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Sample records for management methodology utilizing

  1. Curriculum Design: Nurse Educator's Role in Managing and Utilizing Various Teaching Methodologies.

    ERIC Educational Resources Information Center

    Walters, Norma J.

    The role of the nurse educator in curriculum design in the future is considered. Changing technology, shifts in patient care agencies, legislation and long-term care specialties in nursing are all factors that will have a significant impact on curricula. Plans for managing and utilizing various teaching methodologies will be an important role for…

  2. TANK OPERATIONS CONTRACT CONSTRUCTION MANAGEMENT METHODOLOGY UTILIZING THE AGENCY METHOD OF CONSTRUCTION MANAGEMENT

    SciTech Connect

    LESKO KF; BERRIOCHOA MV

    2010-02-26

    Washington River Protection Solutions, LLC (WRPS) has faced significant project management challenges in managing Davis-Bacon construction work that meets contractually required small business goals. The unique challenge is to provide contracting opportunities to multiple small business constructioin subcontractors while performing high hazard work in a safe and productive manner. Previous to the WRPS contract, construction work at the Hanford Tank Farms was contracted to large companies, while current Department of Energy (DOE) Contracts typically emphasize small business awards. As an integral part of Nuclear Project Management at Hanford Tank Farms, construction involves removal of old equipment and structures and installation of new infrastructure to support waste retrieval and waste feed delivery to the Waste Treatment Plant. Utilizing the optimum construction approach ensures that the contractors responsible for this work are successful in meeting safety, quality, cost and schedule objectives while working in a very hazardous environment. This paper descirbes the successful transition from a traditional project delivery method that utilized a large business general contractor and subcontractors to a new project construction management model that is more oriented to small businesses. Construction has selected the Agency Construction Management Method (John E Schaufelberger, Len Holm, "Management of Construction Projects, A Constructor's Perspective", University of Washington, Prentice Hall 2002). This method was implemented in the first quarter of Fiscal Year 2009 (FY2009), where Construction Management is performed by substantially home office resources from the URS Northwest Office in Richland, Washington. The Agency Method has allowed WRPS to provide proven Construction Managers and Field Leads to mentor and direct small business contractors, thus providing expertise and assurance of a successful project. Construction execution contracts are subcontracted

  3. Uncertainty management in telecommunications uninterruptible power supply systems and on their network by utilizing human reasoning methodology

    NASA Astrophysics Data System (ADS)

    Suntio, Teuvo

    1992-01-01

    A study to find the essential and important matters which can effect the reliable uninterrupted operation of telecommunications power supply systems and to suggest an optimal uncertainty management scheme is reported. The main goal was to find simple and practical but effective methods on which the uncertainty management and the implementation of its tool can be based. Uncertainty management ensures that there is enough reserve energy and minimizes additional uncertainties. It turned out that an optimal solution can be obtained by means of intelligent supervision, control and alarm facilities by utilizing human reasoning methodology, and minimize-uncertainty principles.

  4. Analytical Utility of Campylobacter Methodologies

    USDA-ARS?s Scientific Manuscript database

    The National Advisory Committee on Microbiological Criteria for Foods (NACMCF, or the Committee) was asked to address the analytical utility of Campylobacter methodologies in preparation for an upcoming United States Food Safety and Inspection Service (FSIS) baseline study to enumerate Campylobacter...

  5. 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…

  6. 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…

  7. Utilization management in microbiology.

    PubMed

    Branda, John A; Lewandrowski, Kent

    2014-01-01

    The available literature concerning utilization management in the clinical microbiology laboratory is relatively limited compared with that for high-volume, automated testing in the central Core Laboratory. However, the same strategies employed elsewhere in the clinical laboratory operation can be applied to utilization management challenges in microbiology, including decision support systems, application of evidence-based medicine, screening algorithms and gatekeeper functions. The results of testing in the microbiology laboratory have significant effects on the cost of clinical care, especially costs related to antimicrobial agents and infection control practices. Consequently many of the successful utilization management interventions described in clinical microbiology have targeted not just the volume of tests performed in the laboratory, but also the downstream costs of care. This article will review utilization management strategies in clinical microbiology, including specific examples from our institution and other healthcare organizations.

  8. Tribal water utility management

    SciTech Connect

    Not Available

    1993-03-01

    Contents: primacy program (what is primacy, advantages and disadvantages, treatment as a state, grant applications and funding); safe drinking water act (sampling requirements, coliform standard, public notification, surface water treatment rule impacts, uic and wellhead protection programs, lead/copper rule); water utility management (how is the utility program evaluated, who's responsible, what is the board and tribal council role).

  9. TANK OPERATIONS CONTRACT CONSTRUCTION MANAGEMENT METHODOLOGY UTILIZING THE AGENCY METHOD OF CONSTRUCTION MANAGEMENT TO SAFELY AND EFFECTIVELY COMPLETE NUCLEAR CONSTRUCTION WORK

    SciTech Connect

    LESO KF; HAMILTON HM; FARNER M; HEATH T

    2010-01-14

    Washington River Protection Solutions, LLC (WRPS) has faced significant project management challenges in managing Davis-Bacon construction work that meets contractually required small business goals. The unique challenge is to provide contracting opportunities to multiple small business construction subcontractors while performing high hazard work in a safe and productive manner. Previous to the Washington River Protection Solutions, LLC contract, Construction work at the Hanford Tank Farms was contracted to large companies, while current Department of Energy (DOE) Contracts typically emphasize small business awards. As an integral part of Nuclear Project Management at Hanford Tank Farms, construction involves removal of old equipment and structures and installation of new infrastructure to support waste retrieval and waste feed delivery to the Waste Treatment Plant. Utilizing the optimum construction approach ensures that the contractors responsible for this work are successful in meeting safety, quality, cost and schedule objectives while working in a very hazardous environment. This paper describes the successful transition from a traditional project delivery method that utilized a large business general contractor and subcontractors to a new project construction management model that is more oriented to small businesses. Construction has selected the Agency Construction Management Method. This method was implemented in the first quarter of Fiscal Year (FY) 2009, where Construction Management is performed by substantially home office resources from the URS Northwest Office in Richland, Washington. The Agency Method has allowed WRPS to provide proven Construction Managers and Field Leads to mentor and direct small business contractors, thus providing expertise and assurance of a successful project. Construction execution contracts are subcontracted directly by WRPS to small or disadvantaged contractors that are mentored and supported by DRS personnel. Each small

  10. Utilization Costs of Capital Resources Used by Navy Training Schools: A Methodology,

    DTIC Science & Technology

    A research study was undertaken which developed a methodology for costing capital resource utilization (real property) by Navy training schools. The... methodology was applied in several examples demonstrating the capability of the utilization cost methodology to provide Navy training school managers, at all levels, with a more realistic and representative total training cost.

  11. Project Management Methodology in Human Resource Management

    ERIC Educational Resources Information Center

    Josler, Cheryl; Burger, James

    2005-01-01

    When charged with overseeing a project, how can one ensure that the project will be completed on time, within budget, and to the satisfaction of everyone involved? In this article, the authors examine project management methodology as a means of ensuring that projects are conducted in a disciplined, well-managed and consistent manner that serves…

  12. Project Management Methodology in Human Resource Management

    ERIC Educational Resources Information Center

    Josler, Cheryl; Burger, James

    2005-01-01

    When charged with overseeing a project, how can one ensure that the project will be completed on time, within budget, and to the satisfaction of everyone involved? In this article, the authors examine project management methodology as a means of ensuring that projects are conducted in a disciplined, well-managed and consistent manner that serves…

  13. Utilization management in anatomic pathology.

    PubMed

    Lewandrowski, Kent; Black-Schaffer, Steven

    2014-01-01

    There is relatively little published literature concerning utilization management in anatomic pathology. Nonetheless there are many utilization management opportunities that currently exist and are well recognized. Some of these impact only the cost structure within the pathology department itself whereas others reduce charges for third party payers. Utilization management may result in medical legal liabilities for breaching the standard of care. For this reason it will be important for pathology professional societies to develop national utilization guidelines to assist individual practices in implementing a medically sound approach to utilization management. © 2013.

  14. Decision methodology for the resource utilization of rangeland watersheds

    SciTech Connect

    Khalili, D.

    1986-01-01

    Degradation of rangeland resources leading to the desertification process is viewed in terms of human and climatic influences. While climatic impacts are important, resource utilization as practiced by man is the major cause of desertification. A multi-objective decision methodology developed here is intended for the analysis of alternative management plans of rangeland watersheds under climatic variability. First, a system model is employed to portray the dynamics of a rangeland as it would respond to climatic changes and different grazing intensities. This approach allows for an interaction of inputs such as rainfall, solar radiation, and temperature with the sate of the system which is a range condition index, and with outputs such as production and sediment yield. A simulation package is developed to implement the system model by actually using available data and providing some output values for production and sediment yield. At this stage a number of alternative management plans are identified. The information obtained from the simulation as well as other information of interest are represented by performance criteria, leading to an array of alternative versus criteria. Then, management plans need to be evaluated as they would impact the criteria. A multi-objective decision-making technique is selected to perform the analysis for an identification of preferred management alternatives.

  15. Primary urban energy-management-planning methodology

    SciTech Connect

    Revis, Joseph; Meador, Toni

    1980-11-01

    Metropolitan Dade County, Florida, developed a pragmatic, transferable methodology to assist local governments in attempts to develop and implement energy management plans. A summary of that work is presented and suggestions are provided to guide the application and refinement of a Primary Urban Energy Management Planning Methodology. The methodology provides local governments with the systematic approach for dealing with short and intermediate-term urban energy management problems while at the same time laying the groundwork for the formulation of long-term energy management activities. The five tasks of the methodology summarized are: organizing for the PEP process; performing an energy use and supply inventory; formulating energy management goals and objectives; developing strategies to achieve the energy management objectives; and monitoring and evaluation. (MCW)

  16. Utilization and management of alder.

    Treesearch

    David G. Briggs; Dean S. DeBell; William A. Atkinson

    1978-01-01

    In the Pacific Northwest and British Columbia, red alder often grows on forest lands following natural or man-caused disturbances. Frequently ignored as a pest or weed, many alder stands have developed to the point where important utilization and management questions are being asked. It is recognized that alder is a fast growing species, and that its rapid early growth...

  17. Solid Waste Management Planning--A Methodology

    ERIC Educational Resources Information Center

    Theisen, Hilary M.; And Others

    1975-01-01

    This article presents a twofold solid waste management plan consisting of a basic design methodology and a decision-making methodology. The former provides a framework for the developing plan while the latter builds flexibility into the design so that there is a model for use during the planning process. (MA)

  18. Solid Waste Management Planning--A Methodology

    ERIC Educational Resources Information Center

    Theisen, Hilary M.; And Others

    1975-01-01

    This article presents a twofold solid waste management plan consisting of a basic design methodology and a decision-making methodology. The former provides a framework for the developing plan while the latter builds flexibility into the design so that there is a model for use during the planning process. (MA)

  19. Management methodology for pressure equipment

    NASA Astrophysics Data System (ADS)

    Bletchly, P. J.

    Pressure equipment constitutes a significant investment in capital and a major proportion of potential high-risk plant in many operations and this is particularly so in an alumina refinery. In many jurisdictions pressure equipment is also subject to statutory regulation that imposes obligations on Owners of the equipment with respect to workplace safety. Most modern technical standards and industry codes of practice employ a risk-based approach to support better decision making with respect to pressure equipment. For a management system to be effective it must demonstrate that risk is being managed within acceptable limits.

  20. Basic Project Management Methodologies for Survey Researchers.

    ERIC Educational Resources Information Center

    Beach, Robert H.

