Wolaita and Dawro Zones. A community based cross-sectional study was done among mothers who gave birth within the past one year preceding the survey in Wolaita and Dawro Zones, from February 01 -April 30, 2015 by using a three stage sampling technique. Initially, 6 districts were selected randomly from the total of 17 eligible districts. Then, 2 kebele from each district was selected randomly cumulating a total of 12 clusters. Finally, study participants were selected from each cluster by using systematic sampling technique. Accordingly, 957 mothers were included in the survey. Data was collected by using a pretested interviewer administered structured questionnaire. The questionnaire was prepared by including socio-demographic variables and variables of maternal health service utilization factors. Data was entered using Epi-data version 1.4.4.0 and exported to SPSS version 20 for analysis. Bivariate and multiple logistic regressions were applied to identify candidate and predictor variables respectively. Only 38% of study participants delivered the index child at health facility. Husband's educational status, wealth index, average distance from nearest health facility, wanted pregnancy, agreement to follow post-natal care, problem faced during delivery, birth order, preference of health professional for ante-natal care and maternity care were predictors of institutional delivery. The use of institutional delivery service is low in the study community. Eventhough antenatal care service is high; nearly two in every three mothers delivered their index child out of health facility. Improving socio-economic status of mothers as well as availing modern health facilities to the nearest locality will have a good impact to improve institutional delivery service utilization. Similarly, education is also a tool to improve awareness of mothers and their husbands for the improvement of health care service utilization.

Barriers to using skilled birth attendants' services in mid- and far-western Nepal: a cross-sectional study.

PubMed

Choulagai, Bishnu; Onta, Sharad; Subedi, Narayan; Mehata, Suresh; Bhandari, Gajananda P; Poudyal, Amod; Shrestha, Binjwala; Mathai, Matthews; Petzold, Max; Krettek, Alexandra

2013-12-23

Skilled birth attendants (SBAs) provide important interventions that improve maternal and neonatal health and reduce maternal and neonatal mortality. However, utilization and coverage of services by SBAs remain poor, especially in rural and remote areas of Nepal. This study examined the characteristics associated with utilization of SBA services in mid- and far-western Nepal. This cross-sectional study examined three rural and remote districts of mid- and far-western Nepal (i.e., Kanchanpur, Dailekh and Bajhang), representing three ecological zones (southern plains [Tarai], hill and mountain, respectively) with low utilization of services by SBAs. Enumerators assisted a total of 2,481 women. All respondents had delivered a baby within the past 12 months. We used bivariate and multivariate analyses to assess the association between antenatal and delivery care visits and the women's background characteristics. Fifty-seven percent of study participants had completed at least four antenatal care visits and 48% delivered their babies with the assistance of SBAs. Knowing the danger signs of pregnancy and delivery (e.g., premature labor, prolonged labor, breech delivery, postpartum hemorrhage, severe headache) associated positively with four or more antenatal care visits (OR = 1.71; 95% CI: 1.41-2.07). Living less than 30 min from a health facility associated positively with increased use of both antenatal care (OR = 1.44; 95% CI: 1.18-1.77) and delivery services (OR = 1.25; CI: 1.03-1.52). Four or more antenatal care visits was a determining factor for the utilization of SBAs. Less than half of the women in our study delivered babies with the aid of SBAs, indicating a need to increase utilization of such services in rural and remote areas of Nepal. Distance from health facilities and inadequate transportation pose major barriers to the utilization of SBAs. Providing women with transportation funds before they go to a facility for delivery and managing transportation options will increase service utilization. Moreover, SBA utilization associates positively with women's knowledge of pregnancy danger signs, wealth quintile, and completed antenatal care visits. Nepal's health system must develop strategies that generate demand for SBAs and also reduce financial, geographic and cultural barriers to such services.

[STRATEGY OF USE AND MAINTENANCE OF CLINICAL HOSPITAL CENTER RIJEKA IN ACCORDANCE WITH KEY PERFORMANCE INDICATORS FOR STRATEGIC HEALTHCARE FACILITIES MAINTENANCE].

PubMed

Sjekavica, Mariela; Haller, Herman; Cerić, Anita

2015-01-01

Building usage is the phase in the building life cycle that is most time-consuming, most functional, most significant due to building purpose and often systematically ignored. Maintenance is the set of activities that ensure the planned duration of facility exploitation phase in accordance with the requirements for quality maintenance of a large number of important building features as well as other elements immanent to the nature of facilities' life. The aim of the study is to show the analysis of the current state of organized, planned and comprehensive managerial approach in hospital utilization and maintenance in the Republic of Croatia, given on the case study of Clinical hospital center in Rijeka. The methodology used consists of relevant literature section of theory of facility utilization, maintenance and management in general, hospital buildings especially, display of practice on case study, and comparison of key performance indicators values obtained through interview with those that author Igal M. Shohet defined in his study by field surveys and statistical analyses. Despite many positive indicators of Clinical hospital center Rijeka maintenance, an additional research is needed in order to define a more complete national hospital maintenance strategy.

Analysis of the net energy use impacts of PURPA (Public Utility Regulatory Policy Act) electricity generation under alternative assumptions regarding the technology mix of PURPA generators and displaced utility generators: Final report

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

Not Available

The goals of this study were to explore the magnitude of potential fuel savings (or increased fuel consumption) under different possible combinations of Qualifying Facilities generation and utility displacement, and to identify those combinations which might result in a net increase in fuel consumption. In exploring the impact of cogeneration net heat rate on net savings (or increase) in fuel consumption, the study also addressed the extent to which cogenerator efficiency affects the overall fuel use impact of Public Utility Regulatory Policies Act (PURPA) implementation. This research thus seeks to identify possible scenarios in which PURPA implementation may not resultmore » in the conversation of fossil fuels, and to define possible situations in which the FERC's efficiency standard may lead to energy-inefficient Qualifying Facility development. 9 refs., 6 figs., 6 tabs.« less

Postnatal care utilization among urban women in northern Ethiopia: cross-sectional survey.

PubMed

Gebrehiwot, Genet; Medhanyie, Araya Abrha; Gidey, Gebreamlak; Abrha, Kidan

2018-05-30

Postnatal care service enables health professionals to identify post-delivery problems including potential complications for the mother with her baby and to provide treatments promptly. In Ethiopia, postnatal care service is made accessible to all women for free however the utilization of the service is very low. This study assessed the utilization of postnatal care services of urban women and the factors associated in public health facilities in Mekelle city, Tigrai Region, Northern Ethiopia. A facility based cross sectional study design was used to assess post natal service utilization. Using simple random sampling 367 women who visited maternal and child health clinics in Mekelle city for postnatal care services during January 27 to April 2014 were selected. Data was entered and analyzed using SPSS Version 20.0 software. A binary and multivariable logistic regression was used to identify risk factors associated with the outcome variables. P-value less than 0.05 is used to declare statistical significance. The prevalence of women who utilized postnatal care service was low (32.2%). Women who were private employees and business women were more likely to utilize postnatal care services (AOR = 6.46, 95% CI: 1.91-21.86) and (3.35, 95% CI: 1.10-10.19) respectively compared to house wives., Women who had history of one pregnancy were more likely to utilize the service (AOR = 3.19, 95% CI: 1.06-9.57) compared to women who had history of four and above pregnancies. Women who had knowledge of postnatal care service were also more likely to utilize postnatal care service (AOR = 14.46, 95% CI: 7.55-27.75) than women who lacked knowledge about the services. Postnatal care utilization in the study area is low. Knowledge on postnatal care services and occupation of women had positive impact on postnatal care service utilization. The Mekelle city administration health office and other stakeholders should support and encourage urban health extension workers and health facilities to strengthen providing health education to improve the knowledge of the women about the importance of postnatal care services.

A Cross-Sectional Study of the Characteristics and Determinants of Emergency Care Utilization among People with Intellectual Disabilities in Taiwan

ERIC Educational Resources Information Center

Lin, Jin-Ding; Yen, Chia-Feng; Loh, Ching-Hui; Hsu, Shang-Wei; Huang, Hui-Chi; Tang, Chi-Chieh; Li, Chi-Wei; Wu, Jia-Ling

2006-01-01

Aims: The purpose of this study was to identify health characteristics of people with intellectual disabilities (ID) and to assess the use of emergency care facilities by these people and factors affecting this utilization. Method: A cross-sectional study was employed. Subjects were recruited from the Taiwan National Disability Registration…

Study of the impacts of regulations affecting the acceptance of Integrated Community Energy Systems: public utility, energy facility siting and municipal franchising regulatory programs in Nebraska. Preliminary background report

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

Feurer, D A; Weaver, C L; Gallagher, K C

1980-01-01

The state agency with principal authority to regulate electric public utilities is the Power Review Board (Board). However, the Board in fact, exercised little regulatory authority over heat and power utilities because all electrical power in Nebraska is currently supplied by public authorities and is not subject to regulation by the Board. Gas and water utilities are also subject to general supervision by municipalities. The Board is compised of five members - an attorney, an engineer, one accountant, two lay - persons appointed by the governor and confirmed by the legislature. All members are appointed to overlapping four-year terms, andmore » none may serve more than two consecutive terms. Decisions by the Board require the approval of a majority of its members. The Public Service Commission of Nebraska is a constitutionally created body. Its powers and duties include the regulation of rates, service, and general control of common carriers as the legislature may provide by law. Other state agencies also possess limited regulatory jurisdiction which may be relevant to an energy facility. Public utility regulatory statutes, energy facility siting programs, and municipal franchising authority are examined to identify how they may impact on the ability of an organization, whether or not it be a regulated utility, to construct and operate an ICES.« less

Effect of facility on the operative costs of distal radius fractures.

PubMed

Mather, Richard C; Wysocki, Robert W; Mack Aldridge, J; Pietrobon, Ricardo; Nunley, James A

2011-07-01

The purpose of this study was to investigate whether ambulatory surgery centers can deliver lower-cost care and to identify sources of those cost savings. We performed a cost identification analysis of outpatient volar plating for closed distal radius fractures at a single academic medical center. Multiple costs and time measures were taken from an internal database of 130 consecutive patients and were compared by venue of treatment, either an inpatient facility or an ambulatory, stand-alone surgery facility. The relationships between total cost and operative time and multiple variables, including fracture severity, patient age, gender, comorbidities, use of bone graft, concurrent carpal tunnel release, and surgeon experience, were examined, using multivariate analysis and regression modeling to identify other cost drivers or explanatory variables. The mean operative cost was considerably greater at the inpatient facility ($7,640) than at the outpatient facility ($5,220). Cost drivers of this difference were anesthesia services, post-anesthesia care unit, and operating room costs. Total surgical time, nursing time, set-up, and operative times were 33%, 109%, 105%, and 35% longer, respectively, at the inpatient facility. There was no significant difference between facilities for the additional variables, and none of those variables independently affected cost or operative time. The only predictor of cost and time was facility type. This study supports the use of ambulatory stand-alone surgical facilities to achieve efficient resource utilization in the operative treatment of distal radius fractures. We also identified several specific costs and time measurements that differed between facilities, which can serve as potential targets for tertiary facilities to improve utilization. Economic and Decisional Analysis III. Copyright © 2011 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Perceptions of users and providers on barriers to utilizing skilled birth care in mid- and far-western Nepal: a qualitative study

PubMed Central

Onta, Sharad; Choulagai, Bishnu; Shrestha, Binjwala; Subedi, Narayan; Bhandari, Gajananda P.; Krettek, Alexandra

2014-01-01

Background Although skilled birth care contributes significantly to the prevention of maternal and newborn morbidity and mortality, utilization of such care is poor in mid- and far-western Nepal. This study explored the perceptions of service users and providers regarding barriers to skilled birth care. Design We conducted 24 focus group discussions, 12 each with service users and service providers from different health institutions in mid- and far-western Nepal. All discussions examined the perceptions and experiences of service users and providers regarding barriers to skilled birth care and explored possible solutions to overcoming such barriers. Results Our results determined that major barriers to skilled birth care include inadequate knowledge of the importance of services offered by skilled birth attendants (SBAs), distance to health facilities, unavailability of transport services, and poor availability of SBAs. Other barriers included poor infrastructure, meager services, inadequate information about services/facilities, cultural practices and beliefs, and low prioritization of birth care. Moreover, the tradition of isolating women during and after childbirth decreased the likelihood that women would utilize delivery care services at health facilities. Conclusions Service users and providers perceived inadequate availability and accessibility of skilled birth care in remote areas of Nepal, and overall utilization of these services was poor. Therefore, training and recruiting locally available health workers, helping community groups establish transport mechanisms, upgrading physical facilities and services at health institutions, and increasing community awareness of the importance of skilled birth care will help bridge these gaps. PMID:25119066

Opportunities for Automated Demand Response in California Wastewater Treatment Facilities

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

Aghajanzadeh, Arian; Wray, Craig; McKane, Aimee

Previous research over a period of six years has identified wastewater treatment facilities as good candidates for demand response (DR), automated demand response (Auto-­DR), and Energy Efficiency (EE) measures. This report summarizes that work, including the characteristics of wastewater treatment facilities, the nature of the wastewater stream, energy used and demand, as well as details of the wastewater treatment process. It also discusses control systems and automated demand response opportunities. Furthermore, this report summarizes the DR potential of three wastewater treatment facilities. In particular, Lawrence Berkeley National Laboratory (LBNL) has collected data at these facilities from control systems, submetered processmore » equipment, utility electricity demand records, and governmental weather stations. The collected data were then used to generate a summary of wastewater power demand, factors affecting that demand, and demand response capabilities. These case studies show that facilities that have implemented energy efficiency measures and that have centralized control systems are well suited to shed or shift electrical loads in response to financial incentives, utility bill savings, and/or opportunities to enhance reliability of service. In summary, municipal wastewater treatment energy demand in California is large, and energy-­intensive equipment offers significant potential for automated demand response. In particular, large load reductions were achieved by targeting effluent pumps and centrifuges. One of the limiting factors to implementing demand response is the reaction of effluent turbidity to reduced aeration at an earlier stage of the process. Another limiting factor is that cogeneration capabilities of municipal facilities, including existing power purchase agreements and utility receptiveness to purchasing electricity from cogeneration facilities, limit a facility’s potential to participate in other DR activities.« less

Study of the impacts of regulations affecting the acceptance of Integrated Community Energy Systems: public utility, energy facility siting and municipal franchising regulatory programs in Arizona. Preliminary background report

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

Feurer, D.A.; Weaver, C.L.; Gallagher, K.C.

1980-01-01

This report is one of a series of preliminary reports describing the laws and regulatory programs of the United States and each of the 50 states affecting the siting and operation of energy generating facilities likely to be used in Integrated Community Energy Systems (ICES). Public utility regulatory statutes, energy facility siting programs, and municipal franchising authority are examined to identify how they may impact on the ability of an organization, whether or not it be a regulated utility, to construct and operate an ICES. This report describes laws and regulatory programs in Arizona. The Arizona state constitution establishes themore » Arizona Corporation Commission to regulate public service corporations. Within the area of its jurisdiction, the Commission has exclusive power and may not be interfered with by the legislature except in one narrow instance as described in the case Corporation Commission v. Pacific Greyhound Lines.« less

Bibliography of Literature for Avian Issues in Solar and Wind Energy and Other Activities

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

Walston, Leroy J.; White, Ellen M.; Meyers, Stephanie A.

2015-04-01

Utility-scale solar energy has been a rapidly expanding energy sector in the United States in recent years and is expected to continue to grow. In 2014, concerns were raised over the risk of avian fatalities associated with utility-scale solar plants. With funding from the U.S. Department of Energy SunShot Program, Argonne National Laboratory and the National Renewable Energy Laboratory studied the issue and released A Review of Avian Monitoring and Mitigation Information at Existing Utility-Scale Solar Facilities (ANL/EVS-15/2, March 2015). A comprehensive literature review included peer-reviewed journal articles on avian fatalities from solar energy facilities and other sources (e.g., windmore » energy, building collisions, etc.), project-specific technical reports on avian monitoring and fatality at solar facilities, information on mitigation measures and best management practices, and literature pertaining to avian behavioral patterns and habitat use. The source citations are listed in this bibliography; they are current through December 2014.« less

Water Utility Management Strategies in Turkey: The current situation and the challenges

NASA Astrophysics Data System (ADS)

Alp, E.; Aksoy, M. N.; Koçer, B.

2013-12-01

As the effects of climate change becomes more prominent, current challenges related to water and wastewater management is becoming more serious. Providing water that satisfies environmental and safety standards in terms of quantity and quality is needed to maintain human life without compromising the need of future generations. Besides providing safe and affordable water, necessary treatment should be achieved according to several important factors such as receiving body standards, discharge standards, water reuse options. Therefore, management of water becomes more crucial than ever that states have to provide accessibility of safe water with affordable cost to its citizens with the means of effective utility management, including water treatment facilities, wastewater treatment facilities, water supply facilities and water distribution systems. Water utilities encounter with several challenges related to cost, infrastructure, population, legislation, workforce and resource. This study aims to determine the current situation and the necessary strategies to improve utility management in Turkish municipalities in a sustainable manner. US Environment Protection Agency (EPA) has formed a tool on effective utility management that assists utilities to provide a solution for both current and future challenges. In this study, we used EPA's guidelines and developed a survey consists of 60 questions under 10 sub-topics (Product Quality, Employee & Leadership Development, Stakeholder Understanding & Support, Operational Optimization, Infrastructure Stability, Financial Viability, Community Sustainability, Customer Satisfaction, Operational Resiliency, and Water Resource Adequacy). This survey was sent to the managers of 25 metropolitan municipalities in Turkey to assess the current condition of municipalities. After the evaluation of the survey results for each topic, including the importance given by managers, facilities were rated according to their level of achievement. The scores were given for Rate Achievement from 1 to 5 and Rank Importance from 1 to 10 to the survey outcomes for each topic. Then, rating and ranking matrix was constructed according to score ranges. Results show that Product Quality, Stakeholder Understanding & Support, Infrastructure Stability and Customer Satisfaction are the major topics that needs to be improved according to the utility managers in Turkey. According to the outcomes of the study, water losses and unbilled unmetered consumption of water appeared to be the most important issues with the utility management. The utility managers also think there is still room for improvement to satisfy the needs of the users. Even though the rehabilitation of the infrastructure is a costly investment, it can be compensated with the help of the increased revenues as a result of improvement in water loss and unbilled water use. Suggestions given as a result of this study aim to aid decision makers and local authorities to overcome the significant problems faced during management and to achieve a sustainable utility management.

Assessment of utilization of long acting reversible contraceptive and associated factors among women of reproductive age in Harar City, Ethiopia.

PubMed

Shiferaw, Kasiye; Musa, Abdulbasit

2017-01-01

World health organization report indicated that, in 2013 alone, over 289,000 maternal death that resulted from pregnancy and delivery related complication were reported worldwide indicating a decline of 45% from 1990. The sub-Saharan Africa region alone accounted for 62% of maternal death followed by southern Asian country (24%). Provision of family planning is one of the effective intervention that prevent unwanted and ill spaced pregnancy there by reducing maternal mortality and morbidity. Given that its effectiveness and, associated fewer visits to health facilities, LARC are very important in tackling maternal mortality and morbidity. However, little is known regarding its prevalence in eastern Ethiopia. Thus, this study aimed to assess utilization of long acting reversible contraceptives and associated factors among women of reproductive age groups. A facility based cross-sectional study conducted in Harar city among 402 study participants. The study participants selected by using systematic random sampling method. The quantitative data collected using structured interviewer administered questionnaires. All variables with p-value of ≤ 0.25 in bivariate logistic regression were taken into multivariable model. Variables having p value ≤ 0.05 in the multivariate analysis were taken as significant predictors. Crude and adjusted odds ratios with their 95% confidence intervals were calculated. The study identified that the utilization of long acting reversible contraceptive among mother of reproductive age was 38%. Study participants whose occupation was daily laborer were less likely to utilize long acting reversible contraceptive compared to those whose occupation was house wife (adjusted OR = 0.3; 95% CI 0.01 to 0.8). Moreover, those mothers who were unable to read and write utilize long acting reversible contraceptive 5 times more likely compared to those who were above grade 12 (adjusted OR = 4.9; 95% CI 1.2 to 19.6). The prevalence of long acting reversible contraceptive was found to be low. Maternal education and occupation were factors found to have a significant association with utilization of long acting reversible contraceptive. Community and facility level awareness creation should be reinforced to improve utilization of long acting reversible contraceptives.

A Review of Avian Monitoring and Mitigation Information at Existing Utility-Scale Solar Facilities

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

Walston, Leroy J.; Rollins, Katherine E.; Smith, Karen P.

2015-01-01

There are two basic types of solar energy technology: photovoltaic and concentrating solar power. As the number of utility-scale solar energy facilities using these technologies is expected to increase in the United States, so are the potential impacts on wildlife and their habitats. Recent attention is on the risk of fatality to birds. Understanding the current rates of avian mortality and existing monitoring requirements is an important first step in developing science-based mitigation and minimization protocols. The resulting information also allows a comparison of the avian mortality rates of utility-scale solar energy facilities with those from other technologies and sources,more » as well as the identification of data gaps and research needs. This report will present and discuss the current state of knowledge regarding avian issues at utility-scale solar energy facilities.« less

Does a voucher program improve reproductive health service delivery and access in Kenya?

PubMed

Njuki, Rebecca; Abuya, Timothy; Kimani, James; Kanya, Lucy; Korongo, Allan; Mukanya, Collins; Bracke, Piet; Bellows, Ben; Warren, Charlotte E

2015-05-23

Current assessments on Output-Based Aid (OBA) programs have paid limited attention to the experiences and perceptions of the healthcare providers and facility managers. This study examines the knowledge, attitudes, and experiences of healthcare providers and facility managers in the Kenya reproductive health output-based approach voucher program. A total of 69 in-depth interviews with healthcare providers and facility managers in 30 voucher accredited facilities were conducted. The study hypothesized that a voucher program would be associated with improvements in reproductive health service provision. Data were transcribed and analyzed by adopting a thematic framework analysis approach. A combination of inductive and deductive analysis was conducted based on previous research and project documents. Facility managers and providers viewed the RH-OBA program as a feasible system for increasing service utilization and improving quality of care. Perceived benefits of the program included stimulation of competition between facilities and capital investment in most facilities. Awareness of family planning (FP) and gender-based violence (GBV) recovery services voucher, however, remained lower than the maternal health voucher service. Relations between the voucher management agency and accredited facilities as well as existing health systems challenges affect program functions. Public and private sector healthcare providers and facility managers perceive value in the voucher program as a healthcare financing model. They recognize that it has the potential to significantly increase demand for reproductive health services, improve quality of care and reduce inequities in the use of reproductive health services. To improve program functioning going forward, there is need to ensure the benefit package and criteria for beneficiary identification are well understood and that the public facilities are permitted greater autonomy to utilize revenue generated from the voucher program.

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.

Facilities Inventory and Utilization Study, Fall of 1992: For the State of North Carolina. Twenty-Sixth Edition.

ERIC Educational Resources Information Center

North Carolina Univ., Chapel Hill. Commission on Higher Education Facilities.

This publication presents the results of the twenty-sixth annual inventory and utilization study of the status of space in North Carolina institutions of higher education at the end of the drop-add period of the 1992 fall term. The study provides data for 113 institutions, including the public institutions which comprise the University of North…

Facilities Inventory and Utilization Study, Fall of 1991, for the State of North Carolina. Twenty-Fifth Edition.

ERIC Educational Resources Information Center

North Carolina Univ., Chapel Hill. Commission on Higher Education Facilities.

This publication presents the results of the 25th annual inventory and utilization study of the status of space in North Carolina institutions of higher education at the end of the fall term of 1991. The study provides data for 113 institutions including the public institutions which comprise the University of North Carolina, 39 private non-profit…

Common Utilities in the Energy Systems Integration Facility | Energy

Science.gov Websites

Systems Integration Facility. Common utilities include: Power: Three-phase 480/277 VAC, 208/120 VAC, 240 split-phase VAC, and 120 single-phase VAC Water: Process heating and cooling and research cooling

Some Factors Influencing Effective Utilization of Drinking Water Facilities: Women, Income, and Health in Rural North Ghana

NASA Astrophysics Data System (ADS)

Kendie, S. B.

1996-01-01

In the examination of the implementation of rural drinking water facilities, not enough attention has been paid to analyzing the socioeconomic and political relationships that affect the effective utilization of the facilities, particularly as these relate to women in rural society. This paper suggests that much of the difficulty in instituting the utilization of safe water supply sources has to do with the rather low economic status of women—the main water collectors. Poverty consigns women to long periods of work in activities or jobs that bring little reward. This makes it difficult to effectively digest the messages delivered by program staff and limits the extent of usage of the safe water facilities.

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.

Navajo Tribal Utility Authority Shiprock Wastewater Treatment Facility; Draft NPDES Permit

EPA Pesticide Factsheets

EPA is proposing to issue a NPDES permit (No. NN0020621) to Navajo Tribal Utility Authority (NTUA) for the Shiprock wastewater treatment facility in San Juan County, New Mexico, within the northeastern portion of the Navajo Nation.

Update on the Puerto Rico Electric Power Authority`s spinning reserve battery system

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

Taylor, P.A.

1996-11-01

The Puerto Rico Electric Power Authority completed start-up testing and began commercial operation of a 20MW/14MWh battery energy storage facility in April 1995. The battery system was installed to provide rapid spinning reserve and frequency control for the utility`s island electrical system. This paper outlines the needs of an island utility for rapid spinning reserve; identifies Puerto Rico`s unique challenges; reviews the technical and economic analyses that justified installation of a battery energy system; describes the storage facility that was installed; and presents preliminary operating results of the facility.

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.

Residual Barriers for Utilization of Maternal and Child Health Services: Community Perceptions From Rural Pakistan

PubMed Central

Memon, Zahid; Zaidi, Shehla; Riaz, Atif

2016-01-01

Low utilization of maternal and child care services in rural areas has constrained Pakistan from meeting targets of Millennium Development Goals (MDGs) 4 and 5. This study explores community barriers in accessing Maternal and Child Health (MCH) services in ten remote rural districts of Pakistan. It further presents how the barriers differ across a range of MCH services, and also whether the presence of Community Health Workers (CHWs) reduces client barriers. Qualitative methods were used involving altogether sixty focus group discussions with mothers, their spouses and community health workers. Low awareness, formidable distances, expense, and poorly functional services were the main barriers reported, while cultural and religious restrictions were lesser reported. For preventive services including antenatal care (ANC), facility deliveries, postnatal care (PNC), childhood immunization and family planning, the main barrier was low awareness. Conversely, formidable distances and poorly functional services were the main reported constraints in the event of maternal complications and acute child illnesses. The study also found that clients residing in areas served by CHWs had better awareness only of ANC and family planning, while other MCH services were overlooked by the health worker program. The paper highlights that traditional policy emphasis on health facility infrastructure expansion is not likely to address poor utilization rates in remote rural areas. Preventive MCH services require concerted attention to building community awareness, task shifting from facility to community for services provision, and re-energization of CHW program. For maternal and child emergencies there is strong community demand to utilize health facilities, but this will require catalytic support for transport networks and functional health care centers. PMID:26925902

Predicting Student Satisfaction with an Emphasis on Campus Recreational Sports and Cultural Facilities in a Turkish University

ERIC Educational Resources Information Center

Çelik, Ali Kemal; Akyol, Kübra

2015-01-01

The main purpose of this paper was to determine the predictors of student satisfaction focusing on campus recreational sports and cultural facilities. The present study utilized data from a written-questionnaire administered to one thousand adult undergraduate students. The dependent variable used in predicting student satisfaction was…

Results of an Initial Field Study of New Techniques for Citizen Participation in Educational Facilities Planning.

ERIC Educational Resources Information Center

Zucker, Charles B.

The utility of a particular citizen participation planning approach as applied to educational facilities planning is described. With the aid of a clear-cut decisionmaking procedure, citizens could participate effectively in the development of specific planning policy statements. Such statements could be used to discuss planning priorities, focus…

A qualitative evaluation of the choice of traditional birth attendants for maternity care in 2008 Sierra Leone: implications for universal skilled attendance at delivery.

PubMed

Oyerinde, Koyejo; Harding, Yvonne; Amara, Philip; Garbrah-Aidoo, Nana; Kanu, Rugiatu; Oulare, Macoura; Shoo, Rumishael; Daoh, Kizito

2013-07-01

Maternal and newborn death is common in Sierra Leone; significant reductions in both maternal and newborn mortality require universal access to a skilled attendant during labor and delivery. When too few women use health facilities MDGs 4 and 5 targets will not be met. Our objectives were to identify why women use services provided by TBAs as compared to health facilities; and to suggest strategies to improve utilization of health facilities for maternity and newborn care services. Qualitative data from focus group discussions in communities adjacent to health facilities collected during the 2008 Emergency Obstetric and Newborn Care Needs Assessment were analyzed for themes relating to decision-making on the utilization of TBAs or health facilities. The prohibitive cost of services, and the geographic inaccessibility of health facilities discouraged women from using them while trust in the vast experience of TBAs as well as their compassionate care drew patients to them. Poor facility infrastructure, often absent staff, and the perception that facilities were poorly stocked and could not provide continuum of care services were barriers to facility utilization for maternity and newborn care. Improvements in infrastructure and the 24-hour provision of free, quality, comprehensive, and respectful care will minimize TBA preference in Sierra Leone.

Nesting ecology of a population of Gopherus agassizii at a utility-scale wind energy facility in southern California

USGS Publications Warehouse

Ennen, Joshua R.; Lovich, Jeffrey E.; Meyer, Katherin P.; Bjurlin, Curtis; Arundel, Terence R.

2012-01-01

We investigated the annual nesting ecology of a population of Desert Tortoises (Gopherus agassizii) inhabiting a utility-scale renewable energy (USRE) facility in southern California and compared our results with populations inhabiting relatively undisturbed sites. In 2000, 15 radio-tracked females produced 29 clutches, and 24 nests were monitored to examine nest-site selection, nest predation, hatching success, date of emergence of hatchlings, and hatchling mass and carapace length. Overall, the nesting ecology of the population inhabiting the USRE facility was very similar to other populations of Desert Tortoises inhabiting relatively undisturbed habitats. Oviposition occurred from 12 May to 8 July, which was similar to other sites. Nest depths (11.1 cm), nest predation (12%), hatchling emergence date (7 August and 29 September), and hatchling morphometrics (i.e., MCL: 44.5 mm; mass: 23 g) were all within ranges reported in other populations. Unlike within other populations, we observed no relationship between hatchling size and either maternal body size or egg width. We found no evidence of females selecting for a particular burrow for oviposition of eggs based on environmental or anthropogenic variables. Most nests were located in or near burrows, and nest depth was greater for nests near the entrance than those deeper in the burrow. Although this study suggests that the nesting ecology of the Desert Tortoise population we studied was not adversely affected by the USRE facility, this relationship is only correlative because our study was not a before-after-control-impact (BACI) study, which would establish a cause and effect relationship. As pointed out in a recent review, BACI studies are critically needed to address the wildlife impacts of utility-scale renewable energy development.

Utilization of maternal health-care services by tribal women in Kerala.

PubMed

Jose, Jinu Annie; Sarkar, Sonali; Kumar, S Ganesh; Kar, Sitanshu Sekhar

2014-01-01

The coverage of maternal care services among the tribal women in Kerala is better as compared to other states in India. This study was done to identify the factors contributing to better coverage of maternal care services among the tribal women in Kerala and to study the reasons for remaining differences that exists in utilization of services between tribal and non-tribal pregnant women. This was a descriptive cum qualitative study conducted in Thariode Gramapanchayat in the Wayanad district of Kerala. Among all women who had registered their pregnancies in the 5 sub-centres under CHC Thariode and had delivered between September 2009 and October 2010, equal numbers of tribal and non-tribal ante-natal women, 35 each were interviewed in-depth using a semi-structured questionnaire. Quantitative data was analysed using SPSS Version 16.0. Content analysis was done for qualitative data. The determinants of utilization in tribal women were general awareness, affordability, accessibility and quality of services along with motivation by health workers. Among tribal antenatal women, 85% utilized maternal health care facilities fully compared to 100% among non-tribal women. Lower levels of education and lack of transport facilities were prime factors contributing to under utilization by tribal women. Affordable, accessible and good quality of services in the public health system in Kerala and motivation by health workers were important contributing factors for better utilization of maternal care services.

Utilization of travel reimbursement in the Veterans Health Administration.

PubMed

Nelson, Richard E; Hicken, Bret; Cai, Beilei; Dahal, Arati; West, Alan; Rupper, Randall

2014-01-01

To improve access to care, the Veterans Health Administration (VHA) increased its patient travel reimbursement rate from 11 to 28.5 cents per mile on February 1, 2008, and again to 41.5 cents per mile on November 17, 2008. We identified characteristics of veterans more likely to receive travel reimbursements and evaluated the impact of these increases on utilization of the benefit. We examined the likelihood of receiving any reimbursement, number of reimbursements, and dollar amount of reimbursements for VHA patients before and after both reimbursement rate increases. Because of our data's longitudinal nature, we used multivariable generalized estimating equation models for analysis. Rurality and categorical distance from the nearest VHA facility were examined in separate regressions. Our cohort contained 214,376 veterans. During the study period, the average number of reimbursements per veteran was higher for rural patients compared to urban patients, and for those living 50-75 miles from the nearest VHA facility compared to those living closer. Higher reimbursement rates led to more veterans obtaining reimbursement regardless of urban-rural residence or distance traveled to the nearest VHA facility. However, after the rate increases, urban veterans and veterans living <50 miles from the nearest VHA facility increased their travel reimbursement utilization slightly more than other patients. Our findings suggest an inverted U-shaped relationship between veterans' utilization of the VHA travel reimbursement benefit and travel distance. Both urban and rural veterans responded in roughly equal manner to changes to this benefit. © 2013 National Rural Health Association.

42 CFR 456.520 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Review Plans: FFP, Waivers, and Variances for Hospitals and Mental Hospitals Ur Plan: Remote Facility Variances from Time Requirements § 456.520 Definitions... granted by the Administrator to the Medicaid agency for a specific remote facility to use time periods...

43 CFR 3276.15 - How must I notify BLM of accidents occurring at my utilization facility?

Code of Federal Regulations, 2011 CFR

2011-10-01

... occurring at my utilization facility? You must orally inform us of all accidents that affect operations or create environmental hazards within 24 hours after each accident. When you contact us, we may require you...

Use of hospital data for Safe Motherhood programmes in south Kalimantan, Indonesia.

PubMed

Ronsmans, C; Achadi, E; Sutratikto, G; Zazri, A; McDermott, J

1999-07-01

The evaluation of Safe Motherhood programmes has been hampered by difficulties in measuring the preferred outcomes of maternal mortality and morbidity. The need for adequate indicators has led researchers and programme managers alike to resort to indicators of utilization and quality of health services. In this study we assess the magnitude of four indicators of use of essential obstetric care (EOC) and one indicator of quality of care in health facilities in three districts in South Kalimantan, Indonesia. The general picture which emerges for South Kalimantan is that the use of obstetric services is low. Even in the more urban district of Banjar where facility-based coverage is highest, fewer than 14% of all deliveries take place in an EOC facility, 2% of expected births are admitted to such a facility with a major obstetric intervention (MOI), and 1% of expected births have an MOI for an absolute maternal indication. The use of facility-based EOC is consistently lower in Barito Kuala compared to the other districts, and the differences persist regardless of the indicators used. In this setting with low utilization rates, general rates of utilization of EOC facilities seem to be as satisfactory an indicator of relative access to EOC as more elaborate indicators specifying the reasons for admission. The inequalities in access to care revealed by the various indicators of use of EOC services may prove to be a more powerful stimulus for change than the widely reported and highly inaccurate accounts of the high levels of maternal mortality.

Feasibility Study of Coal Gasification/Fuel Cell/Cogeneration Project. Fort Greely, Alaska Site. Project Description,

DTIC Science & Technology

1985-11-01

Public Utilities Regulatory Policies Act ( PURPA ) criteria for classification as a "Qualifying Facility" (QF). 11. Visual effect of intermittent...the public utility of electric power produced by the cogenerator. The operating standard of PURPA requires that a new QF must produce at least 5% of

Expediting support for the pregnant mothers to obtain antenatal care at public health facilities in rural areas of Balochistan province, Pakistan.

PubMed

Ghaffar, Abdul; Pongpanich, Sathirakorn; Ghaffar, Najma; Chapman, Robert Sedgwick; Mureed, Sheh

2015-01-01

To identify, and compare relative importance of, factors associated with antenatal care (ANC) utilization in rural Balochistan, toward framing a policy to increase such utilization. This cross sectional study was conducted among 513 pregnant women in Jhal Magsi District, Balochistan, in 2011. A standardized interviewer-administered questionnaire was used. Predisposing, enabling, and reinforcing factors were evaluated with generalized linear models (Poisson distribution and log link). Prevalence of any ANC was only 14.4%. Predisposing, enabling, and reinforcing factors were all important determinants of ANC utilization. Reinforcing factors were clearly most important, husband's support for ANC was more important than support from other community members. Among predisposing factors, higher income, education, occupation, and better knowledge regarding benefits of ANC were positively and statistically significantly associated with ANC However increased number of children showed negative association. Complications free pregnancy showed positive significant association with ANC at public health facility among enabling factors. It is very important to increase antenatal care utilization in the study area and similar areas. Policy to achieve this should focus on enhancing support from the husband.

Study of the impacts of regulations affecting the acceptance of Integrated Community Energy Systems: public utility, energy facility siting and municipal franchising regulatory programs in Kentucky. Preliminary background report

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

Feurer, D A; Weaver, C L; Gallagher, K C

1980-01-01

Until April 1, 1979, the Public Service Commission had been vested with exclusive jurisdiction over the regulation of rates and service of utilities. As of that date two new agencies, the Energy Regulatory Commission (ERC) and the Utility Regulatory Commission (URC), have replaced the Public Service Commission. The ERC consists of three full-time members appointed by the governor for four year terms and is responsible for enforcing the provisions of the Kentucky statutes relating to electric and gas utilities. The three-member URC is responsible for enforcing the provisions relating to non-energy utilities such as telephone, sewer, and water utilities. Themore » statutes vest all regulatory authority over public utilities in either the ERC or the URC. Local governments retain only the power to grant local franchises. However, it should be noted, that any utility owned or operated by a political subdivision of the state is exempt from regulation. Thus, local government has complete authority over utilities which are self-owned. Public utility regulatory statutes, energy facility siting programs, and municipal franchising authority are examined to identify how they may impact on the ability of an organization, whether or not it be a regulated utility, to construct and operate an ICES.« less

Proposed Space Flight Experiment Hardware

NASA Technical Reports Server (NTRS)

2003-01-01

The primary thrust for this plan is to develop design tools and fundamental understanding that are timely and consistent with the goal of the various exploration initiatives. The plan will utilize ISS facilities, such as the Fluids Integrated Rack (FIR) and the Microgravity Science Glovebox (MSG). A preliminary flow schematic of Two-Phase Flow Facility (T(phi)FFy) which would utilize FIR is shown in Figure 3. MSG can be utilized to use the Boiling eXperiment Facility (BXF) and Contact Line Dynamics Experiment (CLiDE) Facility. The T(phi)FFy system would have multiple test sections whereby different configurations of heat exchangers could be used to study boiling and condensation phenomena. The test sections would be instrumented for pressure drop, void fraction, heat fluxes, temperatures, high-speed imaging and other diagnostics. Besides a high-speed data acquisition system with a large data storage capability, telemetry could be used to update control and test parameters and download limited amounts of data. In addition, there would be multiple accumulators that could be used to investigate system stability and fluid management issues. The system could accommodate adiabatic tests through either the space station nitrogen supply or have an experiment-specific compressor to pressurize a sufficient amount of air or other non-condensable gas for reuse as the supply bottle is depleted.

Barriers to using skilled birth attendants’ services in mid- and far-western Nepal: a cross-sectional study

PubMed Central

2013-01-01

Background Skilled birth attendants (SBAs) provide important interventions that improve maternal and neonatal health and reduce maternal and neonatal mortality. However, utilization and coverage of services by SBAs remain poor, especially in rural and remote areas of Nepal. This study examined the characteristics associated with utilization of SBA services in mid- and far-western Nepal. Methods This cross-sectional study examined three rural and remote districts of mid- and far-western Nepal (i.e., Kanchanpur, Dailekh and Bajhang), representing three ecological zones (southern plains [Tarai], hill and mountain, respectively) with low utilization of services by SBAs. Enumerators assisted a total of 2,481 women. All respondents had delivered a baby within the past 12 months. We used bivariate and multivariate analyses to assess the association between antenatal and delivery care visits and the women’s background characteristics. Results Fifty-seven percent of study participants had completed at least four antenatal care visits and 48% delivered their babies with the assistance of SBAs. Knowing the danger signs of pregnancy and delivery (e.g., premature labor, prolonged labor, breech delivery, postpartum hemorrhage, severe headache) associated positively with four or more antenatal care visits (OR = 1.71; 95% CI: 1.41-2.07). Living less than 30 min from a health facility associated positively with increased use of both antenatal care (OR = 1.44; 95% CI: 1.18-1.77) and delivery services (OR = 1.25; CI: 1.03-1.52). Four or more antenatal care visits was a determining factor for the utilization of SBAs. Conclusions Less than half of the women in our study delivered babies with the aid of SBAs, indicating a need to increase utilization of such services in rural and remote areas of Nepal. Distance from health facilities and inadequate transportation pose major barriers to the utilization of SBAs. Providing women with transportation funds before they go to a facility for delivery and managing transportation options will increase service utilization. Moreover, SBA utilization associates positively with women’s knowledge of pregnancy danger signs, wealth quintile, and completed antenatal care visits. Nepal’s health system must develop strategies that generate demand for SBAs and also reduce financial, geographic and cultural barriers to such services. PMID:24365039

42 CFR 456.522 - Content of request for variance.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Review Plans: FFP, Waivers, and Variances for Hospitals and Mental Hospitals Ur Plan: Remote Facility Variances from Time..., mental hospital, and ICF located within a 50-mile radius of the facility; (e) The distance and average...

18 CFR 292.311 - Reinstatement of obligation to purchase.

Code of Federal Regulations, 2010 CFR

2010-04-01

... electric energy, a qualifying cogeneration facility, a qualifying small power production facility, a State... utility's obligation to purchase electric energy under this section. Such application shall set forth the... application reinstating the electric utility's obligation to purchase electric energy under this section if...

18 CFR 292.311 - Reinstatement of obligation to purchase.

Code of Federal Regulations, 2011 CFR

2011-04-01

... electric energy, a qualifying cogeneration facility, a qualifying small power production facility, a State... utility's obligation to purchase electric energy under this section. Such application shall set forth the... application reinstating the electric utility's obligation to purchase electric energy under this section if...