    To be effective, project management requires a heavy dependence on the document, list, and computational capability of a computerized environment. Now that microcomputers are readily available, only the rediscovery of classic project management methodology is required for improved resource allocation in small research projects. This paper provides…

  1. Optimizing value utilizing Toyota Kata methodology in a multidisciplinary clinic.

    PubMed

    Merguerian, Paul A; Grady, Richard; Waldhausen, John; Libby, Arlene; Murphy, Whitney; Melzer, Lilah; Avansino, Jeffrey

    2015-08-01

    Value in healthcare is measured in terms of patient outcomes achieved per dollar expended. Outcomes and cost must be measured at the patient level to optimize value. Multidisciplinary clinics have been shown to be effective in providing coordinated and comprehensive care with improved outcomes, yet tend to have higher cost than typical clinics. We sought to lower individual patient cost and optimize value in a pediatric multidisciplinary reconstructive pelvic medicine (RPM) clinic. The RPM clinic is a multidisciplinary clinic that takes care of patients with anomalies of the pelvic organs. The specialties involved include Urology, General Surgery, Gynecology, and Gastroenterology/Motility. From May 2012 to November 2014 we performed time-driven activity-based costing (TDABC) analysis by measuring provider time for each step in the patient flow. Using observed time and the estimated hourly cost of each of the providers we calculated the final cost at the individual patient level, targeting clinic preparation. We utilized Toyota Kata methodology to enhance operational efficiency in an effort to optimize value. Variables measured included cost, time to perform a task, number of patients seen in clinic, percent value-added time (VAT) to patients (face to face time) and family experience scores (FES). At the beginning of the study period, clinic costs were $619 per patient. We reduced conference time from 6 min/patient to 1 min per patient, physician preparation time from 8 min to 6 min and increased Medical Assistant (MA) preparation time from 9.5 min to 20 min, achieving a cost reduction of 41% to $366 per patient. Continued improvements further reduced the MA preparation time to 14 min and the MD preparation time to 5 min with a further cost reduction to $194 (69%) (Figure). During this study period, we increased the number of appointments per clinic. We demonstrated sustained improvement in FES with regards to the families overall experience with their providers

  2. Space station data management system assessment methodology

    NASA Technical Reports Server (NTRS)

    Jones, W. R.; Bahrs, D. L.

    1986-01-01

    A computer-aided modeling tool and methodology was developed and is currently being used to assess candidate designs for the Space Station Data Management System (DMS). The DMS will be a complex distributed computer system including processors, storage devices, local area networks, and software that will support all processing functions on board the Space Station. The methodology produces assessments of the performance, reliability, cost, and physical attributes of the candidate designs. This paper describes the architecture and design of the modeling tool and presents the modeling methodology.

  3. Integrated Management System - Scope, Possibilities And Methodology

    NASA Astrophysics Data System (ADS)

    Čekanová, Katarína

    2015-06-01

    Organizations are becoming more aware of the importance of integrated management systems (IMS). Interest in this subject indicates that IMS are seen as "management systems of the future". Based on this, the aim of this articles characterizes the possibility of building IMS through the identification of common elements and specific requirements in accordance with the ISO 9001, ISO 14001 and OHSAS 18001 professional references. Part of the article is the methodology of building IMS in the organization.

  4. Utilization Management and ACR Select.

    PubMed

    Cooke, Robert

    2015-01-01

    The ACR, published as ACR Select, provides an industry standard for imaging and through its experience with Appropriateness Criteria, is positioned to respond quickly to changing market demands. It has added hundreds of clinically relevant indications to ensure that even common scenarios have coverage. ACR Select is inclusive of numerous other credible content sources and actively receives vetted criteria from other medical specialty societies. ACR Select is well established in the market and available for integration into multiple physician access points. It also has support for the provisions and requirements of PL113-93. Healthcare providers have adopted ACR Select within their physician access points to deliver higher quality imaging services and understand the impact that imaging has on the overall care cycle. This better positions these providers to participate in risk-based contracts based on the value that appropriate imaging delivers. With the passage of PAMA, Congress has set a powerful precedent that has created the opportunity for every healthcare payer to transform the way imaging utilization is managed. Physicians will be required to consult Appropriateness Criteria delivered through CDS when placing orders for HTDI exams for Medicaid patients, and this can easily extend across the entire payer mix. PAMA has passed into public law (PLI113-93) and represents an opportunity for healthcare providers to develop risk based payment models across all imaging services, regardless of the payer of the claim or care setting.

  5. Methodological Challenges Collecting Parent Phone-Call Healthcare Utilization Data

    PubMed Central

    Moreau, Paula; Crawford, Sybil; Sullivan-Bolyai, Susan

    2015-01-01

    Recommendations by the National Institute of Nursing Research and other groups have strongly encouraged nurses to pay greater attention to cost-effectiveness analysis when conducting research. Given the increasing prominence of translational science and comparative effective research, cost-effective analysis has become a basic tool in determining intervention value in research. Tracking phone-call communication (number of calls and context) with cross-checks between parents and healthcare providers is an example of this type of healthcare utilization data collection. This article identifies some methodological challenges that have emerged in the process of collecting this type of data in a randomized controlled trial: Parent education Through Simulation-Diabetes (PETS-D). We also describe ways in which those challenges have been addressed with comparison data results, and make recommendations for future research. PMID:26856491

  6. Methodological challenges collecting parent phone-call healthcare utilization data.

    PubMed

    Moreau, Paula; Crawford, Sybil; Sullivan-Bolyai, Susan

    2016-02-01

    Recommendations by the National Institute of Nursing Research and other groups have strongly encouraged nurses to pay greater attention to cost-effectiveness analysis when conducting research. Given the increasing prominence of translational science and comparative effective research, cost-effective analysis has become a basic tool in determining intervention value in research. Tracking phone-call communication (number of calls and context) with cross-checks between parents and healthcare providers is an example of this type of healthcare utilization data collection. This article identifies some methodological challenges that have emerged in the process of collecting this type of data in a randomized controlled trial: Parent education Through Simulation-Diabetes (PETS-D). We also describe ways in which those challenges have been addressed with comparison data results, and make recommendations for future research. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. SLURM: Simple Linux Utility for Resource Management

    SciTech Connect

    Jette, M; Grondona, M

    2002-12-19

    Simple Linux Utility for Resource Management (SLURM) is an open source, fault-tolerant, and highly scalable cluster management and job scheduling system for Linux clusters of thousands of nodes. Components include machine status, partition management, job management, scheduling and stream copy modules. This paper presents an overview of the SLURM architecture and functionality.

  8. SLURM: Simplex Linux Utility for Resource Management

    SciTech Connect

    Jette, M; Grondona, M

    2003-04-22

    Simple Linux Utility for Resource Management (SLURM) is an open source, fault-tolerant, and highly scalable cluster management and job scheduling system for Linux clusters of thousands of nodes. Components include machine status, partition management, job management, scheduling, and stream copy modules. This paper presents an overview of the SLURM architecture and functionality.

  9. Knowledge management performance methodology regarding manufacturing organizations

    NASA Astrophysics Data System (ADS)

    Istrate, C.; Herghiligiu, I. V.

    2016-08-01

    The current business situation is extremely complicated. Business must adapt to the changes in order (a) to survive on the increasingly dynamic markets, (b) to meet customers’ new request for complex, customized and innovative products. In modern manufacturing organizations it can be seen a substantial improvement regarding the management of knowledge. This occurs due to the fact that organizations realized that knowledge and an efficient management of knowledge generates the highest value. Even it could be said that the manufacturing organizations were and are the biggest beneficiary of KM science. Knowledge management performance (KMP) evaluation in manufacturing organizations can be considered as extremely important because without measuring it, they are unable to properly assess (a) what goals, targets and activities must have continuity, (b) what must be improved and (c) what must be completed. Therefore a proper KM will generate multiple competitive advantages for organizations. This paper presents a developed methodological framework regarding the KMP importance regarding manufacturing organizations. This methodological framework was developed using as research methods: bibliographical research and a panel of specialists. The purpose of this paper is to improve the evaluation process of KMP and to provide a viable tool for manufacturing organizations managers.

  10. Documenting Living Monuments in Indonesia: Methodology for Sustainable Utility

    NASA Astrophysics Data System (ADS)

    Suryaningsih, F.; Purwestri, N.

    2013-07-01

    The systematic documentation of cultural heritage in Indonesia has been developed after the establishment of Bataviaasch Genootschap van Kunsten en Wetenschappen (1778) and De Oudheidkundige Dienst (1913) by the Netherlands Indies government. After Indonesian independent, the tasks of cultural heritage documentation take over by The Ministry of Culture (now become The Ministry of Education of Culture) with focus on the ancient and classical heritage, so called dead monument. The needed of comprehensive documentation data regarding cultural heritage become significant issues since the government and private sector pay attention to the preservation of heritage building in the urban site, so called living monument. The archives of original drawing plan many times do not fit with the existing condition, while the conservation plan demands a document such as built drawing plan to work on. The technology, methodology and system to provide such comprehensive document of heritage building and site become important, to produce good conservation plan and heritage building regular maintenance. It means the products will have a sustainable and various utility values. Since 1994, Documentation Centre for Architecture - Indonesia (PDA), has established to meet the needs of a comprehensive data of heritage building (living monuments), to utilized as basic document for conservation planning. Not only provide document of the digital drawing such site plan, plan, elevation, section and details of architecture elements, but also document of historic research, material analysis and completed with diagnosis and mapping of building damages. This manuscript is about PDA field experience, working in this subject issue

  11. Utilization management in the blood transfusion service.

    PubMed

    Peña, Jeremy Ryan Andrew; Dzik, Walter Sunny

    2014-01-01

    The scope of activity of the Blood Transfusion Service (BTS) makes it unique among the clinical laboratories. The combination of therapeutic and diagnostic roles necessitates a multi-faceted approach to utilization management in the BTS. We present our experience in utilization management in large academic medical center.

  12. The laboratory test utilization management toolbox

    PubMed Central

    Baird, Geoffrey

    2014-01-01

    Efficiently managing laboratory test utilization requires both ensuring adequate utilization of needed tests in some patients and discouraging superfluous tests in other patients. After the difficult clinical decision is made to define the patients that do and do not need a test, a wealth of interventions are available to the clinician and laboratorian to help guide appropriate utilization. These interventions are collectively referred to here as the utilization management toolbox. Experience has shown that some tools in the toolbox are weak and other are strong, and that tools are most effective when many are used simultaneously. While the outcomes of utilization management studies are not always as concrete as may be desired, what data is available in the literature indicate that strong utilization management interventions are safe and effective measures to improve patient health and reduce waste in an era of increasing financial pressure. PMID:24969916

  13. Clinical governance and operations management methodologies.

    PubMed

    Davies, C; Walley, P

    2000-01-01

    The clinical governance mechanism, introduced since 1998 in the UK National Health Service (NHS), aims to deliver high quality care with efficient, effective and cost-effective patient services. Scally and Donaldson recognised that new approaches are needed, and operations management techniques comprise potentially powerful methodologies in understanding the process of care, which can be applied both within and across professional boundaries. This paper summarises four studies in hospital Trusts which took approaches to improving process that were different from and less structured than business process re-engineering (BPR). The problems were then amenable to change at a relatively low cost and short timescale, producing significant improvement to patient care. This less structured approach to operations management avoided incurring overhead costs of large scale and costly change such as new information technology (IT) systems. The most successful changes were brought about by formal tools to control quantity, content and timing of changes.

  14. Time management problems and discounted utility.

    PubMed

    König, Cornelius J; Kleinmann, Martin

    2007-05-01

    The lens of behavioral decision theory offers a new perspective for research on time management. The basic idea of this approach is that people discount future consequences of their time management decisions, meaning that they work on tasks with smaller but sooner outcomes rather than on tasks with larger but later outcomes. The authors performed 2 experimental studies to test whether people are sensitive to differences in the discounted utility of time management decisions. In Experiment 1, they used vignettes of typical time management situations; Experiment 2 was a laboratory simulation (an in-basket task that was part of a training assessment). Participants in both studies were German students. As expected, manipulating the discounted utility of options resulted in different time management decisions. In Experiment 1, reactions to time management situations were judged as less likely if the reactions had lower discounted utilities. In Experiment 2, people spent less time on an interruption.

  15. SLURM: Simple Linux Utility for Resource Management

    SciTech Connect

    Jette, M; Dunlap, C; Garlick, J; Grondona, M

    2002-07-08

    Simple Linux Utility for Resource Management (SLURM) is an open source, fault-tolerant, and highly scalable cluster management and job scheduling system for Linux clusters of thousands of nodes. Components include machine status, partition management, job management, scheduling and stream copy modules. The design also includes a scalable, general-purpose communication infrastructure. This paper presents a overview of the SLURM architecture and functionality.

  16. Utilizing Interns in Facilities Management

    ERIC Educational Resources Information Center

    Judkins, Clarissa; Morris, John P.; Molocznik, Chuck

    2011-01-01

    Facilities management is rapidly changing and developing from a position an individual stumbles into--or work one's way up through--to a discipline and vocation all of its own. There is a need for a collaborative strategy among leaders in practice, education, and research to share knowledge and experience and to establish professional and ethical…

  17. Asset Management for Water and Wastewater Utilities

    EPA Pesticide Factsheets

    Renewing and replacing the nation's public water infrastructure is an ongoing task. Asset management can help a utility maximize the value of its capital as well as its operations and maintenance dollars.