Public Utility Commission manual for Section 210 of PURPA for Vermont

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

Not Available

The Public Utility Regulatory Policies Act of 1978 (PURPA) places obligations on both electric utilities and state regulatory commissions. PURPA requires every electric utility to purchase all energy and capacity made available to it, by a qualifying facility, and to sell energy and capacity to a qualifying facility upon the qualifying facility's request. State regulatory commissions must implement and administer these utility obligations and other requirements that were implemented by the Federal Energy Regulatory Commission's (FERC) final rules, which became effective March 20, 1981, and must set fair rates for electric power purchases and sales between utilities and small powermore » producers. This manual provides a concise, annotated explanation of the final FERC rules, a description of federal and state statutory authorizations, court challenges to these authorizations, analysis of the relationship between federal and state laws, analysis of Vermont's implementation of section 210 of PURPA and for comparison, annotations of selected state regulatory authority decisions.« less

Public Utility Commission manual for Section 210 of PURPA for Montana

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

Not Available

The Public Utility Regulatory Policies Act of 1978 (PURPA) places obligations on both electric utilities and state regulatory commissions. PURPA requires every electric utility to purchase all energy and capacity made available to it, by a qualifying facility, and to sell energy and capacity to a qualifying facility upon the qualifying facility's request. State regulatory commissions must implement and administer these utility obligations and other requirements that were implemented by the Federal Energy Regulatory Commission's (FERC) final rules, which became effective March 20, 1981; and must set fair rates for electric power purchases and sales between utilities and small powermore » producers. This manual provides a concise, annotated explanation of the final FERC rules, a description of federal and state statutory authorizations, court challenges to these authorizations analysis of the relationship between federal and state laws, analysis of Montana's implementation of section 210 of PURPA and for comparison, annotations of selected state regulatory authority decisions.« less

Public Utility Commission manual for Section 210 of PURPA for Arkansas

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

Not Available

The Public Utility Regulatory Policies Act of 1978 (PURPA) places obligations on both electric utilities and state regulatory commissions. PURPA requires every electric utility to purchase all energy and capacity made available to it, by a qualifying facility, and to sell energy and capacity to a qualifying facility upon the qualifying facility's request. State regulatory commissions must implement and administer these utility obligations and other requirements that were implemented by the Federal Energy Regulatory Commission's (FERC) final rules, which became effective March 20, 1981; and must set fair rates for electric power purchases and sales between utilities and small powermore » producers. This manual provides a concise, annotated explanation of the final FERC rules, a description of federal and state statutory authorizations, court challenges to these authorizations, analysis of the relationship between federal and state laws, analysis of Arkansas' implementation of section 210 of PURPA and for comparison, annotations of selected state regulatory authority decisions.« less

Modeling Ballasted Tracks for Pollutants

DOT National Transportation Integrated Search

2012-08-01

In this study, the Regional Transportation Districts (RTDs) light rail operations were examined for pollutant production and runoff. To : accomplish this, a laboratory study utilizing a rainfall-runoff facility was conducted. Input to this labo...

Expert Systems for United States Navy Shore Facilities Utility Operations.

DTIC Science & Technology

1988-03-01

of expertise when assessing the applicability of an expert system. Each of the tasks as similarly ranked to reflect subjective judgement on the...United States Navy Shore Facilities Utility Operations ABSTRACT A technology assessment of expert systems as they might be used in Navy utility...of these applications include design, fault diagnoses, training, data base management, and real-time monitoring. An assessment is given of each

10 CFR 50.51 - Continuation of license.

Code of Federal Regulations, 2010 CFR

2010-01-01

... NUCLEAR REGULATORY COMMISSION DOMESTIC LICENSING OF PRODUCTION AND UTILIZATION FACILITIES Issuance... license will be issued for a fixed period of time to be specified in the license but in no case to exceed... expiration date to authorize ownership and possession of the production or utilization facility, until the...

10 CFR 50.51 - Continuation of license.

Code of Federal Regulations, 2011 CFR

2011-01-01

... NUCLEAR REGULATORY COMMISSION DOMESTIC LICENSING OF PRODUCTION AND UTILIZATION FACILITIES Issuance... license will be issued for a fixed period of time to be specified in the license but in no case to exceed... expiration date to authorize ownership and possession of the production or utilization facility, until the...

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.

An Empirical Study of Logistics Organization, Electronic Linkage, and Performance

DTIC Science & Technology

1993-01-01

utilization of transportation resources, and improved quality management. Researchers have proposed an information technology (IT) implementation model for...management, more efficient utilization of transportation resources, and improved quality management. Researchers have proposed an information...coordination of (1) facility structure, (2) forecasting and order management, (3) transportation , (4) inventory, and (5) warehousing and packaging. The

Telepsychiatry in correctional facilities: using technology to improve access and decrease costs of mental health care in underserved populations.

PubMed

Deslich, Stacie Anne; Thistlethwaite, Timothy; Coustasse, Alberto

2013-01-01

It is unclear if telepsychiatry, a subset of telemedicine, increases access to mental health care for inmates in correctional facilities or decreases costs for clinicians or facility administrators. The purpose of this investigation was to determine how utilization of telepsychiatry affected access to care and costs of providing mental health care in correctional facilities. A literature review complemented by a semistructured interview with a telepsychiatry practitioner. Five electronic databases, the National Bureau of Justice, and the American Psychiatric Association Web sites were searched for this research, and 49 sources were referenced. The literature review examined implementation of telepsychiatry in correctional facilities in Arizona, California, Georgia, Kansas, Ohio, Texas, and West Virginia to determine the effect of telepsychiatry on inmate access to mental health services and the costs of providing mental health care in correctional facilities. Telepsychiatry provided improved access to mental health services for inmates, and this increase in access is through the continuum of mental health care, which has been instrumental in increasing quality of care for inmates. Use of telepsychiatry saved correctional facilities from $12,000 to more than $1 million. The semistructured interview with the telepsychiatry practitioner supported utilization of telepsychiatry to increase access and lower costs of providing mental health care in correctional facilities. Increasing access to mental health care for this underserved group through telepsychiatry may improve living conditions and safety inside correctional facilities. Providers, facilities, and state and federal governments can expect increased savings with utilization of telepsychiatry.

Cost-Benefit Analysis of Green Infrastructures on Community Stormwater Reduction and Utilization: A Case of Beijing, China.

PubMed

Liu, Wen; Chen, Weiping; Feng, Qi; Peng, Chi; Kang, Peng

2016-12-01

Cost-benefit analysis is demanded for guiding the plan, design and construction of green infrastructure practices in rapidly urbanized regions. We developed a framework to calculate the costs and benefits of different green infrastructures on stormwater reduction and utilization. A typical community of 54,783 m 2 in Beijing was selected for case study. For the four designed green infrastructure scenarios (green space depression, porous brick pavement, storage pond, and their combination), the average annual costs of green infrastructure facilities are ranged from 40.54 to 110.31 thousand yuan, and the average of the cost per m 3 stormwater reduction and utilization is 4.61 yuan. The total average annual benefits of stormwater reduction and utilization by green infrastructures of the community are ranged from 63.24 to 250.15 thousand yuan, and the benefit per m 3 stormwater reduction and utilization is ranged from 5.78 to 11.14 yuan. The average ratio of average annual benefit to cost of four green infrastructure facilities is 1.91. The integrated facilities had the highest economic feasibility with a benefit to cost ratio of 2.27, and followed by the storage pond construction with a benefit to cost ratio of 2.14. The results suggested that while the stormwater reduction and utilization by green infrastructures had higher construction and maintenance costs, their comprehensive benefits including source water replacements benefits, environmental benefits and avoided cost benefits are potentially interesting. The green infrastructure practices should be promoted for sustainable management of urban stormwater.

A National Study of Efficiency for Dialysis Centers: An Examination of Market Competition and Facility Characteristics for Production of Multiple Dialysis Outputs

PubMed Central

Ozgen, Hacer; A. Ozcan, Yasar

2002-01-01

Objective To examine market competition and facility characteristics that can be related to technical efficiency in the production of multiple dialysis outputs from the perspective of the industrial organization model. Study Setting Freestanding dialysis facilities that operated in 1997 submitted cost report forms to the Health Care Financing Administration (HCFA), and offered all three outputs—outpatient dialysis, dialysis training, and home program dialysis. Data Sources The Independent Renal Facility Cost Report Data file (IRFCRD) from HCFA was utilized to obtain information on output and input variables and market and facility features for 791 multiple-output facilities. Information regarding population characteristics was obtained from the Area Resources File. Study Design Cross-sectional data for the year 1997 were utilized to obtain facility-specific technical efficiency scores estimated through Data Envelopment Analysis (DEA). A binary variable of efficiency status was then regressed against its market and facility characteristics and control factors in a multivariate logistic regression analysis. Principal Findings The majority of the facilities in the sample are functioning technically inefficiently. Neither the intensity of market competition nor a policy of dialyzer reuse has a significant effect on the facilities' efficiency. Technical efficiency is significantly associated, however, with type of ownership, with the interaction between the market concentration of for-profits and ownership type, and with affiliations with chains of different sizes. Nonprofit and government-owned facilities are more likely than their for-profit counterparts to become inefficient producers of renal dialysis outputs. On the other hand, that relationship between ownership form and efficiency is reversed as the market concentration of for-profits in a given market increases. Facilities that are members of large chains are more likely to be technically inefficient. Conclusions Facilities do not appear to benefit from joint production of a variety of dialysis outputs, which may explain the ongoing tendency toward single-output production. Ownership form does make a positive difference in production efficiency, but only in local markets where competition exists between nonprofit and for-profit facilities. The increasing inefficiency associated with membership in large chains suggests that the growing consolidation in the dialysis industry may not, in fact, be the strategy for attaining more technical efficiency in the production of multiple dialysis outputs. PMID:12132602

Modeling, simulation and control for a cryogenic fluid management facility, preliminary report

NASA Technical Reports Server (NTRS)

Turner, Max A.; Vanbuskirk, P. D.

1986-01-01

The synthesis of a control system for a cryogenic fluid management facility was studied. The severe demand for reliability as well as instrumentation and control unique to the Space Station environment are prime considerations. Realizing that the effective control system depends heavily on quantitative description of the facility dynamics, a methodology for process identification and parameter estimation is postulated. A block diagram of the associated control system is also produced. Finally, an on-line adaptive control strategy is developed utilizing optimization of the velocity form control parameters (proportional gains, integration and derivative time constants) in appropriate difference equations for direct digital control. Of special concern are the communications, software and hardware supporting interaction between the ground and orbital systems. It is visualized that specialist in the OSI/ISO utilizing the Ada programming language will influence further development, testing and validation of the simplistic models presented here for adaptation to the actual flight environment.

Nonterrestrial utilization of materials: Automated space manufacturing facility

NASA Technical Reports Server (NTRS)

1982-01-01

Four areas related to the nonterrestrial use of materials are included: (1) material resources needed for feedstock in an orbital manufacturing facility, (2) required initial components of a nonterrestrial manufacturing facility, (3) growth and productive capability of such a facility, and (4) automation and robotics requirements of the facility.

Utilization of maternal health-care services by tribal women in Kerala

PubMed Central

Jose, Jinu Annie; Sarkar, Sonali; Kumar, S. Ganesh; Kar, Sitanshu Sekhar

2014-01-01

Background: The coverage of maternal care services among the tribal women in Kerala is better as compared to other states in India. Aim: This study was done to identify the factors contributing to better coverage of maternal care services among the tribal women in Kerala and to study the reasons for remaining differences that exists in utilization of services between tribal and non-tribal pregnant women. Settings and Design: This was a descriptive cum qualitative study conducted in Thariode Gramapanchayat in the Wayanad district of Kerala. Materials and Methods: Among all women who had registered their pregnancies in the 5 sub-centres under CHC Thariode and had delivered between September 2009 and October 2010, equal numbers of tribal and non-tribal ante-natal women, 35 each were interviewed in-depth using a semi-structured questionnaire. Statistical Analysis Used: Quantitative data was analysed using SPSS Version 16.0. Content analysis was done for qualitative data. Results: The determinants of utilization in tribal women were general awareness, affordability, accessibility and quality of services along with motivation by health workers. Among tribal antenatal women, 85% utilized maternal health care facilities fully compared to 100% among non-tribal women. Lower levels of education and lack of transport facilities were prime factors contributing to under utilization by tribal women. Conclusions: Affordable, accessible and good quality of services in the public health system in Kerala and motivation by health workers were important contributing factors for better utilization of maternal care services. PMID:24678214

The utilization characteristics of social facilities in the border area of Semarang city

NASA Astrophysics Data System (ADS)

Setioko, Bambang; Olivia, Deasy; Pandelaki, Edward E.; Murtini, Titien Woro

2017-06-01

The rapid growth of settlement in border areas is often considered as a problem of big cities in Indonesia, where people from rural areas prefer to move out and settle in the border areas of big cities due to the provision of better social facilities. Border areas generally do not receive adequate attention and are often overlooked by the local government. It is a common phenomenon in Indonesian cities, including in Semarang City. Increased number of settlements in the border areas in Semarang City is in linear with spontaneous urbanization processes which indicate the heterogeneity emerging of settlement areas. In the early stages of Semarang City spatial planning, the need for social facilities in border areas is included based on the regular standard which is commonly applied to the urban core. In a very short period, the numbers and types of existing social facilities are insufficient to fulfill the needs of the community. Nowadays, in the context of rapid urbanization, the growth of social facilities in border areas is very high. The intense growth of settlements in border areas is very high due to the low price of land in Demak Regency in compared to those of other areas in Semarang City. However, only a few developers involved social facilities as a part of housing estate construction. Consequently, most of the occupants utilize a limited number of social facilities provided by the municipal government, which are actually intended to serve the citizens of Semarang City. This research was conducted at Sendang Mulyo Village which is located in the border of Semarang municipal administrative area and included in Demak Regency. This paper discusses the utilization characteristics of social facilities in the border area of Semarang City, with the aim to get the trigger factors. The method analysis consisted of a statistical test and descriptive analysis. The utilization characteristics were formulated based on the relationship between neighborhood and human behavior. The settlements in the border area of Semarang City have different characteristics. The differences led to a gap of the utilization of facilities between people who live in the planned and unplanned settlement. Therefore, the social spatial concept is required to address the issue.

Skilled Antenatal Care Service Utilization and Its Association with the Characteristics of Women's Health Development Team in Yeky District, South-West Ethiopia: A Multilevel Analysis.

PubMed

Girmaye, Melese; Berhan, Yifru

2016-07-01

In response to high maternal and perinatal morbidities and mortalities in Ethiopia, "Women's Health Development Army" was established to enhance utilization of skilled maternity services including antenatal care (ANC). However, its effect on skilled ANC service utilization is not well measured. Our study was aimed to assess skilled antenatal care service utilization and its association with the characteristics of women's health development team (WHDT). A community based cross sectional study was conducted from January to February 2015. A multi-stage cluster sampling technique was applied, and a total of 748 women (15-49 years) who gave birth in one year preceding the study were included in the study. Data were entered into EPI info version 7 statistical software and exported to STATA version 11 for analysis. Bivariate and multilevel mixed effects analysis techniques were applied to check for association of selected independent variables with utilization of skilled ANC. About 71% women received skilled ANC service at least once. A significant heterogeneity was observed between WHDTs for skilled ANC utilization. Level-1 predictors of skilled ANC utilization were: preference of skilled personnel (AOR=11.0; 95%, CI, 3.02-40.04), awareness about places where to get skilled providers (AOR=51.6; 95% CI, 13.92-,190.97) and listening to radio (AOR=5.7; 95% CI, 1.46-21.94). Distance of WHDT within 2 km radius from the nearest health facility (HF) was the only level-2 significant predictor of skilled ANC service utilization (AOR=8.28; 95%CI, 1.08-62.20). Skilled ANC service utilization is the joint effect of individual and WHDT characters. Awareness and perception creation towards skilled maternity service utilization need to be enhanced. Facilities and transport services should be more accessible towards WHDTs.

Japanese plan for SSF utilization

NASA Technical Reports Server (NTRS)

Mizuno, Toshio

1992-01-01

The Japanese Experiment Module (JEM) program has made significant progress. The JEM preliminary design review was completed in July 1992; construction of JEM operation facilities has begun; and the micro-G airplane, drop shaft, and micro-G experiment rocket are all operational. The national policy for JEM utilization was also established. The Space Experiment Laboratory (SEL) opened in June '92 and will function as a user support center. Eight JEM multiuser facilities are in phase B, and scientific requirements are being defined for 17 candidate multiuser facilities. The National Joint Research Program is about to start. Precursor missions and early Space Station utilization activities are being defined. This paper summarizes the program in outline and graphic form.

Impact of Predicting Health Care Utilization Via Web Search Behavior: A Data-Driven Analysis.

PubMed

Agarwal, Vibhu; Zhang, Liangliang; Zhu, Josh; Fang, Shiyuan; Cheng, Tim; Hong, Chloe; Shah, Nigam H

2016-09-21

By recent estimates, the steady rise in health care costs has deprived more than 45 million Americans of health care services and has encouraged health care providers to better understand the key drivers of health care utilization from a population health management perspective. Prior studies suggest the feasibility of mining population-level patterns of health care resource utilization from observational analysis of Internet search logs; however, the utility of the endeavor to the various stakeholders in a health ecosystem remains unclear. The aim was to carry out a closed-loop evaluation of the utility of health care use predictions using the conversion rates of advertisements that were displayed to the predicted future utilizers as a surrogate. The statistical models to predict the probability of user's future visit to a medical facility were built using effective predictors of health care resource utilization, extracted from a deidentified dataset of geotagged mobile Internet search logs representing searches made by users of the Baidu search engine between March 2015 and May 2015. We inferred presence within the geofence of a medical facility from location and duration information from users' search logs and putatively assigned medical facility visit labels to qualifying search logs. We constructed a matrix of general, semantic, and location-based features from search logs of users that had 42 or more search days preceding a medical facility visit as well as from search logs of users that had no medical visits and trained statistical learners for predicting future medical visits. We then carried out a closed-loop evaluation of the utility of health care use predictions using the show conversion rates of advertisements displayed to the predicted future utilizers. In the context of behaviorally targeted advertising, wherein health care providers are interested in minimizing their cost per conversion, the association between show conversion rate and predicted utilization score, served as a surrogate measure of the model's utility. We obtained the highest area under the curve (0.796) in medical visit prediction with our random forests model and daywise features. Ablating feature categories one at a time showed that the model performance worsened the most when location features were dropped. An online evaluation in which advertisements were served to users who had a high predicted probability of a future medical visit showed a 3.96% increase in the show conversion rate. Results from our experiments done in a research setting suggest that it is possible to accurately predict future patient visits from geotagged mobile search logs. Results from the offline and online experiments on the utility of health utilization predictions suggest that such prediction can have utility for health care providers.

Impact of Predicting Health Care Utilization Via Web Search Behavior: A Data-Driven Analysis

PubMed Central

Zhang, Liangliang; Zhu, Josh; Fang, Shiyuan; Cheng, Tim; Hong, Chloe; Shah, Nigam H

2016-01-01

Background By recent estimates, the steady rise in health care costs has deprived more than 45 million Americans of health care services and has encouraged health care providers to better understand the key drivers of health care utilization from a population health management perspective. Prior studies suggest the feasibility of mining population-level patterns of health care resource utilization from observational analysis of Internet search logs; however, the utility of the endeavor to the various stakeholders in a health ecosystem remains unclear. Objective The aim was to carry out a closed-loop evaluation of the utility of health care use predictions using the conversion rates of advertisements that were displayed to the predicted future utilizers as a surrogate. The statistical models to predict the probability of user’s future visit to a medical facility were built using effective predictors of health care resource utilization, extracted from a deidentified dataset of geotagged mobile Internet search logs representing searches made by users of the Baidu search engine between March 2015 and May 2015. Methods We inferred presence within the geofence of a medical facility from location and duration information from users’ search logs and putatively assigned medical facility visit labels to qualifying search logs. We constructed a matrix of general, semantic, and location-based features from search logs of users that had 42 or more search days preceding a medical facility visit as well as from search logs of users that had no medical visits and trained statistical learners for predicting future medical visits. We then carried out a closed-loop evaluation of the utility of health care use predictions using the show conversion rates of advertisements displayed to the predicted future utilizers. In the context of behaviorally targeted advertising, wherein health care providers are interested in minimizing their cost per conversion, the association between show conversion rate and predicted utilization score, served as a surrogate measure of the model’s utility. Results We obtained the highest area under the curve (0.796) in medical visit prediction with our random forests model and daywise features. Ablating feature categories one at a time showed that the model performance worsened the most when location features were dropped. An online evaluation in which advertisements were served to users who had a high predicted probability of a future medical visit showed a 3.96% increase in the show conversion rate. Conclusions Results from our experiments done in a research setting suggest that it is possible to accurately predict future patient visits from geotagged mobile search logs. Results from the offline and online experiments on the utility of health utilization predictions suggest that such prediction can have utility for health care providers. PMID:27655225

Use of Libraries in Open and Distance Learning System: Barriers to the Use of AIOU Libraries by Tutors and Students

ERIC Educational Resources Information Center

Bhatti, Abdul Jabbar; Jumani, Nabi Bux

2012-01-01

This study explores the library needs of students and tutors of Allama Iqbal Open University (AIOU), utilization level of the library facilities and resources, the problems in the use of library, and suggestions for improvement of library facilities for students and tutors. Data collected from 4080 students and 526 tutors belonging to 15 different…

Microgravity Simulation Facility (MSF)

NASA Technical Reports Server (NTRS)

Richards, Stephanie E. (Compiler); Levine, Howard G.; Zhang, Ye

2016-01-01

The Microgravity Simulator Facility (MSF) at Kennedy Space Center (KSC) was established to support visiting scientists for short duration studies utilizing a variety of microgravity simulator devices that negate the directional influence of the "g" vector (providing simulated conditions of micro or partial gravity). KSC gravity simulators can be accommodated within controlled environment chambers allowing investigators to customize and monitor environmental conditions such as temperature, humidity, CO2, and light exposure.

43 CFR 3277.11 - What records must I keep available for inspection?

Code of Federal Regulations, 2011 CFR

2011-10-01

... operation of your utilization facility, royalty and production meters, and safety training available for BLM inspection for a period of 6 years following the time the records and information are created. (b) This... needs them to determine: (1) Resource production to a utilization facility; or (2) The allocation of...

Evaluating Potential Human Health Risks Associated with the Development of Utility-Scale Solar Energy Facilities on Contaminated Sites

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

Cheng, J. -J.; Chang, Y. -S.; Hartmann, H.

2013-09-01

This report presents a general methodology for obtaining preliminary estimates of the potential human health risks associated with developing a utility-scale solar energy facility on a contaminated site, based on potential exposures to contaminants in soils (including transport of those contaminants into the air).

The Utilization and Design of Physical Facilities for the Rehabilitation of Mentally Retarded. Final Project Report.

ERIC Educational Resources Information Center

Bair, Howard V.; Leland, Henry

To investigate the appropriate design and utilization of physical facilities being constructed as a rehabilitation center, a variety of centers was examined. Conclusions were that flexibility in construction of the physical plant, including nonpermanent walls and fixtures was necessary; program planning should be included in architectural…

A Production Lab the Faculty Can Call Their Own.

ERIC Educational Resources Information Center

Wilkening, Donald J.

1979-01-01

Presents a case study of the development of a faculty media production laboratory by Michigan State University's media center, describing funding, facilities, promotion, utilization, and future plans. (CMV)

The use of music in aged care facilities: A mixed-methods study.

PubMed

Garrido, Sandra; Dunne, Laura; Perz, Janette; Chang, Esther; Stevens, Catherine J

2018-02-01

Music is frequently used in aged care, being easily accessible and cost-effective. Research indicates that certain types of musical engagement hold greater benefits than others. However, it is not clear how effectively music is utilized in aged care facilities and what the barriers are to its further use. This study used a mixed-methods paradigm, surveying 46 aged care workers and conducting in-depth interviews with 5, to explore how music is used in aged care facilities in Australia, staff perceptions of the impact of music on residents, and the barriers to more effective implementation of music in aged care settings.

The National Transonic Facility: A Research Retrospective

NASA Technical Reports Server (NTRS)

Wahls, R. A.

2001-01-01

An overview of the National Transonic Facility (NTF) from a research utilization perspective is provided. The facility was born in the 1970s from an internationally recognized need for a high Reynolds number test capability based on previous experiences with preflight predictions of aerodynamic characteristics and an anticipated need in support of research and development for future aerospace vehicle systems. Selection of the cryogenic concept to meet the need, unique capabilities of the facility, and the eventual research utilization of the facility are discussed. The primary purpose of the paper is to expose the range of investigations that have used the NTF since being declared operational in late 1984; limited research results are included, though many more can be found in the references.

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

Dual-Spool Turbine Facility Design Overview

NASA Technical Reports Server (NTRS)

Giel, Paul; Pachlhofer, Pete

2003-01-01

The next generation of aircraft engines, both commercial and military, will attempt to capitalize on the benefits of close-coupled, vaneless, counter-rotating turbine systems. Experience has shown that significant risks and challenges are present with close-coupled systems in terms of efficiency and durability. The UEET program needs to demonstrate aerodynamic loading and efficiency goals for close-coupled, reduced-stage HP/LP turbine systems as a Level 1 Milestone for FY05. No research facility exists in the U.S. to provide risk reduction for successful development of close-coupled, high and low pressure turbine systems for the next generations of engines. To meet these objectives, the design, construction, and integrated systems testing of a Dual-Spool Turbine Facility (DSTF) facility has been initiated at the NASA Glenn Research Center. The facility will be a warm (-IOOO'F), continuous flow facility for overall aerodynamic performance and detailed flow field measurement acquisition. The facility will have state-of-the-art instrumentation to capture flow physics details. Accurate and reliable speed control will be achieved by utilizing the existing Variable Frequency Drive System. Utilization of this and other existing GRC centralized utilities will reduce the overall construction costs. The design allows for future installation of a turbine inlet combustor profile simulator. This presentation details the objectives of the facility and the concepts used in specifying its capabilities. Some preliminary design results will be presented along with a discussion of plans and schedules.

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;…

Engineering study for a melting, casting, rolling and fabrication facility for recycled contaminated stainless steel

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

NONE

This Preliminary Report is prepared to study the facilities required for recycling contaminated stainless steel scrap into plate which will be fabricated into boxes suitable for the storage of contaminated wastes and rubble. The study is based upon the underlying premise that the most cost effective way to produce stainless steel is to use the same processes employed by companies now in production of high quality stainless steel. Therefore, the method selected for this study for the production of stainless steel plate from scrap is conventional process using an Electric Arc Furnace for meltdown to hot metal, a Continuous Castermore » for production of cast slabs, and a Reversing Hot Mill for rolling the slabs into plate. The fabrication of boxes from the plate utilizes standard Shears, Punch Presses and welding equipment with Robotic Manipulators. This Study presumes that all process fumes, building dusts and vapors will be cycled through a baghouse and a nuclear grade HEPA filter facility prior to discharge. Also, all process waste water will be evaporated into the hot flue gas stream from the furnace utilizing a quench tank; so there will be no liquid discharges from the facility and all vapors will be processed through a HEPA filter. Even though HEPA filters are used today in controlling radioactive contamination from nuclear facilities there is a sparsity of data concerning radioactivity levels and composition of waste that may be collected from contaminated scrap steel processing. This report suggests some solutions to these problems but it is recommended that additional study must be given to these environmental problems.« less

Travel time to maternity care and its effect on utilization in rural Ghana: a multilevel analysis.

PubMed

Masters, Samuel H; Burstein, Roy; Amofah, George; Abaogye, Patrick; Kumar, Santosh; Hanlon, Michael

2013-09-01

Rates of neonatal and maternal mortality are high in Ghana. In-facility delivery and other maternal services could reduce this burden, yet utilization rates of key maternal services are relatively low, especially in rural areas. We tested a theoretical implication that travel time negatively affects the use of in-facility delivery and other maternal services. Empirically, we used geospatial techniques to estimate travel times between populations and health facilities. To account for uncertainty in Ghana Demographic and Health Survey cluster locations, we adopted a novel approach of treating the location selection as an imputation problem. We estimated a multilevel random-intercept logistic regression model. For rural households, we found that travel time had a significant effect on the likelihood of in-facility delivery and antenatal care visits, holding constant education, wealth, maternal age, facility capacity, female autonomy, and the season of birth. In contrast, a facility's capacity to provide sophisticated maternity care had no detectable effect on utilization. As the Ghanaian health network expands, our results suggest that increasing the availability of basic obstetric services and improving transport infrastructure may be important interventions. Copyright © 2013 Elsevier Ltd. All rights reserved.

Expediting support for the pregnant mothers to obtain antenatal care at public health facilities in rural areas of Balochistan province, Pakistan

PubMed Central

Ghaffar, Abdul; Pongpanich, Sathirakorn; Ghaffar, Najma; Chapman, Robert Sedgwick; Mureed, Sheh

2015-01-01

Objectives: To identify, and compare relative importance of, factors associated with antenatal care (ANC) utilization in rural Balochistan, toward framing a policy to increase such utilization. Methods: This cross sectional study was conducted among 513 pregnant women in Jhal Magsi District, Balochistan, in 2011. A standardized interviewer-administered questionnaire was used. Predisposing, enabling, and reinforcing factors were evaluated with generalized linear models (Poisson distribution and log link). Results: Prevalence of any ANC was only 14.4%. Predisposing, enabling, and reinforcing factors were all important determinants of ANC utilization. Reinforcing factors were clearly most important, husband’s support for ANC was more important than support from other community members. Among predisposing factors, higher income, education, occupation, and better knowledge regarding benefits of ANC were positively and statistically significantly associated with ANC However increased number of children showed negative association. Complications free pregnancy showed positive significant association with ANC at public health facility among enabling factors. Conclusion: It is very important to increase antenatal care utilization in the study area and similar areas. Policy to achieve this should focus on enhancing support from the husband. PMID:26150867

7 CFR 1735.91 - Location of facilities.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 11 2010-01-01 2010-01-01 false Location of facilities. 1735.91 Section 1735.91 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF... All Acquisitions and Mergers § 1735.91 Location of facilities. Telephone facilities to be acquired...

Women's preferences for obstetric care in rural Ethiopia: a population-based discrete choice experiment in a region with low rates of facility delivery.

PubMed

Kruk, M E; Paczkowski, M M; Tegegn, A; Tessema, F; Hadley, C; Asefa, M; Galea, S

2010-11-01

Delivery attended by skilled professionals is essential to reducing maternal mortality. Although the facility delivery rate in Ethiopia's rural areas is extremely low, little is known about which health system characteristics most influence women's preferences for delivery services. In this study, women's preferences for attributes of health facilities for delivery in rural Ethiopia were investigated. A population-based discrete choice experiment (DCE) was fielded in Gilgel Gibe, in southwest Ethiopia, among women with a delivery in the past 5 years. Women were asked to select a hypothetical health facility for future delivery from two facilities on a picture card. A hierarchical Bayesian procedure was used to estimate utilities associated with facility attributes: distance, type of provider, provider attitude, drugs and medical equipment, transport and cost. 1006 women completed 8045 DCE choice tasks. Among them, 93.8% had delivered their last child at home. The attributes with the greatest influence on the overall utility of a health facility for delivery were availability of drugs and equipment (mean β=3.9, p<0.01), seeing a doctor versus a health extension worker (mean β=2.1, p<0.01) and a receptive provider attitude (mean β=1.4, p<0.01). Women in rural southwest Ethiopia who have limited personal experience with facility delivery nonetheless value health facility attributes that indicate high technical quality: availability of drugs and equipment and physician providers. Well-designed policy experiments that measure the contribution of quality improvements to facility delivery rates in Ethiopia and other countries with low health service utilisation and high maternal mortality may inform national efforts to reduce maternal mortality.

Casas Maternas in the Rural Highlands of Guatemala: A Mixed-Methods Case Study of the Introduction and Utilization of Birthing Facilities by an Indigenous Population

PubMed Central

Stollak, Ira; Valdez, Mario; Rivas, Karin; Perry, Henry

2016-01-01

ABSTRACT Background: An international NGO, with financial and managerial support from “partner” communities, established Casas Maternas (birthing facilities) in 3 municipalities in the isolated northwestern highlands of the department of Huehuetenango in Guatemala—an area with high maternal mortality ratio (338 maternal deaths per 100,000 live births). Traditional birth attendants are encouraged to bring patients for delivery at the Casas Maternas, where trained staff are present and access to referral care is facilitated. Methods: We conducted a mixed-methods study in San Sebastian Coatán municipality to assess the contribution of 2 Casas Maternas to health facility deliveries among partner and non-partner communities, with particular emphasis on equity in access. We surveyed all women who delivered in the study area between April 2013 and March 2014, the first full year in which both Casas Maternas in the study area were operating. In addition, using purposive sampling, we conducted in-depth interviews with 22 women who delivered and 6 focus group discussions with 42 community leaders, traditional birth attendants, and Casas Maternas staff members. We analyzed the quantitative data using descriptive statstics and the qualitative data with descriptive content analysis. Results: Of the 321 women eligible for inclusion in the study, we surveyed 275 women (14.3% could not be located or refused to participate). Between April 2013 and March 2014, 70% of women living in partner communities delivered in a health facility (54% in a Casa Materna) compared with 30% of women living in non-partner communities (17% in a Casa Materna). There was no statistically significant difference in uptake of the Casa Materna by maternal education and only a weak effect by household wealth. In contrast, distance from the Casa Materna had a pronounced effect. Traditional birth attendants were strong advocates for utilization of the Casa Materna and played an important role in the decision regarding where the birth would take place. In addition, the program’s outreach component, in which peer volunteers visit homes to promote healthy behaviors and appropriate use of health facilities, was identified as a key factor in encouraging mothers to deliver in facilities. Discussion: The Casa Materna approach to strengthening maternity care as developed by Curamericas has potential to increase health facility utilization in isolated mountainous areas inhabited by an indigenous population where access to government services is limited and where maternal mortality is high. The approach shows promise for broader application in Guatemala and beyond. PMID:27016548

Casas Maternas in the Rural Highlands of Guatemala: A Mixed-Methods Case Study of the Introduction and Utilization of Birthing Facilities by an Indigenous Population.

PubMed

Stollak, Ira; Valdez, Mario; Rivas, Karin; Perry, Henry

2016-03-01

An international NGO, with financial and managerial support from "partner" communities, established Casas Maternas (birthing facilities) in 3 municipalities in the isolated northwestern highlands of the department of Huehuetenango in Guatemala-an area with high maternal mortality ratio (338 maternal deaths per 100,000 live births). Traditional birth attendants are encouraged to bring patients for delivery at the Casas Maternas, where trained staff are present and access to referral care is facilitated. We conducted a mixed-methods study in San Sebastian Coatán municipality to assess the contribution of 2 Casas Maternas to health facility deliveries among partner and non-partner communities, with particular emphasis on equity in access. We surveyed all women who delivered in the study area between April 2013 and March 2014, the first full year in which both Casas Maternas in the study area were operating. In addition, using purposive sampling, we conducted in-depth interviews with 22 women who delivered and 6 focus group discussions with 42 community leaders, traditional birth attendants, and Casas Maternas staff members. We analyzed the quantitative data using descriptive statstics and the qualitative data with descriptive content analysis. Of the 321 women eligible for inclusion in the study, we surveyed 275 women (14.3% could not be located or refused to participate). Between April 2013 and March 2014, 70% of women living in partner communities delivered in a health facility (54% in a Casa Materna) compared with 30% of women living in non-partner communities (17% in a Casa Materna). There was no statistically significant difference in uptake of the Casa Materna by maternal education and only a weak effect by household wealth. In contrast, distance from the Casa Materna had a pronounced effect. Traditional birth attendants were strong advocates for utilization of the Casa Materna and played an important role in the decision regarding where the birth would take place. In addition, the program's outreach component, in which peer volunteers visit homes to promote healthy behaviors and appropriate use of health facilities, was identified as a key factor in encouraging mothers to deliver in facilities. The Casa Materna approach to strengthening maternity care as developed by Curamericas has potential to increase health facility utilization in isolated mountainous areas inhabited by an indigenous population where access to government services is limited and where maternal mortality is high. The approach shows promise for broader application in Guatemala and beyond. © Stollak et al.

Determinants of postnatal care utilization in urban community among women in Debre Birhan Town, Northern Shewa, Ethiopia.

PubMed

Angore, Banchalem Nega; Tufa, Efrata Girma; Bisetegen, Fithamlak Solomon

2018-04-19

Reducing maternal mortality and improving maternal health care through increased utilization of postnatal care utilization is a global and local priority. However studies that have been carried out in Ethiopia regarding determinants are limited. So This study aims to assess the magnitude of postnatal care utilization and its determinants in Debre Birhan Town, North Ethiopia. A community-based cross-sectional study was conducted from March 1 to April 25, 2015, in Debre Birhan Town. Data were collected through face-to-face interviews using structured pre-tested questionnaires. The data were entered and cleaned in Epi Info version 3.5 and analyzed using SPSS version 20. Bivariate and multiple logistic regression analyses were used. Variable with p value less than or equal to 0.2 at bivariate analysis were entered into multiple logistic regression. Significance was declared at 0.05 in multiple logistic regressions and considered to be an independent factor. From the total respondents, we found that 327 (83.3%) mothers utilized the postnatal care services. Single mothers were less likely to utilize postnatal care services than those mothers who are married and live together [adjusted odds ratio (AOR) = 0.06, 95% CI (0.01, 0.45)]. This study revealed that respondent's knowledge about postnatal care services is an important predictor of postnatal care utilization [AOR = 0.03, 95% CI (0.00, 0.44)] and mothers who delivered in a health care facility were more likely to receive PNC than mothers who did not deliver in a health care facility [AOR = 0.65, 95% CI (0.58, 0.94)]. The postnatal care utilization rate in Debre Birhan town was 83.3%. Marital status, maternal knowledge, and place of delivery were predictors of postnatal care service utilization. So specific attention should be directed towards the improvement of women's education since the perception of the need for PNC services were positively correlated with the mother's education.

Economically dispatching cogeneration facilities

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

Hernandez, E.

Economic dispatching has been used by utilities to meet the energy demands of their customers for decades. The objective was to first load those units which cost the least to run and slowly increase the loading of more expensive units as the incremental energy price increased. Although this concept worked well for utility based systems where incremental costs rose with peak demand, the independent power producers(IPPs) and the power purchase agreements (PPAs) have drastically changed this notion. Most PPAs structured for the IPP environment have negotiated rates which remain the same during peak periods and base their electrical generation onmore » specific process steam requirements. They also must maintain the required production balance of process steam and electrical load in order to qualify as a Public Utility Regulatory Policies Act (PURPA) facility. Consequently, economically dispatching Cogeneration facilities becomes an exercise in adhering to contractual guidelines while operating the equipment in the most efficient manner possible for the given condition. How then is it possible to dispatch a Cogeneration facility that maintains the electrical load demand of JFK Airport while satisfying all of its heating and cooling needs? Contractually, Kennedy International Airport Cogen (KIAC) has specific obligations concerning electrical and thermal energy exported to JFK Airport. The facility`s impressive array of heating and cooling apparatuses together with the newly installed cogen fulfilled the airport`s needs by utilizing an endless combination of new and previously installed equipment. Moreover, in order to economically operate the plant a well structured operating curriculum was necessary.« less

Utilization of medical care following the Three Mile Island crisis.

PubMed

Houts, P S; Hu, T W; Henderson, R A; Cleary, P D; Tokuhata, G

1984-02-01

Four studies are reported on how utilization of primary health care was affected by the Three Mile Island (TMI) crisis and subsequent distress experienced by persons living in the vicinity of the plant. The studies concerned: 1) Blue Cross-Blue Shield records of claims by primary care physicians in the vicinity of TMI; 2) utilization rates in a family practice located near the facility; 3) interviews with persons living within five miles of TMI following the crisis; and 4) responses to a questionnaire by primary care physicians practicing within 25 miles of TMI. All four studies indicated only slight increases in utilization rates during the year following the crisis. One study found that persons who were upset during the crisis tended to be high practice utilizers both before and after the crisis. These results suggest that, while patterns of physician utilization prior to the TMI crisis predicted emotional response during the crisis, the impact of the TMI crisis on subsequent physician utilization was small.

Utilization of medical care following the Three Mile Island crisis.

PubMed Central

Houts, P S; Hu, T W; Henderson, R A; Cleary, P D; Tokuhata, G

1984-01-01

Four studies are reported on how utilization of primary health care was affected by the Three Mile Island (TMI) crisis and subsequent distress experienced by persons living in the vicinity of the plant. The studies concerned: 1) Blue Cross-Blue Shield records of claims by primary care physicians in the vicinity of TMI; 2) utilization rates in a family practice located near the facility; 3) interviews with persons living within five miles of TMI following the crisis; and 4) responses to a questionnaire by primary care physicians practicing within 25 miles of TMI. All four studies indicated only slight increases in utilization rates during the year following the crisis. One study found that persons who were upset during the crisis tended to be high practice utilizers both before and after the crisis. These results suggest that, while patterns of physician utilization prior to the TMI crisis predicted emotional response during the crisis, the impact of the TMI crisis on subsequent physician utilization was small. PMID:6691524

7 CFR 1738.12 - Location of facilities.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 11 2010-01-01 2010-01-01 false Location of facilities. 1738.12 Section 1738.12 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF... Location of facilities. RUS will make broadband loans for facilities which RUS determines are necessary to...

18 CFR 292.602 - Exemption to qualifying facilities from the Public Utility Holding Company Act and certain State...

Code of Federal Regulations, 2010 CFR

2010-04-01

... 292.602 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY COMMISSION, DEPARTMENT OF ENERGY REGULATIONS UNDER THE PUBLIC UTILITY REGULATORY POLICIES ACT OF 1978 REGULATIONS UNDER SECTIONS... capacity over 30 megawatts if such facility produces electric energy solely by the use of biomass as a...

10 CFR 50.13 - Attacks and destructive acts by enemies of the United States; and defense activities.

Code of Federal Regulations, 2010 CFR

2010-01-01

... LICENSING OF PRODUCTION AND UTILIZATION FACILITIES Requirement of License, Exceptions § 50.13 Attacks and... construct and operate a production or utilization facility, or for an amendment to such license, is not required to provide for design features or other measures for the specific purpose of protection against...

Physician ownership of physical therapy services. Effects on charges, utilization, profits, and service characteristics.

PubMed

Mitchell, J M; Scott, E

1992-10-21

To evaluate the effects of physician ownership of freestanding physical therapy and rehabilitation facilities on utilization, charges, profits, and three measures of service characteristics for physical therapy treatments. Statistical comparison by physician joint venture ownership status of freestanding physical therapy and comprehensive rehabilitation facilities providing physical therapy treatments in Florida. A total of 118 outpatient physical therapy facilities and 63 outpatient comprehensive rehabilitation facilities providing services in Florida during 1989. The data from the facilities were collected under a legislative mandate. Visits per patient, average revenue per patient, percent operating income, percent markup, profits per patient, licensed therapist time per visit, and licensed and nonlicensed medical worker time per visit. Visits per patient were 39% to 45% higher in joint venture facilities. Both gross and net revenue per patient were 30% to 40% higher in facilities owned by referring physicians. Percent operating income and percent markup were significantly higher in joint venture physical therapy and rehabilitation facilities. Licensed physical therapists and licensed therapist assistants employed in non-joint venture facilities spend about 60% more time per visit treating physical therapy patients than licensed therapists and licensed therapist assistants working in joint venture facilities. Joint ventures also generate more of their revenues from patients with well-paying insurance. Our results indicate that utilization, charges per patient, and profits are higher when physical therapy and rehabilitation facilities are owned by referring physicians. With respect to service characteristics, joint venture firms employ proportionately fewer licensed therapists and licensed therapist assistants to perform physical therapy, so that licensed professionals employed in joint venture businesses spend significantly less time per visit treating patients. These results should be of interest to the medical profession, third-party payers, and policymakers, all of whom are concerned about the consequences of physician self-referral arrangements.

Immediate and sustained effects of user fee exemption on healthcare utilization among children under five in Burkina Faso: A controlled interrupted time-series analysis.