  18. Agricultural waste utilization and management

    SciTech Connect

    Not Available

    1985-01-01

    These papers were presented at a symposium on the management and use of agricultural waste products, including food industry wastes. Topics covered include fat and protein recovery from fish wastes, treatments for straw to improve its digestibility, using food industry wastes as animal feeds, various manure treatments and studies of its combustion properties, fermentation, methane and ethanol production, hemp waste water treatment, and heat recovery from manure combustion.

  19. Use of case mix tools for utilization management and planning.

    PubMed

    Perry, Sheril; Homan, Craig

    2009-01-01

    An aging population, new technologies and drugs, and tightening constraints on financial and human resources have placed increased demands on hospitals to meet health care needs. Canadian hospitals, health regions, and ministries are placing a high priority on the evaluation of appropriateness and efficiency of medical care and on the proactive and targeted reduction of inefficiencies. The CMG+ grouping methodology is a case mix tool produced by the Canadian Institute for Health Information (CIHI) to analyze the acute-care inpatient population in Canada. CMG+ methodology can be applied, for example, to utilization management. The expected length of stay (ELOS) indicator can be used as a benchmark for assessing the length-of-stay distribution of various subgroups of patient activity. It can also be used to compute potentially conservable days and to identify those patient subgroups where gains in efficiency may be realized. We describe CMG+ utilization management using this and other examples.

  20. Comparing medicine and management: methodological issues.

    PubMed

    Burau, V

    2016-05-24

    In the study of medicine and management, there is a strong interest in cross-country comparison. Across healthcare systems in industrialised countries, New Public Management has provided a similar reform template, but new governing arrangements exhibit significant national variations. The comparative perspective also offers a leverage to overcome the resistance focus of earlier studies. Comparison raises two overall questions: in what similar and different ways are relations between medicine and management changing across industrialised countries? Why is change occurring in different ways? The questions reflect exploration and explanation as the two basic rationales for comparison. The aim was to provide a critical discussion of different approaches to comparing medicine and management across countries. The analysis was based on a narrative review of relevant studies from several bodies of literature. The majority of studies exploring medicine and management adopt macro level approaches to comparison. Studies draw on a range of notions, including area specific ideal types of professionalism, professionalism as countervailing powers and governmentality. There are much fewer studies exploring relations between medicine and management at the meso level. Analyses treat comparison as a two-dimensional exercise looking across both countries and levels. The majority of studies draws on institutional explanations. These are variations of the path dependency argument and studies include both sector specific and broader political and administrative institutions. There is an emerging body of process-based explanations which connect macro level institutions to organisations and which promote more non-linear comparisons. The lack of meso level comparisons drawing on process explanations is problematic. Empirically, we need to know more about how relations between medicine and management are different across countries. Theoretically, we need to better understand how we can

  1. Establishing benchmarks and metrics for utilization management.

    PubMed

    Melanson, Stacy E F

    2014-01-01

    The changing environment of healthcare reimbursement is rapidly leading to a renewed appreciation of the importance of utilization management in the clinical laboratory. The process of benchmarking of laboratory operations is well established for comparing organizational performance to other hospitals (peers) and for trending data over time through internal benchmarks. However, there are relatively few resources available to assist organizations in benchmarking for laboratory utilization management. This article will review the topic of laboratory benchmarking with a focus on the available literature and services to assist in managing physician requests for laboratory testing. © 2013.

  2. Trade-off decisions in distribution utility management

    NASA Astrophysics Data System (ADS)

    Slavickas, Rimas Anthony

    As a result of the "unbundling" of traditional monopolistic electricity generation and transmission enterprises into a free-market economy, power distribution utilities are faced with very difficult decisions pertaining to electricity supply options and quality of service to the customers. The management of distribution utilities has become increasingly complex, versatile, and dynamic to the extent that conventional, non-automated management tools are almost useless and obsolete. This thesis presents a novel and unified approach to managing electricity supply options and quality of service to customers. The technique formulates the problem in terms of variables, parameters, and constraints. An advanced Mixed Integer Programming (MIP) optimization formulation is developed together with novel, logical, decision-making algorithms. These tools enable the utility management to optimize various cost components and assess their time-trend impacts, taking into account the intangible issues such as customer perception, customer expectation, social pressures, and public response to service deterioration. The above concepts are further generalized and a Logical Proportion Analysis (LPA) methodology and associated software have been developed. Solutions using numbers are replaced with solutions using words (character strings) which more closely emulate the human decision-making process and advance the art of decision-making in the power utility environment. Using practical distribution utility operation data and customer surveys, the developments outlined in this thesis are successfully applied to several important utility management problems. These involve the evaluation of alternative electricity supply options, the impact of rate structures on utility business, and the decision of whether to continue to purchase from a main grid or generate locally (partially or totally) by building Non-Utility Generation (NUG).

  3. Doing qualitative research in general practice: methodological utility and engagement.

    PubMed

    Jaye, Chrystal

    2002-10-01

    General practice uses an eclectic range of research methodology. This includes increasing reliance upon qualitative research methods. There seem to be two distinct treatments of qualitative research within primary care and, in particular, within general practice research. The first is characterized by a purely utilitarian and technical focus, using a qualitative method because it is the most appropriate means of realizing the aims of the research, while the second is characterized by in-depth engagement with the philosophical and paradigmatic aspects of qualitative methodology. In-depth engagement with methodology and theory, and theory building, is an important aspect of masterate and doctoral research within social sciences such as education and anthropology, and in the discipline of nursing, but has not been a feature of qualitative research in medicine. A practical difficulty encountered within postgraduate programmes such as the one in which the author teaches is that when innovative qualitative techniques are used by GPs in their postgraduate research dissertations and theses, it is often beyond GP examiners' own knowledge and experience, yet it fails to measure up to standards established in social sciences, particularly in sociology and anthropology where in-depth reflexive engagement with the theory and philosophy of qualitative methodology is expected. This paper suggests that the value of in-depth engagement with methodology when conducting qualitative research results in creative and innovative ways of conducting research that are consonant with the nature of general practice itself, and strengthens research findings. Therefore, as teachers of research methods and supervisors of research theses, it is important to encourage students conducting qualitative research to engage fully with theoretical and methodological issues.

  4. Solvent Substitution Methodology Using Multiattribute Utility Theory and the Analytical Hierarchical Process

    DTIC Science & Technology

    1994-09-01

    Wright-Patterson Air Force Base, Ohio AFIT/GEE/ENS/94S-3 SOLVENT SUBSTITUTION METHODOLOGY USING MULTIATTRIBUTE UTILITY THEORY AND THE ANALYTICAL...CLASS: AFIT/GEE/ENS/94S-3 THESIS TITLE: Solvent Substitution Methodology using Multiattribute Utility Theory and the Analytical Hierarchical Process...Process: Depot Level 13 Substitution Process: Field Level 16 Contractor Substitution Process 17 Multiattribute Utility Theory (MAUT) 18 Independence

  5. Selection, management and utilization of biosphere reserves.

    Treesearch

    Jerry F. Franklin; Stanley L. Krugman

    1979-01-01

    This publication is directed to the analysis of the selection, management, and utilization of Biosphere Reserves as viewed by scientists from the United States and the Union of Soviet Socialist Republics. Soviet papers focus on types of research and monitoring programs that should be developed on Biosphere Reserves, with emphasis on their use in pollutant monitoring....

  6. SLURM: Simple Linux Utility for Resource Management

    SciTech Connect

    Jette, M; Dunlap, C; Garlick, J; Grondona, M

    2002-04-24

    Simple Linux Utility for Resource Management (SLURM) is an open source, fault-tolerant, and highly scalable cluster management and job scheduling system for Linux clusters of thousands of nodes. Components include machine status, partition management, job management, and scheduling modules. The design also includes a scalable, general-purpose communication infrastructure. Development will take place in four phases: Phase I results in a solid infrastructure; Phase II produces a functional but limited interactive job initiation capability without use of the interconnect/switch; Phase III provides switch support and documentation; Phase IV provides job status, fault-tolerance, and job queuing and control through Livermore's Distributed Production Control System (DPCS), a meta-batch and resource management system.

  7. Application of Six Sigma/CAP methodology: controlling blood-product utilization and costs.

    PubMed

    Neri, Robert A; Mason, Cindy E; Demko, Lisa A

    2008-01-01

    Blood-product components are a limited commodity whose cost is rising. Many patients benefit from their use, but patients who receive transfusions face an unnecessary increased risk for developing infections; fatal, febrile, or allergic reactions; and circulatory overload. To improve patient care, safety, and resource stewardship, transfusion practices must be evaluated for appropriateness (Wilson et al. 2002). A multihospital health system undertook a rigorous study of blood-product utilization patterns and management processes to address cost-control problems in the organization. The system leveraged two process improvement tools widely implemented outside of the healthcare industry: (1) Six Sigma methodology to identify blood-utilization drivers and to standardize transfusion practice, and (2) change acceleration process model to drive effective change. The initiative resulted in a decreased rate of inappropriate transfusions of packed red blood cell from 16 percent to less than 5 percent, improved clinician use of a blood-component order form, establishment of internal benchmarks, enhanced laboratory-to-clinician communication, and better blood-product expense control. The project further demonstrated how out-of-industry tools and methodologies can be adopted, adapted, and systematically applied to generate positive change (Black and Revere 2006).

  8. A Space Utilization Study at Gaston College: Methodology and Procedures.

    ERIC Educational Resources Information Center

    Hall, Pam; Clay, Rex

    In fall 1995, North Carolina's Gaston College undertook a study of space utilization at the college's main campus. A local architectural firm was contracted to document the exact usage of space on campus, establish space requirements to meet present circumstances, and identify future needs. To determine current usage, plots of current and original…

  9. Calculating cost savings in utilization management.

    PubMed

    MacMillan, Donna

    2014-01-01

    A major motivation for managing the utilization of laboratory testing is to reduce the cost of medical care. For this reason it is important to understand the basic principles of cost accounting in the clinical laboratory. The process of laboratory testing includes three distinct components termed the pre-analytic, analytic and post-analytic phases. Utilization management efforts may impact the cost structure of these three phases in different ways depending on the specific details of the initiative. Estimates of cost savings resulting from utilization management programs reported in the literature have often been fundamentally flawed due to a failure to understand basic concepts such as the difference between laboratory costs versus charges and the impact of reducing laboratory test volumes on the average versus marginal cost structure in the laboratory. This article will provide an overview of basic cost accounting principles in the clinical laboratory including both job order and process cost accounting. Specific examples will be presented to illustrate these concepts in various different scenarios.

  10. Development of Management Methodology for Engineering Production Quality

    NASA Astrophysics Data System (ADS)

    Gorlenko, O.; Miroshnikov, V.; Borbatc, N.

    2016-04-01

    The authors of the paper propose four directions of the methodology developing the quality management of engineering products that implement the requirements of new international standard ISO 9001:2015: the analysis of arrangement context taking into account stakeholders, the use of risk management, management of in-house knowledge, assessment of the enterprise activity according to the criteria of effectiveness

  11. Success Rates by Software Development Methodology in Information Technology Project Management: A Quantitative Analysis

    ERIC Educational Resources Information Center

    Wright, Gerald P.

    2013-01-01

    Despite over half a century of Project Management research, project success rates are still too low. Organizations spend a tremendous amount of valuable resources on Information Technology projects and seek to maximize the utility gained from their efforts. The author investigated the impact of software development methodology choice on ten…

  12. Success Rates by Software Development Methodology in Information Technology Project Management: A Quantitative Analysis

    ERIC Educational Resources Information Center

    Wright, Gerald P.

    2013-01-01

    Despite over half a century of Project Management research, project success rates are still too low. Organizations spend a tremendous amount of valuable resources on Information Technology projects and seek to maximize the utility gained from their efforts. The author investigated the impact of software development methodology choice on ten…

  13. National Training for a New Nurse Staffing Resource Management Methodology.

    ERIC Educational Resources Information Center

    Williams, Margaret M.; Blazey, Mary E.

    1998-01-01

    To implement a new resource-management methodology for determining nurse staffing based on expert opinion, a national education program was designed and used to train 172 health care facility coordinators using a systems approach. (SK)

  14. Publishing FAIR Data: An Exemplar Methodology Utilizing PHI-Base

    PubMed Central

    Rodríguez-Iglesias, Alejandro; Rodríguez-González, Alejandro; Irvine, Alistair G.; Sesma, Ane; Urban, Martin; Hammond-Kosack, Kim E.; Wilkinson, Mark D.