PubMed

Zombré, David; De Allegri, Manuela; Ridde, Valéry

2017-04-01

Little is known about the long-term effects of user fee exemption policies on health care use in developing countries. We examined the association between user fee exemption and health care use among children under five in Burkina Faso. We also examined how factors related to characteristics of health facilities and their environment moderate this association. We used a multilevel controlled interrupted time-series design to examine the strength of effect and long term effects of user fee exemption policy on the rate of health service utilization in children under five between January 2004 and December 2014. The initiation of the intervention more than doubled the utilization rate with an immediate 132.596% increase in intervention facilities (IRR: 2.326; 95% CI: 1.980 to 2.672). The effect of the intervention was 32.766% higher in facilities with higher workforce density (IRR: 1.328; 95% CI (1.209-1.446)) and during the rainy season (IRR:1.2001; 95% CI: 1.0953-1.3149), but not significant in facilities with higher dispersed populations (IRR: 1.075; 95% CI: (0.942-1.207)). Although the intervention effect was substantially significant immediately following its inception, the pace of growth, while positive over a first phase, decelerated to stabilize itself three years and 7 months later before starting to decrease slowly towards the end of the study period. This study provides additional evidence to support user fee exemption policies complemented by improvements in health care quality. Future work should include an assessment of the impact of user fee exemption on infant morbidity and mortality and better discuss factors that could explain the slowdown in this upward trend of utilization rates three and a half years after the intervention onset. Copyright © 2017. Published by Elsevier Ltd.

NASA in-house Commercially Developed Space Facility (CDSF) study report. Volume 1: Concept configuration definition

NASA Technical Reports Server (NTRS)

Deryder, L. J.; Chiger, H. D.; Deryder, D. D.; Detweiler, K. N.; Dupree, R. L.; Gillespie, V. P.; Hall, J. B.; Heck, M. L.; Herrick, D. C.; Katzberg, S. J.

1989-01-01

The results of a NASA in-house team effort to develop a concept definition for a Commercially Developed Space Facility (CDSF) are presented. Science mission utilization definition scenarios are documented, the conceptual configuration definition system performance parameters qualified, benchmark operational scenarios developed, space shuttle interface descriptions provided, and development schedule activity was assessed with respect to the establishment of a proposed launch date.

Servicing communication satellites in geostationary orbit

NASA Technical Reports Server (NTRS)

Russell, Paul K.; Price, Kent M.

1990-01-01

The econmic benefits of a LEO space station are quantified by identifying alternative operating scenarios utilizing the space station's transportation facilities and assembly and repair facilities. Particular consideration is given to the analysis of the impact of on-orbit assembly and servicing on a typical communications satellite is analyzed. The results of this study show that on-orbit servicing can increase the internal rate of return by as much as 30 percent.

The influence of travel time on emergency obstetric care seeking behavior in the urban poor of Bangladesh: a GIS study.

PubMed

Panciera, Rocco; Khan, Akib; Rizvi, Syed Jafar Raza; Ahmed, Shakil; Ahmed, Tanvir; Islam, Rubana; Adams, Alayne M

2016-08-22

Availability of Emergency Obstetric Care (EmOC) is crucial to avert maternal death due to life-threatening complications potentially arising during delivery. Research on the determinants of utilization of EmOC has neglected urban settings, where traffic congestion can pose a significant barrier to the access of EmOC facilities, particularly for the urban poor due to costly and limited transportation options. This study investigates the impact of travel time to EmOC facilities on the utilization of facility-based delivery services among mothers living in urban poor settlements in Sylhet, Bangladesh. A cross-sectional EmOC health-seeking behavior survey from 39 poor urban clusters was geo-spatially linked to a comprehensive geo-referenced dataset of EmOC facility locations. Geo-spatial techniques and logistic regression were then applied to quantify the impact of travel time on place of delivery (EmOC facility or home), while controlling for confounding socio-cultural and economic factors. Increasing travel time to the nearest EmOC facility is found to act as a strong deterrent to seeking care for the urban poor in Sylhet. Logistic regression results indicate that a 5-min increase in travel time to the nearest EmOC facility is associated with a 30 % decrease (0.655 odds ratio, 95 % CI: 0.529-0.811) in the likelihood of delivery at an EmOC facility rather than at home. Moreover, the impact of travel time varies substantially between public, NGO and private facilities. A 5-min increase in travel time from a private EmOC facility is associated with a 32.9 % decrease in the likelihood of delivering at a private facility, while for public and Non-Government Organizations (NGO) EmOC facilities, the impact is lower (28.2 and 28.6 % decrease respectively). Other strong determinants of delivery at an EmOC facility are the use of antenatal care and mother's formal education, while Muslim mothers are found to be more likely to deliver at home. Geospatial evidence points to the need to strengthen referral and emergency transport systems in order to reduce urban travel time, and establish or relocate EmOC facilities closer to where the poor reside. However, female education and antenatal care coverage remain the most important determinants of facility delivery.

Place of Delivery Associated With Postnatal Care Utilization Among Childbearing Women in Zambia.

PubMed

Chungu, Charles; Makasa, Mpundu; Chola, Mumbi; Jacobs, Choolwe Nkwemu

2018-01-01

Postnatal care (PNC) utilization is critical to the prevention of maternal morbidity and mortality. Despite its importance, the proportion of women utilizing this service is still low in Zambia. We investigated if place of delivery was associated with PNC utilization in the first 48 h among childbearing women in Zambia. Data from the 2013/14 Zambia Demographic and Health Survey for women, aged 15-49 years, who reported giving birth in the 2 years preceding the survey was used. The data comprised of sociodemographic and other obstetric data, which were cleaned, recoded, and analyzed using STATA version 13 (Stata Corporation, College Station, TX, USA). Multivariate logistic regression was used to examine the association of place of delivery and other background variables. Women who delivered in a health facility were more likely to utilize PNC in the first 48 h compared to those who did not deliver in a health facility: government hospital (AOR 7.24, 95% CI 4.92-11.84), government health center/clinic (AOR 7.15 95% CI 4.79-10.66), other public sector (AOR 23.2 95% CI 3.69-145.91), private hospital/clinic (AOR 10.08 95% CI 3.35-30.35), and Mission hospital/clinic (AOR 8.56 95% CI 4.71-15.53). Additionally, women who were attended to by a skilled personnel during delivery of the baby were more likely to utilize PNC (AOR 2.30, 95% CI 1.57-3.37). Women from rural areas were less likely to utilize PNC in the first 48 h (AOR 0.70, 95% CI 0.53-0.90). Place of delivery was found to be linked with PNC utilization in this population although access to health care is still driven by inequity-related dynamics and imbalances. Given that inequity stresses are heaviest in the rural and poor groups, interventions should aim to reach this group. The study results will help program managers to increase access to health facility delivery and direct interventional efforts toward the affected subpopulations, such as the young and rural women. Furthermore, results will help promote maternal health education on importance of health facility delivery and advise policy makers and program implementers.

Effect of Free Maternal Health Care Program on Health-seeking Behaviour of Women during Pregnancy, Intra-partum and Postpartum Periods in Cross River State of Nigeria: A Mixed Method Study.

PubMed

Edu, Betta Chimaobim; Agan, Thomas U; Monjok, Emmanuel; Makowiecka, Krystyna

2017-06-15

Increasing the percentage of maternal health service utilization in health facilities, through cost-removal policy is important in reducing maternal deaths. The Cross River State Government of Nigeria introduced a cost-removal policy in 2009, under the umbrella of "PROJECT HOPE" where free maternal health services are provided. Since its inception, there has been no formal evaluation of its effectiveness. This study aims to evaluate the effect of the free maternal health care program on the health care-seeking behaviours of pregnant women in Cross River State, Nigeria. A mixed method approach (quantitative and qualitative methods) was used to describe the effect of free maternal health care intervention. The quantitative component uses data on maternal health service utilisation obtained from PROJECT HOPE and Nigeria Demographic Health Survey. The qualitative part uses Focus Group Discussions to examine women's perception of the program. Results suggest weak evidence of change in maternal health care service utilization, as 95% Confidence Intervals overlap even though point estimate suggest increase in utilization. Results of quantitative data show increase in the percentage of women accessing maternal health services. This increase is greater than the population growth rate of Cross River State which is 2.9%, from 2010 to 2013. This increase is likely to be a genuine increase in maternal health care utilisation. Qualitative results showed that women perceived that there have been increases in the number of women who utilize Antenatal care, delivery and Post Partum Care at health facilities, following the removal of direct cost of maternal health services. There is urban and rural differences as well as between communities closer to health facility and those further off. Perceived barriers to utilization are indirect cost of service utilization, poor information dissemination especially in rural areas, perceived poor quality of care at facilities including drug and consumables stock-outs, geographical barriers, inadequate health work force, and poor attitude of skilled health workers and lack of trust in the health system. Reasons for Maternal health care utilisation even under a cost-removal policy is multi-factorial. Therefore, in addition to fee-removal, the government must be committed to addressing other deterrents so as to significantly increase maternal health care service utilisation.

Opportunities for Open Automated Demand Response in Wastewater Treatment Facilities in California - Phase II Report. San Luis Rey Wastewater Treatment Plant Case Study

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

Thompson, Lisa; Lekov, Alex; McKane, Aimee

2010-08-20

This case study enhances the understanding of open automated demand response opportunities in municipal wastewater treatment facilities. The report summarizes the findings of a 100 day submetering project at the San Luis Rey Wastewater Treatment Plant, a municipal wastewater treatment facility in Oceanside, California. The report reveals that key energy-intensive equipment such as pumps and centrifuges can be targeted for large load reductions. Demand response tests on the effluent pumps resulted a 300 kW load reduction and tests on centrifuges resulted in a 40 kW load reduction. Although tests on the facility?s blowers resulted in peak period load reductions ofmore » 78 kW sharp, short-lived increases in the turbidity of the wastewater effluent were experienced within 24 hours of the test. The results of these tests, which were conducted on blowers without variable speed drive capability, would not be acceptable and warrant further study. This study finds that wastewater treatment facilities have significant open automated demand response potential. However, limiting factors to implementing demand response are the reaction of effluent turbidity to reduced aeration load, along with the cogeneration capabilities of municipal facilities, including existing power purchase agreements and utility receptiveness to purchasing electricity from cogeneration facilities.« less

18 CFR 292.204 - Criteria for qualifying small power production facilities.

Code of Federal Regulations, 2011 CFR

2011-04-01

... FEDERAL ENERGY REGULATORY COMMISSION, DEPARTMENT OF ENERGY REGULATIONS UNDER THE PUBLIC UTILITY REGULATORY... production capacity of any other small power production facilities that use the same energy resource, are... production facilities within one mile of such facilities. (b) Fuel use. (1)(i) The primary energy source of...

National Coal Utilization Assessment. a preliminary assessment of the health and environmental effects of coal utilization in the Midwest. Volume I. Energy scenarios, technology characterizations, air and water resource impacts, and health effects

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

Not Available

1977-01-01

This report presents an initial evaluation of the major health and environmental issues associated with increased coal use in the six midwestern states of Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin. Using an integrated assessment approach, the evaluation proceeds from a base-line scenario of energy demand and facility siting for 1975-2020. Emphasis is placed on impacts from coal extraction, land reclamation, coal combustion for electrical generation, and coal gasification. The range of potential impacts and constraints is illustrated by a second scenario that represents an expected upper limit for coal utilization in Illinois. The following are among the more significantmore » issues identified and evaluated in this study: If environmental and related issues can be resolved, coal will continue to be a major source of energy for the Midwest; existing sulfur emission constraints will increase use of western coal; the resource requirements and environmental impacts of coal utilization will require major significant environmental and economic tradeoffs in site selection; short-term (24-hr) ambient standards for sulfur dioxide will limit the sizes of coal facilities or require advanced control technologies; an impact on public health may result from long-range transport of airborne sulfur emissions from coal facilities in the Midwest; inadequately controlled effluents from coal gasification may cause violations of water-quality standards; the major ecological effects of coal extraction are from pre-mining and post-reclamation land use; and sulfur dioxide is the major potential contributor to effects on vegetation of atmospheric emissions from coal facilities.« less

A large high vacuum, high pumping speed space simulation chamber for electric propulsion

NASA Technical Reports Server (NTRS)

Grisnik, Stanley P.; Parkes, James E.

1994-01-01

Testing high power electric propulsion devices poses unique requirements on space simulation facilities. Very high pumping speeds are required to maintain high vacuum levels while handling large volumes of exhaust products. These pumping speeds are significantly higher than those available in most existing vacuum facilities. There is also a requirement for relatively large vacuum chamber dimensions to minimize facility wall/thruster plume interactions and to accommodate far field plume diagnostic measurements. A 4.57 m (15 ft) diameter by 19.2 m (63 ft) long vacuum chamber at NASA Lewis Research Center is described. The chamber utilizes oil diffusion pumps in combination with cryopanels to achieve high vacuum pumping speeds at high vacuum levels. The facility is computer controlled for all phases of operation from start-up, through testing, to shutdown. The computer control system increases the utilization of the facility and reduces the manpower requirements needed for facility operations.

42 CFR 456.614 - Inspections by utilization review committee.

Code of Federal Regulations, 2010 CFR

2010-10-01

... HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.614 Inspections by utilization review...

Method for utilizing decay heat from radioactive nuclear wastes

DOEpatents

Busey, H.M.

1974-10-14

Management of radioactive heat-producing waste material while safely utilizing the heat thereof is accomplished by encapsulating the wastes after a cooling period, transporting the capsules to a facility including a plurality of vertically disposed storage tubes, lowering the capsules as they arrive at the facility into the storage tubes, cooling the storage tubes by circulating a gas thereover, employing the so heated gas to obtain an economically beneficial result, and continually adding waste capsules to the facility as they arrive thereat over a substantial period of time.

Electrical distribution studies for the 200 Area tank farms

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

Fisler, J.B.

1994-08-26

This is an engineering study providing reliability numbers for various design configurations as well as computer analyses (Captor/Dapper) of the existing distribution system to the 480V side of the unit substations. The objective of the study was to assure the adequacy of the existing electrical system components from the connection at the high voltage supply point through the transformation and distribution equipment to the point where it is reduced to its useful voltage level. It also was to evaluate the reasonableness of proposed solutions of identified deficiencies and recommendations of possible alternate solutions. The electrical utilities are normally considered themore » most vital of the utility systems on a site because all other utility systems depend on electrical power. The system accepts electric power from the external sources, reduces it to a lower voltage, and distributes it to end-use points throughout the site. By classic definition, all utility systems extend to a point 5 feet from the facility perimeter. An exception is made to this definition for the electric utilities at this site. The electrical Utility System ends at the low voltage section of the unit substation, which reduces the voltage from 13.8 kV to 2,400, 480, 277/480 or 120/208 volts. These transformers are located at various distances from existing facilities. The adequacy of the distribution system which transports the power from the main substation to the individual area substations and other load centers is evaluated and factored into the impact of the future load forecast.« less

Factors associated with utilization of motorcycle ambulances by pregnant women in rural eastern Uganda: a cross-sectional study.

PubMed

Ssebunya, Rogers; Matovu, Joseph K B

2016-03-03

Evidence suggests that use of motorcycle ambulances can help to improve health facility deliveries; however, few studies have explored the motivators for and barriers to their usage. We explored the factors associated with utilization of motorcycle ambulances by pregnant women in eastern Uganda. This was a cross-sectional, mixed-methods study conducted among 391 women who delivered at four health facilities supplied with motorcycle ambulances in Mbale district, eastern Uganda, between April and May 2014. Quantitative data were collected on socio-demographic and economic characteristics, pregnancy and delivery history, and community and health facility factors associated with utilization of motorcycle ambulances using semi-structured questionnaires. Qualitative data were collected on the knowledge and attitudes towards using motorcycle ambulances by pregnant women through six focus group discussions. Using STATA v.12, we computed the characteristics of women using motorcycle ambulances and used a logistic regression model to assess the correlates of utilization of motorcycle ambulances. Qualitative data were analyzed manually using a master sheet analysis tool. Of the 391 women, 189 (48.3%) reported that they had ever utilized motorcycle ambulances. Of these, 94.7% were currently married or living together with a partner while 50.8% earned less than 50,000 Uganda shillings (US $20) per month. Factors independently associated with use of motorcycle ambulances were: older age of the mother (≥35 years vs ≤24 years; adjusted Odds Ratio (aOR) = 4.3, 95% CI: 2.03, 9.13), sharing a birth plan with the husband (aOR = 2.5, 95% CI: 1.19, 5.26), husband participating in the decision to use the ambulance (aOR =3.22, 95% CI: 1.92, 5.38), and having discussed the use of the ambulance with a traditional birth attendant (TBA) before using it (aOR =3.12, 95% CI: 1.88, 5.19). Qualitative findings indicated that community members were aware of what motorcycle ambulances were meant for and appreciated their role in taking pregnant women to health facilities. The use of motorcycle ambulances was associated with older age of the mother, male participation in birth preparedness, and consultations with TBAs. These findings suggest a need for interventions to involve men in reproductive health as well as efforts to reach women younger than 35 years of age.

A preliminary assessment of avian mortality at utility-scale solar energy facilities in the United States

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

Walston, Leroy J.; Rollins, Katherine E.; LaGory, Kirk E.

Despite the benefits of reduced toxic and carbon emissions and a perpetual energy resource, there is potential for negative environmental impacts resulting from utility-scale solar energy (USSE) development. Although USSE development may represent an avian mortality source, there is little knowledge regarding the magnitude of these impacts in the context of other avian mortality sources. In this study we present a first assessment of avian mortality at USSE facilities through a synthesis of available avian monitoring and mortality information at existing USSE facilities. Using this information, we contextualize USSE avian mortality relative to other forms of avian mortality at 2more » spatial scales: a regional scale (confined to southern California) and a national scale. Systematic avian mortality information was available for three USSE facilities in the southern California region. We estimated annual USSE-related avian mortality to be between 16,200 and 59,400 birds in the southern California region, which was extrapolated to between 37,800 and 138,600 birds for all USSE facilities across the United States that are either installed or under construction. We also discuss issues related to avian–solar interactions that should be addressed in future research and monitoring programs.« less

Pregnant Women's Intentions and Subsequent Behaviors Regarding Maternal and Neonatal Service Utilization: Results from a Cohort Study in Nyanza Province, Kenya.

PubMed

Creanga, Andreea A; Odhiambo, George Awino; Odera, Benjamin; Odhiambo, Frank O; Desai, Meghna; Goodwin, Mary; Laserson, Kayla; Goldberg, Howard

2016-01-01

Higher use of maternal and neonatal health (MNH) services may reduce maternal and neonatal mortality in Kenya. This study aims to: 1) prospectively explore women's intentions to use MNH services (antenatal care, delivery in a facility, postnatal care, neonatal care) at <20 and 30-35 weeks' gestation and their actual use of these services; 2) identify predictors of intention-behavior discordance among women with positive service use intentions; 3) examine associations between place of delivery, women's reasons for choosing it, and birthing experiences. We used data from a 2012-2013 population-based cohort of pregnant women in the Demographic Surveillance Site in Nyanza province, Kenya. Of 1,056 women completing the study (89.1% response rate), 948 had live-births and 22 stillbirths, and they represent our analytic sample. Logistic regression analysis identified predictors of intention-behavior discordance regarding delivery in a facility and use of postnatal and neonatal care. At <20 and 30-35 weeks' gestation, most women intended to seek MNH services (≥93.9% and ≥87.5%, respectively, for all services assessed). Actual service use was high for antenatal (98.1%) and neonatal (88.5%) care, but lower for delivery in a facility (76.9%) and postnatal care (51.8%). Woman's age >35 and high-school education were significant predictors of intention-behavior discordance regarding delivery in a facility; several delivery-related factors were significantly associated with intention-behavior discordance regarding use of postnatal and neonatal care. Delivery facilities were chosen based on proximity to women's residence, affordability, and service quality; among women who delivered outside a health facility, 16.3% could not afford going to a facility. Good/very good birth experiences were reported by 93.6% of women who delivered in a facility and 32.6% of women who did not. We found higher MNH service utilization than previously documented in Nyanza province. Further increasing the number of facility deliveries and use of postnatal care may improve MNH in Kenya.

Out-of-pocket expenses for maternity care in rural Bangladesh: a public-private comparison.

PubMed

Rahman, Moshiur; Rob, Ubaidur; Noor, Forhana Rahman; Bellows, Benjamin

Out-of-pocket expenses incurred by women for availing maternal healthcare services at public and private health facilities in Bangladesh were examined using a baseline household survey evaluating the impact of demand side financing vouchers on utilization and service delivery for maternal healthcare. The survey was conducted in 2010 among 3,300 women who gave birth in the previous 12 months from the start of data collection. Information on costs incurred to receive antenatal, delivery, and postnatal care services was collected. Findings reveal that the majority of women reported paying out-of-pocket expenses for availing maternal healthcare services both at public and private health facilities. Out-of-pocket expenses include registration, consultation, laboratory examination, medicine, transportation, and other associated costs incurred for receiving maternal healthcare services. On average, women paid US$3.60 out-of-pocket expenses for receiving antenatal care at public health facilities and US$12.40 at private health facilities. Similarly, women paid one and half times more for normal (US$42.30) and cesarean deliveries (US$136.20) at private health facilities compared to public health facilities. On the other hand, costs for postnatal care services did not vary significantly between public and private health facilities. Utilization of maternal healthcare services can be improved if out-of-pocket expenses can be minimized. At the same time, effective demand generation strategies are necessary to encourage women to utilize health facilities.

Strategies to encourage and facilitate utility owner participation in transportation projects : guidebook.

DOT National Transportation Integrated Search

2012-11-01

Utility accommodation policies around the country provide minimum requirements for the accommodation, adjustment, and maintenance of utility facilities within the highway right of way. Many state rules and guidelines are based on utility accommodatio...

Knowledge of free delivery policy among women who delivered at health facilities in Oudomxay Province, Lao PDR.

PubMed

Chankham, Tengbriacheu; Yamamoto, Eiko; Reyer, Joshua A; Arafat, Rahman; Khonemany, Innoukham; Panome, Sayamoungkhoun; Hongkham, Dalavong; Bounfeng, Phommalaysith; Anonh, Xeuthvongsa; Hamajima, Nobuyuki

2017-02-01

To promote the utilization of maternal health services and reduce financial barriers, the Laos government introduced its "Free Maternal Health Services Policy" in 2012. This policy provides free maternal health services for pregnant women, which includes costs related to treatment, transportation, food fees, referral and an incentive for four antenatal care appointments. This study aims to ascertain the knowledge level regarding this policy among Lao women and determine their level of satisfaction with the maternal service provision. This is a cross-sectional study conducted in Xay district, La district, and Namore district of Oudomxay province, in August 2015. Three hundred and sixty women who delivered their children at the health facilities from July 2014 to June 2015 were randomly selected from the list of mothers who lived in each area. The majority of women had heard about the free delivery policy and knew that the main health services related to delivery and pregnancy were free of charge. Logistic regression analysis showed that education level (P=0.026), length of stay (P<0.0001) and receiving transportation support (P=0.005) had significant associations with the knowledge level. The women were highly satisfied with the quality of the services, health care providers, and health facilities. However, most mothers were not satisfied with accessibility to health facilities. To increase utilization of health facilities and reduce the maternal mortality ratio in rural areas, the government needs to improve people's education status and health care accessibility.

A solution to water vapor in the National Transonic Facility

NASA Technical Reports Server (NTRS)

Gloss, Blair B.; Bruce, Robert A.

1989-01-01

As cryogenic wind tunnels are utilized, problems associated with the low temperature environment are being discovered and solved. Recently, water vapor contamination was discovered in the National Transonic Facility, and the source was shown to be the internal insulation which is a closed-cell polyisocyanurate foam. After an extensive study of the absorptivity characteristics of the NTF thermal insulation, the most practical solution to the problem was shown to be the maintaining of a dry environment in the circuit at all times. Utilizing a high aspect ratio transport model, it was shown that the moisture contamination effects on the supercritical wing pressure distributions were within the accuracy of setting test conditions and as such were considered negligible for this model.

Current Status of the Utilization of Powered Wheelchair in Preschool Children with Locomotive Disability in Japan

PubMed Central

UYAMA, Sachie; HANAKI, Keiichi

2016-01-01

[Purpose] This study aimed to elucidate the actual state of powered wheelchair (PWC) prescription for preschool children with disabilities in Japan, and also to determine the approximate number of preschool children with disabilities who would potentially benefit from PWC use. [Subjects and Methods] A total of 318 facilities providing rehabilitation for disabled children in Japan were enrolled in the study. A questionnaire about PWC use for preschoolers was mailed to the facilities. Each study items were analyzed employing the Fisher's exact test. [Results] Of the 318 facilities, consent to participate in this study was obtained from 108 (return rate: 34.0%). After PWC provision, many facilities reported improvement in quality of life indices for preschool children with disabilities. It was revealed that there were 6 preschool children from 2 to 6 years of age with disabilities who might acquire a means of independent locomotion through PWC provision and thereby experience improved quality of life. [Conclusion] There was no negative comment from the facilities studied about the prescription and provision of PWC for preschool children with disabilities. PMID:28289577

42 CFR 456.401 - State plan UR requirements and options; UR plan required for intermediate care facility services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false State plan UR requirements and options; UR plan required for intermediate care facility services. 456.401 Section 456.401 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control:...

42 CFR 456.401 - State plan UR requirements and options; UR plan required for intermediate care facility services.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false State plan UR requirements and options; UR plan required for intermediate care facility services. 456.401 Section 456.401 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control:...

Geostationary platform study: Advanced ESGP/evolutionary SSF accommodation study

NASA Technical Reports Server (NTRS)

1990-01-01

The implications on the evolutionary space station of accommodating geosynchronous Earth Orbit (GEO) facilities including unmanned satellites and platforms, manned elements, and transportation and servicing vehicles/elements. The latest existing definitions of typical unmanned GEO facilities and transportation and servicing vehicles/elements are utilized. The physical design, functional design, and operations implications at the space station are determined. Various concepts of the space station from past studies are utilized ranging from the IOC Multifunction Space Station to a branched transportation node space station, and the implications of the accommodation the GEO infrastructure of each type are assessed. Where possible, parametric data are provided to show the implications of variations in sizes and quantities of elements, launch rates, crew sizes, etc. The use of advanced automation, robotics equipment, and an efficient mix of manned/automated support for accomplishing necessary activities at the space station are identified and assessed. The products of this study are configuration sketches, resource requirements, trade studies, and parametric data.

Central Facilities Area Sewage Lagoon Evaluation

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

Giesbrecht, Alan

2015-03-01

The Central Facilities Area (CFA) located in Butte County, Idaho at Idaho National Laboratory (INL) 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 utilizes a center pivot irrigation sprinkler system. The purpose ofmore » this current study is to update the analysis and conclusions of the December 2013 study. In this current study, the new seepage rate and influent flow rate data have been used to update the calculations, model, and analysis.« less

Predictors of Army National Guard and Reserve members' use of Veteran Health Administration health care after demobilizing from OEF/OIF deployment.

PubMed

Harris, Alex H S; Chen, Cheng; Mohr, Beth A; Adams, Rachel Sayko; Williams, Thomas V; Larson, Mary Jo

2014-10-01

This study described rates and predictors of Army National Guard and Army Reserve members' enrollment in and utilization of Veteran Health Administration (VHA) services in the 365 days following demobilization from an index deployment. We also explored regional and VHA facility variation in serving eligible members in their catchment areas. The sample included 125,434 Army National Guard and 48,423 Army Reserve members who demobilized after a deployment ending between FY 2008 and FY 2011. Demographic, geographic, deployment, and Military Health System eligibility were derived from Defense Enrollment Eligibility Reporting System and "Contingency Tracking System" data. The VHA National Patient Care Databases were used to ascertain VHA utilization and status (e.g., enrollee, TRICARE). Logistic regression models were used to evaluate predictors of VHA utilization as an enrollee in the year following demobilization. Of the study members demobilizing during the observation period, 56.9% of Army National Guard members and 45.7% of Army Reserve members utilized VHA as an enrollee within 12 months. Demographic, regional, health coverage, and deployment-related factors were associated with VHA enrollment and utilization, and significant variation by VHA facility was found. These findings can be useful in the design of specific outreach efforts to improve linkage from the Military Health System to the VHA. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

Factors associated with utilization of dental services in a long-term care facility: a descriptive cross-sectional study.

PubMed

Scannapieco, Frank A; Amin, Summar; Salme, Marc; Tezal, Mine

2017-03-01

To describe factors associated with the utilization of dental services in a long-term care facility (LTCF) in Western New York. A descriptive cross-sectional study reviewed the dental and medical records of residents of an LTCF discharged between January 1, 2008 and December 30, 2012. Information on demographic and health variables at admission was extracted from electronic health records. Information on oral health variables was extracted from patient charts. A total of 2,516 residents were discharged between 2008 and 2012. From those, 259 (10.3%) utilized dental services at least once during their stay. Those who utilized dental services were significantly older at admission (78.5 vs. 82.0 years, p < 0.001), stayed longer (1.6 vs. 3.9 years, p < 0.001), more likely to be female (63.6 vs. 75.6%, p = 0.008), and less likely to be married (37.7 vs. 14.0%, p = < 0.001) compared to those who did not. Patients with endocrine, nutritional, metabolic, and immunity disorders, mental disorders, and circulatory system diseases were more likely to receive dental services. Dental services appear to be underutilized by residents of LTCF. Significant differences exist in demographic and health variables between residents who utilize these services compared to those who do not. © 2016 Special Care Dentistry Association and Wiley Periodicals, Inc.

The Mind Body-Wellness in Supportive Housing (Mi-WiSH) study: Design and rationale of a cluster randomized controlled trial of Tai Chi in senior housing.

PubMed

Wayne, Peter M; Gagnon, Margaret M; Macklin, Eric A; Travison, Thomas G; Manor, Bradley; Lachman, Margie; Thomas, Cindy P; Lipsitz, Lewis A

2017-09-01

Supporting the health of growing numbers of frail older adults living in subsidized housing requires interventions that can combat frailty, improve residents' functional abilities, and reduce their health care costs. Tai Chi is an increasingly popular multimodal mind-body exercise that incorporates physical, cognitive, social, and meditative components in the same activity and offers a promising intervention for ameliorating many of the conditions that lead to poor health and excessive health care utilization. The Mind Body-Wellness in Supportive Housing (Mi-WiSH) study is an ongoing two-arm cluster randomized, attention-controlled trial designed to examine the impact of Tai Chi on functional indicators of health and health care utilization. We are enrolling participants from 16 urban subsidized housing facilities (n=320 participants), conducting the Tai Chi intervention or education classes and social calls (attention control) in consenting subjects within the facilities for one year, and assessing these subjects at baseline, 6months, and 1year. Physical function (quantified by the Short Physical Performance Battery), and health care utilization (emergency visits, hospitalizations, skilled nursing and nursing home admissions), assessed at 12months are co-primary outcomes. Our discussion highlights our strategy to balance pragmatic and explanatory features into the study design, describes efforts to enhance site recruitment and participant adherence, and summarizes our broader goal of post study dissemination if effectiveness and cost-effectiveness are demonstrated, by preparing training and protocol manuals for use in housing facilities across the U.S. Copyright © 2017 Elsevier Inc. All rights reserved.

Selection criteria utilized for hyperbaric oxygen treatment of carbon monoxide poisoning.

PubMed

Hampson, N B; Dunford, R G; Kramer, C C; Norkool, D M

1995-01-01

Medical directors of North American hyperbaric oxygen (HBO) facilities were surveyed to assess selection criteria applied for treatment of acute carbon monoxide (CO) poisoning within the hyperbaric medicine community. Responses were received from 85% of the 208 facilities in the United States and Canada. Among responders, 89 monoplace and 58 multiplace chamber facilities treat acute CO poisoning, managing a total of 2,636 patients in 1992. A significant majority of facilities treat CO-exposed patients with coma (98%), transient loss of consciousness (LOC) (77%), ischemic changes on electrocardiogram (91%), focal neurologic deficits (94%), or abnormal psychometric testing (91%), regardless of carboxyhemoglobin (COHb) level. Although 92% would use HBO for a patient presenting with headache, nausea, and COHb 40%, only 62% of facilities utilize a specified minimum COHb level as the sole criterion for HBO therapy of an asymptomatic patient. When COHb is used as an independent criterion to determine HBO treatment, the level utilized varies widely between institutions. Half of responding facilities place limits on the delay to treatment for patients with only transient LOC. Time limits are applied less often in cases with persistent neurologic deficits. While variability exists, majority opinions can be derived for many patient selection criteria regarding the use of HBO in acute CO poisoning.

49 CFR 199.231 - Access to facilities and records.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 3 2011-10-01 2011-10-01 false Access to facilities and records. 199.231 Section... TESTING Alcohol Misuse Prevention Program § 199.231 Access to facilities and records. (a) Except as... access to all facilities utilized in complying with the requirements of this subpart to the Secretary of...

76 FR 50663 - Revisions to Form, Procedures and Criteria for Certification of Qualifying Facility Status for a...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-16

... facilities. List of Subjects in 18 CFR Part 292 Electric power, Electric power plants, Electric utilities... to Form, Procedures and Criteria for Certification of Qualifying Facility Status for a Small Power... small power production or cogeneration facility. DATES: August 16, 2011. FOR FURTHER INFORMATION CONTACT...

18 CFR 292.602 - Exemption to qualifying facilities from the Public Utility Holding Company Act of 2005 and...

Code of Federal Regulations, 2014 CFR

2014-04-01

... PRODUCTION AND COGENERATION Exemption of Qualifying Small Power Production Facilities and Cogeneration... small power production facility with a power production capacity over 30 megawatts if such facility produces electric energy solely by the use of biomass as a primary energy source. (b) Exemption from the...

18 CFR 292.602 - Exemption to qualifying facilities from the Public Utility Holding Company Act of 2005 and...

Code of Federal Regulations, 2012 CFR

2012-04-01

... PRODUCTION AND COGENERATION Exemption of Qualifying Small Power Production Facilities and Cogeneration... small power production facility with a power production capacity over 30 megawatts if such facility produces electric energy solely by the use of biomass as a primary energy source. (b) Exemption from the...

18 CFR 292.602 - Exemption to qualifying facilities from the Public Utility Holding Company Act of 2005 and...

Code of Federal Regulations, 2013 CFR

2013-04-01

... PRODUCTION AND COGENERATION Exemption of Qualifying Small Power Production Facilities and Cogeneration... small power production facility with a power production capacity over 30 megawatts if such facility produces electric energy solely by the use of biomass as a primary energy source. (b) Exemption from the...

Measuring and Explaining Socioeconomic Inequalities in Public Healthcare Utilization in Western Iran: Evidence from a Cross-sectional Survey.

PubMed

Rezaeian, Shahab; Hajizadeh, Mohammad; Rezaei, Satar; Ahmadi, Sina; Kazemi Karyani, Ali; Salimi, Yahya

2018-05-14

Equity in healthcare utilization is a major health policy goal in all healthcare systems. This study aimed to examine socioeconomic inequalities in public healthcare utilization in Kermanshah City, western Iran. A cross-sectional study. Using convenience sampling method, 2040 adult aged 18-65 yr were enrolled from Kermanshah City in 2017. A self-administrated questionnaire was used to collect data on socio-demographic characteristics, socioeconomic status, behavioral factors, and utilization of public healthcare services (inpatient and outpatient care) over the period between from May to Aug 2017. The concentration index (C) was used to measure and decompose socioeconomic inequalities in the utilization inpatient and outpatient care in public sector. The indirect standardization method was used to estimate the horizontal inequity (HI) indices in inpatient and outpatient care use. The utilization outpatient (C=-0.121, 95% CI: -0.171, -0.071) and inpatient care in public sector (C=-0.165, 95% CI: -0.229, -0.101) were concentrated among the poor in Kermanshah, Iran. Socioeconomic status, health-related quality of life, marital status and having a chronic health condition were the main determinants of socioeconomic-related inequalities in the utilization of inpatient and outpatient care in public sector among adults. The distributions of outpatient (HI=-0.045, CI: -0.093 to 0.003) and inpatient care (HI= -0.044 95% CI: -0.102, 0.014) in Kermanshah were pro-poor. These results were not statistically significant (P<0.05). The utilization of public healthcare services in Iran are pro-poor. The pro-poor distribution of inpatient and outpatient care in public facilities calls for initiatives to increase the allocation of resources to public facilities in Iran that may greatly benefit the health outcomes of the poor.

Contracting for health and curative care use in Afghanistan between 2004 and 2005

PubMed Central

Arur, Aneesa; Peters, David; Hansen, Peter; Mashkoor, Mohammad Ashraf; Steinhardt, Laura C.; Burnham, Gilbert

2010-01-01

Afghanistan has used several approaches to contracting as part of its national strategy to increase access to basic health services. This study compares changes in the utilization of outpatient curative services from 2004 to 2005 between the different approaches for contracting-out services to non-governmental service providers, contracting-in technical assistance at public sector facilities, and public sector facilities that did not use contracting. We find that both contracting-in and contracting-out approaches are associated with substantial double difference increases in service use from 2004 to 2005 compared with non-contracted facilities. The double difference increase in contracting-out facilities for outpatient visits is 29% (P < 0.01), while outpatient visits from female patients increased 41% (P < 0.01), use by the poorest quintile increased 68% (P < 0.01) and use by children aged under 5 years increased 27% (P < 0.05). Comparing the individual contracting-out approaches, we find similar increases in outpatient visits when contracts are managed directly by the Ministry of Public Health compared with when contracts are managed by an experienced international non-profit organization. Finally, contracting-in facilities show even larger increases in all the measures of utilization other than visits from children under 5. Although there are minor differences in the results between contracting-out approaches, these differences cannot be attributed to a specific contracting-out approach because of factors limiting the comparability of the groups. It is nonetheless clear that the government was able to manage contracts effectively despite early concerns about their lack of experience, and that contracting has helped to improve utilization of basic health services. PMID:19850664

Analysis on the Utility of Satellite Imagery for Detection of Agricultural Facility

NASA Astrophysics Data System (ADS)

Kang, J.-M.; Baek, S.-H.; Jung, K.-Y.

2012-07-01

Now that the agricultural facilities are being increase owing to development of technology and diversification of agriculture and the ratio of garden crops that are imported a lot and the crops cultivated in facilities are raised in Korea, the number of vinyl greenhouses is tending upward. So, it is important to grasp the distribution of vinyl greenhouses as much as that of rice fields, dry fields and orchards, but it is difficult to collect the information of wide areas economically and correctly. Remote sensing using satellite imagery is able to obtain data of wide area at the same time, quickly and cost-effectively collect, monitor and analyze information from every object on earth. In this study, in order to analyze the utilization of satellite imagery at detection of agricultural facility, image classification was performed about the agricultural facility, vinyl greenhouse using Formosat-2 satellite imagery. The training set of sea, vegetation, building, bare ground and vinyl greenhouse was set to monitor the agricultural facilities of the object area and the training set for the vinyl greenhouses that are main monitoring object was classified and set again into 3 types according the spectral characteristics. The image classification using 4 kinds of supervise classification methods applied by the same training set were carried out to grasp the image classification method which is effective for monitoring agricultural facilities. And, in order to minimize the misclassification appeared in the classification using the spectral information, the accuracy of classification was intended to be raised by adding texture information. The results of classification were analyzed regarding the accuracy comparing with that of naked-eyed detection. As the results of classification, the method of Mahalanobis distance was shown as more efficient than other methods and the accuracy of classification was higher when adding texture information. Hence the more effective monitoring of agricultural facilities is expected to be available if the characteristics such as texture information including satellite images or spatial pattern are studied in detail.

Study of the application of solar chemical dehumidification system to wind tunnel facilities of NASA Lewis Research Center at Cleveland, Ohio

NASA Technical Reports Server (NTRS)

1976-01-01

Energy utilization and cost payback analyses were prepared for proposed modifications. A 50,000 CFM standard compact packaged solid desiccant dehumidifier utilizing high temperature hot water (HTHW) for desiccant regeneration was added. The HTHW is generated by utilizing solar energy and is stored in a storage tank. A steam boiler is provided as a back-up for the solar system. A 50,000 CFM standard compact package solid desiccant dehumidifier utilizing high temperature hot water (HTHW) for desiccant regeneration was added. The HTHW is generated by utilizing a steam boiler and a heat exchanger and is stored in a storage tank.

Cost analysis and efficiency of sub-district health facilities in two districts in Ghana.

PubMed

Aboagye, Anthony Q Q; Degboe, Arnold N K

2011-01-01

To establish the full costs borne by sub-district health facilities in providing services, we analysed the costs and revenues of 10 sub-district health facilities located in two districts in Ghana. The full costs were obtained by considering staff costs, cost of utilities, cost of using health facility equipment, cost of non-drug consumables, equipment maintenance expenses, amounts spent on training, community information sessions and other outreach activities as well as all other costs incurred in running the facilities. We found that (i) a large proportion of sub-district health facility costs is made up of staff salaries; (ii) at all facilities, internally generated funds (IGFs) are substantially lower than costs incurred in running the facilities; (iii) average IGF is several times higher in one district than the other; (iv) wide variations exist in efficiency indicators and (v) there is some evidence that sub-district health facilities may not necessarily be financially more efficient than hospitals in using financial resources. We suggest that the study should be replicated in other districts; but in the mean time, the health authorities should take note of the conclusions and recommendations of this study. Efforts should also be made to improve record keeping at these facilities. Copyright © 2010 John Wiley & Sons, Ltd.

Impact of Antimicrobial Stewardship on Physician Practice in a Geriatric Facility

PubMed Central

Kassett, Nina; Sham, Rosalind; Aleong, Rosanne; Yang, Daisy; Kirzner, Michael; Craft, Aidlee

2016-01-01

Background There is a paucity of literature describing the implementation of antimicrobial stewardship programs (ASPs) in long-term care (LTC) facilities. The current study evaluated the impact of an ASP that was implemented across a geriatric facility, which included an inpatient specialty hospital and an LTC facility. The program included prospective audits with feedback, multidisciplinary education, information technology interventions, and guideline development. Objective To investigate the impact of the ASP on physicians’ prescribing practices in this geriatric facility. Methods Utilization data for antibiotics commonly used to treat urinary tract infections were retrieved for the period September 1, 2011, to August 31, 2013. The study examined whether there were significant changes in overall antibiotic use, ciprofloxacin use, and physician prescribing behaviour after program implementation in September 2012. Results There was no significant change in the total number of antibiotic prescriptions for urinary tract infections in the hospital or the LTC facility after ASP implementation. Significant reductions were seen in the average days of therapy initially prescribed and the actual days of therapy after ASP implementation in the LTC facility but not the hospital. Across both facilities, significant reductions were seen in the number of ciprofloxacin prescriptions. Conclusions The current study showed that an ASP can affect physicians’ antibiotic prescribing behaviour and antibiotic usage in an LTC environment. PMID:28123192

Magnitude of institutional delivery service utilization and associated factors among women in pastoral community of Awash Fentale district Afar Regional State, Ethiopia.

PubMed

Assefa, Luelseged; Alemayehu, Mussie; Debie, Ayal

2018-03-02

Reduction of maternal mortality is a global priority particularly in developing countries like Ethiopia where maternal mortality ratio is one of the highest in the world. Most deliveries in developing countries occur at home without skilled birth attendants. Therefore, the objective of this study was to assess institutional delivery service utilization and associated factors among women in pastoral community of Awash Fentale district, Ethiopia. Overall, 35.2% of women delivered at health facilities. Women who had good knowledge AOR = 2.1, 95% CI 1.32, 4.87), Ante Natal Care (ANC) follow up (AOR = 3.2, 95% CI 1.55, 6.63), resided in a place where distance to reach at the nearby health facilities takes < 30 min (AOR = 3.1; 95% CI 2.57, 66.33) and women whose husband involved in decision regarding delivery place (AOR = 1.9; 95% CI 1.49, 5.07) were more likely to deliver at health facility. Therefore, strengthening ANC services, improving maternal knowledge, involving husbands in decision of delivery place and expanding health facilities in the community would enhance institutional delivery.

Social-psychological implications for recreation resource planning

Treesearch

Hardeep S. Bhullar; Alan R. Everson; Scout L. Gunn

1980-01-01

Many claims have been made concerning the cause/effect relationship between recreation and leisure activity, and the acquisition of quality living. Studies have investigated the utility, quality, and quantity of recreation facilities. Studies of programs, leadership, members, and general classifications of users have also been conducted.

Environmental Assessment (EA): Proposed Software Facilities, Hill Air Force Base, Utah

DTIC Science & Technology

2011-04-19

retention facilities ; • connections to adjacent buried utilities consisting of water, electricity, natural gas, telephone/ data , sanitary sewer, and storm...engineering, development, and testing workloads for F-22 and F-35 aircraft. Military construction (MILCON) project data explain existing facilities ...Existing Facilities MILCON project data state there are no facilities on Hill AFB with adequate security to house the specialized laboratory space or

7 CFR 1735.17 - Facilities financed.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF... Basic Policies § 1735.17 Facilities financed. (a) RUS makes hardship and guaranteed loans to finance the... apparatus owned by the borrower, headquarters facilities, and vehicles not used primarily in construction...

7 CFR 1735.17 - Facilities financed.

Code of Federal Regulations, 2014 CFR

2014-01-01

... Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF... Basic Policies § 1735.17 Facilities financed. (a) RUS makes hardship and guaranteed loans to finance the... apparatus owned by the borrower, headquarters facilities, and vehicles not used primarily in construction...

7 CFR 1735.17 - Facilities financed.

Code of Federal Regulations, 2012 CFR

2012-01-01

... Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF... Basic Policies § 1735.17 Facilities financed. (a) RUS makes hardship and guaranteed loans to finance the... apparatus owned by the borrower, headquarters facilities, and vehicles not used primarily in construction...

7 CFR 1735.17 - Facilities financed.

Code of Federal Regulations, 2013 CFR

2013-01-01

... Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF... Basic Policies § 1735.17 Facilities financed. (a) RUS makes hardship and guaranteed loans to finance the... apparatus owned by the borrower, headquarters facilities, and vehicles not used primarily in construction...

Monitoring potential ecological impacts of a utility-scale photovoltaic panel facility on a creosote-bursage plant community

NASA Astrophysics Data System (ADS)

Apodaca, L.; Devitt, D. A.

2016-12-01

High energy demands and greater financial viability have propelled recent growth in the solar energy market. Southern Nevada is poised to become a major contributor of green energy through the commissioning of public and private lands for solar development, but there exists a pressing need to better understand the ecological consequences of these facilities as documentation of the impacts of large-scale solar operations on surrounding environments is severely lacking. The Copper Mountain 2 (CM2) solar facility in Eldorado Valley, Nevada, USA utilizes nearly 1.8 square kilometers of photovoltaic panels to generate enough energy to power about 50,000 homes and is situated within a predominately creosote (Larrea tridentata) and white bursage (Ambrosia dumosa) habitat. Currently, the potential impacts on the local environment related to this massive development are being studied from two perspectives: microclimate effects and alteration of surface hydrology. A series of meteorological towers and ibuttons are being used to monitor microclimate changes in the area of CM2 and the adjacent natural habitat as localized climate within the facility may be altering growing conditions in nearby desert plant communities. Because the placement of CM2 represents a major obstacle to established surface water flow, a transect of soil moisture probe access tubes have been placed in association with creosote plants along a downslope gradient from the facility to observe changes to soil water storage. Individual creosote and bursage plant physiologies are also being monitored to study any potential increase in plant stress influenced by the CM2 solar facility. Most measurements have been ongoing for at least one year. Greater details on the research infrastructure will be presented along with the latest observational data.

An equity analysis of utilization of health services in Afghanistan using a national household survey.

PubMed

Kim, Christine; Saeed, Khwaja Mir Ahad; Salehi, Ahmad Shah; Zeng, Wu

2016-12-05

Afghanistan has made great strides in the coverage of health services across the country but coverage of key indicators remains low nationally and whether the poorest households are accessing these services is not well understood. We analyzed the Afghanistan Mortality Survey 2010 on utilization of inpatient and outpatient care, institutional delivery and antenatal care by wealth quintiles. Concentration indexes (CIs) were generated to measure the inequality of using the four services. Additional analyses were conducted to examine factors that explain the health inequalities (e.g. age, gender, education and residence). Among households reporting utilization of health services, public health facilities were used more often for inpatient care, while they were used less for outpatient care. Overall, the utilization of inpatient and outpatient care, and antenatal care was equally distributed among income groups, with CIs of 0.04, 0.03 and 0.08, respectively. However, the poor used more public facilities while the wealthy used more private facilities. There was a substantial inequality in the use of institutional delivery services, with a CI of 0.31. Poorer women had a lower rate of institutional deliveries overall, in both public and private facilities, compared to the wealthy. Location was an important factor in explaining the inequality in the use of health services. The large gap between the rich and poor in access to and utilization of key maternal services, such as institutional delivery, may be a central factor to the high rates of maternal mortality and morbidity and impedes efforts to make progress toward universal health coverage. While poorer households use public health services more often, the use of public facilities for outpatient visits remains half that of private facilities. Pro-poor targeting as well as a better understanding of the private sector's role in increasing equitable coverage of maternal health services is needed. Equity-oriented approaches in health should be prioritized to promote more inclusive health system reforms.

What is the cost of providing outpatient HIV counseling and testing and antiretroviral therapy services in selected public health facilities in Nigeria?

PubMed

Aliyu, Husaina Bello; Chuku, Nkata Nwani; Kola-Jebutu, Abimbola; Abubakar, Zubaida; Torpey, Kwasi; Chabikuli, Otto Nzapfurundi

2012-10-01

Limited data on actual cost of providing HIV/AIDS services in Nigeria makes planning difficult. A study was conducted in 9 public health facilities supported by the Global HIV/AIDS Initiative Nigeria. The objective was to determine the cost of outpatient HIV Testing and Counseling (HTC) and antiretroviral therapy (ART) services per patient. Two tertiary and 7 secondary facilities were purposively selected across the six geopolitical regions. Facilities were distributed in urban and rural settings. Utilization and cost data for a 12-month period (January to December 2010) were analyzed. Cost elements included consumables, human resources, infrastructure, trainings, facility management, and Global HIV/AIDS Initiative Nigeria technical support. Total costs were apportioned based on percentage utilization by services, and unit costs were derived by dividing resource inputs by service outputs. Data were analyzed using Microsoft Excel 2003. A sensitivity analysis was also conducted for key assumptions. Mean costs for HTC and ART were US $7.4 and US $209.0, respectively. Costs were higher in Northern facilities (US $6.9, US $250.8), compared with Southern ones (US $6.7, US $194.7); and in tertiary facilities ($18.5, $338.4), compared with secondary ones ($6.3, $204.9). Major cost drivers for HTC and ART were human resources--ranging from 62% to 50%, and ARV drugs--ranging from 54% to 31%, respectively. Governments' ability to negotiate lower priced antiretroviral drugs will be central to reducing the cost of ART. Additionally, use of lower cadre staff to provide HTC will reduce costs and improves efficiency.

Research objectives, opportunities, and facilities for microgravity science

NASA Technical Reports Server (NTRS)

Bayuzick, Robert J.

1992-01-01

Microgravity Science in the U.S.A. involves research in fluids science, combustion science, materials science, biotechnology, and fundamental physics. The purpose is to achieve a thorough understanding of the effects of gravitational body forces on physical phenomena relevant to those disciplines. This includes the study of phenomena which are usually overwhelmed by the presence of gravitational body forces and, therefore, chiefly manifested when gravitational forces are weak. In the pragmatic sense, the research involves gravity level as an experimental parameter. Calendar year 1992 is a landmark year for research opportunities in low earth orbit for Microgravity Science. For the first time ever, three Spacelab flights will fly in a single year: IML-1 was launched on January 22; USML-1 was launched on June 25; and, in September, SL-J will be launched. A separate flight involving two cargo bay carriers, USMP-1, will be launched in October. From the beginning of 1993 up to and including the Space Station era (1997), nine flights involving either Spacelab or USMP carriers will be flown. This will be augmented by a number of middeck payloads and get away specials flying on various flights. All of this activity sets the stage for experimentation on Space Station Freedom. Beginning in 1997, experiments in Microgravity Science will be conducted on the Space Station. Facilities for doing experiments in protein crystal growth, solidification, and biotechnology will all be available. These will be joined by middeck-class payloads and the microgravity glove box for conducting additional experiments. In 1998, a new generation protein crystal growth facility and a facility for conducting combustion research will arrive. A fluids science facility and additional capability for conducting research in solidification, as well as an ability to handle small payloads on a quick response basis, will be added in 1999. The year 2000 will see upgrades in the protein crystal growth and fluids science facilities. From the beginning of 1997 to the fall of 1999 (the 'man-tended capability' era), there will be two or three utilization flights per year. Plans call for operations in Microgravity Science during utilization flights and between utilization flights. Experiments conducted during utilization flights will characteristically require crew interaction, short duration, and less sensitivity to perturbations in the acceleration environment. Operations between utilization flights will involve experiments that can be controlled remotely and/or can be automated. Typically, the experiments will require long times and a pristine environment. Beyond the fall of 1999 (the 'permanently-manned capability' era), some payloads will require crew interaction; others will be automated and will make use of telescience.

Lifesaving emergency obstetric services are inadequate in south-west Ethiopia: a formidable challenge to reducing maternal mortality in Ethiopia.

PubMed

Girma, Meseret; Yaya, Yaliso; Gebrehanna, Ewenat; Berhane, Yemane; Lindtjørn, Bernt

2013-11-04

Most maternal deaths take place during labour and within a few weeks after delivery. The availability and utilization of emergency obstetric care facilities is a key factor in reducing maternal mortality; however, there is limited evidence about how these institutions perform and how many people use emergency obstetric care facilities in rural Ethiopia. We aimed to assess the availability, quality, and utilization of emergency obstetric care services in the Gamo Gofa Zone of south-west Ethiopia. We conducted a retrospective review of three hospitals and 63 health centres in Gamo Gofa. Using a retrospective review, we recorded obstetric services, documents, cards, and registration books of mothers treated and served in the Gamo Gofa Zone health facilities between July 2009 and June 2010. There were three basic and two comprehensive emergency obstetric care qualifying facilities for the 1,740,885 people living in Gamo Gofa. The proportion of births attended by skilled attendants in the health facilities was 6.6% of expected births, though the variation was large. Districts with a higher proportion of midwives per capita, hospitals and health centres capable of doing emergency caesarean sections had higher institutional delivery rates. There were 521 caesarean sections (0.8% of 64,413 expected deliveries and 12.3% of 4,231 facility deliveries). We recorded 79 (1.9%) maternal deaths out of 4,231 deliveries and pregnancy-related admissions at institutions, most often because of post-partum haemorrhage (42%), obstructed labour (15%) and puerperal sepsis (15%). Remote districts far from the capital of the Zone had a lower proportion of institutional deliveries (<2% of expected births compared to an overall average of 6.6%). Moreover, some remotely located institutions had very high maternal deaths (>4% of deliveries, much higher than the average 1.9%). Based on a population of 1.7 million people, there should be 14 basic and four comprehensive emergency obstetric care (EmOC) facilities in the Zone. Our study found that only three basic and two comprehensive EmOC service qualifying facilities serve this large population which is below the UN's minimum recommendation. The utilization of the existing facilities for delivery was also low, which is clearly inadequate to reduce maternal deaths to the MDG target.

Women's social networks and use of facility delivery services for uncomplicated births in North West Ethiopia: a community-based case-control study.

PubMed

Asrese, Kerebih; Adamek, Margaret E

2017-12-28

High maternal mortality has remained an unmet public health challenge in the developing world. Maternal mortality in Ethiopia is among the highest in the world. Since most maternal deaths occur during labor, delivery, and the immediate postpartum period, facility delivery with skilled birth attendants is recommended to reduce maternal mortality. Nonetheless, the majority of women in Ethiopia give birth at home. Individual attributes and availability and accessibility of services deter service utilization. The role of social networks that may facilitate or constrain service use is not well studied. Community-based case-control study was conducted between February and March 2014 in Jabi Tehinan District, North West Ethiopia. Retrospective data were collected from 134 women who had uncomplicated births at health facilities and 140 women who had uncomplicated births at home within a year preceding the survey. Interviews were held with eight women who had uncomplicated births at health facilities and 11 who had uncomplicated births at home. The quantitative data were entered and analyzed using SPSS for Windows versions 16.0 and hierarchical logistic regression model was used for analysis. The qualitative data were transcribed verbatim and data were used to substantiate the quantitative data. The results indicated that social network variables were significantly associated with the use of health facilities for delivery. Taking social networks into account improved the explanation of facility use for delivery services over women's individual attributes. Women embedded within homogeneous network members (Adjusted OR 2.53; 95% CI: 1.26-5.06) and embedded within high SBA endorsement networks (Adjusted OR 7.97; 95% CI: 4.07-12.16) were more likely to deliver at health facilities than their counterparts. Women living in urban areas (Adjusted OR 3.32; 95% CI: 1.37-8.05) and had better knowledge of obstetric complications (Adjusted OR 3.01; 95% CI: 1.46-6.18) were more likely to deliver at health facilities. Social networks facilitate SBA utilization by serving as a reference for the behavior to deliver at health facilities. These findings inform health professionals and other stakeholders regarding the importance of considering women's social networks in designing intervention to increase the proportion of women who deliver at health facilities.

A cross-sectional study to estimate prevalence of periodontal disease in a population of dogs (Canis familiaris) in commercial breeding facilities in Indiana and Illinois

PubMed Central

2018-01-01

The objectives of this cross-sectional study were: 1) to estimate the prevalence and characterize the severity of periodontal disease in a population of dogs housed in commercial breeding facilities; 2) to characterize PD preventive care utilized by facility owners; and 3) to assess inter-rater reliability of a visual scoring assessment tool. Adult dogs (N = 445) representing 42 breeds at 24 CB facilities in Indiana and Illinois were assessed. Periodontal disease was scored visually using the American Veterinary Dental Collage 0-IV scale. Inter-rater reliability was assessed on 198 dogs and facility owners were asked to provide information about the preventive care utilized. The overall prevalence of periodontal disease (Grades I-IV) was 86.3% (95% CI: 82.9, 89.3). An ordered logistic regression analysis found age (OR = 1.4; 95% CI 1.24, 1.54; P<0.0001), facility (OR = 1.13; 95% CI 1.09, 1.18; P<0.0001), sex (OR = 1.7; 95% CI 1.12, 2.65; P = 0.013), and non-professional dental scaling (OR = 2.82; 95% CI 1.34, 5.91; P = 0.006) to be statistically significant. Inter-rater reliability analysis found agreement to be 86.2%, with a weighted kappa of 0.4731 (95% CI 0.3847, 0.5615) indicating moderate agreement. Risk of periodontal disease increased with increasing age. Additionally, a trend toward decreasing risk with increasing weight was also found, although it was not statistically significant. The trends identified agree with studies that have evaluated periodontal disease in the companion dog population and do not support the assumption that the dental health of dogs in commercial breeding facilities is worse than that of the population as a whole. Although there were few cases of severe periodontal disease and all facilities employed some type of preventive care in this sample, the large number of dogs with some degree of disease (Grades I-IV) suggests that further investigation of preventive care is warranted. PMID:29346448

A cross-sectional study to estimate prevalence of periodontal disease in a population of dogs (Canis familiaris) in commercial breeding facilities in Indiana and Illinois.

PubMed

Stella, Judith L; Bauer, Amy E; Croney, Candace C

2018-01-01

The objectives of this cross-sectional study were: 1) to estimate the prevalence and characterize the severity of periodontal disease in a population of dogs housed in commercial breeding facilities; 2) to characterize PD preventive care utilized by facility owners; and 3) to assess inter-rater reliability of a visual scoring assessment tool. Adult dogs (N = 445) representing 42 breeds at 24 CB facilities in Indiana and Illinois were assessed. Periodontal disease was scored visually using the American Veterinary Dental Collage 0-IV scale. Inter-rater reliability was assessed on 198 dogs and facility owners were asked to provide information about the preventive care utilized. The overall prevalence of periodontal disease (Grades I-IV) was 86.3% (95% CI: 82.9, 89.3). An ordered logistic regression analysis found age (OR = 1.4; 95% CI 1.24, 1.54; P<0.0001), facility (OR = 1.13; 95% CI 1.09, 1.18; P<0.0001), sex (OR = 1.7; 95% CI 1.12, 2.65; P = 0.013), and non-professional dental scaling (OR = 2.82; 95% CI 1.34, 5.91; P = 0.006) to be statistically significant. Inter-rater reliability analysis found agreement to be 86.2%, with a weighted kappa of 0.4731 (95% CI 0.3847, 0.5615) indicating moderate agreement. Risk of periodontal disease increased with increasing age. Additionally, a trend toward decreasing risk with increasing weight was also found, although it was not statistically significant. The trends identified agree with studies that have evaluated periodontal disease in the companion dog population and do not support the assumption that the dental health of dogs in commercial breeding facilities is worse than that of the population as a whole. Although there were few cases of severe periodontal disease and all facilities employed some type of preventive care in this sample, the large number of dogs with some degree of disease (Grades I-IV) suggests that further investigation of preventive care is warranted.

Utilization of prostate brachytherapy for low risk prostate cancer: Is the decline overstated?

PubMed

Safdieh, Joseph; Wong, Andrew; Weiner, Joseph P; Schwartz, David; Schreiber, David

2016-08-01

Several prior studies have suggested that brachytherapy utilization has markedly decreased, coinciding with the recent increased utilization of intensity modulated radiation therapy, as well as an increase in urologist-owned centers. We sought to investigate the brachytherapy utilization in a large, hospital-based registry. Men with prostate cancer diagnosed between 2004-2012 and treated with either external beam radiation and/or prostate brachytherapy were abstracted from the National Cancer Database. In order to be included, men had to be clinically staged as T1c-T2aNx-0Mx-0, Gleason 6, PSA ≤ 10.0 ng/ml. Descriptive statistics were used to analyze brachytherapy utilization over time and were compared via χ(2). Multivariate logistic regression was used to assess for covariables associated with increased brachytherapy usage. There were 89,413 men included in this study, of which 37,054 (41.6%) received only external beam radiation, and 52,089 (58.4%) received prostate brachytherapy. The use of brachytherapy declined over time from 62.9% in 2004 to 51.3% in 2012 (p < 0.001). This decline was noted in both academic facilities (60.8% in 2004 to 47.0% in 2012, p < 0.001) as well as in non-academic facilities (63.7% in 2004 to 53.0% in 2012, p < 0.001). The decline was more pronounced in patients who lived closer to treatment facilities than those who lived further. The use of intensity modulated radiation therapy increased during this same time period from 18.4% in 2004 to 38.2% in 2012 (p < 0.001). On multivariate analysis, treatment at an academic center, increasing age, decreasing distance from the treatment center, and years of diagnosis from 2006-2012 were significantly associated with reduced brachytherapy usage. In this hospital-based registry, prostate brachytherapy usage has declined for low risk prostate cancer as intensity modulated radiation therapy usage has increased. However, it still remains the treatment of choice for 51.3% of patients as of 2012.

A cluster randomized implementation trial to measure the effectiveness of an intervention package aiming to increase the utilization of skilled birth attendants by women for childbirth: study protocol

PubMed Central

2014-01-01

Background Nepal is on track to achieve MDG 5 but there is a huge sub-national disparity with existing high maternal mortality in western and hilly regions. The national priority is to reduce this disparity to achieve the goal at sub-national level. Evidences from developing countries show that increasing utilization of skilled attendant at birth is an important indicator for reducing maternal death. Further, there is a very low utilization during childbirth in western and hilly regions of Nepal which clearly depicts the barriers in utilization of skilled birth attendants. So, there is a need to overcome the identified barriers to increase the utilization thereby decreasing the maternal mortality. The hypothesis of this study is that through a package of interventions the utilization of skilled birth attendants will be increased and hence improve maternal health in Nepal. Method/Design This study involves a cluster randomized controlled trial involving approximately 5000 pregnant women in 36 clusters. The 18 intervention clusters will receive the following interventions: i) mobilization of family support for pregnant women to reach the health facility, ii) availability of emergency funds for institutional childbirth, iii) availability of transport options to reach a health facility for childbirth, iv) training to health workers on communication skills, v) security provisions for SBAs to reach services 24/24 through community mobilization; 18 control clusters will not receive the intervention package. The final evaluation of the intervention is planned to be completed by October 2014. Primary study output of this study is utilization of SBA services. Secondary study outputs measure the uptake of antenatal care, post natal checkup for mother and baby, availability of transportation for childbirth, operation of emergency fund, improved reception of women at health services, and improved physical security of SBAs. Discussion The intervention package is designed to increase the utilization of skilled birth attendants by overcoming the barriers related to awareness, finance, transport, security etc. If proven effective, the Ministry of Health has committed to scale up the intervention package throughout the country. Trial registration number ISRCTN78892490. PMID:24646123

A cluster randomized implementation trial to measure the effectiveness of an intervention package aiming to increase the utilization of skilled birth attendants by women for childbirth: study protocol.

PubMed

Bhandari, Gajananda P; Subedi, Narayan; Thapa, Janak; Choulagai, Bishnu; Maskey, Mahesh K; Onta, Sharad R

2014-03-19

Nepal is on track to achieve MDG 5 but there is a huge sub-national disparity with existing high maternal mortality in western and hilly regions. The national priority is to reduce this disparity to achieve the goal at sub-national level. Evidences from developing countries show that increasing utilization of skilled attendant at birth is an important indicator for reducing maternal death. Further, there is a very low utilization during childbirth in western and hilly regions of Nepal which clearly depicts the barriers in utilization of skilled birth attendants. So, there is a need to overcome the identified barriers to increase the utilization thereby decreasing the maternal mortality. The hypothesis of this study is that through a package of interventions the utilization of skilled birth attendants will be increased and hence improve maternal health in Nepal. This study involves a cluster randomized controlled trial involving approximately 5000 pregnant women in 36 clusters. The 18 intervention clusters will receive the following interventions: i) mobilization of family support for pregnant women to reach the health facility, ii) availability of emergency funds for institutional childbirth, iii) availability of transport options to reach a health facility for childbirth, iv) training to health workers on communication skills, v) security provisions for SBAs to reach services 24/24 through community mobilization; 18 control clusters will not receive the intervention package. The final evaluation of the intervention is planned to be completed by October 2014. Primary study output of this study is utilization of SBA services. Secondary study outputs measure the uptake of antenatal care, post natal checkup for mother and baby, availability of transportation for childbirth, operation of emergency fund, improved reception of women at health services, and improved physical security of SBAs. The intervention package is designed to increase the utilization of skilled birth attendants by overcoming the barriers related to awareness, finance, transport, security etc. If proven effective, the Ministry of Health has committed to scale up the intervention package throughout the country. ISRCTN78892490.

New design incinerator being built

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

Not Available

1980-09-01

A $14 million garbage-burning facility is being built by Reedy Creek Utilities Co. in cooperation with DOE at Lake Buena Vista, Fla., on the edge of Walt Disney World. The nation's first large-volume slagging pyrolysis incinerator will burn municipal waste in a more beneficial way and supply 15% of the amusement park's energy demands. By studying the new incinerators slag-producing capabilities, engineers hope to design similar facilities for isolating low-level nuclear wastes in inert, rocklike slag.

Effect of an innovative community based health program on maternal health service utilization in north and south central Ethiopia: a community based cross sectional study.

PubMed

Afework, Mesganaw Fantahun; Admassu, Kesteberhan; Mekonnen, Alemayehu; Hagos, Seifu; Asegid, Meselech; Ahmed, Saifuddin

2014-04-04

Among Millennium Development Goals, achieving the fifth goal (MDG-5) of reducing maternal mortality poses the greatest challenge in Sub-Saharan Africa. Ethiopia has one of the highest maternal mortality ratios in the world with unacceptably low maternal health service utilization. The Government of Ethiopia introduced an innovative community-based intervention as a national strategy under the Health Sector Development Program. This new approach, known as the Health Extension Program, aims to improve access to and equity in essential health services through community based Health Extension Workers. The objective of the study is to assess the role of Health Extension Workers in improving women's utilization of antenatal care, delivery at health facility and postnatal care services. A cross sectional household survey was conducted in early 2012 in two districts of northern and south central parts of Ethiopia. Data were collected from 4949 women who had delivered in the two years preceding the survey. Logistic regression analysis was performed to determine the association between visit by Health Extension Workers during pregnancy and use of maternal health services, controlling for the effect of other confounding factors. The non-adjusted analysis showed that antenatal care attendance at least four times during pregnancy was significantly associated with visit by Health Extension Workers [Odds Ratio 3.46(95% CI 3.07,3.91)], whereas health facility delivery (skilled attendance at birth) was not significantly associated with visit by Health Extension Workers during pregnancy [Odds Ratio 0.87(95% CI 0.25,2.96)]. When adjusted for other factors the association of HEWs visit during pregnancy was weaker for antenatal care attendance [Adjusted Odds Ratio: 1.35(95% CI: 1.05, 1.72)] but positively and significantly associated with health facility delivery [Adjusted Odds Ratio 1.96(1.25,3.06)]. In general HEWs visit during pregnancy improved utilization of maternal health services. Health facility delivery is heavily affected by other factors. Meaningful improvement in skilled attendance at birth (health facility delivery) should include addressing other factors on top of visits by HEWs during pregnancy and specific target oriented interventions during visits by HEWs to support skilled attendance at birth.

Women's autonomy and maternal healthcare service utilization in Ethiopia.

PubMed

Tiruneh, Fentanesh Nibret; Chuang, Kun-Yang; Chuang, Ying-Chih

2017-11-13

Most previous studies on healthcare service utilization in low-income countries have not used a multilevel study design to address the importance of community-level women's autonomy. We assessed whether women's autonomy, measured at both individual and community levels, is associated with maternal healthcare service utilization in Ethiopia. We analyzed data from the 2005 and 2011 Ethiopia Demographic and Health Surveys (N = 6058 and 7043, respectively) for measuring women's decision-making power and permissive gender norms associated with wife beating. We used Spearman's correlation and the chi-squared test for bivariate analyses and constructed generalized estimating equation logistic regression models to analyze the associations between women's autonomy indicators and maternal healthcare service utilization with control for other socioeconomic characteristics. Our multivariate analysis showed that women living in communities with a higher percentage of opposing attitudes toward wife beating were more likely to use all three types of maternal healthcare services in 2011 (adjusted odds ratios = 1.21, 1.23, and 1.18 for four or more antenatal care visits, health facility delivery, and postnatal care visits, respectively). In 2005, the adjusted odds ratios were 1.16 and 1.17 for four or more antenatal care visits and health facility delivery, respectively. In 2011, the percentage of women in the community with high decision-making power was positively associated with the likelihood of four or more antenatal care visits (adjusted odds ratio = 1.14). The association of individual-level autonomy on maternal healthcare service utilization was less profound after we controlled for other individual-level and community-level characteristics. Our study shows that women's autonomy was positively associated with maternal healthcare service utilization in Ethiopia. We suggest addressing woman empowerment in national policies and programs would be the optimal solution.

Access to primary health care for acute vascular events in rural low income settings: a mixed methods study.

PubMed

Ahmed, Shyfuddin; Chowdhury, Muhammad Ashique Haider; Khan, Md Alfazal; Huq, Nafisa Lira; Naheed, Aliya

2017-01-18

Cardiovascular diseases (CVDs) are the leading cause of global mortality. Among the CVDs, acute vascular events (AVE) mainly ischemic heart diseases and stroke are the largest contributors. To achieve 25% reduction in preventable deaths from CVDs by 2025, health systems need to be equipped with extended service coverage in order to provide person-centered care. The overall goal of this proposed study is to assess access to health care in-terms of service availability, care seeking patterns and barriers to access care after AVE in rural Bangladesh. We will consider myocardial infarction (MI) and stroke as acute vascular events. We will conduct a mixed methods study in rural Matlab, Bangladesh. This study will comprise of a) health facility survey, b) structured questionnaire interview and c) qualitative study. We will assess service availabilities by creating an inventory of public and private health facilities. Readiness of the facilities to deliver services for AVE will be assessed through a health facility survey using 'service availability and readiness assessment' (SARA) tools of the World Health Organization (WHO). We will interview survivors of AVE and caregivers (present and accompanied the person during the event) of person who died from AVE for exploring patterns of care seeking during an AVE. For exploring barriers to access care for AVE, we will conduct in-depth interview with survivors of AVE and caregivers of the person who died from AVE. We will also conduct key informant interviews with the service providers at primary health care (PHC) facilities and government high level officials at central health administration of Bangladesh. This study will provide a comprehensive picture of access to primary health care services during acute cardiovascular events as stroke & MI in rural context of Bangladesh. It will explore available service facilities in rural area for management, utilization of services and barriers to access care during an acute emergency. This study will help to generate hypothesis, develop programs and policies for better access to care for AVE in similar rural settings considering barriers of access and improving utilization.

National Trends (2009-2013) for Palliative Care Utilization for Patients Receiving Prolonged Mechanical Ventilation.

PubMed

Chatterjee, Kshitij; Goyal, Abhinav; Kakkera, Krishna; Harrington, Sarah; Corwin, Howard L

2018-05-04

Patients requiring mechanical ventilation have high morbidity and mortality. Providing palliative care services has been suggested as a way to improve comprehensive management of critically ill patients. We examined the trend in the utilization of palliative care among adults who require prolonged mechanical ventilation. Primary objectives were to determine the trend in palliative care utilization over time, predictors for palliative care utilization, and palliative care impact on hospital length of stay. Retrospective, cross-sectional study. The National Inpatient Sample data between 2009 and 2013 was used for this study. Adults (age ≥ 18 yr) who underwent prolonged mechanical ventilation (≥ 96 consecutive hr) were studied. Palliative care and mechanical ventilation were identified using the corresponding International Classification of Diseases, 9th revision, Clinical Modification, codes. A total of 1,751,870 hospitalizations with prolonged mechanical ventilation were identified between 2009 and 2013. The utilization of palliative care increased yearly from 6.5% in 2009 to 13.1% in 2013 (p < 0.001). Among the mechanically ventilated patients who died, palliative care increased from 15.9% in 2009 to 33.3% in 2013 (p < 0.001). Median hospital length of stay for patients with and without palliative care was 13 and 17 days, respectively (p < 0.001). Patients discharged to either short- or long-term care facilities had a shorter length of stay if palliative care was provided (15 vs 19 d; p < 0.001). The factors associated with a higher palliative care utilization included older age, malignancy, larger hospitals in urban areas, and teaching hospitals. Non-Caucasian race was associated with lower palliative care utilization. Among patients who undergo prolonged mechanical ventilation, palliative care utilization is increasing, particularly in patients who die during hospitalization. Using palliative care for mechanically ventilated patients who are discharged to either short- or long-term care facilities is associated with a shorter hospital length of stay.

Occupational disease surveillance of an aircraft rework facility.

PubMed

Fung, F; Bundy, M; Kennon, R

1990-11-01

Analysis of the 1987-1988 morbidity data of an aircraft rework facility's 6,672 employees identified 118 patients with occupational diseases. In our study, 61 cases (52%) involved eye and skin conditions. This was comparable to the State of California occupational diseases report. However, systemic conditions appeared to be higher (24% vs. 7%) in the study group, and this finding may need further investigation to clarify its significance. Patients employed as craftworkers accounted for nearly half of all reported occupational diseases. Federal workers in this facility appeared to have a higher percentage (70%) of "no time lost" when compared with that of the State of California report (54%). The utility of morbidity data in the prevention of occupational diseases is discussed.

Patterns of health service utilization at a medical school clinic in Ghana.

PubMed

Yawson, A E; Malm, K L; Adu, A A; Wontumi, G-M; Biritwum, R B

2012-09-01

The University of Ghana Medical School (UGMS) Clinic provides healthcare service which is free at point of service to students, staff, retired staff and dependents of staff of the College of Health Sciences. However, since 1983, no in-depth review of health service provision or utilization has been undertaken. This study reviewed client characteristics, utilization and disease patterns at the clinic and also compared the disease patterns to that of other primary health facilities nationwide. This was an analytical cross-sectional study undertaken at the UGMS clinic in Korle-Bu. It was a retrospective review of records of all clients attending the facility from January 2002 to December, 2004. More males than females attended the clinic and majority (63.9%) of clients were between 15-44 years (median age was 26 years). Dependents of staff constituted the highest attendants (41%) to the clinic. Among staff, junior staffs were in the majority. Malaria, respiratory tract infection and musculoskeletal pain were the most common conditions seen. Overall, 83% of clients were treated and discharged per visit without the need for review visits. Dependents of staff used the facility the most and they live in many different part of the city of Accra, and to ask them to attend the clinic for care is not efficient. It will be better to provide or supplement their securing of insurance so that they could access health care close to their homes and save time and attention to students and staff.

Reconstruction of 3d Objects of Assets and Facilities by Using Benchmark Points

NASA Astrophysics Data System (ADS)

Baig, S. U.; Rahman, A. A.

2013-08-01

Acquiring and modeling 3D geo-data of building assets and facility objects is one of the challenges. A number of methods and technologies are being utilized for this purpose. Total station, GPS, photogrammetric and terrestrial laser scanning are few of these technologies. In this paper, points commonly shared by potential facades of assets and facilities modeled from point clouds are identified. These points are useful for modeling process to reconstruct 3D models of assets and facilities stored to be used for management purposes. These models are segmented through different planes to produce accurate 2D plans. This novel method improves the efficiency and quality of construction of models of assets and facilities with the aim utilize in 3D management projects such as maintenance of buildings or group of items that need to be replaced, or renovated for new services.

Socio-Demographic Determinants of Maternal Health-Care Service Utilization Among Rural Women in Anambra State, South East Nigeria

PubMed Central

Emelumadu, OF; Ukegbu, AU; Ezeama, NN; Kanu, OO; Ifeadike, CO; Onyeonoro, UU

2014-01-01

Background: Although, antenatal care (ANC) attendance in sub Saharan Africa is high, however this does not always translate into quality ANC care service utilization. Aim: This study therefore is aimed at exploring pattern of maternal health (MH) services utilization and the socio-demographic factors influencing it in Anambra State, South East Nigeria. Subjects and Methods: A total of 310 women of reproductive age with a previous history of gestation attending ANC services between September, 2007 and August, 2008 in selected Primary Health Centers in Anambra State were studied. Responses were elicited from the study participants using a pre-tested, semi-structured interviewer-administered questionnaire. Data collected were analyzed using Statistical Package for Social Sciences (SPSS) version 17 (SPSS Inc, Chicago Illinois, USA). Association between socio-demographic characteristics and pattern of utilization of ANC and delivery services was measured using χ2-test, Regression analysis was done to identify factors associated with utilization of MH services. P < 0.05 was assumed to be significant. Results: Use of health facility was 293 (97.0%) and 277 (92,7%) out 302 women for ANC and delivery services respectively. Most women attended their first ANC consultation during the preceding pregnancy was after the first trimester and about 31% (94/298) of them had <4 ANC visits prior to delivery. Socio-demographic factors were found to be significantly associated with places where MH care services are accessed. Parity was found to be associated with timing of ANC booking and number of ANC attendance (χ2 = 9.49, P = 0.05). Odds of utilizing formal health facility for MH services were found to be significantly associated with increasing age (P < 0.01) and educational status of mothers (P < 0.001). Conclusions: The study revealed high maternal service utilization and 10% fetal loss, hence the need to address the gaps of late ANC booking and low ANC visits. PMID:24971212

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

78 FR 38313 - Kings River Conservation District; Notice of Preliminary Permit Application Accepted for Filing...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-26

...-hours utilizing one Kaplan-bulb turbine. A preliminary design of the facilities and selection of the turbine and generator would be performed during the feasibility study. Applicant Contact: Mr. David Orth...

Handicapped and Elderly Vertical Movement Assessment Study

DOT National Transportation Integrated Search

1976-02-01

The report discusses the selection and assessment of seven (7) types of vertical movement devices for potential use in older types of fixed rail urban mass transit facilities. The potential utilization of these devices is directed towards an increase...

Skylab reuse study, reference data. Part 2: Appendixes

NASA Technical Reports Server (NTRS)

1978-01-01

Contents: (1) evaluations of the dysbarism risk associated with a Skylab revisit by shuttle; (2) mission model/payload data sheets; (3) life sciences utilization of on-board Skylab medical facilities; (4) airlock module description; and (5) orbital workshop description.

Utilization Management in Department of Defense Military Treatment Facilities

DTIC Science & Technology

1992-07-01

Health Affairs) Mendez (1992) clearly states that his plan is for the military health services system’s quality assessment and criteria to become more...also worthy of note that second surgical opinions are not part of Assistant Secretary of Defense (Health Affairs) Mendez ’ (1992) memonrandur on...Affairs) Mendez ’ (1992) quality management policy already states that military medical treatment facilities will begin to implement utilization

43 CFR 3271.10 - What do I need to start preparing a site and building and testing a utilization facility on...

Code of Federal Regulations, 2012 CFR

2012-10-01

... 43 Public Lands: Interior 2 2012-10-01 2012-10-01 false What do I need to start preparing a site and building and testing a utilization facility on Federal land leased for geothermal resources? 3271.10 Section 3271.10 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF LAND MANAGEMENT, DEPARTMENT OF THE INTERIOR...

43 CFR 3271.10 - What do I need to start preparing a site and building and testing a utilization facility on...

Code of Federal Regulations, 2014 CFR

2014-10-01

... 43 Public Lands: Interior 2 2014-10-01 2014-10-01 false What do I need to start preparing a site and building and testing a utilization facility on Federal land leased for geothermal resources? 3271.10 Section 3271.10 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF LAND MANAGEMENT, DEPARTMENT OF THE INTERIOR...

43 CFR 3271.10 - What do I need to start preparing a site and building and testing a utilization facility on...

Code of Federal Regulations, 2013 CFR

2013-10-01

... 43 Public Lands: Interior 2 2013-10-01 2013-10-01 false What do I need to start preparing a site and building and testing a utilization facility on Federal land leased for geothermal resources? 3271.10 Section 3271.10 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF LAND MANAGEMENT, DEPARTMENT OF THE INTERIOR...

43 CFR 3271.10 - What do I need to start preparing a site and building and testing a utilization facility on...

Code of Federal Regulations, 2011 CFR

2011-10-01

... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false What do I need to start preparing a site and building and testing a utilization facility on Federal land leased for geothermal resources? 3271.10 Section 3271.10 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF LAND MANAGEMENT, DEPARTMENT OF THE INTERIOR...

Routine health information system utilization and factors associated thereof among health workers at government health institutions in East Gojjam Zone, Northwest Ethiopia.

PubMed

Shiferaw, Atsede Mazengia; Zegeye, Dessalegn Tegabu; Assefa, Solomon; Yenit, Melaku Kindie

2017-08-07

Using reliable information from routine health information systems over time is an important aid to improving health outcomes, tackling disparities, enhancing efficiency, and encouraging innovation. In Ethiopia, routine health information utilization for enhancing performance is poor among health workers, especially at the peripheral levels of health facilities. Therefore, this study aimed to assess routine health information system utilization and associated factors among health workers at government health institutions in East Gojjam Zone, Northwest Ethiopia. An institution based cross-sectional study was conducted at government health institutions of East Gojjam Zone, Northwest Ethiopia from April to May, 2013. A total of 668 health workers were selected from government health institutions, using the cluster sampling technique. Data collected using a standard structured and self-administered questionnaire and an observational checklist were cleaned, coded, and entered into Epi-info version 3.5.3, and transferred into SPSS version 20 for further statistical analysis. Variables with a p-value of less than 0.05 at multiple logistic regression analysis were considered statistically significant factors for the utilization of routine health information systems. The study revealed that 45.8% of the health workers had a good level of routine health information utilization. HMIS training [AOR = 2.72, 95% CI: 1.60, 4.62], good data analysis skills [AOR = 6.40, 95%CI: 3.93, 10.37], supervision [AOR = 2.60, 95% CI: 1.42, 4.75], regular feedback [AOR = 2.20, 95% CI: 1.38, 3.51], and favorable attitude towards health information utilization [AOR = 2.85, 95% CI: 1.78, 4.54] were found significantly associated with a good level of routine health information utilization. More than half of the health workers working at government health institutions of East Gojjam were poor health information users compared with the findings of others studies. HMIS training, data analysis skills, supervision, regular feedback, and favorable attitude were factors related to routine health information system utilization. Therefore, a comprehensive training, supportive supervision, and regular feedback are highly recommended for improving routine health information utilization among health workers at government health facilities.

A Primer on Electric Utilities, Deregulation, and Restructuring of U.S. Electricity Markets

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

Warwick, William M.

2002-06-03

This primer is offered as an introduction to utility restructuring to better prepare readers for ongoing changes in public utilities and associated energy markets. It is written for use by individuals with responsibility for the management of facilities that use energy, including energy managers, procurement staff, and managers with responsibility for facility operations and budgets. The primer was prepared by the Pacific Northwest National Laboratory under sponsorship from the U.S. Department of Energy?s Federal Energy Management Program. The impetus for this primer originally came from the Government Services Administration who supported its initial development.

42 CFR 456.607 - Notification before inspection.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.607 Notification before inspection. No facility may be...

Does Travel Time to a Radiation Facility Impact Patient Decision-Making Regarding Treatment for Prostate Cancer? A Study of the New Hampshire State Cancer Registry.

PubMed

Ghali, Fady; Celaya, Maria; Laviolette, Michael; Ingimarsson, Johann; Carlos, Heather; Rees, Judy; Hyams, Elias

2018-02-01

We sought to determine whether further distance from a radiation center is associated with lower utilization of external beam radiation therapy (XRT). We retrospectively identified patients with a new diagnosis of localized prostate cancer (CaP) within the New Hampshire State Cancer Registry from 2004 to 2011. Patients were categorized by age, D'Amico risk category, year of treatment, marital status, season of diagnosis, urban/rural residence, and driving time to the nearest radiation facility. Treatment decisions were stratified into those requiring multiple trips (XRT) or a single trip (surgery or brachytherapy). Multivariable regression analysis was performed. A total of 4,731 patients underwent treatment for newly diagnosed CaP during the study period, including 1,575 multitrip (XRT) and 3,156 single-trip treatments. Of these, 87.6% lived within a 30-minute drive to a radiation facility. In multivariable analysis, time to the nearest radiation facility was not associated with treatment decisions (P = .26). However, higher risk category, older age, married status, and winter diagnosis were associated with XRT (P < .05). More recent year of diagnosis and urban residence were associated with single-trip therapy (primarily surgery) (P < .05). There was a significant interaction between travel time and season of diagnosis (P = .03), as well as a marginally significant interaction with urban/rural status (P = .07). Overall, further travel time to a radiation facility was not associated with lower utilization of XRT. These data are encouraging regarding access to care for CaP in New Hampshire. © 2016 National Rural Health Association.

[Patterns of utilization of external employee assistance program--analysis of employees who have their psychiatrists].

PubMed

Ito, H; Fujii, K; Sasaki, Y

1998-01-01

The purpose of this paper is to clarify some patterns of utilization of an external employee assistance program (EAP) we have conducted for other public and private facilities in the Tokyo Kenbikyoin Foundation between April, 1986 and December, 1996. The subjects were 26 men and 12 women in 7 facilities under the following conditions: (1) Employees who have already had their own psychiatrists at the first interview of the external EAP; (2) Facilities utilize the EAP for two or more employees who met the first criterion. As a result, utilization patterns differed depending on medical staff's attitude toward the external EAP. There was a significant difference according to sex. The rate for men was 54% in worksites where medical staff understood this external program (worksite A1) and 93% in worksites where they did not (worksite A2-3, B). As to expectations for the program, there were more consultations for organizational measurements (63%) in worksite A1, while less organizational matters (27%) and more personal complains about their psychiatrists in the worksite A2-3, and B. These results suggest that the involvement of medical staff is the key to utilizing the external EAP effectively.