    2016-01-01

    Pathogen-Host interaction data is core to our understanding of disease processes and their molecular/genetic bases. Facile access to such core data is particularly important for the plant sciences, where individual genetic and phenotypic observations have the added complexity of being dispersed over a wide diversity of plant species vs. the relatively fewer host species of interest to biomedical researchers. Recently, an international initiative interested in scholarly data publishing proposed that all scientific data should be “FAIR”—Findable, Accessible, Interoperable, and Reusable. In this work, we describe the process of migrating a database of notable relevance to the plant sciences—the Pathogen-Host Interaction Database (PHI-base)—to a form that conforms to each of the FAIR Principles. We discuss the technical and architectural decisions, and the migration pathway, including observations of the difficulty and/or fidelity of each step. We examine how multiple FAIR principles can be addressed simultaneously through careful design decisions, including making data FAIR for both humans and machines with minimal duplication of effort. We note how FAIR data publishing involves more than data reformatting, requiring features beyond those exhibited by most life science Semantic Web or Linked Data resources. We explore the value-added by completing this FAIR data transformation, and then test the result through integrative questions that could not easily be asked over traditional Web-based data resources. Finally, we demonstrate the utility of providing explicit and reliable access to provenance information, which we argue enhances citation rates by encouraging and facilitating transparent scholarly reuse of these valuable data holdings. PMID:27433158

  15. Publishing FAIR Data: An Exemplar Methodology Utilizing PHI-Base.

    PubMed

    Rodríguez-Iglesias, Alejandro; Rodríguez-González, Alejandro; Irvine, Alistair G; Sesma, Ane; Urban, Martin; Hammond-Kosack, Kim E; Wilkinson, Mark D

    2016-01-01

    Pathogen-Host interaction data is core to our understanding of disease processes and their molecular/genetic bases. Facile access to such core data is particularly important for the plant sciences, where individual genetic and phenotypic observations have the added complexity of being dispersed over a wide diversity of plant species vs. the relatively fewer host species of interest to biomedical researchers. Recently, an international initiative interested in scholarly data publishing proposed that all scientific data should be "FAIR"-Findable, Accessible, Interoperable, and Reusable. In this work, we describe the process of migrating a database of notable relevance to the plant sciences-the Pathogen-Host Interaction Database (PHI-base)-to a form that conforms to each of the FAIR Principles. We discuss the technical and architectural decisions, and the migration pathway, including observations of the difficulty and/or fidelity of each step. We examine how multiple FAIR principles can be addressed simultaneously through careful design decisions, including making data FAIR for both humans and machines with minimal duplication of effort. We note how FAIR data publishing involves more than data reformatting, requiring features beyond those exhibited by most life science Semantic Web or Linked Data resources. We explore the value-added by completing this FAIR data transformation, and then test the result through integrative questions that could not easily be asked over traditional Web-based data resources. Finally, we demonstrate the utility of providing explicit and reliable access to provenance information, which we argue enhances citation rates by encouraging and facilitating transparent scholarly reuse of these valuable data holdings.

  16. 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.

  17. 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

  18. Management structure: establishing a laboratory utilization program and tools for utilization management.

    PubMed

    Snozek, Christine; Kaleta, Erin; Hernandez, James S

    2014-01-01

    As laboratories are challenged to do more with fewer resources, the pathologist and laboratory director will play a greater role in improving the effectiveness of the laboratory, as well as addressing the overuse, misuse and underuse of laboratory testing. We describe the necessary characteristics for pathologists and laboratory directors to successfully lead utilization efforts, as well as key leadership tools and essential steps in creating a utilization management program. When we established a laboratory test utilization program de novo, it became clear how important the laboratory director was in guiding those initiatives by working with stakeholders outside of the laboratory, particularly clinicians, nurses and administrators. © 2013.

  19. Toward a methodology for complexity management

    SciTech Connect

    Chisholm, G.H.

    1992-12-01

    This report focuses on the Battle Management/Command, Control, and Communication (BM/C{sup 3}) element of the Global Protection Against Limited Strike (GPALS) system. The approach is based on the development and validation of a generic BM/C{sup 3} model. Central to the approach is the tenet that the design is divided into multiple layers. The critical functions make up the bottom layer, where trust is established and significant design effort is required.

  20. Toward a methodology for complexity management

    SciTech Connect

    Chisholm, G.H.

    1992-12-01

    This report focuses on the Battle Management/Command, Control, and Communication (BM/C[sup 3]) element of the Global Protection Against Limited Strike (GPALS) system. The approach is based on the development and validation of a generic BM/C[sup 3] model. Central to the approach is the tenet that the design is divided into multiple layers. The critical functions make up the bottom layer, where trust is established and significant design effort is required.

  1. Spent fuel management fee methodology and computer code user's manual.

    SciTech Connect

    Engel, R.L.; White, M.K.

    1982-01-01

    The methodology and computer model described here were developed to analyze the cash flows for the federal government taking title to and managing spent nuclear fuel. The methodology has been used by the US Department of Energy (DOE) to estimate the spent fuel disposal fee that will provide full cost recovery. Although the methodology was designed to analyze interim storage followed by spent fuel disposal, it could be used to calculate a fee for reprocessing spent fuel and disposing of the waste. The methodology consists of two phases. The first phase estimates government expenditures for spent fuel management. The second phase determines the fees that will result in revenues such that the government attains full cost recovery assuming various revenue collection philosophies. These two phases are discussed in detail in subsequent sections of this report. Each of the two phases constitute a computer module, called SPADE (SPent fuel Analysis and Disposal Economics) and FEAN (FEe ANalysis), respectively.

  2. Implementation of a siting methodology for utility size WECS in western Massachusetts and northwestern Connecticut

    SciTech Connect

    Kirchhoff, R.H.; Kaminsky, F.C.

    1981-01-01

    This paper describes a long term research project by Northeast Utilities and the University of Massachusetts to identify candidate sites for utility size wind energy systems in Western Massachusetts and Northwestern Connecticut. A generalized methodology is described for identifying the candidate sites. This methodology includes the use of biological wind prospecting, data collection with TALA kites, computerized wind mapping with MATHEW, and the installation of long run data collection stations. This paper also describes the use of a mass consistent flow model known as MATHEW in developing computerized wind maps for selected regions of the area under study.

  3. Management of health care expenditure by soft computing methodology

    NASA Astrophysics Data System (ADS)

    Maksimović, Goran; Jović, Srđan; Jovanović, Radomir; Aničić, Obrad

    2017-01-01

    In this study was managed the health care expenditure by soft computing methodology. The main goal was to predict the gross domestic product (GDP) according to several factors of health care expenditure. Soft computing methodologies were applied since GDP prediction is very complex task. The performances of the proposed predictors were confirmed with the simulation results. According to the results, support vector regression (SVR) has better prediction accuracy compared to other soft computing methodologies. The soft computing methods benefit from the soft computing capabilities of global optimization in order to avoid local minimum issues.

  4. Heart Failure: Diagnosis, Management and Utilization

    PubMed Central

    Inamdar, Arati A.; Inamdar, Ajinkya C.

    2016-01-01

    Despite the advancement in medicine, management of heart failure (HF), which usually presents as a disease syndrome, has been a challenge to healthcare providers. This is reflected by the relatively higher rate of readmissions along with increased mortality and morbidity associated with HF. In this review article, we first provide a general overview of types of HF pathogenesis and diagnostic features of HF including the crucial role of exercise in determining the severity of heart failure, the efficacy of therapeutic strategies and the morbidity/mortality of HF. We then discuss the quality control measures to prevent the growing readmission rates for HF. We also attempt to elucidate published and ongoing clinical trials for HF in an effort to evaluate the standard and novel therapeutic approaches, including stem cell and gene therapies, to reduce the morbidity and mortality. Finally, we discuss the appropriate utilization/documentation and medical coding based on the severity of the HF alone and with minor and major co-morbidities. We consider that this review provides an extensive overview of the HF in terms of disease pathophysiology, management and documentation for the general readers, as well as for the clinicians/physicians/hospitalists. PMID:27367736

  5. Effective Case Study Methodologies in the Management of IT Courses.

    ERIC Educational Resources Information Center

    Buffington, James R.; Harper, Jeffrey S.

    Many Association to Advance Collegiate Schools of Business (AACSB) accredited schools require undergraduate Management Information Systems (MIS) majors to take a course in the management of information technology. Over half of these schools utilize case studies in the teaching of this course. Case studies are an important vehicle for teaching…

  6. Technology Transfer and Utilization Methodology; Further Analysis of the Linker Concept.

    ERIC Educational Resources Information Center

    Jolly, James A.; Creighton, J. W.

    This study is based on a comparison of data from two independent studies of technology utilization and dissemination methodology that sought to identify the behavior characteristics of "linkers" and "stabilizers" and their relative existence within different groups of technical personnel. Hypothesis for this study is that the…

  7. The Columbia Registry of Information and Utilization Management Trials.

    PubMed Central

    Balas, E A; Stockham, M G; Mitchell, M A; Austin, S M; West, D A; Ewigman, B G

    1995-01-01

    OBJECTIVE: T systematically locate, register, and abstract information used in comparing effects of various information services (computerized and noncomputerized) and utilization management interventions on the process and outcome of patient care. DESIGN: Manual and electronic database searches located reports that met three main criteria: 1) randomized controlled trial; 2) information or utilization management intervention in the study group with no similar intervention in the control group; and 3) effect of the intervention on the process and/or outcome of patient care had been measured. Published reports were registered in the Columbia Registry. RESULTS: Nearly 600 reports were collected from 24 countries and 189 different publications. Frequently tested interventions included patients or physician education, telephone follow-up, patient or physician reminders, and home care services. Frequently reported effect variables included hospitalization rate, length of stay, immunization rate, and mortality rate. Standardized formal tools were developed for the separation and abstraction of practical information and methodologic details from the collected trial reports. CONCLUSIONS: The registry provides a new source of information for meta-analyses, traditional reviews, and executive summaries of quality improvement of health services. The streamlined knowledge engineering process of quality evaluation and abstraction of critical information can generate helpful information for practitioners and researchers simultaneously. PMID:7496880

  8. Economics of Red Pine Management for Utility Pole Timber

    Treesearch

    Gerald H. Grossman; Karen Potter-Witter

    1991-01-01

    Including utility poles in red pine management regimes leads to distinctly different management recommendations. Where utility pole markets exist, managing for poles will maximize net returns. To do so, plantations should be maintained above 110 ft2/ac, higher than usually recommended. In Michigan's northern lower peninsula, approximately...

  9. The Nuclear Organization and Management Analysis Concept methodology: Four years later

    SciTech Connect

    Haber, S.B.; Shurberg, D.A.; Barriere, M.T.; Hall, R.E.

    1992-08-01

    The Nuclear Organization and Management Analysis Concept was first presented at the IEEE Human Factors meeting in Monterey in 1988. In the four years since that paper, the concept and its associated methodology has been demonstrated at two commercial nuclear power plants (NPP) and one fossil power plant. In addition, applications of some of the methods have been utilized in other types of organizations, and products are being developed from the insights obtained using the concept for various organization and management activities. This paper will focus on the insights and results obtained from the two demonstration studies at the commercial NPPs. The results emphasize the utility of the methodology and the comparability of the results from the two organizations.

  10. The Nuclear Organization and Management Analysis Concept methodology: Four years later

    SciTech Connect

    Haber, S.B.; Shurberg, D.A.; Barriere, M.T.; Hall, R.E.

    1992-01-01

    The Nuclear Organization and Management Analysis Concept was first presented at the IEEE Human Factors meeting in Monterey in 1988. In the four years since that paper, the concept and its associated methodology has been demonstrated at two commercial nuclear power plants (NPP) and one fossil power plant. In addition, applications of some of the methods have been utilized in other types of organizations, and products are being developed from the insights obtained using the concept for various organization and management activities. This paper will focus on the insights and results obtained from the two demonstration studies at the commercial NPPs. The results emphasize the utility of the methodology and the comparability of the results from the two organizations.

  11. Space Utilization Management within William Beaumont Army Medical Center

    DTIC Science & Technology

    2007-04-01

    degree to which organizational activities emphasize maintaining the status quo in contrast to growth. (Robbins, 2003, p .525) Space Utilization Management...Conformity to the rules becomes the primary basis for reward and upward mobility. ( p . 528) Space Utilization Management 23 Culture can enhance organizational...34 is no longer effective (Robbins, 2003, p .529). Space Utilization Management 24 Another aspect that can have an affect on the problem of space

  12. Geographical information system methodology and instruction impact on water managers

    NASA Astrophysics Data System (ADS)

    McCowan, Ladonna Cecile

    Scope and method of study. Solutions addressing the dilemma of nonpoint source [NPS] pollution are dependent on education, assessment, and best management practices [BMP]. Educational programs must provide and simplify complex relationships between NPS and water quality. This study evaluates the impact of a geographical information system [GIS] methodology and its instruction to water managers by assessing changes in their attitude, perceived knowledge, and planned management practices. Findings and conclusion. Water managers knowledge and behavior were not found significantly different between the GIS and without-GIS courses. There was a significant difference between the courses for attitude. However, the significance was in favor of the without-GIS workshop. The pre- then post-survey was inadequate to establish reliable baseline data for the water managers. Over estimation to pre-survey questions generated inaccuracies in the post-survey data. The result of the course presentation had an impact on the water managers perceived knowledge, attitude and planned behavior toward water quality. GIS methodology has potential for enhances educational material for water managers.

  13. The methodology of database design in organization management systems

    NASA Astrophysics Data System (ADS)

    Chudinov, I. L.; Osipova, V. V.; Bobrova, Y. V.

    2017-01-01

    The paper describes the unified methodology of database design for management information systems. Designing the conceptual information model for the domain area is the most important and labor-intensive stage in database design. Basing on the proposed integrated approach to design, the conceptual information model, the main principles of developing the relation databases are provided and user’s information needs are considered. According to the methodology, the process of designing the conceptual information model includes three basic stages, which are defined in detail. Finally, the article describes the process of performing the results of analyzing user’s information needs and the rationale for use of classifiers.

  14. Management and utilization of poultry wastes.

    PubMed

    Williams, C M; Barker, J C; Sims, J T

    1999-01-01

    Waste by-products such as excreta or bedding material that are generated by the worldwide annual production of more than 40 million metric tons (t) of poultry meat and 600 billion eggs are generally land applied as the final step of a producer's waste management strategy. Under proper land application conditions, the nutrients and organisms in poultry wastes pose little environmental threat. Environmental contamination occurs when land application of poultry wastes is in excess of crop utilization potential, or is done under poor management conditions causing nutrient loss from environmental factors such as soil erosion or surface runoff during rainfall. Environmental parameters of concern are N, P, and certain metals (Cu and Zn in particular), as well as pathogenic microorganisms that may be contained in poultry waste. The biochemical cycle of N is very dynamic, and N contained in poultry waste may either be removed by crop harvest, leave the animal production facility, waste treatment lagoon, or application field as a gas (NH3, NO, NO2, N2O, or N2), or, due to its mobility in soil, be transported in organic or inorganic N forms in the liquid state via surface runoff or leaching into groundwater. Elevated concentrations of NO3-N in groundwater used for human consumption is a health risk to infants that are susceptible to methemoglobinemia. An environmental impact resulting from elevated NO3-N is eutrophication of surface waters. Ammonia loss from poultry waste is an environmental concern because of volatilized wet and dry deposits of NH3 into nitrogen-sensitive ecosystems. Phosphorus in poultry wastes may contribute to environmental degradation by accelerating the process of eutrophication. Unlike N, P is very immobile in soil and must first be transported to a surface water environment to have an environmental impact. It is generally accepted, however, that this nutrient affects receiving waters via transport in eroding soil as sediment-bound P or in surface

  15. Design, Development and Utilization Perspectives on Database Management Systems

    ERIC Educational Resources Information Center

    Shneiderman, Ben

    1977-01-01

    This paper reviews the historical development of integrated data base management systems and examines competing approaches. Topics include management and utilization, implementation and design, query languages, security, integrity, privacy and concurrency. (Author/KP)

  16. Propulsion integration of hypersonic air-breathing vehicles utilizing a top-down design methodology

    NASA Astrophysics Data System (ADS)

    Kirkpatrick, Brad Kenneth

    In recent years, a focus of aerospace engineering design has been the development of advanced design methodologies and frameworks to account for increasingly complex and integrated vehicles. Techniques such as parametric modeling, global vehicle analyses, and interdisciplinary data sharing have been employed in an attempt to improve the design process. The purpose of this study is to introduce a new approach to integrated vehicle design known as the top-down design methodology. In the top-down design methodology, the main idea is to relate design changes on the vehicle system and sub-system level to a set of over-arching performance and customer requirements. Rather than focusing on the performance of an individual system, the system is analyzed in terms of the net effect it has on the overall vehicle and other vehicle systems. This detailed level of analysis can only be accomplished through the use of high fidelity computational tools such as Computational Fluid Dynamics (CFD) or Finite Element Analysis (FEA). The utility of the top-down design methodology is investigated through its application to the conceptual and preliminary design of a long-range hypersonic air-breathing vehicle for a hypothetical next generation hypersonic vehicle (NHRV) program. System-level design is demonstrated through the development of the nozzle section of the propulsion system. From this demonstration of the methodology, conclusions are made about the benefits, drawbacks, and cost of using the methodology.

  17. CERTS; A Comparative Evaluation Method for Risk Management Methodologies and Tools

    DTIC Science & Technology

    1990-03-01

    This thesis develops a comparative evaluation method for computer security risk management methodologies and tools. The subjective biases inherent to...current comparison practices are reduced by measuring unique characteristics of computer security risk management methodologies. Standardized...methodologies and tools to each other. As a demonstration of its effectiveness, our method is applied to four distinct risk management methodologies and

  18. [Factors conditioning primary care services utilization. Empirical evidence and methodological inconsistencies].

    PubMed

    Sáez, M

    2003-01-01

    In Spain, the degree and characteristics of primary care services utilization have been the subject of analysis since at least the 1980s. One of the main reasons for this interest is to assess the extent to which utilization matches primary care needs. In fact, the provision of an adequate health service for those who most need it is a generally accepted priority. The evidence shows that individual characteristics, mainly health status, are the factors most closely related to primary care utilization. Other personal characteristics, such as gender and age, could act as modulators of health care need. Some family and/or cultural variables, as well as factors related to the health care professional and institutions, could explain some of the observed variability in primary care services utilization. Socioeconomic variables, such as income, reveal a paradox. From an aggregate perspective, income is the main determinant of utilization as well as of health care expenditure. When data are analyzed for individuals, however, income is not related to primary health utilization. The situation is controversial, with methodological implications and, above all, consequences for the assessment of the efficiency in primary care utilization. Review of the literature reveals certain methodological inconsistencies that could at least partly explain the disparity of the empirical results. Among others, the following flaws can be highlighted: design problems, measurement errors, misspecification, and misleading statistical methods.Some solutions, among others, are quasi-experiments, the use of large administrative databases and of primary data sources (design problems); differentiation between types of utilization and between units of analysis other than consultations, and correction of measurement errors in the explanatory variables (measurement errors); consideration of relevant explanatory variables (misspecification); and the use of multilevel models (statistical methods).

  19. 42 CFR 423.153 - Drug utilization management, quality assurance, and medication therapy management programs (MTMPs).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 3 2012-10-01 2012-10-01 false Drug utilization management, quality assurance, and... Drug utilization management, quality assurance, and medication therapy management programs (MTMPs). (a... D plan, a drug utilization management program, quality assurance measures and systems, and an...

  20. 42 CFR 423.153 - Drug utilization management, quality assurance, and medication therapy management programs (MTMPs).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 3 2013-10-01 2013-10-01 false Drug utilization management, quality assurance, and... Drug utilization management, quality assurance, and medication therapy management programs (MTMPs). (a... D plan, a drug utilization management program, quality assurance measures and systems, and an...

  1. 42 CFR 423.153 - Drug utilization management, quality assurance, and medication therapy management programs (MTMPs).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Drug utilization management, quality assurance, and... Drug utilization management, quality assurance, and medication therapy management programs (MTMPs). (a... D plan, a drug utilization management program, quality assurance measures and systems, and an...

  2. Strategic methodology for advancing food manufacturing waste management paradigms

    NASA Astrophysics Data System (ADS)

    Rosentrater, Kurt A.

    2004-12-01

    As manufacturing industries become more cognizant of the ecological effects that their firms have on the surrounding environment, their waste streams are increasingly becoming viewed not as materials in need of disposal, but rather as resources that can be reused, recycled, or reprocessed into valuable products. Within the food processing sector there are many examples of value-added use of processing residues, although many of these focus solely on utilization as livestock feed ingredients. In addition to livestock feed, though, many other potential avenues exist for food processing waste streams, including food grade as well as industrial products. Unfortunately, the challenge to food processors is actually conducting the byproduct development work. In fact, no clear delineation exists that describes necessary components for an effective byproduct development program. This paper describes one such strategic methodology that could help fill this void. It consists of identifying, quantifying, characterizing, developing, analyzing, optimizing, and modeling the waste stream of interest. This approach to byproduct development represents an inclusive strategy that can be used to more effectively implement value-added utilization programs. Not only is this methodology applicable to food processing operations, but any industrial or manufacturing firm could benefit from instituting the formal components described here. Thus, this methodology, if implemented by a manufacturer, could hold the potential for increasing the probability of meeting the goals of industrial ecology, namely, that of developing and operating sustainable systems.

  3. Evaluation in health: participatory methodology and involvement of municipal managers

    PubMed Central

    de Almeida, Cristiane Andrea Locatelli; Tanaka, Oswaldo Yoshimi

    2016-01-01

    ABSTRACT OBJECTIVE To analyze scopes and limits of the use of participatory methodology of evaluation with municipal health managers and administrators. METHODS Qualitative research with health policymakers and managers of the Comissão Intergestores Regional (CIR – Regional Interagency Commission) of a health region of the state of Sao Paulo in Brazil. Representatives from seven member cities participated in seven workshops facilitated by the researchers, with the aim of assessing a specific problem of the care line, which would be used as a tracer of the system integrality. The analysis of the collected empirical material was based on the hermeneutic-dialectic methodology and aimed at the evaluation of the applied participatory methodology, according to its capacity of promoting a process of assessment capable to be used as a support for municipal management. RESULTS With the participatory approach of evaluation, we were able to promote in-depth discussions with the group, especially related to the construction of integral care and to the inclusion of the user’s perspective in decision-making, linked to the search for solution to concrete problems of managers. By joint exploration, the possibility of using data from electronic information systems was opened, as well as information coming directly from the users of the services, to enhance discussions and negotiations between partners. The participants were disbelievers of the replication potential of this type of evaluation without the direct monitoring of the academy, given the difficulty of organizing the process in everyday life, already taken by emergency and political issues. CONCLUSIONS Evaluations of programs and services carried out within the Regional Interagency Commission, starting from the local interest and facilitating the involvement of its members by the use of participatory methodologies, can contribute to the construction of integral care. To the extent that the act of evaluating stay

  4. Elementary Christian School Teachers Utilizing Biblical Concepts in Classroom Management

    ERIC Educational Resources Information Center

    Hill, Christy E.

    2014-01-01

    This phenomenological study examined biblical concepts utilized by elementary Christian school teachers in classroom management in two Christian schools in Virginia. Items examined included which biblical components were being utilized and how teachers are utilizing them. Determining factors influencing the incorporation of biblical concepts in…

  5. Elementary Christian School Teachers Utilizing Biblical Concepts in Classroom Management

    ERIC Educational Resources Information Center

    Hill, Christy E.

    2014-01-01

    This phenomenological study examined biblical concepts utilized by elementary Christian school teachers in classroom management in two Christian schools in Virginia. Items examined included which biblical components were being utilized and how teachers are utilizing them. Determining factors influencing the incorporation of biblical concepts in…

  6. A hybrid design methodology for structuring an Integrated Environmental Management System (IEMS) for shipping business.

    PubMed

    Celik, Metin

    2009-03-01

    The International Safety Management (ISM) Code defines a broad framework for the safe management and operation of merchant ships, maintaining high standards of safety and environmental protection. On the other hand, ISO 14001:2004 provides a generic, worldwide environmental management standard that has been utilized by several industries. Both the ISM Code and ISO 14001:2004 have the practical goal of establishing a sustainable Integrated Environmental Management System (IEMS) for shipping businesses. This paper presents a hybrid design methodology that shows how requirements from both standards can be combined into a single execution scheme. Specifically, the Analytic Hierarchy Process (AHP) and Fuzzy Axiomatic Design (FAD) are used to structure an IEMS for ship management companies. This research provides decision aid to maritime executives in order to enhance the environmental performance in the shipping industry.