Facilities Management: A Program for the 1980s.

ERIC Educational Resources Information Center

Kaiser, Harvey H.

1980-01-01

Successful facilities management is described as based on a 10-point comprehensive program including: (1) physical planning policy; (2) facilities analysis; (3) management audit; (4) space utilization; (5) capital programs; (6) deferred maintenance; (7) controlled maintenance; (8) energy conservation; (9) environmental quality, health, and safety;…

43 CFR 3272.11 - How do I describe the proposed utilization facility?

Code of Federal Regulations, 2011 CFR

2011-10-01

...) BUREAU OF LAND MANAGEMENT, DEPARTMENT OF THE INTERIOR MINERALS MANAGEMENT (3000) GEOTHERMAL RESOURCE... proposed facility operations, including estimated total production and injection rates; estimated well flow... site(s); (e) The source, quality, and proposed consumption rate of water to be used during facility...

Booster Applications Facility report, phase 2

NASA Astrophysics Data System (ADS)

Thieberger, P.

1991-06-01

This report summarizes studies and planning performed by Brookhaven National Laboratory (BNL) personnel at the request of NASA for the design, construction and operation of experimental areas and facilities for utilization of ion beams from the BNL Booster synchrotron particle accelerator. These facilities would be primarily utilized to simulate space radiation for radiobiological research, shielding studies and detector calibrations. The feasibility of such a project has been established, preliminary designs and cost estimates have been developed and a formal proposal can be submitted pending DOE concurrence. The main body of this report consists of the material presented by BNL during the meeting with a NASA appointed Panel on December 10 and 11, 1990. The individual speakers have provided brief summaries of their talks and explanations of their figures. In addition there are two appendices. One, contains detailed discussion of the shared mode of operation and the corresponding beam compatibility tables. The second appendix contains cost estimate details. An executive summary on budgets and schedules has been added, containing possible phased construction and outfitting scenarios and the corresponding expense and commitment profiles as well as new operational cost estimates. Material contained in the executive summary reflects the correction of some errors and new studies performed in response to the NASA Panel suggestions.

A Case Study on TRICARE Online Web-enabled Appointing: Improving Utilization Rates at Navy Medical Treatment Facilities

DTIC Science & Technology

2009-10-20

Low usage volume raised concerns about the effectiveness of TOL. In 2004, the eHealth Division of TMA Information Management conducted a study to...Case Study 31 (Version 15.8). Falls Church, VA: Department of Defense, TRICARE Management Activity, Information Management eHealth Division

NREL Partners With General Electric, Duke Energy on Grid Voltage Regulation

Science.gov Websites

Study | Energy Systems Integration Facility | NREL NREL Partners With General Electric, Duke Energy on Grid Voltage Regulation Study NREL Partners With General Electric, Duke Energy on Grid Voltage Regulation Study When a large solar photovoltaic (PV) system is connected to the electric grid, a utility's

Evaluation of vision training using 3D play game

NASA Astrophysics Data System (ADS)

Kim, Jung-Ho; Kwon, Soon-Chul; Son, Kwang-Chul; Lee, Seung-Hyun

2015-03-01

The present study aimed to examine the effect of the vision training, which is a benefit of watching 3D video images (3D video shooting game in this study), focusing on its accommodative facility and vergence facility. Both facilities, which are the scales used to measure human visual performance, are very important factors for man in leading comfortable and easy life. This study was conducted on 30 participants in their 20s through 30s (19 males and 11 females at 24.53 ± 2.94 years), who can watch 3D video images and play 3D game. Their accommodative and vergence facility were measured before and after they watched 2D and 3D game. It turned out that their accommodative facility improved after they played both 2D and 3D games and more improved right after they played 3D game than 2D game. Likewise, their vergence facility was proved to improve after they played both 2D and 3D games and more improved soon after they played 3D game than 2D game. In addition, it was demonstrated that their accommodative facility improved to greater extent than their vergence facility. While studies have been so far conducted on the adverse effects of 3D contents, from the perspective of human factor, on the imbalance of visual accommodation and convergence, the present study is expected to broaden the applicable scope of 3D contents by utilizing the visual benefit of 3D contents for vision training.

Factors Associated With Utilization of Cardiac Rehabilitation Among Patients With Ischemic Heart Disease in the Veterans Health Administration: A QUALITATIVE STUDY.

PubMed

Schopfer, David W; Priano, Susan; Allsup, Kelly; Helfrich, Christian D; Ho, P Michael; Rumsfeld, John S; Forman, Daniel E; Whooley, Mary A

2016-01-01

Cardiac rehabilitation (CR) programs reduce morbidity and mortality in patients with ischemic heart disease but are vastly underutilized in the United States, including the Veterans Health Administration (VA) Healthcare System. Numerous barriers affecting utilization have been identified in other health care systems, but the specific factors affecting Veterans are unknown. We sought to identify barriers and facilitators associated with utilization of CR in VA facilities. We performed a qualitative study of 56 VA patients, providers, and CR program managers at 30 VA facilities across the United States. We conducted semistructured interviews with key informants to explore their attitudes and knowledge toward CR. Interviews were conducted until thematic saturation occurred. Analyses using grounded theory to identify key themes were conducted using the qualitative data analysis package ATLAS.ti. We identified 6 themes as barriers and 5 as facilitators. The most common barriers to participation in CR were patient transportation issues (68%), lack of patient willingness to participate (41%), and no access to a nearby VA hospital with a CR program (30%). The most common facilitators were involvement of a dedicated provider or "clinical champion" (50%), provider knowledge of or experience with CR (48%), and patient desire for additional medical support (32%). Our findings suggest that addressing access issues and educating and activating providers on CR may increase utilization of CR programs. Targeting these specific factors may improve utilization of CR programs.

Methods for evaluating temporal trends in noise exposure

PubMed Central

Neitzel, RL; Galusha, D; Dixon-Ernst, C; Rabinowitz, PM

2014-01-01

Objective Hearing conservation programs have been mandatory in many US industries since 1983. Since then, three program elements (audiometric testing, hearing protection, and training) have been the focus of much research. By comparison, little has been done on noise exposure evaluation. Design and study sample Utilizing a large dataset (>10,000 measurements over 20 years) from eight facilities operated by a multinational aluminum manufacturing company, we evaluated several approaches to assessing temporal trends in Time Weighted Average (TWA) exposures and the fraction of measurements exceeding 85 dBA by facility, by exposure group within facility, and by individual worker within facility. Results Overall, exposures declined across locations over the study period. Several facilities demonstrated substantial reductions in exposure, and the results of mean noise levels and exceedance fractions generally showed good agreement. The results of analyses at the individual level diverged with analyses by facility and exposure group within facility, suggesting that individual-level analyses, while challenging, may provide important information not available from coarser levels of analysis. Conclusions Validated metrics are needed to allow for assessment of temporal trends in noise exposure. Such metrics will improve our ability to characterize, in a standardized manner, efforts to reduce noise-induced hearing loss. PMID:24564696

National Information Utility Seeks to Serve Schools Nationwide.

ERIC Educational Resources Information Center

Platzer, Nancy

1985-01-01

Outlines the pros and cons of the National Information Utility Program, which is designed to provide current updatable courseware to schools nationwide. The information is broadcast over FM radio and television signals to facilities subscribing to the utility. (MD)

INTEGRATION OF FACILITY MODELING CAPABILITIES FOR NUCLEAR NONPROLIFERATION ANALYSIS

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

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

2011-07-18

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

Statistical Evaluation of Utilization of the ISS

NASA Technical Reports Server (NTRS)

Andrews, Ross; Andrews, Alida

2006-01-01

PayLoad Utilization Modeler (PLUM) is a statistical-modeling computer program used to evaluate the effectiveness of utilization of the International Space Station (ISS) in terms of the number of research facilities that can be operated within a specified interval of time. PLUM is designed to balance the requirements of research facilities aboard the ISS against the resources available on the ISS. PLUM comprises three parts: an interface for the entry of data on constraints and on required and available resources, a database that stores these data as well as the program output, and a modeler. The modeler comprises two subparts: one that generates tens of thousands of random combinations of research facilities and another that calculates the usage of resources for each of those combinations. The results of these calculations are used to generate graphical and tabular reports to determine which facilities are most likely to be operable on the ISS, to identify which ISS resources are inadequate to satisfy the demands upon them, and to generate other data useful in allocation of and planning of resources.

Estimation of marginal costs at existing waste treatment facilities.

PubMed

Martinez-Sanchez, Veronica; Hulgaard, Tore; Hindsgaul, Claus; Riber, Christian; Kamuk, Bettina; Astrup, Thomas F

2016-04-01

This investigation aims at providing an improved basis for assessing economic consequences of alternative Solid Waste Management (SWM) strategies for existing waste facilities. A bottom-up methodology was developed to determine marginal costs in existing facilities due to changes in the SWM system, based on the determination of average costs in such waste facilities as function of key facility and waste compositional parameters. The applicability of the method was demonstrated through a case study including two existing Waste-to-Energy (WtE) facilities, one with co-generation of heat and power (CHP) and another with only power generation (Power), affected by diversion strategies of five waste fractions (fibres, plastic, metals, organics and glass), named "target fractions". The study assumed three possible responses to waste diversion in the WtE facilities: (i) biomass was added to maintain a constant thermal load, (ii) Refused-Derived-Fuel (RDF) was included to maintain a constant thermal load, or (iii) no reaction occurred resulting in a reduced waste throughput without full utilization of the facility capacity. Results demonstrated that marginal costs of diversion from WtE were up to eleven times larger than average costs and dependent on the response in the WtE plant. Marginal cost of diversion were between 39 and 287 € Mg(-1) target fraction when biomass was added in a CHP (from 34 to 303 € Mg(-1) target fraction in the only Power case), between -2 and 300 € Mg(-1) target fraction when RDF was added in a CHP (from -2 to 294 € Mg(-1) target fraction in the only Power case) and between 40 and 303 € Mg(-1) target fraction when no reaction happened in a CHP (from 35 to 296 € Mg(-1) target fraction in the only Power case). Although average costs at WtE facilities were highly influenced by energy selling prices, marginal costs were not (provided a response was initiated at the WtE to keep constant the utilized thermal capacity). Failing to systematically address and include costs in existing waste facilities in decision-making may unintendedly lead to higher overall costs at societal level. To avoid misleading conclusions, economic assessment of alternative SWM solutions should not only consider potential costs associated with alternative treatment but also include marginal costs associated with existing facilities. Copyright © 2016 Elsevier Ltd. All rights reserved.

Water and Sewage Utilities Sector (NAICS 2213)

EPA Pesticide Factsheets

Environmental regulation information for water utilities, including drinking and wastewater treatment facilities. Includes links to NESHAP for POTW, compliance information, and information about pretreatment programs.

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

PubMed

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

2015-09-01

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

Plasma Gradient Piston: a new approach to precision pulse shaping

NASA Astrophysics Data System (ADS)

Prisbrey, Shon T.

2011-10-01

We have successfully developed a method to create shaped pressure drives from large shocks that can be applied to a wide variety of experimental platforms. The method consists of transforming a large shock or blast wave into a ramped pressured drive by utilizing a graded density reservoir that unloads across a gap and stagnates against the sample being studied. The utilization of a graded density reservoir, different materials, and a gap transforms the energy in the initial large shock into a quasi-isentropic ramped compression. Control of the ramp history is via the size of the initial shock, the chosen reservoir materials, their densities, the thickness of each density layer, and the gap size. There are two keys to utilizing this approach to create ramped drives: the ability to produce a large shock, and making the layered density reservoir. A number of facilities can produce the strong initial shock (Z, Omega, NIF, Phoenix, high explosives, NIKE, LMJ, pulsed power,...). We have demonstrated ramped drives from 0.5 to 1.5 Mbar utilizing a large shock created at the Omega laser facility. We recently concluded a pair of NIF drive shots where we successfully converted a hohlraum-generated shock into a stepped, ramped pressure drive with a peak pressure of ~4 - 5 Mbar in a Ta sample. We will explain the basic concepts needed for producing a ramped pressure drive, compare experimental data with simulations from Omega (Pmax ~ 1 Mbar) and NIF (Pmax ~ 5-10 Mbar), and present designs for ramped, staged-shock designs up to Pmax ~ 30 Mbar. The approach that we have developed enables precision pulse shaping of the drive (applied pressure vs. time) via target characteristics, as opposed to tailoring laser power vs time or Z-pinch facility current vs time. This enables ramped, quasi-isentropic materials studies to be performed on a wide variety of HED facilities. This work performed under the auspices of the U.S. Department of Energy by Lawrence Livermore National Laboratory under Contract DE-AC52-07NA27344. LLNL-ABS-490532.

Avionics test bed development plan

NASA Technical Reports Server (NTRS)

Harris, L. H.; Parks, J. M.; Murdock, C. R.

1981-01-01

A development plan for a proposed avionics test bed facility for the early investigation and evaluation of new concepts for the control of large space structures, orbiter attached flex body experiments, and orbiter enhancements is presented. A distributed data processing facility that utilizes the current laboratory resources for the test bed development is outlined. Future studies required for implementation, the management system for project control, and the baseline system configuration are defined. A background analysis of the specific hardware system for the preliminary baseline avionics test bed system is included.

Sensing and Active Flow Control for Advanced BWB Propulsion-Airframe Integration Concepts

NASA Technical Reports Server (NTRS)

Fleming, John; Anderson, Jason; Ng, Wing; Harrison, Neal

2005-01-01

In order to realize the substantial performance benefits of serpentine boundary layer ingesting diffusers, this study investigated the use of enabling flow control methods to reduce engine-face flow distortion. Computational methods and novel flow control modeling techniques were utilized that allowed for rapid, accurate analysis of flow control geometries. Results were validated experimentally using the Techsburg Ejector-based wind tunnel facility; this facility is capable of simulating the high-altitude, high subsonic Mach number conditions representative of BWB cruise conditions.

An Analysis of Attendance Patterns in the Experimental Food Service System at Travis Air Force Base

DTIC Science & Technology

1974-12-01

Food Service System Study was undertaken to develop wideranging improvements in current Air Force food service operations. Of particular concern was the need to increase consumer attendance and utilization of the dining facilities. A number of changes were implemented during the experiment including menu modifications, dining hall renovations, and the introduction of three new food service operations - a modular fast food unit, a flight line facility, and an ethnic, specialty meal service provided by one of the renovated dining

A History of Educational Facilities Laboratories (EFL)

ERIC Educational Resources Information Center

Marks, Judy

2009-01-01

The Educational Facilities Laboratories (EFL), an independent research organization established by the Ford Foundation, opened its doors in 1958 under the direction of Harold B. Gores, a distinguished educator. Its purpose was to help schools and colleges maximize the quality and utility of their facilities, stimulate research, and disseminate…

Goldsboro City Schools Comprehensive Survey 1988-89.

ERIC Educational Resources Information Center

North Carolina State Dept. of Public Instruction, Raleigh. Div. of School Planning.

This report presents results of a comprehensive survey of the Goldsboro (North Carolina) City School System conducted during the 1988-89 school year. The purpose of the survey was to determine long-range planning implications for the areas of organization, facility utilization, facility needs, site development, and media facilities. The report is…

Suicide Prevention in Juvenile Facilities.

ERIC Educational Resources Information Center

Hayes, Lindsay M.

2000-01-01

Youth suicide is recognized as a serious public health problem, but suicide within juvenile facilities has not received comparable attention, and the extent and nature of these deaths remain unknown. This article utilizes an example of a young man in a juvenile justice facility who succeeded in committing suicide to illustrate these points.…

18 CFR 292.204 - Criteria for qualifying small power production facilities.

Code of Federal Regulations, 2010 CFR

2010-04-01

... primary energy source of the facility must be biomass, waste, renewable resources, geothermal resources... FEDERAL ENERGY REGULATORY COMMISSION, DEPARTMENT OF ENERGY REGULATIONS UNDER THE PUBLIC UTILITY REGULATORY... production facilities that use the same energy resource, are owned by the same person(s) or its affiliates...

PERT Planning for Physical Educational Facilities.

ERIC Educational Resources Information Center

Moriarty, R. J.

1973-01-01

Because of the high degree of interest in education and physical education in Canada, there has been a phenomenal growth in physical education facilities. Physical educators must become facility specialists in order to contribute to the planning, procurement, and utilization of the new complexes that are being developed. Among the most difficult…

18 CFR 292.309 - Termination of obligation to purchase from qualifying facilities.

Code of Federal Regulations, 2011 CFR

2011-04-01

... POLICIES ACT OF 1978 WITH REGARD TO SMALL POWER PRODUCTION AND COGENERATION Arrangements Between Electric Utilities and Qualifying Cogeneration and Small Power Production Facilities Under Section 210 of the Public... into a new contract or obligation to purchase electric energy from a qualifying cogeneration facility...

18 CFR 292.309 - Termination of obligation to purchase from qualifying facilities.

Code of Federal Regulations, 2010 CFR

2010-04-01

... POLICIES ACT OF 1978 WITH REGARD TO SMALL POWER PRODUCTION AND COGENERATION Arrangements Between Electric Utilities and Qualifying Cogeneration and Small Power Production Facilities Under Section 210 of the Public... into a new contract or obligation to purchase electric energy from a qualifying cogeneration facility...

18 CFR 292.309 - Termination of obligation to purchase from qualifying facilities.

Code of Federal Regulations, 2013 CFR

2013-04-01

... POLICIES ACT OF 1978 WITH REGARD TO SMALL POWER PRODUCTION AND COGENERATION Arrangements Between Electric Utilities and Qualifying Cogeneration and Small Power Production Facilities Under Section 210 of the Public... into a new contract or obligation to purchase electric energy from a qualifying cogeneration facility...

18 CFR 292.309 - Termination of obligation to purchase from qualifying facilities.

Code of Federal Regulations, 2012 CFR

2012-04-01

... POLICIES ACT OF 1978 WITH REGARD TO SMALL POWER PRODUCTION AND COGENERATION Arrangements Between Electric Utilities and Qualifying Cogeneration and Small Power Production Facilities Under Section 210 of the Public... into a new contract or obligation to purchase electric energy from a qualifying cogeneration facility...

18 CFR 292.309 - Termination of obligation to purchase from qualifying facilities.

Code of Federal Regulations, 2014 CFR

2014-04-01

... POLICIES ACT OF 1978 WITH REGARD TO SMALL POWER PRODUCTION AND COGENERATION Arrangements Between Electric Utilities and Qualifying Cogeneration and Small Power Production Facilities Under Section 210 of the Public... into a new contract or obligation to purchase electric energy from a qualifying cogeneration facility...

10 CFR 50.78 - Facility information and verification.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 1 2011-01-01 2011-01-01 false Facility information and verification. 50.78 Section 50.78 Energy NUCLEAR REGULATORY COMMISSION DOMESTIC LICENSING OF PRODUCTION AND UTILIZATION FACILITIES Us/iaea... International Atomic Energy Agency (IAEA) and take other action as necessary to implement the US/IAEA Safeguards...

10 CFR 50.78 - Facility information and verification.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 1 2010-01-01 2010-01-01 false Facility information and verification. 50.78 Section 50.78 Energy NUCLEAR REGULATORY COMMISSION DOMESTIC LICENSING OF PRODUCTION AND UTILIZATION FACILITIES Us/iaea... International Atomic Energy Agency (IAEA) and take other action as necessary to implement the US/IAEA Safeguards...

Measuring the Efficient Utilization of Medical Personnel at Navy Military Treatment Facilities

DTIC Science & Technology

1990-06-01

measures of effectiveness (MOE) for utilizing manpower at a medical treatment facility by analyzing data from Navy hospitals. The MOE will be able to...at Navy facili- ties will be used to compare alternative MOEs., The data resources are categorized into expenditures, Naval health-care statistics ...of years., At the Office of the Chief of Naval Operations, OP-801 maintains financial data of medical budgets, 2. NAVAL HEALTH-CARE STATISTICS The

Work Smarter Not Harder: Utilizing an Environmental Management Information System to Meet Regulatory Compliance and Reporting Requirements for a Major Source Title V Facility

DTIC Science & Technology

2011-05-10

Environmental Management Information System to Meet Regulatory Compliance and Reporting Requirements for a Major Source Title V Facility. Tannis Danley...AND SUBTITLE Work Smarter Not Harder: Utilizing an Environmental Management Information System to Meet Regulatory Compliance and Reporting...Carson) – EMS (Hawaii Garrison, West Virginia National Guard) Environmental Management Information System (EMIS) National Defense Center for Energy and

43 CFR 3271.14 - What do I need to do to start building and testing a utilization facility if it is not located on...

Code of Federal Regulations, 2014 CFR

2014-10-01

... 43 Public Lands: Interior 2 2014-10-01 2014-10-01 false What do I need to do to start building and testing a utilization facility if it is not located on Federal lands leased for geothermal resources? 3271.14 Section 3271.14 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF LAND MANAGEMENT, DEPARTMENT OF THE...

43 CFR 3271.14 - What do I need to do to start building and testing a utilization facility if it is not located on...

Code of Federal Regulations, 2012 CFR

2012-10-01

... 43 Public Lands: Interior 2 2012-10-01 2012-10-01 false What do I need to do to start building and testing a utilization facility if it is not located on Federal lands leased for geothermal resources? 3271.14 Section 3271.14 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF LAND MANAGEMENT, DEPARTMENT OF THE...

43 CFR 3271.14 - What do I need to do to start building and testing a utilization facility if it is not located on...

Code of Federal Regulations, 2011 CFR

2011-10-01

... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false What do I need to do to start building and testing a utilization facility if it is not located on Federal lands leased for geothermal resources? 3271.14 Section 3271.14 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF LAND MANAGEMENT, DEPARTMENT OF THE...

43 CFR 3271.14 - What do I need to do to start building and testing a utilization facility if it is not located on...

Code of Federal Regulations, 2013 CFR

2013-10-01

... 43 Public Lands: Interior 2 2013-10-01 2013-10-01 false What do I need to do to start building and testing a utilization facility if it is not located on Federal lands leased for geothermal resources? 3271.14 Section 3271.14 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF LAND MANAGEMENT, DEPARTMENT OF THE...

The causal effects of home care use on institutional long-term care utilization and expenditures.

PubMed

Guo, Jing; Konetzka, R Tamara; Manning, Willard G

2015-03-01

Limited evidence exists on whether expanding home care saves money overall or how much institutional long-term care can be reduced. This paper estimates the causal effect of Medicaid-financed home care services on the costs and utilization of institutional long-term care using Medicaid claims data. A unique instrumental variable was applied to address the potential bias caused by omitted variables or reverse effect of institutional care use. We find that the use of Medicaid-financed home care services significantly reduced but only partially offset utilization and Medicaid expenditures on nursing facility services. A $1000 increase in Medicaid home care expenditures avoided 2.75 days in nursing facilities and reduced annual Medicaid nursing facility costs by $351 among people over age 65 when selection bias is addressed. Failure to address selection biases would misestimate the substitution and offset effects. Copyright © 2015 John Wiley & Sons, Ltd.

Analysis of PURPA and solar energy

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

Rice, M.

The Public Utility Regulatory Policies Act of 1978 (PURPA) is designed to promote energy conservation, the efficient use of utility resources, and equitable rates. PURPA specifically directs the Federal Energy Regulatory Commission (FERC) to encourage small power production from renewable resources (and also cogeneration of electric energy as well as heat) by setting standards under which facilities qualify for interconnection, and guidelines for sales between utilities and independent facilities. The way FERC carries out this mandate may critically affect the development of solar alternatives to electric power production from fossil and nuclear resources. This report comments on proposed FERC regulationsmore » and suggests ways to encourage small power production within the PURPA mandate. In addition, some internal strains within PURPA are analyzed that seem to limit the effectiveness with which FERC can encourage independent facilities, and possible modifications to PURPA are suggested. 255 references.« less

Service providers' experiences of disrespectful and abusive behavior towards women during facility based childbirth in Addis Ababa, Ethiopia.

PubMed

Asefa, Anteneh; Bekele, Delayehu; Morgan, Alison; Kermode, Michelle

2018-01-05

Disrespect and abuse (D&A) of women during childbirth by the attending staff in health facilities has been widely reported in many countries. Although D&A in labor rooms is recognized as a deterrent to maternal health service utilization, approaches to defining, classifying, and measuring D&A are still at an early stage of development. This study aims to enhance understanding of service providers' experiences of D&A during facility based childbirth in health facilities in Addis Ababa. A facility based cross-sectional study was conducted in August 2013 in one hospital and three health centers. A total of 57 health professionals who had assisted with childbirth during the study period completed a self-administered questionnaire. Service providers' personal observations of mistreatment during childbirth and their perceptions of respectful maternity care (RMC) were assessed. Data were entered into and analyzed using SPSS version 16 software. The majority (83.7%) of participants were aged <30 years (mean = 27.25 ± 5.45). Almost half (43.9%) were midwives, and 77.2% had less than five years experience as a health professional. Work load was reported to be very high by 31.6% of participants, and 28% rated their working environment as poor or very poor. Almost half (50.3%) of participants reported that service providers do not generally obtain women's consent prior to procedures. One-quarter (25.9%) reported having ever witnessed physical abuse (physical force, slapping, or hitting) in their health facility. They also reported observing privacy violations (34.5%), and women being detained against their will (18%). Violations of women's rights were self-reported by 14.5% of participants. More than half (57.1%) felt that they had been disrespected and abused in their work place. The majority of participants (79.6%) believed that lack of respectful care discourages pregnant women from coming to health facilities for delivery. The study findings indicate that most service providers from these facilities had witnessed disrespectful practices during childbirth, and recognized that such practices have negative consequences for service utilization. These findings can help decision makers plan for interventions to improve RMC taking account of the provider perspective.

42 CFR 456.520 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Review Plans: FFP, Waivers, and Variances for Hospitals and Mental Hospitals Ur Plan: Remote Facility Variances from Time Requirements § 456.520 Definitions...

Evaluation of overweight load routing on buried utility facilities

DOT National Transportation Integrated Search

2011-02-01

Overweight traffic movements can negatively affect pavement integrity and quality. However, it is less : known to what degree buried utility plant along and across the right of way is affected by these overweight : loads, especially if the utility fa...

TAN HOT SHOP AND SUPPORT FACILITY UTILIZATION STUDY

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

Phillips, Ken Crawforth

2001-11-01

Impacts to the U.S. Department of Energy (DOE) complex caused by early closure (prior to 2018) and Demolition and Dismantlement (D&D) of the Test Area North (TAN) hot shop and its support facilities are explored in this report. Various possible conditions, such as Standby, Safe Store and Lay-up, that the facility may be placed in prior to eventually being turned over to D&D are addressed. The requirements, impacts, and implications to the facility and to the DOE Complex are discussed for each condition presented in the report. Some details of the report reference the Idaho National Engineering and Environmental Laboratorymore » (INEEL) Spent Nuclear Fuel Life Cycle Baseline Plan, the INEEL 2000 Infrastructure Long Range Plan, and other internal INEEL reports.« less

TAN Hot Shop and Support Facility Utilization Study

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

Picker, B.A.

2001-11-16

Impacts to the U.S. Department of Energy (DOE) complex caused by early closure (prior to 2018) and Demolition and Dismantlement (D and D) of the Test Area North (TAN) hot shop and its support facilities are explored in this report. Various possible conditions, such as Standby, Safe Store and Lay-up, that the facility may be placed in prior to eventually being turned over to D and D are addressed. The requirements, impacts, and implications to the facility and to the DOE Complex are discussed for each condition presented in the report. Some details of the report reference the Idaho Nationalmore » Engineering and Environmental Laboratory (INEEL) Spent Nuclear Fuel Life Cycle Baseline Plan, the INEEL 2000 Infrastructure Long Range Plan, and other internal INEEL reports.« less

Study of the Relevance of the Quality of Care, Operating Efficiency and Inefficient Quality Competition of Senior Care Facilities.

PubMed

Lin, Jwu-Rong; Chen, Ching-Yu; Peng, Tso-Kwei

2017-09-11

The purpose of this research is to examine the relation between operating efficiency and the quality of care of senior care facilities. We designed a data envelopment analysis, combining epsilon-based measure and metafrontier efficiency analyses to estimate the operating efficiency for senior care facilities, followed by an iterative seemingly unrelated regression to evaluate the relation between the quality of care and operating efficiency. In the empirical studies, Taiwan census data was utilized and findings include the following: Despite the greater operating scale of the general type of senior care facilities, their average metafrontier technical efficiency is inferior to that of nursing homes. We adopted senior care facility accreditation results from Taiwan as a variable to represent the quality of care and examined the relation of accreditation results and operating efficiency. We found that the quality of care of general senior care facilities is negatively related to operating efficiency; however, for nursing homes, the relationship is not significant. Our findings show that facilities invest more in input resources to obtain better ratings in the accreditation report. Operating efficiency, however, does not improve. Quality competition in the industry in Taiwan is inefficient, especially for general senior care facilities.

Study of the Relevance of the Quality of Care, Operating Efficiency and Inefficient Quality Competition of Senior Care Facilities

PubMed Central

Lin, Jwu-Rong; Chen, Ching-Yu; Peng, Tso-Kwei

2017-01-01

The purpose of this research is to examine the relation between operating efficiency and the quality of care of senior care facilities. We designed a data envelopment analysis, combining epsilon-based measure and metafrontier efficiency analyses to estimate the operating efficiency for senior care facilities, followed by an iterative seemingly unrelated regression to evaluate the relation between the quality of care and operating efficiency. In the empirical studies, Taiwan census data was utilized and findings include the following: Despite the greater operating scale of the general type of senior care facilities, their average metafrontier technical efficiency is inferior to that of nursing homes. We adopted senior care facility accreditation results from Taiwan as a variable to represent the quality of care and examined the relation of accreditation results and operating efficiency. We found that the quality of care of general senior care facilities is negatively related to operating efficiency; however, for nursing homes, the relationship is not significant. Our findings show that facilities invest more in input resources to obtain better ratings in the accreditation report. Operating efficiency, however, does not improve. Quality competition in the industry in Taiwan is inefficient, especially for general senior care facilities. PMID:28892019

Nuclear waste

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

Not Available

1991-09-01

Radioactive waste is mounting at U.S. nuclear power plants at a rate of more than 2,000 metric tons a year. Pursuant to statute and anticipating that a geologic repository would be available in 1998, the Department of Energy (DOE) entered into disposal contracts with nuclear utilities. Now, however, DOE does not expect the repository to be ready before 2010. For this reason, DOE does not want to develop a facility for monitored retrievable storage (MRS) by 1998. This book is concerned about how best to store the waste until a repository is available, congressional requesters asked GAO to review themore » alternatives of continued storage at utilities' reactor sites or transferring waste to an MRS facility, GAO assessed the likelihood of an MRSA facility operating by 1998, legal implications if DOE is not able to take delivery of wastes in 1998, propriety of using the Nuclear Waste Fund-from which DOE's waste program costs are paid-to pay utilities for on-site storage capacity added after 1998, ability of utilities to store their waste on-site until a repository is operating, and relative costs and safety of the two storage alternatives.« less

First Facility Utilization Manual. A Teachers Guide to the Use of the FLNT Elementary School. Fort Lincoln New Town Education System.

ERIC Educational Resources Information Center

General Learning Corp., Washington, DC.

This guide endeavors to teach the faculty how to manipulate the structure of the new facility in the most creative way. The first chapters discuss the interior design, graphic considerations within the facility, materials and equipment suited for open space schools, and recommended audio-systems. Later chapters cover the exterior facilities, such…

The Granite Mountain Atmospheric Sciences Testbed (GMAST): A Facility for Long Term Complex Terrain Airflow Studies

NASA Astrophysics Data System (ADS)

Zajic, D.; Pace, J. C.; Whiteman, C. D.; Hoch, S.

2011-12-01

This presentation describes a new facility at Dugway Proving Ground (DPG), Utah that can be used to study airflow over complex terrain, and to evaluate how airflow over a mountain barrier affects wind patterns over adjacent flatter terrain. DPG's primary mission is to conduct testing, training, and operational assessments of chemical and biological weapon systems. These operations require very precise weather forecasts. Most test operations at DPG are conducted on fairly flat test ranges having uniform surface cover, where airflow patterns are generally well-understood. However, the DPG test ranges are located alongside large, isolated mountains, most notably Granite Mountain, Camelback Mountain, and the Cedar Mountains. Airflows generated over, or influenced by, these mountains can affect wind patterns on the test ranges. The new facility, the Granite Mountain Atmospheric Sciences Testbed, or GMAST, is designed to facilitate studies of airflow interactions with topography. This facility will benefit DPG by improving understanding of how mountain airflows interact with the test range conditions. A core infrastructure of weather sensors around and on Granite Mountain has been developed including instrumented towers and remote sensors, along with automated data collection and archival systems. GMAST is expected to be in operation for a number of years and will provide a reference domain for mountain meteorology studies, with data useful for analysts, modelers and theoreticians. Visiting scientists are encouraged to collaborate with DPG personnel to utilize this valuable scientific resource and to add further equipment and scientific designs for both short-term and long-term atmospheric studies. Several of the upcoming MATERHORN (MountAin TERrain atmospHeric mOdeling and obseRvatioNs) project field tests will be conducted at DPG, giving an example of GMAST utilization and collaboration between DPG and visiting scientists.

Phase 0 study for a geothermal superheated water proof of concept facility

NASA Technical Reports Server (NTRS)

Douglass, R. H.; Pearson, R. O.

1974-01-01

A Phase 0 study for the selection of a representative liquid-dominated geothermal resource of moderate salinity and temperature is discussed. Selection and conceptual design of a nominal 10-MWe energy conversion system, and implementation planning for Phase 1: subsystem (component, experiments) and Phase 2: final design, construction, and operation of experimental research facilities are reported. The objective of the overall program is to demonstrate the technical and economic viability of utilizing moderate temperature and salinity liquid-dominated resources with acceptable environmental impact, and thus encourage commercial scale development of geothermal electrical power generation.

The utilization of automated external defibrillators in Taiwan.

PubMed

Wang, Tsung-Hsi; Wu, Hsi-Wen; Hou, Peter C; Tseng, Hao-Jui

2018-03-24

Increasing attention to care of patient succumbed to out-of-hospital cardiac arrest (OHCA) and evidence for improved survival have resulted in many countries to encourage the use automated external defibrillators (AEDs) by legislation. In Taiwan, the amendment of the Emergency Medical Services Act mandated the installation of AEDs in designated areas in 2013. Since then, 6151 AEDs have been installed and registered in mandated and non-mandated locations. The purpose of this study was to investigate the utilization of AEDs at mandated and non-mandated locations. This paper analyzed 217 cases in whom AEDs was used between July 11, 2013 and July 31, 2015. Descriptive statistics were used to analyze the data. The highest frequency of AEDs used was in long-term care facilities, accounting for 34 (15.7%) cases. The second and third highest was in schools and commuting stations. The highest utilization rate of registered AED was in long-term care facilities (73.9%), the second was in residential areas, and the third was in hot spring areas. Employees at the designated locations or medical personnel operated the AED in 143 cases (84.6%), and bystanders, relatives, friends or others operated the AEDs in 26 cases (15.4%). On-site Return of Spontaneous Circulation (ROSC) after applying AEDs occurred in 76 cases (45.8%). Long-term care facilities had the highest utilization of AEDs and government should pay more attention to enforce the installing of AEDs in these places. The government also needs to promote the education public on how to search the AEDs locations. Copyright © 2018. Published by Elsevier B.V.

Factors associated with safe delivery service utilization among women in Sheka zone, southwest Ethiopia.

PubMed

Asres, Abyot; Davey, Gail

2015-04-01

Attempts to predict pregnancy and childbirth complications before they occur have not been successful. Provision of safe delivery service for all births is considered to be a critical intervention for ensuring safe motherhood. Hence the aim of the study was to assess factors associated with safe delivery service utilization among women in Sheka Zone South West Ethiopia. A community based comparative cross sectional survey was conducted among 554 women in Sheka Zone from February to March 2008. Data were collected through structured pre-tested questionnaire and entered into Epinfo version 3.3. Analyses were done with SPSS version 13 computer software with which bivariate and multiple logistic regressions were carried out. Mothers who completed at least secondary school were more likely to give birth at health facility than those uneducated (AOR = 3.26, 95 % CI 1.51-7.06). Women with birth order above four were less likely to give birth in a health facility than those with first order births (AOR = 0.21, 95 %CI 0.10-0.43). Women who had encountered problems in their immediate birth and received prenatal care were more likely to give birth at health facilities AOR = 33.78 95 % CI 16.44-69.39) and (AOR = 2.55, 95 % CI 1.05-6.21) respectively. Factors associated with safe delivery service utilization are related to the women's socioeconomic status and obstetric experiences. Consequently promotion of maternal education, prenatal care utilization, information education and communication on obstetric risks and general health service expansion are needed to ensure safe delivery service.

Increased Utilization of Primary Health Care Centers for Birthing Care in Tamil Nadu, India: A Visible Impact of Policies, Initiatives, and Innovations.

PubMed

Pandian, Jayanthi; Suresh, Saradha; Desikachari, B R; Padmanaban, P

2013-01-01

Tamil Nadu has been showing an increasing trend in institutional deliveries since early 1990's and has now achieved near 100%. Among the institutional deliveries, a change was observed since 2006, wherein primary health centers (PHCs) showed a four-fold increase in deliveries, while other public and private health facilities showed a decline, despite equal access to all categories of health facilities. What led to this increased utilization of PHCs for birthing care? Policies, documents, and published reports of the Government of Tamil Nadu (GoTN) were reviewed and interviews were conducted with the various stakeholders involved in providing birthing care in the PHCs. This study analyzes the impact of the policies and supply side initiatives and innovations which led to increase utilization of the PHCs for birthing care. Scaling up of 24 × 7 services in all PHCs, upgrading PHCs with good infrastructure, human resources, and women friendly services have helped to boost the image of the PHCs. Pro-women policies like maternity benefit schemes, birth companionship, providing food, and compulsory stay for 48 h following delivery have attracted women towards PHC. Innovative strategies like maternity picnics and use of expected date of delivery (EDD) chart for follow-up have made women choose PHCs, while periodic reviews and support to staff has improved service delivery. Women centered policies, efficient managerial systems, quality care, and innovative marketing of services have together contributed to increased utilization of PHCs for birthing. Other states could explore the possibility of replicating this model to make optimal use the PHC facilities.

Feasibility of a medium-size central cogenerated energy facility, energy management memorandum

NASA Astrophysics Data System (ADS)

Porter, R. W.

1982-09-01

The thermal-economic feasibility was studied of a medium-size central cogenerated energy facility designed to serve five varied industries. Generation options included one dual-fuel diesel and one gas turbine, both with waste heat boilers, and five fired boilers. Fuels included natural gas, and for the fired-boiler cases, also low-sulphur coal and municipal refuse. The fired-boiler cogeneration systems employed back-pressure steam turbines. For coal and refuse, the option of steam only without cogeneration was also assessed. The refuse-fired cases utilized modular incinerators. The options provided for a wide range of steam and electrical capacities. Deficient steam was assumed generated independently in existing equipment. Excess electrical power over that which could be displaced was assumed sold to Commonwealth Edison Company under PURPA (Public Utility Regulator Policies Act). The facility was assumed operated by a mutually owned corporation formed by the cogenerated power users. The economic analysis was predicted on currently applicable energy-investment tax credits and accelerated depreciation for a January 1985 startup date. Based on 100% equity financing, the results indicated that the best alternative was the modular-incinerator cogeneration system.

Hybrid Propulsion In-Situ Resource Utilization Test Facility Results

NASA Technical Reports Server (NTRS)

Karp, Ashley Chandler; Nakazono, Barry; Vaughan, David; Warner, William N.

2015-01-01

Hybrid rockets present a promising alternative to conventional chemical propulsion systems for In-Situ Resource Utilization (ISRU) and in-space applications. While they have many benefits for these applications, there are still many small details that require research before they can be adopted into flight systems. A flexible test facility was developed at JPL to test operation of hybrid motors at small scale (5 cm outer diameter fuel grains) over a range of conditions. Specifically, this paper studies two of the major advantages: low temperature performance and throttling. Paraffin-based hybrid rockets are predicted to have good performance at low temperatures. This could significantly decrease the overall system mass by minimizing the thermal conditioning required for Mars or outer planet applications. Therefore, the coefficient of thermal expansion and glass transition of paraffin are discussed. Additionally, deep throttling has been considered for several applications. This was a natural starting point for hotfire testing using the hybrid propulsion ISRU test facility. Additionally, short length to diameter ratio (L/D) fuel grains are tested to determine if these systems can be packaged into geometrically constrained spaces.

43 CFR 3272.12 - What environmental protection measures must I include in my utilization plan?

Code of Federal Regulations, 2011 CFR

2011-10-01

... must I include in my utilization plan? 3272.12 Section 3272.12 Public Lands: Interior Regulations... MANAGEMENT (3000) GEOTHERMAL RESOURCE LEASING Utilization Plan and Facility Construction Permit § 3272.12 What environmental protection measures must I include in my utilization plan? (a) Describe, at a...

Analyses in support of risk-informed natural gas vehicle maintenance facility codes and standards :

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

Ekoto, Isaac W.; Blaylock, Myra L.; LaFleur, Angela Christine

2014-03-01

Safety standards development for maintenance facilities of liquid and compressed gas fueled large-scale vehicles is required to ensure proper facility design and operation envelopes. Standard development organizations are utilizing risk-informed concepts to develop natural gas vehicle (NGV) codes and standards so that maintenance facilities meet acceptable risk levels. The present report summarizes Phase I work for existing NGV repair facility code requirements and highlights inconsistencies that need quantitative analysis into their effectiveness. A Hazardous and Operability study was performed to identify key scenarios of interest. Finally, scenario analyses were performed using detailed simulations and modeling to estimate the overpressure hazardsmore » from HAZOP defined scenarios. The results from Phase I will be used to identify significant risk contributors at NGV maintenance facilities, and are expected to form the basis for follow-on quantitative risk analysis work to address specific code requirements and identify effective accident prevention and mitigation strategies.« less

LSU: The Library Space Utilization Methodology.

ERIC Educational Resources Information Center

Hall, Richard B.

A computerized research technique for measuring the space utilization of public library facilities provides a behavioral activity and occupancy analysis for library planning purposes. The library space utilization (LSU) methodology demonstrates that significant information about the functional requirements of a library can be measured and…

10 CFR 50.30 - Filing of application; oath or affirmation.

Code of Federal Regulations, 2010 CFR

2010-01-01

... operate, or manufacture, a production or utilization facility (including an early site permit, combined.... (e) Filing Fees. Each application for a standard design approval or production or utilization... 50.30 Energy NUCLEAR REGULATORY COMMISSION DOMESTIC LICENSING OF PRODUCTION AND UTILIZATION...

42 CFR 456.614 - Inspections by utilization review committee.

Code of Federal Regulations, 2011 CFR

2011-10-01

....614 Section 456.614 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.614 Inspections by utilization review...

42 CFR 456.614 - Inspections by utilization review committee.

Code of Federal Regulations, 2013 CFR

2013-10-01

....614 Section 456.614 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.614 Inspections by utilization review...

42 CFR 456.614 - Inspections by utilization review committee.

Code of Federal Regulations, 2014 CFR

2014-10-01

....614 Section 456.614 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.614 Inspections by utilization review...

42 CFR 456.614 - Inspections by utilization review committee.

Code of Federal Regulations, 2012 CFR

2012-10-01

....614 Section 456.614 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.614 Inspections by utilization review...

The use of reproductive healthcare at commune health stations in a changing health system in Vietnam.