  7. Policies, standards and managements associated with PG utilization

    NASA Astrophysics Data System (ADS)

    Chuan, L. M.; Zheng, H. G.; Zhao, J. J.; Wang, A. L.; Sun, S. F.

    2017-08-01

    With rapid growth in the production of high concentration phosphate and compound fertilizers in China, PG production is increasing every year. However, its utilization is not increasing at the same pace. Phosphogypsum is usually stored in such a way that not only it occupies lot of land, but also leads to minimal environmental pollution. This paper summarized the policies, standards and managements issues associated with PG utilization, and in order to help the PG utilization and management effectively.

  8. Application of broadcast FM for utility energy management communications

    SciTech Connect

    Eden, R.C.; Deyhimy, I.; Williamson, R.

    1982-07-01

    Technological and economic aspects of various approaches to electric utility Energy Management communications for remote control are discussed. Communication systems employing radio frequency (RF) transmission techniques are treated in some detail with comparisons being made between narrowband VHF transmitter systems, those systems utilizing a portion of AM broadcast radio channels and systems using a portion of FM broadcast radio channels. Finally, typical utility energy management applications of these systems are discussed.

  9. The effect of regulation on the professionally managed utility

    SciTech Connect

    Czamanski, O.Z.

    1980-12-01

    Mixed empirical evidence concerning the A-J effect suggests that regulatory constraints affect utilities differently, depending upon their organizational structure. An important characteristic of firms is the concern for profits on the part of managements. This concern is related to the extent that management owns the firms' residual claims. In the case of many utilities, professional management means divorce of ownership from the firm's decision-making.

  10. Methodology of management of dredging operations I. Conceptual developments.

    PubMed

    Abriak, N E; Junqua, G; Dubois, V; Gregoire, P; Mac Farlane, F; Damidot, D

    2006-04-01

    This article presents a new methodology for the management of dredging operations. Partly derived from existing methodologies (OECD, UNEP, AIPCN), its aim is to be more complete, by integrating the qualities and complementarities of former methodologies. Moreover, it was carried out in a context of sustainable development. Indeed, it supports, according to a framework of industrial ecology, the development and the implementation of solutions of waste improvement of dredged materials, in order to minimize the environmental impact of dredging. It also uses a tool of MultiCriteria Decision-Making Aid (M.C.D.M.A.), in order to integrate local characteristics. In addition, this tool, called DRAGSED, allows to a dialogue to be established between all the parties concerned with a dredging project (harbour's authorities, industrialists, municipalities, administrations, populations, associations,...). Thus, the implementation of this methodology enables consensus to be reached for the dredging solution retained. It also proposes an environmental follow-up, which will allow an evaluation during its application.

  11. A successful trial utilizing the Leuzinger-Bohleber methodology for evaluation of psychoanalytic treatment: preliminary report.

    PubMed

    Rascón, Socorro Ramonet; Corona, Pablo Cuevas; Lartigue, Teresa; Rios, Josefina Mendoza; Garza, David López

    2005-10-01

    Utilizing audio-recorded psychoanalytic interviews of both patients and their analysts, group discussions of these interviews, and the application of questionnaires commonly used in psychotherapy research, the authors investigate the potential use of the Leuzinger-Bohleber methodology as an objective evaluative instrument to assess the quality of psychoanalytic treatment. Preliminary study results were obtained through interviews conducted with seven analysts and their respective patients, three of whom were treated with psychoanalysis (three or more sessions per week, for a duration of no less than one year) and four with psychotherapy (one or two sessions per week, for a duration of no less than one year). Patients were found to be eager to participate, and no adverse experiences were reported by analysts, patients or the research team. In addition to the interviews, further data were obtained through review of mailed-in questionnaires completed by 21 patients. The authors present both preliminary observations regarding the methodology as a whole, as well as the detailed results of one specific case subject treated with psychotherapy. Review of study findings supports the utilization of this methodology as an evaluative instrument which may ultimately advance current knowledge of the process and outcome of psychoanalytic treatment.

  12. Using Risk Assessment Methodologies to Meet Management Objectives

    NASA Technical Reports Server (NTRS)

    DeMott, D. L.

    2015-01-01

    Current decision making involves numerous possible combinations of technology elements, safety and health issues, operational aspects and process considerations to satisfy program goals. Identifying potential risk considerations as part of the management decision making process provides additional tools to make more informed management decision. Adapting and using risk assessment methodologies can generate new perspectives on various risk and safety concerns that are not immediately apparent. Safety and operational risks can be identified and final decisions can balance these considerations with cost and schedule risks. Additional assessments can also show likelihood of event occurrence and event consequence to provide a more informed basis for decision making, as well as cost effective mitigation strategies. Methodologies available to perform Risk Assessments range from qualitative identification of risk potential, to detailed assessments where quantitative probabilities are calculated. Methodology used should be based on factors that include: 1) type of industry and industry standards, 2) tasks, tools, and environment 3) type and availability of data and 4) industry views and requirements regarding risk & reliability. Risk Assessments are a tool for decision makers to understand potential consequences and be in a position to reduce, mitigate or eliminate costly mistakes or catastrophic failures.

  13. Computational methodologies for compound database searching that utilize experimental protein-ligand interaction information.

    PubMed

    Tan, Lu; Batista, Jose; Bajorath, Jürgen

    2010-09-01

    Ligand- and target structure-based methods are widely used in virtual screening, but there is currently no methodology available that fully integrates these different approaches. Herein, we provide an overview of various attempts that have been made to combine ligand- and structure-based computational screening methods. We then review different types of approaches that utilize protein-ligand interaction information for database screening and filtering. Interaction-based approaches make use of a variety of methodological concepts including pharmacophore modeling and direct or indirect encoding of protein-ligand interactions in fingerprint formats. These interaction-based methods have been successfully applied to tackle different tasks related to virtual screening including postprocessing of docking poses, prioritization of binding modes, selectivity analysis, or similarity searching. Furthermore, we discuss the recently developed interacting fragment approach that indirectly incorporates 3D interaction information into 2D similarity searching and bridges between ligand- and structure-based methods.

  14. 42 CFR 423.153 - Drug utilization management, quality assurance, and medication therapy management programs (MTMPs).

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Drug utilization management, quality assurance, and... management, quality assurance, and medication therapy management programs (MTMPs). (a) General rule. Each... utilization management program, quality assurance measures and systems, and an MTMP as described in...

  15. 42 CFR 423.153 - Drug utilization management, quality assurance, and medication therapy management programs (MTMPs).

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Drug utilization management, quality assurance, and... management, quality assurance, and medication therapy management programs (MTMPs). (a) General rule. Each... utilization management program, quality assurance measures and systems, and an MTMP as described in...

  16. Beyond utilization control: managing care with customers.

    PubMed

    Morath, J

    1998-01-01

    Allina Health System embarked on a rigorous process to better understand the customer's perception of care and service. The milestone for quality is the participation of the patient, member, and family in the health care system to determine care and service quality. The challenge for those in health care is to understand and manage the complex cultural changes this inclusion implies.

  17. UTILITY DATA ARCHIVING FOR RISK MANAGEMENT

    EPA Science Inventory

    EPA let a contract for a consultant to collect information about historical changes in operations and maintenance, design and construction, and planning and siting for water and wastewater infrastructure. The goal of this research study is to determine risk management alternativ...

  18. UTILITY DATA ARCHIVING FOR RISK MANAGEMENT

    EPA Science Inventory

    EPA let a contract for a consultant to collect information about historical changes in operations and maintenance, design and construction, and planning and siting for water and wastewater infrastructure. The goal of this research study is to determine risk management alternativ...

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

    SciTech Connect

    1995-07-01

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

  20. Safety assessment methodology in management of spent sealed sources.

    PubMed

    Mahmoud, Narmine Salah

    2005-02-14

    Environmental hazards can be caused from radioactive waste after their disposal. It was therefore important that safety assessment methodologies be developed and established to study and estimate the possible hazards, and institute certain safety methodologies that lead and prevent the evolution of these hazards. Spent sealed sources are specific type of radioactive waste. According to IAEA definition, spent sealed sources are unused sources because of activity decay, damage, misuse, loss, or theft. Accidental exposure of humans from spent sealed sources can occur at the moment they become spent and before their disposal. Because of that reason, safety assessment methodologies were tailored to suit the management of spent sealed sources. To provide understanding and confidence of this study, validation analysis was undertaken by considering the scenario of an accident that occurred in Egypt, June 2000 (the Meet-Halfa accident from an iridium-192 source). The text of this work includes consideration related to the safety assessment approaches of spent sealed sources which constitutes assessment context, processes leading an active source to be spent, accident scenarios, mathematical models for dose calculations, and radiological consequences and regulatory criteria. The text also includes a validation study, which was carried out by evaluating a theoretical scenario compared to the real scenario of Meet-Halfa accident depending on the clinical assessment of affected individuals.

  1. Using Risk Assessment Methodologies to Meet Management Objectives

    NASA Technical Reports Server (NTRS)

    DeMott, D. L.

    2015-01-01

    Corporate and program objectives focus on desired performance and results. ?Management decisions that affect how to meet these objectives now involve a complex mix of: technology, safety issues, operations, process considerations, employee considerations, regulatory requirements, financial concerns and legal issues. ?Risk Assessments are a tool for decision makers to understand potential consequences and be in a position to reduce, mitigate or eliminate costly mistakes or catastrophic failures. Using a risk assessment methodology is only a starting point. ?A risk assessment program provides management with important input in the decision making process. ?A pro-active organization looks to the future to avoid problems, a reactive organization can be blindsided by risks that could have been avoided. ?You get out what you put in, how useful your program is will be up to the individual organization.

  2. A public utility model for managing public land recreation enterprises.

    Treesearch

    Tom. Quinn

    2002-01-01

    Through review of relevant economic principles and judicial precedent, a case is made that public-land recreation enterprises are analogous to traditionally recognized public utilities. Given the historical concern over the societal value of recreation and associated pricing issues, public-land management policies failing to acknowledge these utility-like...

  3. [PHOLY: A pilot study of drug utilization in civil hospices in Lyon - methodology and difficulties].

    PubMed

    Dubois, V; Rachet, F; Aulagner, G; Boissel, J P

    1998-01-01

    PHOLY is a study of drug Prescription in Hospices civils of LYon by a transverse and descriptive survey. It aims at studying the methodology of such an investigation in a large university medical centre, elaborating a methodology for continuous assessment of prescribing, comparing prescriptions with scientific knowledge and identifying specific therapies. We collected 1525 questionnaires from 4333 hospitalized patients in 11 hospitals (prescriptions and indications). The main difficulties we encountered concerned communications (4 letters), fewer questionnaires collected than expected (1525/3018), many missing data, and the lack of a specific budget, thus allowing only partial data exploitation and control. This study revealed many problems such as relevant information for physicians, training and management of investigators, control, data capture and analysis. However, a prescription study may be possible with limited means.

  4. Knowledge Value Added (KVA) Methodology as a Tool for Measuring the Utilization of Knowledge Assets Aboard Marine Corps Installations

    DTIC Science & Technology

    2008-06-01

    1996 Submitted in partial fulfillment of the requirements for the degree of MASTER OF SCIENCE IN INFORMATION TECHNOLOGY MANAGEMENT from...Value Added Methodologies. Masters Thesis, Information Technology Management Department, Naval Postgraduate School, Jun 2003. Bourazanis...Management Techniques and Their Impact on the Marine Corps in a Navy Marine Corps Intranet Environment. Masters Thesis, Information Technology Management Department

  5. Spatially explicit methodology for coordinated manure management in shared watersheds.

    PubMed

    Sharara, Mahmoud; Sampat, Apoorva; Good, Laura W; Smith, Amanda S; Porter, Pamela; Zavala, Victor M; Larson, Rebecca; Runge, Troy

    2017-05-01

    Increased clustering and consolidation of livestock production systems has been linked to adverse impacts on water quality. This study presents a methodology to optimize manure management within a hydrologic region to minimize agricultural phosphorus (P) loss associated with winter manure application. Spatial and non-spatial data representing livestock, crop, soil, terrain and hydrography were compiled to determine manure P production rates, crop P uptake, existing manure storage capabilities, and transportation distances. Field slope, hydrologic soil group (HSG), and proximity to waterbodies were used to classify crop fields according to their runoff risk for winter-applied manure. We use these data to construct a comprehensive optimization model that identifies optimal location, size, and transportation strategy to achieve environmental and economic goals. The environmental goal was the minimization of daily hauling of manure to environmentally sensitive crop fields, i.e., those classified as high P-loss fields, whereas the economic goal was the minimization of the transportation costs across the entire study area. A case study encompassing two contiguous 10-digit hydrologic unit subwatersheds (HUC-10) in South Central Wisconsin, USA was developed to demonstrate the proposed methodology. Additionally, scenarios representing different management decisions (storage facility maximum volume, and project capital) and production conditions (increased milk production and 20-year future projection) were analyzed to determine their impact on optimal decisions. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  6. A methodology model for quality management in a general hospital.

    PubMed

    Stern, Z; Naveh, E

    1997-01-01

    A reappraisal is made of the relevance of industrial modes of quality management to the issues of medical care. Analysis of the nature of medical care, which differentiates it from the supplier-client relationships of industry, presents the main intrinsic characteristics, which create problems in application of the industrial quality management approaches to medical care. Several examples are the complexity of the relationship between the medical action and the result obtained, the client's nonacceptance of economic profitability as a value in his medical care, and customer satisfaction biased by variable standards of knowledge. The real problems unique to hospitals are addressed, and a methodology model for their quality management is offered. Included is a sample of indicator vectors, measurements of quality care, cost of medical care, quality of service, and human resources. These are based on the trilogy of planning quality, quality control, and improving quality. The conclusions confirm the inadequacy of industrial quality management approaches for medical institutions and recommend investment in formulation of appropriate concepts.

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

    DTIC Science & Technology

    1992-07-01

    institution-wide benefits of A Space Utilization 20 facility management automation , to include (a) the ability to identify current discrepancies in...September). Survey Pinpoints Leading Application and Shows That 47% Rely on FM Automation . FacilitiesDesign andt Mia-maI. pp 35.36. Ledeen, K. (1989, August...conference room is not needed. 100 NSF for libary reference material is needed. 200 NSF is authorized. Total 100 Support Areas: Equipment/Device

  8. 42 CFR 484.230 - Methodology used for the calculation of the low-utilization payment adjustment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Methodology used for the calculation of the low-utilization payment adjustment. 484.230 Section 484.230 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... Prospective Payment System for Home Health Agencies § 484.230 Methodology used for the calculation of the...

  9. Risk Assessment Methodology for Water utilities (RAM-W) : the foundation for emergency response planning.

    SciTech Connect

    Danneels, Jeffrey John

    2005-03-01

    Concerns about acts of terrorism against critical infrastructures have been on the rise for several years. Critical infrastructures are those physical structures and information systems (including cyber) essential to the minimum operations of the economy and government. The President's Commission on Critical Infrastructure Protection (PCCIP) probed the security of the nation's critical infrastructures. The PCCIP determined the water infrastructure is highly vulnerable to a range of potential attacks. In October 1997, the PCCIP proposed a public/private partnership between the federal government and private industry to improve the protection of the nation's critical infrastructures. In early 2000, the EPA partnered with the Awwa Research Foundation (AwwaRF) and Sandia National Laboratories to create the Risk Assessment Methodology for Water Utilities (RAM-W{trademark}). Soon thereafter, they initiated an effort to create a template and minimum requirements for water utility Emergency Response Plans (ERP). All public water utilities in the US serving populations greater than 3,300 are required to undertaken both a vulnerability assessment and the development of an emergency response plan. This paper explains the initial steps of RAM-W{trademark} and then demonstrates how the security risk assessment is fundamental to the ERP. During the development of RAM-W{trademark}, Sandia performed several security risk assessments at large metropolitan water utilities. As part of the scope of that effort, ERPs at each utility were reviewed to determine how well they addressed significant vulnerabilities uncovered during the risk assessment. The ERP will contain responses to other events as well (e.g. natural disasters) but should address all major findings in the security risk assessment.

  10. Opportunities for increasing utility of models for rangeland management

    USDA-ARS?s Scientific Manuscript database

    A tremendous need exists for ecosystem models to assist in rangeland management, but the utility of models developed to date has been minimal for enterprise-level decision making. Three areas in which models have had limited effectiveness for land managers are 1) addressing contemporary needs associ...

  11. Prudent management of utility assets -- Problem or promise?

    SciTech Connect

    Hatch, D.; Serwinowski, M.

    1998-07-01

    As utilities move into a deregulated market, the extent and nature of their asset base, as well as, the manner in which they have managed it, may play a key factor in the form of regulatory recovery. Utilities must face the issue of stranded assets. One form of addressing this issue is using ``EVA'', Economic Value Added as a mechanism to form financial models for prudent asset management. The authors present an approach to this challenging aspect of deregulation. They focus on the following utility assets: buildings/facilities, and excess real physical assets. Primarily focusing on Niagara Mohawk, two or three case studies are used to demonstrate how proactive management and EVA analysis transforms underperforming utility assets. These will be presented in a way that can show benefits for all utility stakeholders such as cost avoidance, load growth, real estate tax savings, stranded asset reductions, environmental gains, corporate image enhancement, and regulatory/governmental gains; over and above possible economic gains. Examples will be given that include the transformation of utility assets into award winning commercial, residential, and industrial developments as well as recreational/park lands and greenways. Similarly, other examples will show the many tangible and intangible benefits of an effective investment recovery and waste stream management program. Various strategies will also be presented that detail how utilities can begin to develop a total comprehensive plan for their asset portfolio. The first step in realizing and maximizing EVA towards a portfolio of assets is a change in corporate policy--one from passive ownership to active prudent management. Service and cost will drive competition resulting from full deregulation. To drive down costs, utilities will need to become more efficient in dealing with their asset base. By embracing an EVA model on an entire asset portfolio, utilities can prepare and excel in the newly shaped marketplace.

  12. An Ecological and Economic Assessment Methodology for Coastal Ecosystem Management

    NASA Astrophysics Data System (ADS)

    Nobre, Ana M.

    2009-07-01

    An adaptation of the Drivers-Pressure-State-Impact-Response methodology is presented in this work. The differential DPSIR (ΔDPSIR) was developed to evaluate impacts on the coastal environment and as a tool for integrated ecosystem management. The aim of the ΔDPSIR is to provide scientifically-based information required by managers and decision-makers to evaluate previously adopted policies, as well as future response scenarios. The innovation of the present approach is to provide an explicit link between ecological and economic information related to the use and management of a coastal ecosystem within a specific timeframe. The application of ΔDPSIR is illustrated through an analysis of developments in a Southwest European coastal lagoon between 1985 and 1995. The value of economic activities dependent on the lagoon suffered a significant reduction (ca. -60%) over that period, mainly due to a decrease in bivalve production. During that decade the pressures from the catchment area were managed (ca. 176 million Euros), mainly through the building of waste water treatment plants. Notwithstanding this, the ecosystem state worsened with respect to abnormal clam mortalities due to a parasite infection and to benthic eutrophication symptoms in specific problematic areas. The negative economic impacts during the decade were estimated between -565 and -315 million Euros, of which 9-49% represent the cost of environmental externalities. Evaluation of these past events indicates that future management actions should focus on reducing the limitation on local clam seeds, which should result in positive impacts to both the local socio-economy and biodiversity.

  13. An ecological and economic assessment methodology for coastal ecosystem management.

    PubMed

    Nobre, Ana M

    2009-07-01

    An adaptation of the Drivers-Pressure-State-Impact-Response methodology is presented in this work. The differential DPSIR (DeltaDPSIR) was developed to evaluate impacts on the coastal environment and as a tool for integrated ecosystem management. The aim of the DeltaDPSIR is to provide scientifically-based information required by managers and decision-makers to evaluate previously adopted policies, as well as future response scenarios. The innovation of the present approach is to provide an explicit link between ecological and economic information related to the use and management of a coastal ecosystem within a specific timeframe. The application of DeltaDPSIR is illustrated through an analysis of developments in a Southwest European coastal lagoon between 1985 and 1995. The value of economic activities dependent on the lagoon suffered a significant reduction (ca. -60%) over that period, mainly due to a decrease in bivalve production. During that decade the pressures from the catchment area were managed (ca. 176 million Euros), mainly through the building of waste water treatment plants. Notwithstanding this, the ecosystem state worsened with respect to abnormal clam mortalities due to a parasite infection and to benthic eutrophication symptoms in specific problematic areas. The negative economic impacts during the decade were estimated between -565 and -315 million Euros, of which 9-49% represent the cost of environmental externalities. Evaluation of these past events indicates that future management actions should focus on reducing the limitation on local clam seeds, which should result in positive impacts to both the local socio-economy and biodiversity.

  14. A Quantitative Examination of Critical Success Factors Comparing Agile and Waterfall Project Management Methodologies

    ERIC Educational Resources Information Center

    Pedersen, Mitra

    2013-01-01

    This study investigated the rate of success for IT projects using agile and standard project management methodologies. Any successful project requires use of project methodology. Specifically, large projects require formal project management methodologies or models, which establish a blueprint of processes and project planning activities. This…

  15. A Quantitative Examination of Critical Success Factors Comparing Agile and Waterfall Project Management Methodologies

    ERIC Educational Resources Information Center

    Pedersen, Mitra

    2013-01-01

    This study investigated the rate of success for IT projects using agile and standard project management methodologies. Any successful project requires use of project methodology. Specifically, large projects require formal project management methodologies or models, which establish a blueprint of processes and project planning activities. This…

  16. Managing the Collaborative Networks Lifecycle: A Meta-Methodology

    NASA Astrophysics Data System (ADS)

    Noran, Ovidiu

    The benefits of using various forms of Collaborative Networks (CNs) to create agile virtual organisations (Va), shop floors and laboratories, or to bring together professionals worldwide in virtual communities are commonly acknowledged in both academia and industry. Currently however, the existing CN knowledge is scattered and overlapping; this is a transitional phase in the maturing of the CN domain and its evolution towards a proper discipline. The.progress of the CN research domain (and its practical applications) relies upon the structuring of relevant knowledge into a consistent framework that conveys an unambiguous and agreed-upon collaborative paradigm. The methodological aspect of this integration effort can be significantly supported by the creation of a high-level artefact, able to express and manage existing and emerging knowledge related to the creation and operation of various CN types and their concrete manifestations. The proposed artefact could take the form of a 'to-do list on how to create methods' (thus, a meta-methodology) for specific enterprise architecture (EA) tasks or task types, which typically include the information system (IS) supporting the business.

  17. On Robust Methodologies for Managing Public Health Care Systems

    PubMed Central

    Nimmagadda, Shastri L.; Dreher, Heinz V.

    2014-01-01

    Authors focus on ontology-based multidimensional data warehousing and mining methodologies, addressing various issues on organizing, reporting and documenting diabetic cases and their associated ailments, including causalities. Map and other diagnostic data views, depicting similarity and comparison of attributes, extracted from warehouses, are used for understanding the ailments, based on gender, age, geography, food-habits and other hereditary event attributes. In addition to rigor on data mining and visualization, an added focus is on values of interpretation of data views, from processed full-bodied diagnosis, subsequent prescription and appropriate medications. The proposed methodology, is a robust back-end application, for web-based patient-doctor consultations and e-Health care management systems through which, billions of dollars spent on medical services, can be saved, in addition to improving quality of life and average life span of a person. Government health departments and agencies, private and government medical practitioners including social welfare organizations are typical users of these systems. PMID:24445953

  18. On robust methodologies for managing public health care systems.

    PubMed

    Nimmagadda, Shastri L; Dreher, Heinz V

    2014-01-17

    Authors focus on ontology-based multidimensional data warehousing and mining methodologies, addressing various issues on organizing, reporting and documenting diabetic cases and their associated ailments, including causalities. Map and other diagnostic data views, depicting similarity and comparison of attributes, extracted from warehouses, are used for understanding the ailments, based on gender, age, geography, food-habits and other hereditary event attributes. In addition to rigor on data mining and visualization, an added focus is on values of interpretation of data views, from processed full-bodied diagnosis, subsequent prescription and appropriate medications. The proposed methodology, is a robust back-end application, for web-based patient-doctor consultations and e-Health care management systems through which, billions of dollars spent on medical services, can be saved, in addition to improving quality of life and average life span of a person. Government health departments and agencies, private and government medical practitioners including social welfare organizations are typical users of these systems.