PubMed

Ngo, Anh D; Hill, Peter S

2011-09-27

With health sector reform in Vietnam moving towards greater pluralism, commune health stations (CHSs) have been subject to growing competition from private health services and increasing numbers of patients bypassing CHSs for higher-level health facilities. This study describes the pattern of reproductive health (RH) and family planning (FP) service utilization among women at CHSs and other health facilities, and explores socio-demographic determinants of RH service utilization at the CHS level. This study was based on a cross-sectional survey conducted in Thua Thien Hue and Vinh Long provinces, using a multi-stage cluster sampling technique. Questionnaire-based interviews with 978 ever-married women at reproductive age provided data on socio-demographic characteristics, current use of FP methods, history of RH service use, and the health facility attended for their most recent services. Multiple logistic regression analyses were used to identify socio-demographic determinants of their use of CHS RH services. Eighty nine percent of ever-married women reported current use of birth control with 49% choosing intra-uterine device (IUD). Eighty nine percent of pregnant women attended facility-based antenatal care (ANC) with 62% having at least 3 check-ups during their latest pregnancy. Ninety one percent of mothers had their last delivery in a health facility. Seventy-one percent of respondents used CHS for IUD insertion, 55% for antenatal check-ups, and 77% gynecological examination. District and provincial/central hospitals dominated the provision of delivery service, used by 57% of mothers for their latest delivery. The percentage of women opting for private ANC services was reported at 35%, though the use of private delivery services was low (11%). Women who were farmers, earning a lower income, having more than 2 children, and living in a rural area were more likely than others to use ANC, delivery, and/or gynecological check-up services at the CHS. Women choice of providers for FP and RH services that help them plan and protect their pregnancies is driven by socio-economic factors. While the CHS retains significant utilization rates, it is under challenge by preferences for hospital-based delivery and the growing use of private ANC services.

42 CFR 456.521 - Conditions for granting variance requests.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Review Plans: FFP, Waivers, and Variances for Hospitals and Mental Hospitals Ur Plan: Remote Facility Variances from Time...

42 CFR 456.525 - Request for renewal of variance.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Review Plans: FFP, Waivers, and Variances for Hospitals and Mental Hospitals Ur Plan: Remote Facility Variances from Time...

42 CFR 456.525 - Request for renewal of variance.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Review Plans: FFP, Waivers, and Variances for Hospitals and Mental Hospitals Ur Plan: Remote Facility Variances from Time...

STUDY ON THE RECYCLING SYSTEM OF WASTE PLASTICS AND MIXED PAPER FROM A LONG-TERM PERSPECTIVE

NASA Astrophysics Data System (ADS)

Fujii, Minoru; Fujita, Tsuyoshi; Chen, Xudong; Ohnishi, Satoshi; Osako, Masahiro; Moriguchi, Yuichi; Yamaguchi, Naohisa

Plastics and mixed paper in municipal solid waste are valuable resources with high calorific value. However, the recycling cost to utilize them tends to be expensive. In addition, recycling system has to be consistent with the reduce of wastes on which should be put higher-priority to lower carbon emission and save resources in the long term. In this paper, we proposed a recycling system (smart recycling system) which consists of a local center an d existing facilities in arterial industries. In the local center, collected waste plastics and mixed paper from household are processed on the same line into a form suitable for transportation and handling in a facility of arterial in dustry which can utilize those wastes effectively. At the same time, a part of plastics with high quality is processed into a recycled resin in the center. It was suggested that, by utilizing existing facilities in arterial industries which have enough and flexible capacity to accept those wastes, the system can be a robust system even if the amount of wastes generation fluctuates widely. The effect of CO2 reduction and cost by installing the system were calculated and it was estimated that 3.5 million ton of additional annual CO2 reduction could be brought in Tokyo and surrounding three prefectures without co nsiderable increase in cost.

Maximization of revenues for power sales from a solid waste resources recovery facility

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

Not Available

1991-12-01

The report discusses the actual implementation of the best alternative in selling electrical power generated by an existing waste-to-energy facility, the Metro-Dade County Resources Recovery Plant. After the plant processes and extracts various products out of the municipal solid waste, it burns it to produce electrical power. The price for buying power to satisfy the internal needs of our Resources Recovery Facility (RRF) is substantially higher than the power price for selling electricity to any other entity. Therefore, without any further analysis, it was decided to first satisfy those internal needs and then export the excess power. Various alternatives weremore » thoroughly explored as to what to do with the excess power. Selling power to the power utilities or utilizing the power in other facilities were the primary options.« less

Trends in CT scan rates in children and pregnant women: teaching, private, public and nonprofit facilities.

PubMed

Hoshiko, Sumi; Smith, Daniel; Fan, Cathyn; Jones, Carrie R; McNeel, Sandra V; Cohen, Ronald A

2014-05-01

Radiation exposure from medical sources now equals or exceeds that from natural background sources, largely attributable to a 20-fold increase in CT use since 1980. Increasing exposure to children and fetuses is of most concern due to their heightened susceptibility. More recently, CT use may be leveling or decreasing, but it is unclear whether this change is widespread or varies by type of institution. We sought to characterize trends in CT utilization in California hospitals and emergency departments among children and pregnant women, looking at different types of facilities, such as teaching, private, public and nonprofit institutions. We examined frequency of CT examinations by year from 229 facilities reporting CT usage in routinely collected California statewide data for 2005-2012. We modeled trends overall and by facility type. CT scans for pediatric and pregnant patient visits in the emergency department increased initially, then started to decline after 2008. Among hospital admissions, rates declined or leveled after 2005. In the emergency department, CT rates varied between types of facilities, with teaching hospitals reducing use sooner and more sharply than other types of facilities. CT utilization in California among children and pregnant women has begun to level or decline. Still, population exposure remains at historically high levels, warranting consideration of potential public health implications. Further examination of reasons for trends among hospital types, particularly how teaching hospitals have reduced rates of CT utilization, may help identify strategies for CT reduction without compromising patient care.

Can psychiatric liaison reduce neuroleptic use and reduce health service utilization for dementia patients residing in care facilities.

PubMed

Ballard, Clive; Powell, Ian; James, Ian; Reichelt, Katharina; Myint, Pat; Potkins, Dawn; Bannister, Carol; Lana, Marisa; Howard, Robert; O'Brien, John; Swann, Alan; Robinson, Damian; Shrimanker, Jay; Barber, Robert

2002-02-01

The quality of care and overuse of neuroleptic medication in care environments are major issues in the care of elderly people with dementia. The quality of care (Dementia Care Mapping), the severity of Behavioural and Psychological Symptoms (BPSD--Neuropsychiatric Inventory), expressive language skills (Sheffield Acquired Language Disorder scale), service utilization and use of neuroleptic drugs was compared over 9 months between six care facilities receiving a psychiatric liaison service and three facilities receiving the usual clinical support, using a single blind design. There was a significant reduction in neuroleptic usage in the facilities receiving the liaison service (McNemar test p<0.0001), but not amongst those receiving standard clinical support (McNemar test p=0.07). There were also significantly less GP contacts (t=3.9 p=0.0001) for residents in the facilities receiving the liaison service, and a three fold reduction in psychiatric in-patient bed usage (Bed days per person 0.6 vs. 1.5). Residents in care facilities receiving the liaison service experienced significantly less deterioration in expressive language skills (t=2.2 p=0.03), but there were no significant differences in BPSD or wellbeing. A resource efficient psychiatric liaison service can reduce neuroleptic drug use and reduce some aspects of health service utilization; but a more extensive intervention is probably required to improve the overall quality of care. Copyright 2002 John Wiley & Sons, Ltd.

Standby power generation under utility curtailment contract agreements

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

Nolan, G.J.; Puccio, V.J.; Calhoun, C.W.

1995-12-31

Many utilities in the US offer large industrial and commercial customers power sales contracts which have attractive rates under a curtailment requirement. This curtailment requirement allows the utility to require the customer to reduce its power demand to a predetermined level within a specific time period. If the required curtailment is not achieved by the customer within the allocated time period, stiff financial penalties are usually enforced by the utility. The attractiveness of the contract rates usually is proportional to the amount of curtailment required. To take advantage of these attractive rates, a customer must be able to withstand themore » curtailment without supplemental generation or must add standby generation to meet its needs. Obviously, the cost of the curtailments to the customer should not exceed the economic benefits of reduced rates. This paper reviews the alternatives faced by a curtailment contract customer together with potential load shedding and standby generation system designs. An example of implementing a curtailment contract at an existing industrial facility is presented. The example facility, Boeing Helicopters of Philadelphia, Pennsylvania required both load shedding and standby generation. The load shedding scheme is fairly complex and is controlled by a programmable logic controller (PLC). The standby generation and load shedding systems for the example facility are examined in detail. Also, lessons learned from implementing the required modifications to the example facility are discussed.« less

40 CFR 63.10685 - What are the requirements for the control of contaminants from scrap?

Code of Federal Regulations, 2010 CFR

2010-07-01

... Area Sources: Electric Arc Furnace Steelmaking Facilities Standards and Compliance Requirements § 63..., lead, and free organic liquids. For metallic scrap utilized in the EAF at your facility, you must... scrap at your facility subject to paragraph (a)(1) of this section and other scrap subject to paragraph...

40 CFR 63.10685 - What are the requirements for the control of contaminants from scrap?

Code of Federal Regulations, 2011 CFR

2011-07-01

... Area Sources: Electric Arc Furnace Steelmaking Facilities Standards and Compliance Requirements § 63..., lead, and free organic liquids. For metallic scrap utilized in the EAF at your facility, you must... scrap at your facility subject to paragraph (a)(1) of this section and other scrap subject to paragraph...

New Spaces for Learning: Designing College Facilities to Utilize Instructional Aids and Media. Revised.

ERIC Educational Resources Information Center

Hauf, Harold D.; And Others

Colleges need appropriate large group instructional facilities for effective and efficient use of instructional aids and media. A well planned system of facilities must provide space for learning; production, origination, and support; storage and retrieval. Design begins with a building plan--a statement, made jointly by the administrator and…

The Attached Payload Facility Program: A Family of In-Space Commercial Facilities for Technology, Science and Industry

NASA Technical Reports Server (NTRS)

Avery, Don E.; Kaszubowski, Martin J.; Kearney, Michael E.; Howard, Trevor P.

1996-01-01

It is anticipated that as the utilization of space increases in both the government and commercial sec tors the re will be a high degree of interest in materials and coatings research as well as research in space environment definition, deployable structures, multi-functional structures and electronics. The International Space Station (ISS) is an excellent platform for long-term technology development because it provides large areas for external attached payloads, power and data capability, and ready access for experiment exchange and return. An alliance of SPACEHAB, MicroCraft, Inc. and SpaceTec, Inc. has been formed to satisfy this research need through commercial utilization of the capabilities of ISS. The alliance will provide a family of facilities designed to provide low-cost, reliable access to space for experimenters. This service would start as early as 1997 and mature to a fully functional attached facility on ISS by 2001. The alliances facilities are based on early activities by NASA, Langley Research Center (LaRC) to determine the feasibility of a Material Exposure Facility (MEF).

Web-Based Requesting and Scheduling Use of Facilities

NASA Technical Reports Server (NTRS)

Yeager, Carolyn M.

2010-01-01

Automated User's Training Operations Facility Utilization Request (AutoFUR) is prototype software that administers a Web-based system for requesting and allocating facilities and equipment for astronaut-training classes in conjunction with scheduling the classes. AutoFUR also has potential for similar use in such applications as scheduling flight-simulation equipment and instructors in commercial airplane-pilot training, managing preventive- maintenance facilities, and scheduling operating rooms, doctors, nurses, and medical equipment for surgery. Whereas requesting and allocation of facilities was previously a manual process that entailed examination of documents (including paper drawings) from different sources, AutoFUR partly automates the process and makes all of the relevant information available via the requester s computer. By use of AutoFUR, an instructor can fill out a facility-utilization request (FUR) form on line, consult the applicable flight manifest(s) to determine what equipment is needed and where it should be placed in the training facility, reserve the corresponding hardware listed in a training-hardware inventory database, search for alternative hardware if necessary, submit the FUR for processing, and cause paper forms to be printed. Auto-FUR also maintains a searchable archive of prior FURs.

Selfie@ssessment as an Alternative Form of Self-Assessment at Undergraduate Level in Higher Education

ERIC Educational Resources Information Center

Tulgar, Aysegül Takkaç

2017-01-01

This study aimed to get ideas formed by undergraduate foreign language students about the applicability, advantages and disadvantages of "selfie@ssessment", which can be regarded as an alternative form of self-assessment utilizing modern mobile phone technologies and the available Internet facilities. Underpinning this study of…

Lung Focused Resuscitation at a Specialized Donor Care Facility Improves Lung Procurement Rates.

PubMed

Chang, Stephanie H; Kreisel, Daniel; Marklin, Gary F; Cook, Lindsey; Hachem, Ramsey; Kozower, Benjamin D; Balsara, Keki R; Bell, Jennifer M; Frederiksen, Christine; Meyers, Bryan F; Patterson, G Alexander; Puri, Varun

2018-05-01

Lung procurement for transplantation occurs in approximately 20% of brain dead donors and is a major impediment to wider application of lung transplantation. We investigated the effect of lung protective management at a specialized donor care facility on lung procurement rates from brain dead donors. Our local organ procurement organization instituted a protocol of lung protective management at a freestanding specialized donor care facility in 2008. Brain dead donors from 2001 to 2007 (early period) were compared with those from 2009 to 2016 (current period) for lung procurement rates and other solid-organ procurement rates using a prospectively maintained database. An overall increase occurred in the number of brain dead donors during the study period (early group, 791; late group, 1,333; p < 0.0001). The lung procurement rate (lung donors/all brain dead donors) improved markedly after the introduction of lung protective management (early group, 157 of 791 [19.8%]; current group, 452 of 1,333 [33.9%]; p < 0.0001). The overall organ procurement rate (total number of organs procured/donor) also increased during the study period (early group, 3.5 organs/donor; current group, 3.8 organs/donor; p = 0.006). Lung protective management in brain dead donors at a specialized donor care facility is associated with higher lung utilization rates compared with conventional management. This strategy does not adversely affect the utilization of other organs in a multiorgan donor. Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

A national study of efficiency for dialysis centers: an examination of market competition and facility characteristics for production of multiple dialysis outputs.

PubMed

Ozgen, Hacer; Ozcan, Yasar A

2002-06-01

To examine market competition and facility characteristics that can be related to technical efficiency in the production of multiple dialysis outputs from the perspective of the industrial organization model. Freestanding dialysis facilities that operated in 1997 submitted cost report fonns to the Health Care Financing Administration (HCFA), and offered all three outputs--outpatient dialysis, dialysis training, and home program dialysis. The Independent Renal Facility Cost Report Data file (IRFCRD) from HCFA was utilized to obtain information on output and input variables and market and facility features for 791 multiple-output facilities. Information regarding population characteristics was obtained from the Area Resources File. Cross-sectional data for the year 1997 were utilized to obtain facility-specific technical efficiency scores estimated through Data Envelopment Analysis (DEA). A binary variable of efficiency status was then regressed against its market and facility characteristics and control factors in a multivariate logistic regression analysis. The majority of the facilities in the sample are functioning technically inefficiently. Neither the intensity of market competition nor a policy of dialyzer reuse has a significant effect on the facilities' efficiency. Technical efficiency is significantly associated, however, with type of ownership, with the interaction between the market concentration of for-profits and ownership type, and with affiliations with chains of different sizes. Nonprofit and government-owned Facilities are more likely than their for-profit counterparts to become inefficient producers of renal dialysis outputs. On the other hand, that relationship between ownership form and efficiency is reversed as the market concentration of for-profits in a given market increases. Facilities that are members of large chains are more likely to be technically inefficient. Facilities do not appear to benefit from joint production of a variety of dialysis outputs, which may explain the ongoing tendency toward single-output production. Ownership form does make a positive difference in production efficiency, but only in local markets where competition exists between nonprofit and for-profit facilities. The increasing inefficiency associated with membership in large chains suggests that the growing consolidation in the dialysis industry may not, in fact, be the strategy for attaining more technical efficiency in the production of multiple dialysis outputs.

The GreenLab Research Facility: A Micro-Grid Integrating Production, Consumption and Storage of Clean Energy

NASA Technical Reports Server (NTRS)

McDowell Bomani, Bilal Mark; Elbuluk, Malik; Fain, Henry; Kankam, Mark D.

2012-01-01

There is a large gap between the production and demand for energy from alternative fuel and alternative renewable energy sources. The NASA Glenn Research Center (GRC) has initiated a laboratory-pilot study that concentrates on using biofuels as viable alternative fuel resources for the field of aviation, as well as, utilizing wind and solar technologies as alternative renewable energy resources, and in addition, the use of pumped water for storage of energy that can be retrieved through hydroelectric generation. This paper describes the GreenLab Research Facility and its power and energy sources with .recommendations for worldwide expansion and adoption of the concept of such a facility

42 CFR 456.508 - Withdrawal of waiver.

Code of Federal Regulations, 2011 CFR

2011-10-01

... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Review Plans: FFP, Waivers, and..., 1978, as amended at 61 FR 38399, July 24, 1996] UR Plan: Remote Facility Variances from Time...

Life sciences utilization of Space Station Freedom

NASA Technical Reports Server (NTRS)

Chambers, Lawrence P.

1992-01-01

Space Station Freedom will provide the United States' first permanently manned laboratory in space. It will allow, for the first time, long term systematic life sciences investigations in microgravity. This presentation provides a top-level overview of the planned utilization of Space Station Freedom by NASA's Life Sciences Division. The historical drivers for conducting life sciences research on a permanently manned laboratory in space as well as the advantages that a space station platform provides for life sciences research are discussed. This background information leads into a description of NASA's strategy for having a fully operational International Life Sciences Research Facility by the year 2000. Achieving this capability requires the development of the five discipline focused 'common core' facilities. Once developed, these facilities will be brought to the space station during the Man-Tended Capability phase, checked out and brought into operation. Their delivery must be integrated with the Space Station Freedom manifest. At the beginning of Permanent Manned Capability, the infrastructure is expected to be completed and the Life Sciences Division's SSF Program will become fully operational. A brief facility description, anticipated launch date and a focused objective is provided for each of the life sciences facilities, including the Biomedical Monitoring and Countermeasures (BMAC) Facility, Gravitational Biology Facility (GBF), Gas Grain Simulation Facility (GGSF), Centrifuge Facility (CF), and Controlled Ecological Life Support System (CELSS) Test Facility. In addition, hardware developed by other NASA organizations and the SSF International Partners for an International Life Sciences Research Facility is also discussed.

Intersocietal Accreditation Commission Accreditation Status of Outpatient Cerebrovascular Testing Facilities Among Medicare Beneficiaries: The VALUE Study.

PubMed

Brown, Scott C; Wang, Kefeng; Dong, Chuanhui; Farrell, Mary Beth; Heller, Gary V; Gornik, Heather L; Hutchisson, Marge; Needleman, Laurence; Benenati, James F; Jaff, Michael R; Meier, George H; Perese, Susana; Bendick, Phillip; Hamburg, Naomi M; Lohr, Joann M; LaPerna, Lucy; Leers, Steven A; Lilly, Michael P; Tegeler, Charles; Katanick, Sandra L; Alexandrov, Andrei V; Siddiqui, Adnan H; Rundek, Tatjana

2016-09-01

Accreditation of cerebrovascular ultrasound laboratories by the Intersocietal Accreditation Commission (IAC) and equivalent organizations is supported by the Joint Commission certification of stroke centers. Limited information exists on the accreditation status and geographic distribution of cerebrovascular testing facilities in the United States. Our study objectives were to identify the proportion of IAC-accredited outpatient cerebrovascular testing facilities used by Medicare beneficiaries, describe their geographic distribution, and identify variations in cerebrovascular testing procedure types and volumes by accreditation status. As part of the VALUE (Vascular Accreditation, Location, and Utilization Evaluation) Study, we examined the proportion of IAC-accredited facilities that conducted cerebrovascular testing in a 5% Centers for Medicare and Medicaid Services random Outpatient Limited Data Set in 2011 and investigated their geographic distribution using geocoding. Among 7327 outpatient facilities billing Medicare for cerebrovascular testing, only 22% (1640) were IAC accredited. The proportion of IAC-accredited cerebrovascular testing facilities varied by region (χ(2)[3] = 177.1; P < .0001), with 29%, 15%, 13%, and 10% located in the Northeast, South, Midwest, and West, respectively. However, of the total number of cerebrovascular outpatient procedures conducted in 2011 (38,555), 40% (15,410) were conducted in IAC-accredited facilities. Most cerebrovascular testing procedures were carotid duplex, with 40% of them conducted in IAC-accredited facilities. The proportion of facilities conducting outpatient cerebrovascular testing accredited by the IAC is low and varies by region. The growing number of certified stroke centers should be accompanied by more accredited outpatient vascular testing facilities, which could potentially improve the quality of stroke care.

Design summary of a geostationary facility utilized as a communications platform

NASA Technical Reports Server (NTRS)

Barberis, N. J.; Brown, J. V.

1986-01-01

This paper describes the technical aspects of a geostationary platform facility that makes maximum use of the planned NASA space station and its elements, mainly the orbital maneuvering vehicle (OMV) and the orbital transfer vehicles (OTV). The platform design concept is described, with emphasis on the key technologies utilized to configure the platform. Key systems aspects include a design summary with discussion of the controls, telemetry, command and ranging, power, propulsion, control electronics, thermal control subsystems, and space station interfaces. The use of the facility as a communications platform is developed to demonstrate the attractiveness of the concept. The economic benefits are discussed, as well as the concept of servicing for payload upgrade.

Options to improve energy efficiency for educational building

NASA Astrophysics Data System (ADS)

Jahan, Mafruha

The cost of energy is a major factor that must be considered for educational facility budget planning purpose. The analysis of energy related issues and options can be complex and requires significant time and detailed effort. One way to facilitate the inclusion of energy option planning in facility planning efforts is to utilize a tool that allows for quick appraisal of the facility energy profile. Once such an appraisal is accomplished, it is then possible to rank energy improvement options consistently with other facility needs and requirements. After an energy efficiency option has been determined to have meaningful value in comparison with other facility planning options, it is then possible to utilize the initial appraisal as the basis for an expanded consideration of additional facility and energy use detail using the same analytic system used for the initial appraisal. This thesis has developed a methodology and an associated analytic model to assist in these tasks and thereby improve the energy efficiency of educational facilities. A detailed energy efficiency and analysis tool is described that utilizes specific university building characteristics such as size, architecture, envelop, lighting, occupancy, thermal design which allows reducing the annual energy consumption. Improving the energy efficiency of various aspects of an educational building's energy performance can be complex and can require significant time and experience to make decisions. The approach developed in this thesis initially assesses the energy design for a university building. This initial appraisal is intended to assist administrators in assessing the potential value of energy efficiency options for their particular facility. Subsequently this scoping design can then be extended as another stage of the model by local facility or planning personnel to add more details and engineering aspects to the initial screening model. This approach can assist university planning efforts to identify the most cost effective combinations of energy efficiency strategies. The model analyzes and compares the payback periods of all proposed Energy Performance Measures (EPMs) to determine which has the greatest potential value.

Energy Systems Integration News | Energy Systems Integration Facility |

Science.gov Websites

technologies and business models help utilities and tech companies address integrate distributed energy invaders: Disruptive technologies crowding the utility space" at the Utilities in a Time of Change and Franyutti, Vice-President, Energy Business Group, Mexichem

18 CFR 415.33 - Uses by special permit.

Code of Federal Regulations, 2014 CFR

2014-04-01

... transient enterprises. (3) Drive-in theaters, signs and billboards. (4) Extraction of sand, gravel and other...) Utilities, railroad tracks, streets and bridges. Public utility facilities, roads, railroad tracks and... of protection may be provided for minor or auxiliary roads, railroads or utilities. (5) Water supply...

18 CFR 415.33 - Uses by special permit.

Code of Federal Regulations, 2011 CFR

2011-04-01

... transient enterprises. (3) Drive-in theaters, signs and billboards. (4) Extraction of sand, gravel and other...) Utilities, railroad tracks, streets and bridges. Public utility facilities, roads, railroad tracks and... of protection may be provided for minor or auxiliary roads, railroads or utilities. (5) Water supply...

18 CFR 415.33 - Uses by special permit.

Code of Federal Regulations, 2012 CFR

2012-04-01

... transient enterprises. (3) Drive-in theaters, signs and billboards. (4) Extraction of sand, gravel and other...) Utilities, railroad tracks, streets and bridges. Public utility facilities, roads, railroad tracks and... of protection may be provided for minor or auxiliary roads, railroads or utilities. (5) Water supply...

18 CFR 415.33 - Uses by special permit.

Code of Federal Regulations, 2010 CFR

2010-04-01

... transient enterprises. (3) Drive-in theaters, signs and billboards. (4) Extraction of sand, gravel and other...) Utilities, railroad tracks, streets and bridges. Public utility facilities, roads, railroad tracks and... of protection may be provided for minor or auxiliary roads, railroads or utilities. (5) Water supply...

18 CFR 415.33 - Uses by special permit.

Code of Federal Regulations, 2013 CFR

2013-04-01

... transient enterprises. (3) Drive-in theaters, signs and billboards. (4) Extraction of sand, gravel and other...) Utilities, railroad tracks, streets and bridges. Public utility facilities, roads, railroad tracks and... of protection may be provided for minor or auxiliary roads, railroads or utilities. (5) Water supply...

Extremely Intensive and Conservative Fault Capability Studies on Nuclear Facilities in Japan after the 2011 Tohoku Earthquake and Fukushima Daiichi Incident

NASA Astrophysics Data System (ADS)

Okumura, K.

2013-12-01

Rocks of the Japanese islands are mostly faulted since the Mesozoic Era. The opening of the Sea of Japan in Middle Miocene stretched most of the Japanese crust together with rifting systems. Modern compressional tectonic regime started in Pliocene and accelerated during Quaternary. The ubiquitous bedrock fault prior to the Quaternary had long been regarded as incapable for the future rupturing. This view on the bedrock fault, however, is in question after the March 11, 2011 Tohoku earthquake and tsunamis. There is no scientific reason for the Tohoku earthquake to let the geologists and seismologists worry about the capability of the long-deceased fault. Neither the unexpected April 11, 2011 extensional faulting event on shore in southern Fukushima prefecture has any scientific reason as well. There was no change and no new stress field, but the psychological situation of the scientists and the public welcomed the wrong belief in unexpected stress changes all over Japan, in the same manner that the March 11 M 9 was not expected. Finally, the capabilities of the bedrock faults, fractures, and joints came up to concern about seismic safety of nuclear facilities. After the incidents, the nuclear regulation authority of Japan began reevaluation of the seismic safety of all facilities in Japan. The primary issues of the reevaluation were conjunctive multi-fault mega-earthquakes and the capabilities of the bedrock faults, precisely reflecting the Tohoku events. The former does not require immediate abandonment of a facility. However, the latter now denies any chance of continued operation. It is because of the new (July 2013) safety guide gave top priority to the capability of the displacement under a facility for the evaluation on safe operation. The guide also requires utmost deterministic manner in very conservative ways. The regulators ordered the utility companies to thoroughly examine the capability for several sites, and started review of the studies in late 2012. Many of the Japanese critical nuclear facilities are built on bedrocks with faults, fractures, and joints. They were not regarded as capable when the facilities were built in 1970's to 1990's. In many cases it was not possible to know about Late Pleistocene movement owing to the lack of young sediments on bedrocks. In a few cases, geologist studied past movement and found nothing. Some very cautious researchers on nuclear safety overturned previous evaluation easily. The capability studies by the utility companies then became very serious. The young sediments that may indicate the timing of faulting were completely removed during construction. Within bedrock, it is almost impossible to demonstrate that there was no recent displacement. The regulators are very rigid and relentless to require perfect evidence of incapability. Now several utility companies are opening huge trenches, digging beside a reactor, or drilling many cores from bedrock in the site spending billions of Yen. The results of extremely intensive studies brought a lot of information on the geologic structures and their capabilities. This paper will summarize the scientific finding and their meaning on the seismic safety of critical nuclear facilities.

A community-based cluster randomized controlled trial (cRCT) to evaluate the impact and operational assessment of "safe motherhood and newborn health promotion package": study protocol.

PubMed

Hoque, Dewan Md Emdadul; Chowdhury, Mohiuddin Ahsanul Kabir; Rahman, Ahmed Ehsanur; Billah, Sk Masum; Bari, Sanwarul; Tahsina, Tazeen; Hasan, Mohammad Mehedi; Islam, Sajia; Islam, Tajul; Mori, Rintaro; Arifeen, Shams El

2018-05-03

Despite considerable progress in reduction of both under-five and maternal mortality in recent decades, Bangladesh is still one of the low and middle income countries with high burden of maternal and neonatal mortality. The primary objective of the current study is to measure the impact of a comprehensive package of interventions on maternal and neonatal mortality. In addition, changes in coverage, quality and utilization of maternal and newborn health (MNH) services, social capital, and cost effectiveness of the interventions will be measured. A community-based, cluster randomized controlled trial design will be adopted and implemented in 30 unions of three sub-districts of Chandpur district of Bangladesh. Every union, the lowest administrative unit of the local government with population of around 20,000-30,000, will be considered a cluster. Based on the baseline estimates, 15 clusters will be paired for random assignment as intervention and comparison clusters. The primary outcome measure is neonatal mortality, and secondary outcomes are coverage of key interventions like ANC, PNC, facility and skilled provider delivery. Baseline, midterm and endline household survey will be conducted to assess the key coverage of interventions. Health facility assessment surveys will be conducted periodically to assess facility readiness and utilization of MNH services in the participating health facilities. The current study is expected to provide essential strong evidences on the impact of a comprehensive package of interventions to the Bangladesh government, and other developmental partners. The study results may help in prioritizing, planning, and scaling-up of Safe Motherhood Promotional interventions in other geographical areas of Bangladesh as well as to inform other developing countries of similar settings. NCT03032276 .

30 CFR 780.14 - Operation plan: Maps and plans.

Code of Federal Regulations, 2012 CFR

2012-07-01

...: (1) Buildings, utility corridors and facilities to be used; (2) The area of land to be affected...) Each facility to be used to protect and enhance fish and wildlife and related environmental values; (10...

30 CFR 780.14 - Operation plan: Maps and plans.

Code of Federal Regulations, 2013 CFR

2013-07-01

...: (1) Buildings, utility corridors and facilities to be used; (2) The area of land to be affected...) Each facility to be used to protect and enhance fish and wildlife and related environmental values; (10...

30 CFR 780.14 - Operation plan: Maps and plans.

Code of Federal Regulations, 2014 CFR

2014-07-01

...: (1) Buildings, utility corridors and facilities to be used; (2) The area of land to be affected...) Each facility to be used to protect and enhance fish and wildlife and related environmental values; (10...

NPDES Permit for Lame Deer Lagoon Wastewater Treatment Facility in Montana

EPA Pesticide Factsheets

Final permit authorizes the Northern Cheyenne Utilities Commission to discharge from its Lame Deer Lagoon wastewater treatment facility located in Rosebud County, Montana to Lame Deer Creek, a tributary to Rosebud Creek.

NPDES Permit: Shiprock Wastewater Treatment Facility, Shiprock, New Mexico

EPA Pesticide Factsheets

NPDES Permit, Fact Sheet, and Response to Comments explaining EPA's issue of NPDES Permit No. NN0020621 to the Navajo Tribal Utility Authority Shiprock Wastewater Treatment Facility, Shiprock, San Juan County, New Mexico.

45 CFR 63.21 - Obligation and liquidation by grantee.

Code of Federal Regulations, 2011 CFR

2011-10-01

... utilities, for travel, and for the rental of facilities, shall be considered to have been obligated as of the time such services were rendered, such travel was performed, and such rented facilities were used...

23 CFR 771.118 - FTA categorical exclusions

Code of Federal Regulations, 2014 CFR

2014-04-01

...) Acquisition, installation, operation, evaluation, replacement, and improvement of discrete utilities and... activities; rehabilitation of public transportation buildings, structures, or facilities; retrofitting for... transportation vehicles, facilities or structures, or upgrading to current standards. (6) Acquisition or transfer...

23 CFR 771.118 - FTA categorical exclusions

Code of Federal Regulations, 2013 CFR

2013-04-01

...) Acquisition, installation, operation, evaluation, replacement, and improvement of discrete utilities and... activities; rehabilitation of public transportation buildings, structures, or facilities; retrofitting for... transportation vehicles, facilities or structures, or upgrading to current standards. (6) Acquisition or transfer...

75 FR 21287 - Empire Pipeline Inc.; Notice of Application

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-23

..., Inc. (EPI), 6363 Main Street, Williamsville, New York 14221, filed in Docket No. CP10-136-000, an... utilizing EPI's existing cross-border facilities. EPI proposes no new facilities in its application. The...

Access to water and sanitation facilities in primary schools: A neglected educational crisis in Ngamiland district in Botswana

NASA Astrophysics Data System (ADS)

Ngwenya, B. N.; Thakadu, O. T.; Phaladze, N. A.; Bolaane, B.

2018-06-01

In developing countries, the sanitation and hygiene provision often receives limited resources compared to the water supply. However, water supply benefits tend to diminish if improved sanitation and hygiene are neglected. This paper presents findings of a situational analysis of water supply, sanitation and hygiene infrastructure and their utilization in three primary schools in north-western Botswana. The overall objective of the paper is to determine access and functionality of water supply, sanitation and hygiene infrastructure in three primary schools. The specific objectives are: a) Learners' perspective of their water and sanitation facilities and b) gendered utilization of sanitation and hygiene facilities. Data were collected through a face-to-face administered social survey tool to 286 learners selected through proportionate stratified random sampling from three purposively selected villages in the middle and lower Okavango Delta. Findings indicate that standpipes provide 96% of potable water supply. However, the majority (65% of leaners) indicated that they 'sometimes' experienced water shortage due to dry/nonfunctioning taps/pumps and leaks/wastage. Overall, schools have relatively sufficient sanitation facilities consisting of both water borne toilets and VIP latrines. The major sanitation gap identified was that 80% flush toilets hardly work, while 77% of VIP toilets were in disrepair. Furthermore, poor water supply compromised hand washing with 65.7% learners "always" washing their hands if school standpipes had water, while the majority did not wash hands if standpipes were dry. The study concluded that availability of sanitation infrastructure does not necessarily translate into utilization in the study area due to multiple problems, such as lack of personal hygiene supplies (regular toilet paper and hand washing detergents), privacy issues and recurring water problems. The chronicity of inadequate water, sanitation and hygiene infrastructure in primary schools is critical and there is urgent need to address these challenges in order to create a conducive learning environment in primary schools in the district.

Working together to ensure safety at hydro projects

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

Bartel, J.W.

Providing for public safety around a hydroelectric facility can be critically important to the welfare of a hydro-power producer. With this in mind, Wisconsin Electric Power Company and Wisconsin Public Service Corporation have worked together to develop consistent safety signage and several for their hydro projects. Although the two utilities sometimes compete for electric customers, they cooperate to ensure the safety to those customers. Both WE and WPS took steps in 1986 to make their operations safer through involvement in the Wisconsin/Michigan Hydro User Group. The organization has 25 members-primarily of electric utilities and paper companies-who operate hydro facilities inmore » the two states. The two areas that the HUG studied in public safety were signs and warning systems. HUG established a sign committee to study how to increase safety of people around hydro plants through signs, explained Ted Handrick, hydro plant superintendent at WPS. The committee's recommendations led to development of a statewide uniform sign system adopted by all HUG members. The committee used Wisconsin Department of Natural Resources' guidelines for warning signs and portages in developing the signage standards. HUG members are converting to these new sign standards as they replace old signs and/or install new signs. Notices describing the new signage system have been placed near each hydro plant, at boat landings, and in campgrounds. The signs are mounted well above ground level so they can be seen and easily read by recreationalists. Warning systems, in accordance with HUG warning standards, were installed at WE and WPS hydro facilities. These systems alert nearby recreational users of rapid increases in water flow when generating units are turned on or when spillway gates are opened. Soon after the authors installed equipment to remotely operate its hydro facilities, the utility experienced a dramatic increase increase in intrusion on dams and other structures at the projects.« less

Experiences of stigma, discrimination, care and support among people living with HIV: A four country study

PubMed Central

Neuman, Melissa; Obermeyer, Carla Makhlouf; Cherutich, Peter; Desclaux, Alice; Hardon, Anita; Ky-Zerbo, Odette; Namakhoma, Ireen; Wanyenze, Rhoda

2013-01-01

While it is widely agreed that HIV-related stigma may impede access to treatment and support, there is little evidence describing who is most likely to experience different forms of stigma and discrimination and how these affect disclosure and access to care. This study examined experiences of interpersonal discrimination, internalized stigma, and discrimination at health care facilities among HIV-positive adults aged 18 years and older utilizing health facilities in four countries in Sub-Saharan Africa (N=536). Prevalence of interpersonal discrimination across all countries was 34.6%, with women significantly more likely to experience interpersonal discrimination than men. Prevalences of internalized stigma varied across countries, ranging from 9.6% (Malawi) to 45.0% (Burkina Faso). Prevalence of health care discrimination was 10.4% across all countries. In multivariate analyses, we found positive, significant, and independent associations between disclosure and interpersonal discrimination and support group utilization, and positive associations between both internalized stigma and health care discrimination and referral for medications. PMID:23479002

Implementing PURPA : Renewable Resource Development in the Pacific Northwest : Executive Summary.

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

Washington State Energy Office.

The Public Utilities Regulatory Policies Act (PURPA) of 1979 requires that electrical utilities interconnect with qualifying facilities (QFs) and purchase electricity at a rate based upon their full avoided cost of providing both capacity and energy. Facilities that qualify for PURPA benefits include solar or geothermal electric units, hydropower, municipal solid waste or biomass-fired power plants, and cogeneration projects that satisfy maximum size, fuel use, ownership, location, and/or efficiency criteria. The mandate of PURPA, coupled with the electrical energy deficits projected to occur in the Pacific Northwest by the mid 1980s, led to resurgence of interest in the development ofmore » small, decentralized, non-utility owned and operated generating stations. A variety of would-be developers conducted feasibility studies and initiated environmental permitting and power marketing discussions with appropriate authorities. While many proposed PURPA projects fill by the wayside, others were successfully brought on-line. A variety of public and private sector developers, including cities, counties, irrigation districts, utilities, ranchers, timber companies, and food processing plants, successfully negotiated PURPA-based, or share-the-savings'' power purchase contracts. Other developers run their meter backwards'' or provide energy to their local utilities at the same rate that would otherwise be paid to Bonneville. This document provides a summary resource development of these renewable projects in the Pacific Northwest.« less

Past and Present Large Solid Rocket Motor Test Capabilities

NASA Technical Reports Server (NTRS)

Kowalski, Robert R.; Owen, David B., II

2011-01-01

A study was performed to identify the current and historical trends in the capability of solid rocket motor testing in the United States. The study focused on test positions capable of testing solid rocket motors of at least 10,000 lbf thrust. Top-level information was collected for two distinct data points plus/minus a few years: 2000 (Y2K) and 2010 (Present). Data was combined from many sources, but primarily focused on data from the Chemical Propulsion Information Analysis Center s Rocket Propulsion Test Facilities Database, and heritage Chemical Propulsion Information Agency/M8 Solid Rocket Motor Static Test Facilities Manual. Data for the Rocket Propulsion Test Facilities Database and heritage M8 Solid Rocket Motor Static Test Facilities Manual is provided to the Chemical Propulsion Information Analysis Center directly from the test facilities. Information for each test cell for each time period was compiled and plotted to produce a graphical display of the changes for the nation, NASA, Department of Defense, and commercial organizations during the past ten years. Major groups of plots include test facility by geographic location, test cells by status/utilization, and test cells by maximum thrust capability. The results are discussed.

The Utility-Scale Future - Continuum Magazine | NREL

Science.gov Websites

Spring 2011 / Issue 1 Continuum. Clean Energy Innovation at NREL The Utility-Scale Future Continuum facility will lead the way. Wind Innovation Enables Utility-Scale 02 Wind Innovation Enables Utility-Scale Archives 9 Beyond R&D: Market Impact 8 NREL Analysis 7 Partnering: An Engine for Innovation 6 Energy

Comparison of Perceived and Technical Healthcare Quality in Primary Health Facilities: Implications for a Sustainable National Health Insurance Scheme in Ghana

PubMed Central

Alhassan, Robert Kaba; Duku, Stephen Opoku; Janssens, Wendy; Nketiah-Amponsah, Edward; Spieker, Nicole; van Ostenberg, Paul; Arhinful, Daniel Kojo; Pradhan, Menno; Rinke de Wit, Tobias F.

2015-01-01

Background Quality care in health facilities is critical for a sustainable health insurance system because of its influence on clients’ decisions to participate in health insurance and utilize health services. Exploration of the different dimensions of healthcare quality and their associations will help determine more effective quality improvement interventions and health insurance sustainability strategies, especially in resource constrained countries in Africa where universal access to good quality care remains a challenge. Purpose To examine the differences in perceptions of clients and health staff on quality healthcare and determine if these perceptions are associated with technical quality proxies in health facilities. Implications of the findings for a sustainable National Health Insurance Scheme (NHIS) in Ghana are also discussed. Methods This is a cross-sectional study in two southern regions in Ghana involving 64 primary health facilities: 1,903 households and 324 health staff. Data collection lasted from March to June, 2012. A Wilcoxon-Mann-Whitney test was performed to determine differences in client and health staff perceptions of quality healthcare. Spearman’s rank correlation test was used to ascertain associations between perceived and technical quality care proxies in health facilities, and ordered logistic regression employed to predict the determinants of client and staff-perceived quality healthcare. Results Negative association was found between technical quality and client-perceived quality care (coef. = -0.0991, p<0.0001). Significant staff-client perception differences were found in all healthcare quality proxies, suggesting some level of unbalanced commitment to quality improvement and potential information asymmetry between clients and service providers. Overall, the findings suggest that increased efforts towards technical quality care alone will not necessarily translate into better client-perceived quality care and willingness to utilize health services in NHIS-accredited health facilities. Conclusion There is the need to intensify client education and balanced commitment to technical and perceived quality improvement efforts. This will help enhance client confidence in Ghana’s healthcare system, stimulate active participation in the national health insurance, increase healthcare utilization and ultimately improve public health outcomes. PMID:26465935

Comparison of Perceived and Technical Healthcare Quality in Primary Health Facilities: Implications for a Sustainable National Health Insurance Scheme in Ghana.

PubMed

Alhassan, Robert Kaba; Duku, Stephen Opoku; Janssens, Wendy; Nketiah-Amponsah, Edward; Spieker, Nicole; van Ostenberg, Paul; Arhinful, Daniel Kojo; Pradhan, Menno; Rinke de Wit, Tobias F

2015-01-01

Quality care in health facilities is critical for a sustainable health insurance system because of its influence on clients' decisions to participate in health insurance and utilize health services. Exploration of the different dimensions of healthcare quality and their associations will help determine more effective quality improvement interventions and health insurance sustainability strategies, especially in resource constrained countries in Africa where universal access to good quality care remains a challenge. To examine the differences in perceptions of clients and health staff on quality healthcare and determine if these perceptions are associated with technical quality proxies in health facilities. Implications of the findings for a sustainable National Health Insurance Scheme (NHIS) in Ghana are also discussed. This is a cross-sectional study in two southern regions in Ghana involving 64 primary health facilities: 1,903 households and 324 health staff. Data collection lasted from March to June, 2012. A Wilcoxon-Mann-Whitney test was performed to determine differences in client and health staff perceptions of quality healthcare. Spearman's rank correlation test was used to ascertain associations between perceived and technical quality care proxies in health facilities, and ordered logistic regression employed to predict the determinants of client and staff-perceived quality healthcare. Negative association was found between technical quality and client-perceived quality care (coef. = -0.0991, p<0.0001). Significant staff-client perception differences were found in all healthcare quality proxies, suggesting some level of unbalanced commitment to quality improvement and potential information asymmetry between clients and service providers. Overall, the findings suggest that increased efforts towards technical quality care alone will not necessarily translate into better client-perceived quality care and willingness to utilize health services in NHIS-accredited health facilities. There is the need to intensify client education and balanced commitment to technical and perceived quality improvement efforts. This will help enhance client confidence in Ghana's healthcare system, stimulate active participation in the national health insurance, increase healthcare utilization and ultimately improve public health outcomes.

Incorporating elements of social franchising in government health services improves the quality of infant and young child feeding counselling services at commune health centres in Vietnam.

PubMed

Nguyen, Phuong H; Kim, Sunny S; Keithly, Sarah C; Hajeebhoy, Nemat; Tran, Lan M; Ruel, Marie T; Rawat, Rahul; Menon, Purnima

2014-12-01

Although social franchising has been shown to enhance the quality of reproductive health services in developing countries, its effect on nutrition services remains unexamined. This study assessed the effects of incorporating elements of social franchising on shaping the quality of infant and young child feeding (IYCF) counselling facilities and services in Vietnam. Process-related data collected 12 months after the launch of the first franchises were used to compare randomly assigned Alive & Thrive-supported health facilities (AT-F, n = 20) with standard facilities (SF, n = 12) across three dimensions of service quality: 'structure', 'process' and 'outcome' that capture the quality of facilities, service delivery, and client perceptions and use, respectively. Data collection included facility assessments (n = 32), staff surveys (n = 96), counselling observations (n = 137), client exit interviews (n = 137) and in-depth interviews with mothers (n = 48). Structure: AT-F were more likely to have an unshared, well-equipped room for nutrition counselling than SF (65.0% vs 10.0%). Compared with SF providers, AT-F staff had better IYCF knowledge (mean score 9.9 vs 8.8, range 0-11 for breastfeeding; mean score 3.6 vs 3.2, range 0-4 for complementary feeding). AT-F providers also demonstrated significantly better interpersonal communication skills (score 9.6 vs 5.1, range 0-13) and offered more comprehensive counselling sessions. Overall utilization of franchises was low (10%). A higher proportion of pregnant women utilized franchise services (48.9%), compared with mothers with children 6-23.9 months (1.4%). There was no quantitative difference in client satisfaction with counselling services between AT-F and SF, but franchise users praised the AT-F for problem solving related to child feeding. Incorporating elements of social franchising significantly enhances the quality of IYCF counselling services within government primary healthcare facilities, particularly their structural and process attributes. Provided that service utilization is improved through demand generation, this model has the potential to impact IYCF practices and child nutrition. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.

Evaluation of the impact of the voucher and accreditation approach on improving reproductive behaviors and status in Cambodia

PubMed Central

2011-01-01

Background Cost of delivering reproductive health services to low income populations will always require total or partial subsidization by government and/or development partners. Broadly termed "demand-side financing" or "output-based aid", these strategies include a range of interventions that channel government or donor subsidies to the user rather than the service provider. Initial pilot assessments of reproductive health voucher programs suggest that they can increase access, reduce inequities, and enhance program efficiency and service quality. However, there is a paucity of evidence describing how these programs function in different settings for various reproductive health services. Methods/Design Population Council, funded by the Bill and Melinda Gates Foundation, intends to generate evidence around the "voucher and accreditation" approaches to improving the reproductive health of low-income women in Cambodia. The study comprises of four populations: facilities, providers, women of reproductive age using facilities, and women and men who have been pregnant and/or used family planning within the previous 12 months. The study will be carried out in a sample of 20 health facilities that are accredited to provide maternal and newborn health and family planning services to women holding vouchers from operational districts in three provinces: Kampong Thom, Kampot and Prey Veng and a matched sample of non-accredited facilities in three other provinces. Health facility assessments will be conducted at baseline and endline to track temporal changes in quality-of-care, client out-of-pocket costs, and utilization. Facility inventories, structured observations, and client exit interviews will be used to collect comparable data across facilities. Health providers will also be interviewed and observed providing care. A population survey of about 3000 respondents will also be conducted in areas where vouchers are distributed and similar non-voucher locations. Discussion A quasi-experimental study will investigate the impact of the voucher approach on improving reproductive health behaviors, reproductive health status and reducing inequities at the population level and assess effects on access, equity and quality of care at the facility level. If the voucher scheme in Cambodia is found effective, it may help other countries adopt this approach for improving utilization and access to reproductive health and family planning services. PMID:21864405

Study of Lyndon B. Johnson Space Center utility systems

NASA Technical Reports Server (NTRS)

Redding, T. E.; Huber, W. C.

1977-01-01

The results of an engineering study of potential energy saving utility system modifications for the NASA Lyndon B. Johnson Space Center are presented. The objective of the study was to define and analyze utility options that would provide facility energy savings in addition to the approximately 25 percent already achieved through an energy loads reduction program. A systems engineering approach was used to determine total system energy and cost savings resulting from each of the ten major options investigated. The results reported include detailed cost analyses and cost comparisons of various options. Cost are projected to the year 2000. Also included are a brief description of a mathematical model used for the analysis and the rationale used for a site survey to select buildings suitable for analysis.

Differential effects of community health worker visits across social and economic groups in Uttar Pradesh, India: a link between social inequities and health disparities.

PubMed

Seth, Aparna; Tomar, Shweta; Singh, Kultar; Chandurkar, Dharmendra; Chakraverty, Amit; Dey, Arnab; Das, Arup K; Hay, Katherine; Saggurti, Niranjan; Boyce, Sabrina; Raj, Anita; Silverman, Jay G

2017-03-07

Uttar Pradesh (UP) accounts for the largest number of neonatal deaths in India. This study explores potential socio-economic inequities in household-level contacts by community health workers (CHWs) and whether the effects of such household-level contacts on receipt of health services differ across populations in this state. A multistage sampling design identified live births in the last 12 months across the 25 highest-risk districts of UP (N = 4912). Regression models described the relations between household demographics (caste, religion, wealth, literacy) and CHW contact, and interactions of demographics and CHW contact in predicting health service utilization (> = 4 antenatal care (ANC) visits, facility delivery, modern contraceptive use). No differences were found in likelihood of CHW contact based on caste, religion, wealth or literacy. Associations of CHW contact with receipt of ANC and facility delivery were significantly affected by religion, wealth and literacy. CHW contact increased the odds of 4 or more ANC visits only among non-Muslim women, increased the odds of both four or more ANC visits and facility delivery only among lower wealth women, increased the odds of facility delivery to a greater degree among illiterate vs. literate women. CHW visits play a vital role in promoting utilization of critical maternal health services in UP. However, significant social inequities exist in associations of CHW visits with such service utilization. Research to clarify these inequities, as well as training for CHWs to address potential biases in the qualities or quantity of their visits based on household socio-economic characteristics is recommended.

Proton Therapy Facility Planning From a Clinical and Operational Model.

PubMed

Das, Indra J; Moskvin, Vadim P; Zhao, Qingya; Cheng, Chee-Wai; Johnstone, Peter A

2015-10-01

This paper provides a model for planning a new proton therapy center based on clinical data, referral pattern, beam utilization and technical considerations. The patient-specific data for the depth of targets from skin in each beam angle were reviewed at our center providing megavoltage photon external beam and proton beam therapy respectively. Further, data on insurance providers, disease sites, treatment depths, snout size and the beam angle utilization from the patients treated at our proton facility were collected and analyzed for their utilization and their impact on the facility cost. The most common disease sites treated at our center are head and neck, brain, sarcoma and pediatric malignancies. From this analysis, it is shown that the tumor depth from skin surface has a bimodal distribution (peak at 12 and 26 cm) that has significant impact on the maximum proton energy, requiring the energy in the range of 130-230 MeV. The choice of beam angles also showed a distinct pattern: mainly at 90° and 270°; this indicates that the number of gantries may be minimized. Snout usage data showed that 70% of the patients are treated with 10 cm snouts. The cost of proton beam therapy depends largely on the type of machine, maximum beam energy and the choice of gantry versus fixed beam line. Our study indicates that for a 4-room center, only two gantry rooms could be needed at the present pattern of the patient cohorts, thus significantly reducing the initial capital cost. In the USA, 95% and 100% of patients can be treated with 200 and 230 MeV proton beam respectively. Use of multi-leaf collimators and pencil beam scanning may further reduce the operational cost of the facility. © The Author(s) 2014.

Quality of antenatal care service provision in health facilities across sub–Saharan Africa: Evidence from nationally representative health facility assessments

PubMed Central

Kanyangarara, Mufaro; Munos, Melinda K; Walker, Neff

2017-01-01

Background Utilization of antenatal care (ANC) services has increased over the past two decades. Continued gains in maternal and newborn health will require an understanding of both access and quality of ANC services. We linked health facility and household survey data to examine the quality of service provision for five ANC interventions across health facilities in sub–Saharan Africa. Methods Using data from 20 nationally representative health facility assessments – the Service Provision Assessment (SPA) and the Service Availability and Readiness Assessment (SARA), we estimated facility level readiness to deliver five ANC interventions: tetanus toxoid vaccine for pregnant women, intermittent preventive treatment for malaria in pregnancy (IPTp), syphilis detection and treatment in pregnancy, iron supplementation and hypertensive disease case management. Facility level indicators were stratified by health facility type, managing authority and location, then linked to estimates of ANC utilization in that stratum from the corresponding Demographic and Health Surveys (DHS) to generate population level estimates of the ‘likelihood of appropriate care’. Finally, the association between estimates of the ‘likelihood of appropriate care’ from the linking approach and estimates of coverage levels from the DHS were assessed. Findings A total of 10 534 health facilities were surveyed in the 20 health facility assessments, of which 8742 reported offering ANC services and were included in the analysis. Health facility readiness to deliver IPTp, iron supplementation, and tetanus toxoid vaccination was higher (median: 84.1%, 84.9% and 82.8% respectively) than readiness to deliver hypertensive disease case management and syphilis detection and treatment (median: 23.0% and 19.9% respectively). Coverage of at least 4 ANC visits ranged from 24.8% to 75.8%. Estimates of the likelihood of appropriate care derived from linking health facility and household survey data showed marked gaps for all interventions, particularly hypertensive disease case management and syphilis detection and treatment. There was fairly good concordance between our estimates of high likelihood of appropriate care and DHS estimates of coverage for iron supplementation, IPTp, and tetanus toxoid vaccination. Conclusion Linking household surveys to health facility assessments revealed marked gaps in population–level coverage of quality ANC interventions and underscored the need for a double–pronged approach to increase ANC utilization and improve the quality of ANC services. PMID:29163936

Quality of antenatal care service provision in health facilities across sub-Saharan Africa: Evidence from nationally representative health facility assessments.

PubMed

Kanyangarara, Mufaro; Munos, Melinda K; Walker, Neff

2017-12-01

Utilization of antenatal care (ANC) services has increased over the past two decades. Continued gains in maternal and newborn health will require an understanding of both access and quality of ANC services. We linked health facility and household survey data to examine the quality of service provision for five ANC interventions across health facilities in sub-Saharan Africa. Using data from 20 nationally representative health facility assessments - the Service Provision Assessment (SPA) and the Service Availability and Readiness Assessment (SARA), we estimated facility level readiness to deliver five ANC interventions: tetanus toxoid vaccine for pregnant women, intermittent preventive treatment for malaria in pregnancy (IPTp), syphilis detection and treatment in pregnancy, iron supplementation and hypertensive disease case management. Facility level indicators were stratified by health facility type, managing authority and location, then linked to estimates of ANC utilization in that stratum from the corresponding Demographic and Health Surveys (DHS) to generate population level estimates of the 'likelihood of appropriate care'. Finally, the association between estimates of the 'likelihood of appropriate care' from the linking approach and estimates of coverage levels from the DHS were assessed. A total of 10 534 health facilities were surveyed in the 20 health facility assessments, of which 8742 reported offering ANC services and were included in the analysis. Health facility readiness to deliver IPTp, iron supplementation, and tetanus toxoid vaccination was higher (median: 84.1%, 84.9% and 82.8% respectively) than readiness to deliver hypertensive disease case management and syphilis detection and treatment (median: 23.0% and 19.9% respectively). Coverage of at least 4 ANC visits ranged from 24.8% to 75.8%. Estimates of the likelihood of appropriate care derived from linking health facility and household survey data showed marked gaps for all interventions, particularly hypertensive disease case management and syphilis detection and treatment. There was fairly good concordance between our estimates of high likelihood of appropriate care and DHS estimates of coverage for iron supplementation, IPTp, and tetanus toxoid vaccination. Linking household surveys to health facility assessments revealed marked gaps in population-level coverage of quality ANC interventions and underscored the need for a double-pronged approach to increase ANC utilization and improve the quality of ANC services.

42 CFR 456.523 - Revised UR plan.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Review Plans: FFP, Waivers, and Variances for Hospitals and Mental Hospitals Ur Plan: Remote Facility Variances from Time Requirements § 456.523 Revised... control over the utilization of services; and (2) Conducts reviews in a way that improves the quality of...

42 CFR 456.523 - Revised UR plan.

Code of Federal Regulations, 2011 CFR

2011-10-01

...) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Review Plans: FFP, Waivers, and Variances for Hospitals and Mental Hospitals Ur Plan: Remote Facility Variances from Time Requirements § 456.523 Revised... control over the utilization of services; and (2) Conducts reviews in a way that improves the quality of...

Opportunities for Energy Efficiency and Open Automated Demand Response in Wastewater Treatment Facilities in California -- Phase I Report

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

Lekov, Alex; Thompson, Lisa; McKane, Aimee

This report summarizes the Lawrence Berkeley National Laboratory?s research to date in characterizing energy efficiency and automated demand response opportunities for wastewater treatment facilities in California. The report describes the characteristics of wastewater treatment facilities, the nature of the wastewater stream, energy use and demand, as well as details of the wastewater treatment process. It also discusses control systems and energy efficiency and automated demand response opportunities. In addition, several energy efficiency and load management case studies are provided for wastewater treatment facilities.This study shows that wastewater treatment facilities can be excellent candidates for open automated demand response and thatmore » facilities which have implemented energy efficiency measures and have centralized control systems are well-suited to shift or shed electrical loads in response to financial incentives, utility bill savings, and/or opportunities to enhance reliability of service. Control technologies installed for energy efficiency and load management purposes can often be adapted for automated demand response at little additional cost. These improved controls may prepare facilities to be more receptive to open automated demand response due to both increased confidence in the opportunities for controlling energy cost/use and access to the real-time data.« less

Standard Operating Procedure Utilization for Tuberculosis Microscopy in Mekelle City, North Ethiopia.

PubMed

Weldu, Yemane; Gebru, Hagos; Kahsay, Getahun; Teweldemedhn, Gebremichael; Hagos, Yifter; Kahsay, Amlsha

2017-01-01

The aim of this study was to assess the utilization of standard operating procedures for acid-fast bacilli (AFB) smear microscopy. A facility-based cross-sectional study was conducted in select health institutions in Mekelle City, Ethiopia, from July 1, 2015, through August 30, 2015. Using a simple random sampling technique, 18 health facilities were included in the study. Data were collected using a standard checklist and entered into Epi Info version 3.5.4 (Centers for Disease Control and Prevention, Atlanta, GA) for editing. Analysis was done using SPSS version 20 (SPSS, Chicago, IL). Of the 18 laboratory facilities, only seven (38.9%) had a legible AFB registration book. In three (16.7%) of the laboratories, heat fixation was not applied before adding primary staining reagent. In 12 (66.7%), the staining reagents had precipitates. Two laboratories had microscopes with mechanical stages that could not move freely on both axes. Seven (38.9%) of the laboratories reported samples to be negative before examining all required fields. Most laboratories, 16 (88.9%) and 17 (94.4%), respectively, did not run positive and negative controls after new batch reagent preparation. Tuberculosis microscopy was found to be substandard with clear gaps in documentation, sample collection, and processing. © American Society for Clinical Pathology, 2017. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Nuclear facility decommissioning and site remedial actions: A selected bibliography: Volume 8

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

Owen, P.T.; Michelson, D.C.; Knox, N.P.

1987-09-01

The 553 abstracted references on nuclear facility decommissioning, uranium mill tailings management, and site remedial actions constitute the eighth in a series of reports. Foreign and domestic literature of all types - technical reports, progress reports, journal articles, symposia proceedings, theses, books, patents, legislation, and research project descriptions - has been included. The bibliography contains scientific, technical, economic, regulatory, and legal information pertinent to the US Department of energy's remedial action program. Major chapters are Surplus Facilities Management Program, Nuclear Facilities Decommissioning, Formerly Utilized Sites Remedial Action Program, Facilities Contaminated with Naturally Occurring Radionuclides, Uranium Mill Tailings Remedial Action Program,more » Uranium Mill Tailings Management, Technical Measurements Center, and General Remedial Action Program Studies. Chapter sections for chapters 1, 2, 5, and 6 include Design, Planning, and Regulations; Environmental Studies and Site Surveys; Health, Safety, and Biomedical Studies; Decontamination Studies; Dismantlement and Demolition; Site Stabilization and Reclamation; Waste Disposal; Remedial Action Experience; and General Studies. Within these categories, references are arranged alphabetically by first author. Those references having no individual author are listed by corporate affiliation or by publication description. Indexes are provided for author, corporate affiliation, title word, publication description, geographic location, and keywords. The appendix contains a list of frequently used acronyms and abbreviations.« less

High-Lift Flight Tunnel - Phase II Report. Phase 2 Report

NASA Technical Reports Server (NTRS)

Lofftus, David; Lund, Thomas; Rote, Donald; Bushnell, Dennis M. (Technical Monitor)

2000-01-01

The High-Lift Flight Tunnel (HiLiFT) concept is a revolutionary approach to aerodynamic ground testing. This concept utilizes magnetic levitation and linear motors to propel an aerodynamic model through a tube containing a quiescent test medium. This medium (nitrogen) is cryogenic and pressurized to achieve full flight Reynolds numbers higher than any existing ground test facility world-wide for the range of 0.05 to 0.50 Mach. The results of the Phase II study provide excellent assurance that the HiLiFT concept will provide a valuable low-speed, high Reynolds number ground test facility. The design studies concluded that the HiLiFT facility is feasible to build and operate and the analytical studies revealed no insurmountable difficulties to realizing a practical high Reynolds number ground test facility. It was determined that a national HiLiFT facility, including development, would cost approximately $400M and could be operational by 2013 if fully funded. Study participants included National Aeronautics and Space Administration Langley Research Center as the Program Manager and MSE Technology Applications, Inc., (MSE) of Butte, Montana as the prime contractor and study integrator. MSE#s subcontractors included the University of Texas at Arlington for aerodynamic analyses and the Argonne National Laboratory for magnetic levitation and linear motor technology support.

Does closure of children's medical home impact their immunization coverage?

PubMed

Kolasa, M S; Stevenson, J; Ossa, A; Lutz, J

2014-12-01

Little is known about the impact closing a health care facility has on immunization coverage of children utilizing that facility as a medical home. The authors assessed the impact of closing a Medicaid managed care facility in Philadelphia on immunization coverage of children, primarily low income children from racial/ethnic minority groups, utilizing that facility for routine immunizations. Observational longitudinal cohort case study. Eligible children were born 03/01/05-06/30/07, present in Philadelphia's immunization information system (IIS), and were active clients of the facility before it closed in September 2007. IIS-recorded immunization coverage at ages 5, 7, 13, 16 and 19 months through January 2009 was compared between clinic children age-eligible to receive specific vaccines before clinic closing (preclosure cohorts) and children not age-eligible to receive those vaccines prior to closing (postclosure cohorts). Of 630 eligible children, 99 (16%) had no additional IIS-recorded immunizations. Third dose DTaP vaccine coverage at age seven months among preclosure cohorts was 54.4% vs. 40.3% among postclosure cohorts [risk ratio 1.31 (1.15,1.49)]. Fourth dose DTaP coverage at 19 months was 65.9% vs. 57.7% [risk ratio 1.24 (1.08,1.42)]. MMR coverage at 16 months was 79.5% vs. 69.9% [risk ratio 1.47 (1.22, 1.76)]. Coverage for the 431331 vaccination series at 19 months was 63.8% vs. 53.8% [risk ratio 1.28 (1.12,1.88)]. Immunization coverage declined at key age milestones for active clients of a Medicaid managed care that closed as compared with preclosure cohorts of clients from the same facility. When a primary health care facility closes, efforts should be made to ensure that children who had received vaccinations at that facility quickly establish a new medical home. Published by Elsevier Ltd.

Overview of the Life Science Glovebox (LSG) Facility and the Research Performed in the LSG

NASA Technical Reports Server (NTRS)

Cole, J. Michael; Young, Yancy

2016-01-01

The Life Science Glovebox (LSG) is a rack facility currently under development with a projected availability for International Space Station (ISS) utilization in the FY2018 timeframe. Development of the LSG is being managed by the Marshal Space Flight Center (MSFC) with support from Ames Research Center (ARC) and Johnson Space Center (JSC). The MSFC will continue management of LSG operations, payload integration, and sustaining following delivery to the ISS. The LSG will accommodate life science and technology investigations in a "workbench" type environment. The facility has a.Ii enclosed working volume that is held at a negative pressure with respect to the crew living area. This allows the facility to provide two levels of containment for handling Biohazard Level II and lower biological materials. This containment approach protects the crew from possible hazardous operations that take place inside the LSG work volume. Research investigations operating inside the LSG are provided approximately 15 cubic feet of enclosed work space, 350 watts of28Vdc and l IOVac power (combined), video and data recording, and real time downlink. These capabilities will make the LSG a highly utilized facility on ISS. The LSG will be used for biological studies including rodent research and cell biology. The LSG facility is operated by the Payloads Operations Integration Center at MSFC. Payloads may also operate remotely from different telescience centers located in the United States and different countries. The Investigative Payload Integration Manager (IPIM) is the focal to assist organizations that have payloads operating in the LSG facility. NASA provides an LSG qualification unit for payload developers to verify that their hardware is operating properly before actual operation on the ISS. This poster will provide an overview of the LSG facility and a synopsis of the research that will be accomplished in the LSG. The authors would like to acknowledge Ames Research Center, Johnson Space Center, Teledyne Brown Engineering, MOOG-Bradford Engineering and the entire LSG Team for their inputs into this abstract.

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.

Factors associated with utilization of skilled service delivery among women in rural Northern Ghana: a cross sectional study.

PubMed

Gudu, William; Addo, Bright

2017-05-31

Ghana's current Maternal Mortality Ratio (MMR) of 319 per 100,000 live births makes achievement of the Sustainable Development Goal of 70 maternal deaths per 100,000 live births or less by 2030 appear to be illusory. Skilled assistance during childbirth is a critical strategy to reducing maternal mortality, yet the proportion of deliveries taking place within health facilities where such assistance is provided is very low in Ghana, with huge disparity between urban and rural women. To address the gap in skilled attendance in rural Upper East Region, the Ghana Health Service (GHS) in 2005 piloted a program that involved training of Community Health Officers (CHOs) as midwives. This study explored factors associated with skilled delivery services utilization in a predominantly rural district in Ghana. A cross-sectional study, data was collected from a sample of 400 women between the ages of 15 and 49 years who had given birth a year prior to the study. We used frequencies and percentages for descriptive analysis and chi-square (χ 2 ) test for relationship between independents factors and utilization of skilled delivery services. Of the 400 women included in the analysis, 93.3% of them delivered in a health facility. Almost all of the mothers (97.3%) attended or received antenatal care at their last pregnancy with 75.0% of them having four or more ANC visits. The proportion of women who received ANC and utilized skilled delivery services was high (91.5%). Mother's educational attainment, ANC attendance, frequency of ANC visits, satisfaction with ANC services and possession of valid NHIS card significantly associated with utilisation of skilled delivery services. For a predominantly rural district, the percentage of women who deliver within health facilities where skilled assistance is available is very encouraging and a significant stride towards reducing Ghana's overall MMR. Having four or more ANC visits and improving on the quality of care provided has a great potential of improving uptake of skilled delivery services.

Quality of the delivery services in health facilities in Northern Ethiopia.

PubMed

Fisseha, Girmatsion; Berhane, Yemane; Worku, Alemayehu; Terefe, Wondwossen

2017-03-09

Substantial improvements have been observed in the coverage of and access to maternal health service, especially in skilled birth attendants, in Ethiopia. However, the quality of care has been lagging behind. Therefore, this study investigated the status of the quality of delivery services in Northern Ethiopia. A facility based survey was conducted from December 2014 to February 2015 in Northern Ethiopia. The quality of delivery service was assessed in 32 health facilities using a facility audit checklist, by reviewing delivery, by conducting in-depth interview and observation, and by conducting exit interviews with eligible mothers. Facilities were considered as 'good quality' if they scored positively on 75% of the quality indicators set in the national guidelines for all the three components; input (materials, infrastructure, and human resource), process (adherence to standard care procedures during intrapartum and immediate postpartum periods) and output (the mothers' satisfaction and utilization of lifesaving procedures). Overall 2 of 32 (6.3%) of the study facilities fulfilled all the three quality components; input, process and output. Two of the three components were assessed as good in 11 of the 32 (34.4%) health facilities. The input quality was the better of the other quality components; which was good in 21 out of the 32 (65.6%) health facilities. The process and output quality was good in only 10 of the 32 (31.3%) facilities. Only 6.3% of the studied health facilities had good quality in all three dimensions of quality measures that was done in accordance to the national delivery service guidelines. The most compromised quality component was the process. Systematic and sustained efforts need to be strengthened to improve all dimensions of quality in order to achieve the desired quality of delivery services and increase the proportion of births occurring in health facilities.

18 CFR 292.208 - Special requirements for hydroelectric small power production facilities located at a new dam or...

Code of Federal Regulations, 2010 CFR

2010-04-01

... for hydroelectric small power production facilities located at a new dam or diversion. 292.208 Section... 201 AND 210 OF THE PUBLIC UTILITY REGULATORY POLICIES ACT OF 1978 WITH REGARD TO SMALL POWER PRODUCTION AND COGENERATION Qualifying Cogeneration and Small Power Production Facilities § 292.208 Special...

18 CFR 292.208 - Special requirements for hydroelectric small power production facilities located at a new dam or...

Code of Federal Regulations, 2011 CFR

2011-04-01

... for hydroelectric small power production facilities located at a new dam or diversion. 292.208 Section... 201 AND 210 OF THE PUBLIC UTILITY REGULATORY POLICIES ACT OF 1978 WITH REGARD TO SMALL POWER PRODUCTION AND COGENERATION Qualifying Cogeneration and Small Power Production Facilities § 292.208 Special...

Correlates of service utilization among homeless youth.

PubMed

Tyler, Kimberly A; Akinyemi, Sarah L; Kort-Butler, Lisa A

2012-07-01

Though few studies exist on service utilization among homeless youth in the U.S., services are important because without them, many of these young people may resort to delinquent strategies in order to meet their daily survival needs. The current study examines frequency and correlates of service utilization (i.e., shelters, food programs, street outreach, counseling, STI and HIV testing) among a sample of 249 homeless youth ages 14 to 21. Multivariate analysis revealed significant differences in service usage by sex, age, and sexual orientation. Experiencing family physical and/or sexual abuse, being kicked out of the family home, spending more nights per week sleeping on the street, and having ever stayed in a group home facility were significant correlates of homeless youths' service usage.

Scope of Work for Integration Management and Installation Services of the National Ignition Facility Beampath Infrastructure System

NASA Astrophysics Data System (ADS)

Coyle, P. D.

2000-03-01

The goal of the National Ignition Facility (NIF) project is to provide an above ground experimental capability for maintaining nuclear competence and weapons effects simulation and to provide a facility capable of achieving fusion ignition using solid-state lasers as the energy driver. The facility will incorporate 192 laser beams, which will be focused onto a small target located at the center of a spherical target chamber-the energy from the laser beams will be deposited in a few billionths of a second. The target will then implode, forcing atomic nuclei to sufficiently high temperatures and densities necessary to achieve a miniature fusion reaction. The NIF is under construction, at Livermore, California, located approximately 50 miles southeast of San Francisco, California. The University of California, Lawrence Livermore National Laboratory (LLNL), operating under Prime Contract W-7405-ENG. 48 with the U.S. Department of Energy (DOE), shall subcontract for Integration Management and Installation (IMI) Services for the Beampath Infrastructure System (BIS). The BIS includes Beampath Hardware and Beampath Utilities. Conventional Facilities work for the NIF Laser and Target Area Building (LTAB) and Optics Assembly Building (OAB) is over 86 percent constructed. This Scope of Work is for Integration Management and Installation (IMI) Services corresponding to Management Services, Design Integration Services, Construction Services, and Commissioning Services for the NIB BIS. The BIS includes Beampath Hardware and Beampath Utilities. Beampath Hardware and Beampath Utilities include beampath vessels, enclosures, and beam tubes; auxiliary and utility systems; and support structures. A substantial amount of GFE will be provided by the University for installation as part of the infrastructure packages.

17 CFR 250.58 - Exemption of investments in certain nonutility companies.

Code of Federal Regulations, 2011 CFR

2011-04-01

... facilities,” as defined under the Public Utility Regulatory Policies Act of 1978, as amended (“PURPA”), and... primarily to enable the qualifying facility to satisfy the useful thermal output requirements under PURPA...

Space Studies Board Annual Report 1994

NASA Technical Reports Server (NTRS)

1995-01-01

The following summaries of major reports are presented: (1) 'Scientific Opportunities in the Human Exploration of Space;' (2) 'A Space Physics Paradox;' (3) 'An Integrated Strategy for the Planetary Sciences;' and (4) 'ONR (Office of Naval Research) Research Opportunities in Upper Atmospheric Sciences.' Short reports on the following topics are also presented: life and microgravity sciences and the Space Station Program, the Space Infrared Telescope Facility and the Stratospheric Observatory for infrared astronomy, the Advanced X-ray Astrophysics Facility and Cassini Saturn Probe, and the utilization of the Space Station.

Strategic Defense Initiative Demonstration/Validation Program Environmental Assessment. Space-Based Surveillance and Tracking System (SSTS),

DTIC Science & Technology

1987-08-01

take place in both contractor and government facilities. The on-orbit evaluation could utilize modified launch facilities depending on the launch...technological issues : o Telescope Optics: Verify that the distortions associated vith large optical elements satisfy detection and tracking requirements; verify...Validation program vould be car- ried out at contractor facilities that 1’ave not been identified and at six government facilities (Arnold Engineering

Waste to Watts and Water: Enabling Self-Contained Facilities Using Microbial Fuel Cells

DTIC Science & Technology

2008-05-01

suitable growing medium. LOC - Line of communications . Used in a military sense to indicate a main supply route. It includes transportation by ships...fresh water. Self-Contained Facilities - Facilities that do not rely on outside infrastructure or lines of communication for utilities such as water...require in future facilities is the ability to operate cleanly and efficiently apart from the infrastructure network and line of communications (LOCs) both

48 CFR 970.4102-1 - Policy.

Code of Federal Regulations, 2010 CFR

2010-10-01

... DOE to acquire utility service(s) by subcontract, i.e., what the benefits are, such as economic..., shall be applied to a subcontract level acquisition for furnishing utility services to a facility owned...

Critical Issues of Web-Enabled Technologies in Modern Organizations.

ERIC Educational Resources Information Center

Khosrow-Pour, Mehdi; Herman, Nancy

2001-01-01

Discusses results of a Delphi study that explored issues related to the utilization and management of Web-enabled technologies by modern organizations. Topics include bandwidth restrictions; security; data integrity; inadequate search facilities; system incompatibilities; failure to adhere to standards; email; use of metadata; privacy and…

A Long-Term Study of the Microbial Community Structure in a Simulated Chloraminated Drinking Water Distribution System - abstract

EPA Science Inventory

Many US water treatment facilities use chloramination to limit regulated disinfectant by-product formation. However, chloramination has been shown to promote nitrifying bacteria, and 30 to 63% of water utilities using secondary chloramine disinfection experience nitrification ep...

SCHOOL SITES. SELECTION AND DEVELOPMENT.

ERIC Educational Resources Information Center

REIDA, G.W.

CERTAIN CRITICAL CRITERIA SHOULD BE CONSIDERED IN SELECTING THE SCHOOL SITE. IMPORTANT IS THE STUDY OF SUCH FACTORS AS PRESENT AND PROJECTED PUPIL POPULATION, THE SCHOOL MASTER PLAN, MAIN THOROUGHFARES, DWELLINGS, LAND USE, SOILS, (SHOWN BY SERVICE MAPS), EXISTING SCHOOL FACILITIES AND ATTENDANCE, BOUNDARIES, UTILITY SERVICES AND FLOOD CONTROLS.…

Association of Inpatient Antimicrobial Utilization Measures with Antimicrobial Stewardship Activities and Facility Characteristics of Veterans Affairs Medical Centers.

PubMed

Graber, Christopher J; Jones, Makoto M; Chou, Ann F; Zhang, Yue; Goetz, Matthew Bidwell; Madaras-Kelly, Karl; Samore, Matthew H; Glassman, Peter A

2017-05-01

Antimicrobial stewardship programs (ASPs) have been advocated to improve antimicrobial utilization, but program implementation is variable. Antimicrobial stewardship programs (ASPs) have been advocated to improve antimicrobial utilization, but program implementation is variable. To determine associations between ASPs and facility characteristics, and inpatient antimicrobial utilization measures in the Veterans Affairs (VA) system in 2012. In 2012, VA administered a survey on antimicrobial stewardship practices to designated ASP contacts at VA acute care hospitals. From the survey, we identified 34 variables across 3 domains (evidence, organizational context, and facilitation) that were assessed using multivariable least absolute shrinkage and selection operator regression against 4 antimicrobial utilization measures from 2012: aggregate acute care antimicrobial use, antimicrobial use in patients with non-infectious primary discharge diagnoses, missed opportunities to convert from parenteral to oral antimicrobial therapy, and double anaerobic coverage. All 130 VA facilities with acute care services. Variables associated with at least 3 favorable changes in antimicrobial utilization included presence of postgraduate physician/pharmacy training programs, number of antimicrobial-specific order sets, frequency of systematic de-escalation review, presence of pharmacists and/or infectious diseases (ID) attendings on acute care ward teams, and formal ID training of the lead ASP pharmacist. Variables associated with 2 unfavorable measures included bed size, the level of engagement with VA Antimicrobial Stewardship Task Force online resources, and utilization of antimicrobial stop orders. Formalization of ASP processes and presence of pharmacy and ID expertise are associated with favorable utilization. Systematic de-escalation review and order set establishment may be high-yield interventions. Journal of Hospital Medicine 2017;12:301-309. © 2017 Society of Hospital Medicine

Surgical resource utilization in urban terrorist bombing: a computer simulation.

PubMed

Hirshberg, A; Stein, M; Walden, R

1999-09-01

The objective of this study was to analyze the utilization of surgical staff and facilities during an urban terrorist bombing incident. A discrete-event computer model of the emergency room and related hospital facilities was constructed and implemented, based on cumulated data from 12 urban terrorist bombing incidents in Israel. The simulation predicts that the admitting capacity of the hospital depends primarily on the number of available surgeons and defines an optimal staff profile for surgeons, residents, and trauma nurses. The major bottlenecks in the flow of critical casualties are the shock rooms and the computed tomographic scanner but not the operating rooms. The simulation also defines the number of reinforcement staff needed to treat noncritical casualties and shows that radiology is the major obstacle to the flow of these patients. Computer simulation is an important new tool for the optimization of surgical service elements for a multiple-casualty situation.

43 CFR 3274.11 - What must I give BLM to approve my commercial use permit application?

Code of Federal Regulations, 2014 CFR

2014-10-01

... configuration, including meters; (f) A schematic flow diagram of the utilization facility, including... calibration schedule of production, injection, and royalty meters; (b) A schematic diagram of the utilization... is located off the utilization site, give us a generalized schematic diagram of the electrical...

43 CFR 3274.11 - What must I give BLM to approve my commercial use permit application?

Code of Federal Regulations, 2012 CFR

2012-10-01

... configuration, including meters; (f) A schematic flow diagram of the utilization facility, including... calibration schedule of production, injection, and royalty meters; (b) A schematic diagram of the utilization... is located off the utilization site, give us a generalized schematic diagram of the electrical...

43 CFR 3274.11 - What must I give BLM to approve my commercial use permit application?

Code of Federal Regulations, 2011 CFR

2011-10-01

... configuration, including meters; (f) A schematic flow diagram of the utilization facility, including... calibration schedule of production, injection, and royalty meters; (b) A schematic diagram of the utilization... is located off the utilization site, give us a generalized schematic diagram of the electrical...

43 CFR 3274.11 - What must I give BLM to approve my commercial use permit application?

Code of Federal Regulations, 2013 CFR

2013-10-01

... configuration, including meters; (f) A schematic flow diagram of the utilization facility, including... calibration schedule of production, injection, and royalty meters; (b) A schematic diagram of the utilization... is located off the utilization site, give us a generalized schematic diagram of the electrical...

NREL, San Diego Gas & Electric Are Advancing Utility Microgrid Performance

Science.gov Websites

in Borrego Springs, California | Energy Systems Integration Facility | NREL NREL, San Diego Gas & Electric Models Utility Microgrid in Borrego Springs NREL, San Diego Gas & Electric Are Advancing Utility Microgrid Performance in Borrego Springs, California San Diego Gas & Electric Company

Using Multicriteria Analysis in Issues Concerning Adaptation of Historic Facilities for the Needs of Public Utility Buildings with a Function of a Theatre

NASA Astrophysics Data System (ADS)

Obracaj, Piotr; Fabianowski, Dariusz

2017-10-01

Implementations concerning adaptation of historic facilities for public utility objects are associated with the necessity of solving many complex, often conflicting expectations of future users. This mainly concerns the function that includes construction, technology and aesthetic issues. The list of issues is completed with proper protection of historic values, different in each case. The procedure leading to obtaining the expected solution is a multicriteria procedure, usually difficult to accurately define and requiring designer’s large experience. An innovative approach has been used for the analysis, namely - the modified EA FAHP (Extent Analysis Fuzzy Analytic Hierarchy Process) Chang’s method of a multicriteria analysis for the assessment of complex functional and spatial issues. Selection of optimal spatial form of an adapted historic building intended for the multi-functional public utility facility was analysed. The assumed functional flexibility was determined in the scope of: education, conference, and chamber spectacles, such as drama, concerts, in different stage-audience layouts.

Utility involvement in cogeneration and small power production since PURPA

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

Hallaron, S.A.

One of the objectives of PURPA was more efficient energy production through cogeneration and the use of renewable resources. Under PURPA regulations, cogeneration and small power-producing plants may file for qualifying status to receive benefits allowed by the National Energy Act. There has been a steady increase in the number of qualifying facilities (QFs) and some electric utilities have increased ownership of small power-producing facilities as well as electric purchases from QFs. QFs are not only exempt from federal and state utility regulations under PURPA, but they also may be eligible for an exemption from the provisions of the Fuelmore » Use Act of 1978 which prohibits or limits use of oil and natural gas in power plants and other major fuel-burning installations. To obtain QF status under PURPA, small power-producing facilities are limited to a capacity of 80 MW or less and must use some combination of biomass, waste, geothermal, or other renewable resource as the primary energy source. Cogenerators are not limited in size or fuel. The purchase of electricity from cogenerators and small power producers can be an attractive alternative for utilities in meeting future demands.« less

Section 210 of PURPA and solar-thermal-energy development: the current regulatory environment and suggestions for future action. Task III report

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

Not Available

Section 210 of the Public Utility Regulatory Policies Act of 1978 (PURPA) (16 U.S.C. Section 824a-3) (Attachment 1) was enacted to overcome certain institutional barriers and to provide a favorable, non-discriminatory regulatory environment for the integration of electricity-producing solar thermal and other qualifying technologies into the electric utility network. PURPA Section 210 is designed to reduce these institutional barriers for qualifying cogeneration and small power production facilities (QF's) - terminology which includes solar thermal facilities producing electricity for sale, if other prerequisites are met - by exempting certain QF's from economically burdensome legal requirements applicable to electric utilities, and bymore » requiring utilities to offer to purchase electricity from, and sell electricity to, QF's at reasonable and non-discriminatory rates. The present and future PURPA Section 210 regulatory implications for solar thermal QF's are explored. The current PURPA Section 210 regulatory environment and its consequences for solar thermal energy development are outlined. Legislation pending before Congress to amend PURPA Section 210 is described. Possible amendments to PURPA Section 210 that might further stimulate construction and operation of economically sound solar thermal facilities are explored.« less

Sitting duck or wise old owl. [electricity generation and transmission and public relations

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

Rappoport, D.M.

Utilities are building few generating stations these days, but modest customer growth means that transmission and distribution facilities must be built or rebuilt in the coming years. This means a customer typically opposing a construction project is likely to be a suburbanite worried about the effect a distribution or transmission line or substation may have on home values as well as the potential health risks posed by that facility. Those worried about the prospect of falling home prices or potential health risks have the motivation and the means to make life difficult for utilities that don't understand how the rulesmore » of the game have changed. While the profile of the protestors has changed in recent years, the views of many utility executives have not. Too many still believe the public can be ignored when it comes to siting facilities or structuring rates. Utilities will spend mightily to mollify the public after it becomes angry. But it would be less costly - and more productive - to invest in advance in an ongoing program to help avoid an angry public. If that approach is successful, those in media and government relations will find they have fewer brushfires.« less

Primary School Buildings in Asia: Administration, Facilities and Programmes.

ERIC Educational Resources Information Center

Soriano, Domingo

Primary school buildings of the Asian Member States of UNESCO are evaluated in this study, which is in three parts--(1) a statement of the purposes and procedures of the study, with comments and recommendations relating to the primary school situation, (2) a detailed analysis of the replies to the questionnaire which was utilized, and (3) a…

Utilities on the primary road system.

DOT National Transportation Integrated Search

1992-05-01

This chapter covers initial placement, adjustment, improvement, relocation, replacement and maintenance of utility facilities in, on, above, or below the right-of-way of primary highways, including attachments to primary highway structures. It embodi...

PURPA 210 avoided cost rates: Economic and implementation issues

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

Devine, M.D.; Chartock, M.A.; Gunn, E.M.

The purpose of Section 210 of the Public Utilities Regulatory Policies Act (PURPA) was to promote the utilization of waste and renewable fuels and cogeneration processes for increasing electric power supplies. It represents a radical change in policy by allowing financially unregulated parties to generate power in ''qualifying facilities'' and by requiring utilities to purchase this power at the utilities' marginal (or ''avoided'') cost. PURPA 210 has clearly had a major impact as measured by the actual and proposed number of new qualifying facilities; however, implementation has been difficult due to the adversarial nature of the process for negotiating ormore » setting the avoided cost rates. This paper reviews the pertinent PURPA rules and regulations, analyzes the status of current avoided cost rates that have been established, and discusses implementation issues and options for resolving those issues.« less

Increased Utilization of Primary Health Care Centers for Birthing Care in Tamil Nadu, India: A Visible Impact of Policies, Initiatives, and Innovations

PubMed Central

Pandian, Jayanthi; Suresh, Saradha; Desikachari, B. R.; Padmanaban, P.

2013-01-01

Background: Tamil Nadu has been showing an increasing trend in institutional deliveries since early 1990's and has now achieved near 100%. Among the institutional deliveries, a change was observed since 2006, wherein primary health centers (PHCs) showed a four-fold increase in deliveries, while other public and private health facilities showed a decline, despite equal access to all categories of health facilities. What led to this increased utilization of PHCs for birthing care? Material and Methods: Policies, documents, and published reports of the Government of Tamil Nadu (GoTN) were reviewed and interviews were conducted with the various stakeholders involved in providing birthing care in the PHCs. This study analyzes the impact of the policies and supply side initiatives and innovations which led to increase utilization of the PHCs for birthing care. Results: Scaling up of 24 × 7 services in all PHCs, upgrading PHCs with good infrastructure, human resources, and women friendly services have helped to boost the image of the PHCs. Pro-women policies like maternity benefit schemes, birth companionship, providing food, and compulsory stay for 48 h following delivery have attracted women towards PHC. Innovative strategies like maternity picnics and use of expected date of delivery (EDD) chart for follow-up have made women choose PHCs, while periodic reviews and support to staff has improved service delivery. Conclusion: Women centered policies, efficient managerial systems, quality care, and innovative marketing of services have together contributed to increased utilization of PHCs for birthing. Other states could explore the possibility of replicating this model to make optimal use the PHC facilities. PMID:26664836

Thailand's universal coverage scheme and its impact on health-seeking behavior.

PubMed

Paek, Seung Chun; Meemon, Natthani; Wan, Thomas T H

2016-01-01

Thailand's Universal Coverage Scheme (UCS) has improved healthcare access and utilization since its initial introduction in 2002. However, a substantial proportion of beneficiaries has utilized care outside the UCS boundaries. Because low utilization may be an indication of a policy gap between people's health needs and the services available to them, we investigated the patterns of health-seeking behavior and their social/contextual determinants among UCS beneficiaries in the year 2013. The study findings from the outpatient analysis showed that the use of designated facilities for care was significantly higher in low-income, unemployed, and chronic status groups. The findings from the inpatient analysis showed that the use of designated facilities for care was significantly higher in the low-income, older, and female groups. Particularly, for the low-income group, we found that they (1) had greater health care needs, (2) received a larger number of services from designated facilities, and (3) paid the least for both inpatient and outpatient services. This pro-poor impact indicated that the UCS could adequately respond to beneficiaries' needs in terms of vertical equity. However, we also found that a considerable proportion of beneficiaries utilized out-of-network services, which implied a lack of universal access to policy services from a horizontal equity point of view. Thus, the policy should continue expanding and diversifying its service benefits to strengthen horizontal equity. Particularly, private sector involvement for those who are employed as well as the increased unmet health needs of those in rural areas may be important policy priorities for that. Lastly, methodological issues such as severity adjustment and a detailed categorization of health-seeking behaviors need to be further considered for a better understanding of the policy impact.

Effect of Facility Ownership on Utilization of Arthroscopic Shoulder Surgery.

PubMed

Black, Eric M; Reynolds, John; Maltenfort, Mitchell G; Williams, Gerald R; Abboud, Joseph A; Lazarus, Mark D

2018-03-01

We examined practice patterns and surgical indications in the management of common shoulder procedures by surgeons practicing at physician-owned facilities. This study was a retrospective analysis of 501 patients who underwent arthroscopic shoulder procedures performed by five surgeons in our practice at one of five facilities during an 18-month period. Two of the facilities were physician-owned, and three of the five surgeons were shareholders. Demographics, insurance status, symptom duration, time from injury/symptom onset to the decision to perform surgery (at which time surgical consent is obtained), and time to schedule surgery were studied to determine the influence of facility type and physician shareholder status. Median duration of symptoms before surgery was significantly shorter in workers' compensation patients than in non-workers' compensation patients (47% less; P < 0.0001) and in men than in women (31% less; P < 0.001), but was not influenced by shareholder status or facility ownership (P > 0.05). Time between presentation and surgical consent was not influenced by facility ownership (P = 0.39) or shareholder status (P = 0.50). Time from consent to procedure was 13% faster in physician-owned facilities than in non-physician-owned facilities (P = 0.03) and 35% slower with shareholder physicians than with nonshareholder physicians (P < 0.0001). The role of physician investment in private healthcare facilities has caused considerable debate in the orthopaedic surgery field. To our knowledge, this study is the first to examine the effects of shareholder status and facility ownership on surgeons' practice patterns, surgical timing, and measures of nonsurgical treatment before shoulder surgery. Neither shareholder status nor facility ownership characteristics influenced the speed with which surgeons determined that shoulder surgery was indicated or surgeons' use of preoperative nonsurgical treatment. After the need for surgery was determined, patients underwent surgery sooner at physician-owned facilities than at non-physician-owned facilities and with nonshareholder physicians than with shareholder physicians. Level III.

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.

42 CFR 456.600 - Purpose.

Code of Federal Regulations, 2010 CFR

2010-10-01

... ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.600 Purpose. This subpart prescribes requirements for periodic inspections of care and services intermediate care facilities (ICF's), and institutions for mental diseases (IMD...

Technical solutions to overcrowded park and ride facilities

DOT National Transportation Integrated Search

2007-05-01

This report presents the results on potential techniques to more efficiently utilize existing park and ride : technologies and plan for future changes to the park and ride facilities. It presents: : A summary of parking monitoring and parking guidanc...

From health search to healthcare: explorations of intention and utilization via query logs and user surveys

PubMed Central

White, Ryen W; Horvitz, Eric

2014-01-01

Objective To better understand the relationship between online health-seeking behaviors and in-world healthcare utilization (HU) by studies of online search and access activities before and after queries that pursue medical professionals and facilities. Materials and methods We analyzed data collected from logs of online searches gathered from consenting users of a browser toolbar from Microsoft (N=9740). We employed a complementary survey (N=489) to seek a deeper understanding of information-gathering, reflection, and action on the pursuit of professional healthcare. Results We provide insights about HU through the survey, breaking out its findings by different respondent marginalizations as appropriate. Observations made from search logs may be explained by trends observed in our survey responses, even though the user populations differ. Discussion The results provide insights about how users decide if and when to utilize healthcare resources, and how online health information seeking transitions to in-world HU. The findings from both the survey and the logs reveal behavioral patterns and suggest a strong relationship between search behavior and HU. Although the diversity of our survey respondents is limited and we cannot be certain that users visited medical facilities, we demonstrate that it may be possible to infer HU from long-term search behavior by the apparent influence that health concerns and professional advice have on search activity. Conclusions Our findings highlight different phases of online activities around queries pursuing professional healthcare facilities and services. We also show that it may be possible to infer HU from logs without tracking people's physical location, based on the effect of HU on pre- and post-HU search behavior. This allows search providers and others to develop more robust models of interests and preferences by modeling utilization rather than simply the intention to utilize that is expressed in search queries. PMID:23666794

The Feasibility of the Nationwide Health Information Network.

PubMed

Valle, Jazmine; Gomes, Christian; Godby, Tyler; Coustasse, Alberto

2016-01-01

The Nationwide Health Information Network (NHIN) use in health care facilities was examined for utilization and efficacy; although the advantages are abundant, health care facilities have been reluctant to adopt it because of associated costs. The purpose of this study was to analyze the feasibility of a US NHIN by exploring and determining the benefits of an NHIN and assessing the barriers to its implementation. The research methodology applied in examining the implementation of NHIN in the United States was a qualitative literature review, which followed the basic guidelines of a systematic literature review, partnered with a semistructured interview of a chief information officer of a private, nonprofit, 193-bed hospital located in Westminster, Maryland. A total of 33 sources were referenced. The results of this study suggest that implementation and utilization of NHIN by health care industry stakeholders lead to an increased quality of patient care, increased patient-provider communication, and cost-savings opportunities. Increased quality of care is achieved by reducing adverse drug events and medical errors. Cost-savings opportunities are generated by a reduction in spending and prices that is attributable to electronic health record systems' increased efficiency and effectiveness. Nevertheless, barriers to NHIN implementation and utilization still remain throughout the health care industry, the main one being concerns about interoperability.

Perspectives on utilization of community based health information systems in Western Kenya.

PubMed

Flora, Otieno Careena; Margaret, Kaseje; Dan, Kaseje

2017-01-01

Health information systems (HIS) are considered fundamental for the efficient delivery of high quality health care. However, a large number of legal and practical constraints influence the design and introduction of such systems. The inability to quantify and analyse situations with credible data and to use data in planning and managing service delivery plagues Africa. Establishing effective information systems and using this data for planning efficient health service delivery is essential to district health systems' performance improvement. Community Health Units in Kenya are central points for community data collection, analysis, dissemination and use. In Kenya, data tend to be collected for reporting purposes and not for decision-making at the point of collection. This paper describes the perspectives of local users on information use in various socio-economic contexts in Kenya. Information for this study was gathered through semi-structured interviews. The interviewees were purposefully selected from various community health units and public health facilities in the study area. The data were organized and analysed manually, grouping them into themes and categories. Information needs of the community included service utilization and health status information. Dialogue was the main way of information utilization in the community. However, health systems and personal challenges impeded proper collection and use of information. The challenges experienced in health information utilization may be overcome by linkages and coordination between the community and the health facilities. The personal challenges can be remedied using a motivational package that includes training of the Community Health Workers.

Supporting NASA Facilities Through GIS

NASA Technical Reports Server (NTRS)

Ingham, Mary E.

2000-01-01

The NASA GIS Team supports NASA facilities and partners in the analysis of spatial data. Geographic Information System (G[S) is an integration of computer hardware, software, and personnel linking topographic, demographic, utility, facility, image, and other geo-referenced data. The system provides a graphic interface to relational databases and supports decision making processes such as planning, design, maintenance and repair, and emergency response.

Estimating earthquake-induced failure probability and downtime of critical facilities.

PubMed

Porter, Keith; Ramer, Kyle

2012-01-01

Fault trees have long been used to estimate failure risk in earthquakes, especially for nuclear power plants (NPPs). One interesting application is that one can assess and manage the probability that two facilities - a primary and backup - would be simultaneously rendered inoperative in a single earthquake. Another is that one can calculate the probabilistic time required to restore a facility to functionality, and the probability that, during any given planning period, the facility would be rendered inoperative for any specified duration. A large new peer-reviewed library of component damageability and repair-time data for the first time enables fault trees to be used to calculate the seismic risk of operational failure and downtime for a wide variety of buildings other than NPPs. With the new library, seismic risk of both the failure probability and probabilistic downtime can be assessed and managed, considering the facility's unique combination of structural and non-structural components, their seismic installation conditions, and the other systems on which the facility relies. An example is offered of real computer data centres operated by a California utility. The fault trees were created and tested in collaboration with utility operators, and the failure probability and downtime results validated in several ways.

Employee organizational commitment and hospital performance.

PubMed

Baird, Kevin M; Tung, Amy; Yu, Yanjie

2017-09-15

There is widespread evidence of the purported benefits of employee organizational commitment (EOC) and its impact on both individual and organizational performance. This study contributes to this literature by providing a unique insight into this relationship, focusing on the interrelationship between EOC with hospital performance and the role of the provision of adequate facilities in eliciting EOC. The aim of this study was to introduce and empirically examine a new theoretical model in which it is argued that the performance of hospitals with regard to the provision of adequate facilities (medical facilities, support facilities, and staff resources) influences the level of EOC, which in turn influences hospital performance with regard to patient care and operational effectiveness. To examine the interrelationships between the provision of adequate facilities, EOC, and hospital performance, the study utilizes a survey of hospital managers. The findings support the theoretical model, with the provision of support facilities and staff resources positively indirectly associated with both patient care and operational effectiveness through their impact on EOC. The findings highlight the importance of providing adequate facilities and EOC within hospitals and suggest that CEOs and general managers should try to enhance the provision of such resources in an attempt to elicit EOC within their hospitals. The findings suggest that managers should try to enhance their provision of adequate facilities in order to elicit EOC and enhance hospital performance. With regard to medical facilities, they should consider and incorporate the latest technology and up-to-date equipment. They should also provide adequate staff resources, including appropriate numbers of beds, nurses, and doctors, to prevent "fatigue" (West, 2001, p. 41) and provide adequate support facilities.

Impact Testing for Materials Science at NASA - MSFC

NASA Technical Reports Server (NTRS)

Sikapizye, Mitch

2010-01-01

The Impact Testing Facility (ITF) at NASA - Marshall Space Flight Center is host to different types of guns used to study the effects of high velocity impacts. The testing facility has been and continues to be utilized for all NASA missions where impact testing is essential. The Facility has also performed tests for the Department of Defense, other corporations, as well as universities across the nation. Current capabilities provided by Marshall include ballistic guns, light gas guns, exploding wire gun, and the Hydrometeor Impact Gun. A new plasma gun has also been developed which would be able to propel particles at velocities of 20km/s. This report includes some of the guns used for impact testing at NASA Marshall and their capabilities.

Meeting the challenge of competition through structured entrepreneurship.

PubMed

Cates, N R

1987-01-01

The growth of the health care industry within the last several decades has changed the very nature of health care facilities. Where once these facilities were only concerned with health-related issues, they are now concerned with their status as businesses. These facilities now utilize business functions such as marketing, advertising, sales, and strategic planning. This article explains how health care facilities can use structural entrepreneurship in order to meet the business-related challenges of the future.

An assessment of rural health care delivery system in some areas of West Bengal-an overview.

PubMed

Ray, Sandip Kumar; Basu, Subhra S; Basu, Amal Kumar

2011-01-01

A cross sectional observational study was carried out in three districts of West Bengal by following observational, quantitative and qualitative methods during July to December 2006 to find out the extent of utilization, strengths, weaknesses and gap as well as suggest recommendations in connection with health care delivery system for the state of West Bengal, India. A total of 672 episodes of illnesses were reported (2 weeks recall) by the study population of the three selected districts in three geographically separated divisions of West Bengal. None did seek care from any health facilities for treatment in case of 221 (32.89%) episodes; especially from tribal areas where in case of 76.19% none sought any health care from any facilities depended on their home remedies. In rest of episodes the (451), majority preferred government health facilities (38.58%), followed by Unqualified quacks (29.27%) due to low cost as well as living in close proximity, 27.27% preferred qualified Private practitioners and only 4.88% preferred AYUSH, as a first choice. Referral was mostly by self or by close relatives/families (61%) and not by a doctor. Awareness is required to avoid unnecessary referral. Cleanliness of the premises, face-lift, and clean toilet with privacy and availability of safe drinking water facilities could have an improved client satisfaction in rural health care delivery systems. This could be achieved through community participation with the involvement of PRI. However, as observed in the study RCH services including Family Planning as well as immunization services (preventive services) were utilized much better while there was a strong need of improvement of Post Natal Care, otherwise, Neonatal and Maternal mortality and morbidity will continue to be high.

Maize Haploid Induction and Doubling II – Experience with Exotic and Elite Maize Populations

USDA-ARS?s Scientific Manuscript database

As a follow-up to our previous study, second year information will be presented addressing questions on haploid induction and doubling, utilizing exotic and elite maize. These projects result from collaborations between Iowa State Doubled Haploid Facility (http://www.plantbreeding.iastate.edu/DHF/D...

Closing Schools without Enraging the Public.

ERIC Educational Resources Information Center

Orrell, Donald B.

In the late 1970's, declining enrollment in Raytown, Missouri, prompted the school board to employ an outside consulting firm to prepare a 10-year comprehensive demographic forecast. The enrollment forecast clearly indicated that the decline would continue. A facility utilization study found that the overall physical condition of the schools was…

The Effectiveness of an Emergent Literacy Intervention for Teenage Parents

ERIC Educational Resources Information Center

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

2016-01-01

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

Implementing a Batterer's Intervention Program in a Correctional Setting: A Tertiary Prevention Model

ERIC Educational Resources Information Center

Yorke, Nada J.; Friedman, Bruce D.; Hurt, Pat

2010-01-01

This study discusses the pretest and posttest results of a batterer's intervention program (BIP) implemented within a California state prison substance abuse program (SAP), with a recommendation for further programs to be implemented within correctional institutions. The efficacy of utilizing correctional facilities to reach offenders who…

75 FR 60093 - Record of Decision for the United States Marine Corps Basewide Utilities Infrastructure Project...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-29

... construction, operation, and maintenance of utility infrastructure upgrades, expansions, and improvements... and wastewater facilities and road improvements to Range 130. All practical means to avoid or minimize...

Development of a utility conflict management system.

DOT National Transportation Integrated Search

2009-02-01

A critical process for the timely development and delivery of highway construction projects is the early : identification and depiction of utility interests that may interfere with proposed highway facilities. The : effective management of such utili...

The effects of organization on medical utilization: an analysis of service line organization.

PubMed

Byrne, Margaret M; Charns, Martin P; Parker, Victoria A; Meterko, Mark M; Wray, Nelda P

2004-01-01

To determine whether clinical service lines in primary care and mental health reduces inpatient and urgent care utilization. All VHA medical centers were surveyed to determine whether service lines had been established in primary care or mental health care prior to the beginning of fiscal year 1997 (FY97). Facility-level data on medical utilization from Veterans Health Affairs (VHA) administrative databases were used for descriptive and multivariate regression analyses of utilization and of changes in measures between FY97 and FY98. Nine primary care-related and 5 mental health-related variables were analyzed. Primary care and mental health service lines had been established in approximately half of all facilities. Service lines varied in duration and extent of restructuring. Mere presence of a service line had no positive and several negative effects on measured outcome variables. More detailed analyses showed that some types of service lines have statistically significant and mostly negative effects on both mental health and primary care-related measures. Newly implemented service lines had significantly less improvement in measures over time than facilities with no service line. Health care organizations are implementing innovative organizational structures in hopes of improving quality of care and reducing resource utilization. We found that service lines in primary care and mental health may lead to an initial period of disruption, with little evidence of a beneficial effect on performance for longer duration service lines.

Micro-focused Small Angle Neutron Scattering and Imaging for Science and Engineering Using RTP--A Preliminary Study

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

Mohamed, Abdul Aziz; Al Rashid Megat Ahmad, Megat Harun; Md Idris, Faridah

2010-01-05

Malaysian Nuclear Agency's (Nuclear Malaysia) Small Angle Neutron Scattering (SANS) facility--(MYSANS)--is utilizing low flux of thermal neutron at the agency's 1 MW TRIGA reactor. As the design nature of the 8 m SANS facility can allow object resolution in the range between 5 and 80 nm to be obtained. It can be used to study alloys, ceramics and polymers in certain area of problems that relate to samples containing strong scatterers or contrast. The current SANS system at Malaysian Nuclear Agency is only capable to measure Q in limited range with a PSD (128x128) fixed at 4 m from themore » sample. The existing reactor hall that incorporate this MYSANS facility has a layout that prohibits the rebuilding of MYSANS therefore the position between the wavelength selector (HOPG) and sample and the PSD cannot be increased for wider Q range. The flux of the neutron at current sample holder is very low which around 10{sup 3} n/cm{sup 2}/sec. Thus it is important to rebuild the MYSANS to maximize the utilization of neutron. Over the years, the facility has undergone maintenance and some changes have been made. Modification on secondary shutter and control has been carried out to improve the safety level of the instrument. A compact micro-focus SANS method can suit this objective together with an improve cryostat system. This paper will explain some design concept and approaches in achieving higher flux and the modification needs to establish the micro-focused SANS.« less

Race/Ethnic Disparities in the Utilization of Treatment for Drug Dependent Inmates in U.S. State Correctional Facilities

PubMed Central

Nowotny, Kathryn M.

2014-01-01

This study examines race/ethnic disparities in treatment for drug dependent inmates in state correctional facilities. The data come from the 2004 Survey of Inmates in State Correctional Facilities. Fixed effects logistic regression is used to analyze treatment outcomes for 5,180 inmates housed within 286 prisons. The analysis accounts for differences in background characteristics (i.e., age, gender, marital status, foreign born status, veteran status), socioeconomic characteristics (i.e., education, employment prior to incarceration), mental health (i.e., diagnosis with a serious mental illness), and incarceration experiences (i.e., current conviction, previous incarceration episodes, time served, additional sentencing requirements, external social support, disciplinary violations). The findings identify a remarkable unmet need among drug dependent inmates in that less than one-half of drug dependent inmates had received any type of treatment in prison at the time of the interview with the most common treatment type being self-help groups. Compared to whites, drug dependent Latino inmates have significantly lower odds of utilizing treatment, yet there are no significant black-white disparities found. Implications for drug treatment within prisons are discussed. PMID:25270722

Unleashing the Power of Distributed CPU/GPU Architectures: Massive Astronomical Data Analysis and Visualization Case Study

NASA Astrophysics Data System (ADS)

Hassan, A. H.; Fluke, C. J.; Barnes, D. G.

2012-09-01

Upcoming and future astronomy research facilities will systematically generate terabyte-sized data sets moving astronomy into the Petascale data era. While such facilities will provide astronomers with unprecedented levels of accuracy and coverage, the increases in dataset size and dimensionality will pose serious computational challenges for many current astronomy data analysis and visualization tools. With such data sizes, even simple data analysis tasks (e.g. calculating a histogram or computing data minimum/maximum) may not be achievable without access to a supercomputing facility. To effectively handle such dataset sizes, which exceed today's single machine memory and processing limits, we present a framework that exploits the distributed power of GPUs and many-core CPUs, with a goal of providing data analysis and visualizing tasks as a service for astronomers. By mixing shared and distributed memory architectures, our framework effectively utilizes the underlying hardware infrastructure handling both batched and real-time data analysis and visualization tasks. Offering such functionality as a service in a “software as a service” manner will reduce the total cost of ownership, provide an easy to use tool to the wider astronomical community, and enable a more optimized utilization of the underlying hardware infrastructure.

Barriers to sexual reproductive health services and rights among young people in Mtwara district, Tanzania: a qualitative study

PubMed Central

Mbeba, Rita Moses; Mkuye, Martin Sem; Magembe, Grace Elias; Yotham, William Lubazi; Mellah, Alfred obeidy; Mkuwa, Serafina Baptist

2012-01-01

Background In Tanzania over 1/3 of the population is under 24 years. Nationwide 23% of teenagers have started childbearing. However, Mtwara Region has the highest percentage (25.5%) of teenagers who begin childbearing early. Mtwara District has a teenage pregnancy rate of 11% with young people utilizing sexual reproductive health services (SRHS) less frequently than adults.This study aimed at gaining insights on barriers to the utilization of SRHS in Mtwara district. Methods A qualitative study was carried out using focus group discussions, facility assessment interviews and case studies. A total of nine focus group discussions (comprising 8 to10 persons per group) were conducted among girls (10-18 years), community leaders and adults. Data was transcribed using pattern matching methods then merged into relevant themes for analysis and interpretation. Results The study revealed that a good number of health facilities do not have skilled service providers (SPs) on sexual reproductive health rights. Girls start sexual intercourse between 9 and12 years. Services sought included; education, family planning and voluntary counseling and testing. However, the services were inaccessible due to lack of privacy, confidentiality, equipments and negative attitudes from SPs. Initiation ceremonies, early marriages and gender disparities were mentioned as social-cultural barriers to SRH rights. Conclusion This study has demonstrated that factors such as lack of youth friendly services, gender disparity and unfavorable socio-cultural practices may create barriers to accessing adolescent SRHS and rights. Therefore, there is a need to integrate youth friendly services in health facilities and advocate for behavior change. PMID:23467684

77 FR 1780 - Notice of Passenger Facility Charge (PFC) Approvals and Disapprovals

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-11

... development--design and construction. Site utilities--design and construction. Stormwater facilities--design and construction. Airside/apron--design and construction. Landside/roadway--design and construction. General aviation terminal/apron--design and construction. Airport beacon relocation--design and...

42 CFR 456.607 - Notification before inspection.

Code of Federal Regulations, 2012 CFR

2012-10-01

....607 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.607 Notification before inspection. No facility may be...

42 CFR 456.607 - Notification before inspection.

Code of Federal Regulations, 2011 CFR

2011-10-01

....607 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.607 Notification before inspection. No facility may be...

42 CFR 456.607 - Notification before inspection.

Code of Federal Regulations, 2014 CFR

2014-10-01

....607 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.607 Notification before inspection. No facility may be...

42 CFR 456.607 - Notification before inspection.

Code of Federal Regulations, 2013 CFR

2013-10-01

....607 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.607 Notification before inspection. No facility may be...

Race/ethnic disparities in the utilization of treatment for drug dependent inmates in U.S. state correctional facilities.

PubMed

Nowotny, Kathryn M

2015-01-01

Research has documented racial and ethnic disparities in utilization, access, continuity, and quality of care for psychiatric disorders including treatment for substance use disorders among those with similar need in the general community. Currently, the extent of racial and ethnic disparities in treatment within U.S. correctional facilities is unknown. This study examines race/ethnic disparities in treatment for drug dependent inmates using the 2004 Survey of Inmates in State Correctional Facilities. Fixed effects logistic regression is used to analyze treatment outcomes for 5180 inmates housed within 286 prisons. The analysis accounts for differences in background characteristics (i.e., age, gender, marital status, foreign born status, veteran status), socioeconomic characteristics (i.e., education, employment prior to incarceration), mental health (i.e., diagnosis with a serious mental illness), and incarceration experiences (i.e., current conviction, previous incarceration episodes, time served, additional sentencing requirements, external social support, disciplinary violations). The findings identify a remarkable unmet need among drug dependent inmates in that less than one-half of drug dependent inmates had received any type of treatment in prison at the time of the interview with the most common treatment type being self-help groups. Compared to whites, drug dependent Latino inmates have significantly lower odds of utilizing treatment, yet there are no significant black--white disparities found. The current study suggests that treatment for drug dependent inmates needs to be expanded to include clinically or medically based treatment since the failure to address addictions in the criminal legal system has been identified as the single most significant reason for rearrest and recidivism once released. Copyright © 2014 Elsevier Ltd. All rights reserved.

Feasibility and clinical utility of the Japanese version of the Abbey pain scale in Japanese aged care.

PubMed

Takai, Yukari; Yamamoto-Mitani, Noriko; Chiba, Yumi; Kato, Ayako

2014-06-01

Active usage of observational pain scales in Japanese aged-care facilities has not been previously described. Therefore, to examine the feasibility and clinical utility of the Abbey Pain Scale-Japanese version (APS-J), this study examined the interrater reliability of the APS-J among a researcher, nurses, and care workers in aged-care facilities in Japan. This study also aimed to obtain nurses' and care workers' opinions on use of the scale. The following data were collected from 88 residents of two aged-care facilities: demographics, Barthel Index, Folstein Mini-Mental Examination (MMSE), 15-item Geriatric Depression Scale (GDS-15), and APS-J for pain. The researchers, nurses, and care workers independently assessed the residents' pain by using the APS-J, and intraclass correlation coefficients (ICC) for interrater reliability and Cronbach alpha for internal consistency were examined. The ICC between researchers and nurses, researchers and care workers, and nurses and care workers were 0.68, 0.74, and 0.76, respectively. Nurses and care workers were invited for focus group interviews to obtain their opinions regarding APS-J use. During these interviews, nurses and care workers stated that the observational points of APS-J subscales were the criteria they normally used to evaluate residents' pain. Several nurses and care workers reported a gap between the estimated pain intensity and APS-J score. Unclear APS-J criteria, difficulties in observing residents, and insufficient practice guidelines were also reported. Our findings indicate that the APS-J has moderate reliability and clinically utility. To facilitate APS-J usage, education and clinical guidelines for pain management may be required for nurses and care workers. Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Impact of Superstorm Sandy on Medicare Patients' Utilization of Hospitals and Emergency Departments.

PubMed

Stryckman, Benoit; Walsh, Lauren; Carr, Brendan G; Hupert, Nathaniel; Lurie, Nicole

2017-10-01

National health security requires that healthcare facilities be prepared to provide rapid, effective emergency and trauma care to all patients affected by a catastrophic event. We sought to quantify changes in healthcare utilization patterns for an at-risk Medicare population before, during, and after Superstorm Sandy's 2012 landfall in New Jersey (NJ). This study is a retrospective cohort study of Medicare beneficiaries impacted by Superstorm Sandy. We compared hospital emergency department (ED) and healthcare facility inpatient utilization in the weeks before and after Superstorm Sandy landfall using a 20% random sample of Medicare fee-for-service beneficiaries continuously enrolled in 2011 and 2012 (N=224,116). Outcome measures were pre-storm discharges (or transfers), average length of stay, service intensity weight, and post-storm ED visits resulting in either discharge or hospital admission. In the pre-storm week, hospital transfers from skilled nursing facilities (SNF) increased by 39% and inpatient discharges had a 0.3 day decreased mean length of stay compared to the prior year. In the post-storm week, ED visits increased by 14% statewide; of these additional "surge" patients, 20% were admitted to the hospital. The increase in ED demand was more than double the statewide average in the most highly impacted coastal regions (35% versus 14%). Superstorm Sandy impacted both pre- and post-storm patient movement in New Jersey; post-landfall ED surge was associated with overall storm impact, which was greatest in coastal counties. A significant increase in the number and severity of pre-storm transfer patients, in particular from SNF, as well as in post-storm ED visits and inpatient admissions, draws attention to the importance of collaborative regional approaches to healthcare in large-scale events.

Regulation and Mindful Resident Care in Nursing Homes

PubMed Central

Colón-Emeric, Cathleen S.; Plowman, Donde; Bailey, Donald; Corazzini, Kirsten; Utley-Smith, Queen; Ammarell, Natalie; Toles, Mark; Anderson, Ruth

2009-01-01

Regulatory oversight is intended to improve the health outcomes of nursing home residents, yet evidence suggests that regulations can inhibit mindful staff behaviors that are associated with effective care. We explored the influence of regulations on mindful staff behavior as it relates to resident health outcomes, and offer a theoretical explanation of why regulations sometimes enhance mindfulness and other times inhibit it. We analyzed data from an in-depth, multiple case study including field notes, interviews, and documents collected in 8 nursing homes. We completed a conceptual/thematic description using the concept of mindfulness to reframe the observations. Shared facility mission strongly impacted staff perceptions of the purpose and utility of regulations. In facilities with a resident-centered culture, regulations increased mindful behavior, whereas in facilities with a cost-focused culture, regulations reduced mindful care practices. When managers emphasized the punitive aspects of regulation we observed a decrease in mindful practices in all facilities. PMID:20479137

Inequities in utilization of reproductive and maternal health services in Ethiopia.

PubMed

Bobo, Firew Tekle; Yesuf, Elias Ali; Woldie, Mirkuzie

2017-06-19

Disparities in health services utilization within and between regional states of countries with diverse socio-cultural and economic conditions such as Ethiopia is a frequent encounter. Understanding and taking measures to address unnecessary and avoidable differences in the use of reproductive and maternal health services is a key concern in Ethiopia. The aim of the study was to examine degree of equity in reproductive and maternal health services utilization in Ethiopia. Data from Ethiopia demographic health survey 2014 was analyzed. We assessed inequities in utilization of modern contraceptive methods, antenatal care, facility based delivery and postnatal checkup. Four standard equity measurement methods were used; equity gaps, rate-ratios, concertation curve and concentration index. Inequities in service utilization were exhibited favoring women in developed regions, urban residents, most educated and the wealthy. Antenatal care by skilled provider was three times higher among women with post-secondary education than mothers with no education. Women in the highest wealth quantile had about 12 times higher skilled birth attendance than those in lowest wealth quantile. The rate of postnatal care use among urban resident was about 6 times that of women in rural area. Use of modern contraceptive methods was more equitably utilized service while, birth at health facility was less equitable across all economic levels, favoring the wealthy. Considerable inequity between and within regions of Ethiopia in the use of maternal health services was demonstrated. Strategically targeting social determinants of health with special emphasis to women education and economic empowerment will substantially contribute for altering the current situation favorably.

Energy Regulation Effects on Critical Infrastructure Protection

DTIC Science & Technology

2008-12-01

Holding Company Act (1935) PURPA Public Utility Regulatory Policies Act (1978) QF Qualifying Facility RTO Regional Transmission Organization SEC...1935 (PUHCA) and the Federal Power Act; the Public Utility Regulatory Policies Act of 1978 ( PURPA ); and the Energy Policy Acts of 1992 (EPAct 1992) and...Congress passed the Public Utility Regulatory Policies Act ( PURPA ) in 1978 which required electric utilities to buy electricity from other generating

Process cost and facility considerations in the selection of primary cell culture clarification technology.

PubMed

Felo, Michael; Christensen, Brandon; Higgins, John

2013-01-01

The bioreactor volume delineating the selection of primary clarification technology is not always easily defined. Development of a commercial scale process for the manufacture of therapeutic proteins requires scale-up from a few liters to thousands of liters. While the separation techniques used for protein purification are largely conserved across scales, the separation techniques for primary cell culture clarification vary with scale. Process models were developed to compare monoclonal antibody production costs using two cell culture clarification technologies. One process model was created for cell culture clarification by disc stack centrifugation with depth filtration. A second process model was created for clarification by multi-stage depth filtration. Analyses were performed to examine the influence of bioreactor volume, product titer, depth filter capacity, and facility utilization on overall operating costs. At bioreactor volumes <1,000 L, clarification using multi-stage depth filtration offers cost savings compared to clarification using centrifugation. For bioreactor volumes >5,000 L, clarification using centrifugation followed by depth filtration offers significant cost savings. For bioreactor volumes of ∼ 2,000 L, clarification costs are similar between depth filtration and centrifugation. At this scale, factors including facility utilization, available capital, ease of process development, implementation timelines, and process performance characterization play an important role in clarification technology selection. In the case study presented, a multi-product facility selected multi-stage depth filtration for cell culture clarification at the 500 and 2,000 L scales of operation. Facility implementation timelines, process development activities, equipment commissioning and validation, scale-up effects, and process robustness are examined. © 2013 American Institute of Chemical Engineers.

Overview of Opportunities for Co-Location of Solar Energy Technologies and Vegetation

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

Macknick, Jordan; Beatty, Brenda; Hill, Graham

2013-12-01

Large-scale solar facilities have the potential to contribute significantly to national electricity production. Many solar installations are large-scale or utility-scale, with a capacity over 1 MW and connected directly to the electric grid. Large-scale solar facilities offer an opportunity to achieve economies of scale in solar deployment, yet there have been concerns about the amount of land required for solar projects and the impact of solar projects on local habitat. During the site preparation phase for utility-scale solar facilities, developers often grade land and remove all vegetation to minimize installation and operational costs, prevent plants from shading panels, and minimizemore » potential fire or wildlife risks. However, the common site preparation practice of removing vegetation can be avoided in certain circumstances, and there have been successful examples where solar facilities have been co-located with agricultural operations or have native vegetation growing beneath the panels. In this study we outline some of the impacts that large-scale solar facilities can have on the local environment, provide examples of installations where impacts have been minimized through co-location with vegetation, characterize the types of co-location, and give an overview of the potential benefits from co-location of solar energy projects and vegetation. The varieties of co-location can be replicated or modified for site-specific use at other solar energy installations around the world. We conclude with opportunities to improve upon our understanding of ways to reduce the environmental impacts of large-scale solar installations.« less

Why is continuum of care from home to health facilities essential to improve perinatal survival?

PubMed

Bahl, Rajiv; Qazi, Shamim; Darmstadt, Gary L; Martines, Jose

2010-12-01

The period around the time of delivery is extremely hazardous for infants in developing countries. After the first week the risk drops sharply, and survival improves markedly. To reduce perinatal mortality, a continuum of care between the home and the various facilities is essential during pregnancy, childbirth and the newborn period. This paper reviews strategies to promote the establishment of this continuum: providing health care within or close to home by frontline workers and increasing the use of services in health facilities through community mobilization and financing strategies. As perinatal care and care for seriously sick children face common challenges and lessons could be learned from successful strategies for management of other illnesses, this paper also reviews intervention models involving community health workers (CHWs) to improve case management of sick children at the household and community levels. Available evidence suggests that the community strategy with the greatest impact on neonatal mortality is home visits by CHWs combined with community mobilization. The same strategy appears to be effective in increasing health facility utilization. An equally effective strategy for increasing health facility utilization seems to be financing health care to remove financial access barriers, particularly using conditional cash transfers or vouchers. Although the availability of information on the effect of community interventions to improve newborn health has increased in the recent past, significant gaps remain. Information on the effectiveness of strategies in different settings, particularly in sub-Saharan Africa, cost-effectiveness and sustainability are particularly needed and should be gathered in future studies. Copyright © 2010 Elsevier Inc. All rights reserved.

Utilization of the Philippine Research Reactor as a training facility for nuclear power plant operators

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

Palabrica, R.J.

1981-01-01

The Philippines has a 1-MW swimming-pool reactor facility operated by the Philippine Atomic Energy Commission (PAEC). The reactor is light-water moderated and cooled, graphite reflected, and fueled with 90% enriched uranium. Since it became critical in 1963 it has been utilized for research, radioisotope production, and training. It was used initially in the training of PAEC personnel and other research institutions and universities. During the last few years, however, it has played a key role in training personnel for the Philippine Nuclear Power Project (PNPP).

Saturn Apollo Program

NASA Image and Video Library

1968-03-01

The Saturn 1B first stage (S-IB) enters the NASA barge Point Barrow, in March 1968. The Marshall Space Flight Center (MSFC) utilized a number of water transportation craft to transport the Saturn stages to-and-from the manufacturing facilities and test sites, as well as delivery to the Kennedy Space Center for launch. Developed by the Marshall Space Flight Center and built by the Chrysler Corporation at Michoud Assembly Facility (MAF), the S-IB utilized the eight H-1 engines and each produced 200,000 pounds of thrust, a combined thrust of 1,600,000 pounds.

Coal conversion products Industrial applications

NASA Technical Reports Server (NTRS)

Warren, D.; Dunkin, J.

1980-01-01

The synfuels economic evaluation model was utilized to analyze cost and product economics of the TVA coal conversion facilities. It is concluded that; (1) moderate yearly future escalations ( 6%) in current natural gas prices will result in medium-Btu gas becoming competitive with natural gas at the plant boundary; (2) utilizing DRI price projections, the alternate synfuel products, except for electricity, will be competitive with their counterparts; (3) central site fuel cell generation of electricity, utilizing MBG, is economically less attractive than the other synthetic fuels, given projected price rises in electricity produced by other means; and (4) because of estimated northern Alabama synfuels market demands, existing conventional fuels, infrastructure and industrial synfuels retrofit problems, a diversity of transportable synfuels products should be produced by the conversion facility.

Optimizing utility owner participation in the project development and delivery process.

DOT National Transportation Integrated Search

2013-04-01

Coordination with utility owners during the project development and delivery process involves multiple : activities, such as requesting and collecting data about the location and characteristics of existing facilities to : identifying and analyzing u...

Utility accommodation policy of the Iowa State Highway Commission.

DOT National Transportation Integrated Search

1970-05-01

This policy covers initial placement, adjustment, relocation and : replacement of utility facilities in, on, above or below all highway : rightof way over:Wnicn tneiowa.~state :Hig'hwaycommission exercises : control of access. It embodies the bas...

Impact of referral transport system on institutional deliveries in Haryana, India.

PubMed

Prinja, Shankar; Jeet, Gursimer; Kaur, Manmeet; Aggarwal, Arun Kumar; Manchanda, Neha; Kumar, Rajesh

2014-06-01

Creation of a strong referral transport network across the country is necessary for improving physical access to public sector health facilities. In this study we evaluated the referral transport services in Haryana, i.e. Haryana Swasthya Vaahan Sewa (HSVS), now known as National Ambulance Service (NAS), to assess the extent and pattern of utilization, and to ascertain its effect on public sector institutional deliveries. Secondary data on 116,562 patients transported during April to July 2011 in Haryana state were analysed to assess extent and pattern of NAS utilization. Exit interviews were conducted with 270 consecutively selected users and non- users of referral services respectively in Ambala (High NAS utilization), Hisar (medium utilization) and Narnaul (low utilization) districts. Month-wise data on institutional deliveries in public facilities during 2005-2012 were collected in these three districts, and analysed using interrupted time series analysis to assess the impact of NAS on institutional deliveries. Female gender (OR=77.7), rural place of residence (OR=5.96) and poor socio-economic status (poorest wealth quintile OR=2.64) were significantly associated with NAS ambulance service usage. Institutional deliveries in Haryana rose significantly after the introduction of NAS service in Ambala (OR=137.4, 95% CI=22.4-252.4) and Hisar (OR=215, 95% CI=88.5-341.3) districts. No significant increase was observed in Narnaul (OR=4.5, 95% CI=-137.4 to 146.4) district. The findings of the present study showed a positive effect of referral transport service on increasing institutional deliveries. However, this needs to be backed up with adequate supply of basic and emergency obstetric care at hospitals and health centres.

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

NASA Technical Reports Server (NTRS)

1978-01-01

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

Assessing infection control practices to protect health care workers and patients in Malawi from nosocomial transmission of Mycobacterium tuberculosis.

PubMed

Flick, Robert J; Munthali, Adamson; Simon, Katherine; Hosseinipour, Mina; Kim, Maria H; Mlauzi, Lameck; Kazembe, Peter N; Ahmed, Saeed

2017-01-01

Transmission of Mycobacterium tuberculosis (TB) in health settings threatens health care workers and people living with HIV in sub-Saharan Africa. Nosocomial transmission is reduced with implementation of infection control (IC) guidelines. The objective of this study is to describe implementation of TB IC measures in Malawi. We conducted a cross-sectional study utilizing anonymous health worker questionnaires, semi-structured interviews with facility managers, and direct observations at 17 facilities in central Malawi. Of 592 health care workers surveyed, 34% reported that all patients entering the facility were screened for cough and only 8% correctly named the four most common signs and symptoms of TB in adults. Of 33 managers interviewed, 7 (21%) and 1 (3%) provided the correct TB screening questions for use in adults and children, respectively. Of 592 health workers, only 2.4% had been screened for TB in the previous year. Most (90%) reported knowing their HIV status, 53% were tested at their facility of employment, and half reported they would feel comfortable receiving ART or TB treatment at their facility of employment. We conclude that screening is infrequently conducted and knowledge gaps may undercut its effectiveness. Further, health care workers do not routinely access TB and HIV diagnostic and treatment services at their facility of employment.

42 CFR 456.610 - Basis for determinations.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.610 Basis for determinations. In making the... psychiatric facilities, and mental hospitals; and (2) At least quarterly in ICFs; (c) Tests or observations of...

42 CFR 475.105 - Prohibition against contracting with health care facilities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... facilities. 475.105 Section 475.105 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS QUALITY IMPROVEMENT ORGANIZATIONS Utilization and Quality Control Quality Improvement Organizations § 475.105 Prohibition against contracting...

SOLVENT-FREE FACILE SYNTHESIS OF NOVEL α-TOSYLOXY β-KETO SULFONES USING [HYDROXY(TOSYLOXY)IODO]BENZENE

EPA Science Inventory

A facile, general and high yielding protocol for the synthesis of novel α-tosyloxy β-keto sulfones is described utilizing relatively non-toxic, [hydroxy(tosyloxy)iodo]benzene, under solvent-free conditions at room temperature.

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.

The Generic Data Capture Facility

NASA Technical Reports Server (NTRS)

Connell, Edward B.; Barnes, William P.; Stallings, William H.

1987-01-01

The Generic Data Capture Facility, which can provide data capture support for a variety of different types of spacecraft while enabling operations costs to be carefully controlled, is discussed. The data capture functions, data protection, isolation of users from data acquisition problems, data reconstruction, and quality and accounting are addressed. The TDM and packet data formats utilized by the system are described, and the development of generic facilities is considered.

43 CFR 3271.13 - How do I obtain approval to build pipelines and facilities connecting the well field to...

Code of Federal Regulations, 2011 CFR

2011-10-01

... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false How do I obtain approval to build pipelines and facilities connecting the well field to utilization facilities not located on Federal lands leased for geothermal resources? 3271.13 Section 3271.13 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF LAND...

43 CFR 3271.13 - How do I obtain approval to build pipelines and facilities connecting the well field to...

Code of Federal Regulations, 2013 CFR

2013-10-01

... 43 Public Lands: Interior 2 2013-10-01 2013-10-01 false How do I obtain approval to build pipelines and facilities connecting the well field to utilization facilities not located on Federal lands leased for geothermal resources? 3271.13 Section 3271.13 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF LAND...