  19. Exploring utility function in utility management: an evaluating method of library preservation.

    PubMed

    Yan, Bin; Shi, Feng; Yu, Rui-Qiang

    2013-12-01

    In order to seek a new method of book evaluation and realize book resources sharing among the regional university libraries, we think that library should collect books of the high utility value in the case of limited funds. We proposed a changing Bellman equation as a utility function and used the explicit functions of the book usage factor and the book usage half-life derived from the utility function as an evaluating method of the collecting books. The results from empirical data given some conclusions such as the varieties diversity, the collected risk, the tendencies of reading varieties, species continuity and so on and a librarian can use the utility management to supplement the collections management.

  20. Orion GN&C Fault Management System Verification: Scope And Methodology

    NASA Technical Reports Server (NTRS)

    Brown, Denise; Weiler, David; Flanary, Ronald

    2016-01-01

    In order to ensure long-term ability to meet mission goals and to provide for the safety of the public, ground personnel, and any crew members, nearly all spacecraft include a fault management (FM) system. For a manned vehicle such as Orion, the safety of the crew is of paramount importance. The goal of the Orion Guidance, Navigation and Control (GN&C) fault management system is to detect, isolate, and respond to faults before they can result in harm to the human crew or loss of the spacecraft. Verification of fault management/fault protection capability is challenging due to the large number of possible faults in a complex spacecraft, the inherent unpredictability of faults, the complexity of interactions among the various spacecraft components, and the inability to easily quantify human reactions to failure scenarios. The Orion GN&C Fault Detection, Isolation, and Recovery (FDIR) team has developed a methodology for bounding the scope of FM system verification while ensuring sufficient coverage of the failure space and providing high confidence that the fault management system meets all safety requirements. The methodology utilizes a swarm search algorithm to identify failure cases that can result in catastrophic loss of the crew or the vehicle and rare event sequential Monte Carlo to verify safety and FDIR performance requirements.

  1. Renewable Electricity Benefits Quantification Methodology: A Request for Technical Assistance from the California Public Utilities Commission

    SciTech Connect

    Mosey, G.; Vimmerstedt, L.

    2009-07-01

    The California Public Utilities Commission (CPUC) requested assistance in identifying methodological alternatives for quantifying the benefits of renewable electricity. The context is the CPUC's analysis of a 33% renewable portfolio standard (RPS) in California--one element of California's Climate Change Scoping Plan. The information would be used to support development of an analytic plan to augment the cost analysis of this RPS (which recently was completed). NREL has responded to this request by developing a high-level survey of renewable electricity effects, quantification alternatives, and considerations for selection of analytic methods. This report addresses economic effects and health and environmental effects, and provides an overview of related analytic tools. Economic effects include jobs, earnings, gross state product, and electricity rate and fuel price hedging. Health and environmental effects include air quality and related public-health effects, solid and hazardous wastes, and effects on water resources.

  2. Cost-utility analysis of methadone maintenance treatment: a methodological approach.

    PubMed

    Vanagas, Giedrius; Padaiga, Zilvinas; Bagdonas, Eugenijus

    2006-01-01

    Economic considerations influence the substance user treatment system. These considerations influence who gets treatment and for how long, as well as determining what services they receive and in what setting. Current medical literature argues that maintenance treatment reduces risk-taking behavior, such as injection drug use and needle sharing. Treatment also reduces the mortality associated with abuse of opiates by injection and can cause decreases in costs incurred by the criminal justice system and social services agencies. This suggests the need for complex economic evaluations of a maintenance treatment to find out the optimum treatment program. This paper describes methods of economic evaluation in health care and reviews the methodology of cost-utility analysis in economic evaluations of methadone maintenance treatment.

  3. Intramuscular sensation in conscious human subjects: a qualitative and quantitative study utilizing signal detection theory methodology.

    PubMed

    Murphy, Bernadette; Dawson, Noel; Irwin, R John

    2002-01-01

    To investigate whether human subjects could consciously perceive different levels of intramuscular sensation, EMG needle electrodes were inserted into the forearm extensor musculature. Qualitative descriptions of the types of sensations evoked at various current intensities were recorded. A series of preliminary experiments was performed in order to determine the optimum waveform, current intensity, duration and separation between adjacent current pairs that could reliably be discriminated by conscious human subjects. The methodology of signal detection theory was utilized to obtain the discrimination measure, d' (d prime). Values of d' were obtained for sequential blocks of trials consisting of randomly delivered blocks of 50 "strong" and 50 "weak" stimuli. The ability to discriminate both noxious and non-noxious stimuli was determined using d'. It was demonstrated that human subjects are able to qualitatively describe non-nociceptive sensations elicited by low levels of intramuscular stimulation. Subjects were able to reliably discriminate pairs of electrical stimuli separated in intensity by 0.4 dB over four sequential blocks of trials on the same day and on different days. This work demonstrates that signal detection theory methods can reliably measure sensory discrimination in skeletal muscle, for both noxious and non-noxious levels of electrical stimulation. A protocol is proposed for appropriate future use of this methodology to investigate alterations in muscle sensation following experimental interventions.

  4. Impact of HMO ownership on management processes and utilization outcomes.

    PubMed

    Ahern, M; Molinari, C

    2001-05-01

    To examine the effects of health maintenance organization (HMO) ownership characteristics on selected utilization outcomes and management processes affecting utilization. We used 1995 HMO data from the American Association of Health Plans. Using regression analysis, we examined the relation between HMO utilization (hospital discharges, days, and average length of stay; cardiac catheterization procedures; and average cost of outpatient prescriptions) and the structural characteristics of HMOs: ownership type (insurance company, hospital, physician, independent, and national managed care company), HMO size, for-profit status, model type, geographic region, and payer mix. HMO ownership type is significantly associated with medical management processes, including risk sharing by providers, risk sharing by consumers, and other management strategies. Relative to hospital-owned HMOs, insurance company-owned HMOs have fewer hospital discharges, fewer hospital days, and longer lengths of stay. National managed care organization-owned HMOs have fewer cardiac catheterizations and lower average outpatient prescription costs. Independently owned HMOs have more cardiac catheterizations. For-profit HMOs have lower prescription costs. Relative to hospital-owned HMOs, insurance company-owned HMOs are more likely to use hospital risk sharing and provider capitation and less likely to use out-of-pocket payments for hospital use and a closed formulary. National managed care organization-owned HMOs are less likely to use provider capitation, out-of-pocket payments for hospital use, catastrophic case management, and hospital risk sharing. Physician-hospital-owned HMOs are less likely to use catastrophic case management. For-profit HMOs are more likely to use hospital risk sharing and catastrophic case management. HMO ownership type affects utilization outcomes and management strategies.

  5. Utilization management in radiology, part 2: perspectives and future directions.

    PubMed

    Duszak, Richard; Berlin, Jonathan W

    2012-10-01

    Increased utilization of medical imaging in the early part of the last decade has resulted in numerous efforts to reduce associated spending. Recent initiatives have focused on managing utilization with radiology benefits managers and real-time order entry decision support systems. Although these approaches might seem mutually exclusive and their application to radiology appears unique, the historical convergence and broad acceptance of both programs within the pharmacy sector may offer parallels for their potential future in medical imaging. In this second installment of a two-part series, anticipated trends in radiology utilization management are reviewed. Perspectives on current and future potential roles of radiologists in such initiatives are discussed, particularly in light of emerging physician payment models.

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

    SciTech Connect

    1997-12-01

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

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

    SciTech Connect

    1997-01-01

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

  8. Change management methodologies trained for automotive infotainment projects

    NASA Astrophysics Data System (ADS)

    Prostean, G.; Volker, S.; Hutanu, A.

    2017-01-01

    An Automotive Electronic Control Units (ECU) development project embedded within a car Environment is constantly under attack of a continuous flow of modifications of specifications throughout the life cycle. Root causes for those modifications are for instance simply software or hardware implementation errors or requirement changes to satisfy the forthcoming demands of the market to ensure the later commercial success. It is unavoidable that from the very beginning until the end of the project “requirement changes” will “expose” the agreed objectives defined by contract specifications, which are product features, budget, schedule and quality. The key discussions will focus upon an automotive radio-navigation (infotainment) unit, which challenges aftermarket devises such as smart phones. This competition stresses especially current used automotive development processes, which are fit into a 4 Year car development (introduction) cycle against a one-year update cycle of a smart phone. The research will focus the investigation of possible impacts of changes during all phases of the project: the Concept-Validation, Development and Debugging-Phase. Building a thorough understanding of prospective threats is of paramount importance in order to establish the adequate project management process to handle requirement changes. Personal automotive development experiences and Literature review of change- and configuration management software development methodologies led the authors to new conceptual models, which integrates into the structure of traditional development models used in automotive projects, more concretely of radio-navigation projects.

  9. The INEL approach: Environmental Restoration Program management and implementation methodology

    SciTech Connect

    1996-02-01

    The overall objectives of the INEL Environmental Restoration (ER) Program management approach are to facilitate meeting mission needs through the successful implementation of a sound, and effective project management philosophy. This paper outlines the steps taken to develop the ER program, and explains further the implementing tools and processes used to achieve what can be viewed as fundamental to a successful program. The various examples provided will demonstrate how the strategies for implementing these operating philosophies are actually present and at work throughout the program, in spite of budget drills and organizational changes within DOE and the implementing contractor. A few of the challenges and successes of the INEL Environmental Restoration Program have included: a) completion of all enforceable milestones to date, b) acceleration of enforceable milestones, c) managing funds to reduce uncosted obligations at year end by utilizing greater than 99% of FY-95 budget, d) an exemplary safety record, e) developing a strategy for partial Delisting of the INEL by the year 2000, f) actively dealing with Natural Resource Damages Assessment issues, g) the achievement of significant project cost reductions, h) and implementation of a partnering charter and application of front end quality principles.

  10. US electric utility demand-side management, 1994

    SciTech Connect

    1995-12-26

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

  11. Multicriteria methodological approach to manage urban air pollution

    NASA Astrophysics Data System (ADS)

    Vlachokostas, Ch.; Achillas, Ch.; Moussiopoulos, N.; Banias, G.

    2011-08-01

    Managing urban air pollution necessitates a feasible and efficient abatement strategy which is characterised as a defined set of specific control measures. In practice, hard budget constraints are present in any decision-making process and therefore available alternatives need to be hierarchised in a fast but still reliable manner. Moreover, realistic strategies require adequate information on the available control measures, taking also into account the area's special characteristics. The selection of the most applicable bundle of measures rests in achieving stakeholders' consensus, while taking into consideration mutually conflicting views and criteria. A preliminary qualitative comparison of alternative control measures would be most handy for decision-makers, forming the grounds for an in-depth analysis of the most promising ones. This paper presents an easy-to-follow multicriteria methodological approach in order to include and synthesise multi-disciplinary knowledge from various stakeholders so as to result into a priority list of abatement options, achieve consensus and secure the adoption of the resulting optimal solution. The approach relies on the active involvement of public authorities and local stakeholders in order to incorporate their environmental, economic and social preferences. The methodological scheme is implemented for the case of Thessaloniki, Greece, an area considered among the most polluted cities within Europe, especially with respect to airborne particles. Intense police control, natural gas penetration in buildings and metro construction equally result into the most "promising" alternatives in order to control air pollution in the GTA. The three optimal alternatives belong to different thematic areas, namely road transport, thermal heating and infrastructure. Thus, it is obvious that efforts should spread throughout all thematic areas. Natural gas penetration in industrial units, intense monitoring of environmental standards and regular

  12. A Review of Citation Analysis Methodologies for Collection Management

    ERIC Educational Resources Information Center

    Hoffmann, Kristin; Doucette, Lise

    2012-01-01

    While there is a considerable body of literature that presents the results of citation analysis studies, most researchers do not provide enough detail in their methodology to reproduce the study, nor do they provide rationale for methodological decisions. In this paper, we review the methodologies used in 34 recent articles that present a…

  13. A Review of Citation Analysis Methodologies for Collection Management

    ERIC Educational Resources Information Center

    Hoffmann, Kristin; Doucette, Lise

    2012-01-01

    While there is a considerable body of literature that presents the results of citation analysis studies, most researchers do not provide enough detail in their methodology to reproduce the study, nor do they provide rationale for methodological decisions. In this paper, we review the methodologies used in 34 recent articles that present a…

  14. Contingency management: utility in the treatment of drug abuse disorders.

    PubMed

    Stitzer, M L; Vandrey, R

    2008-04-01

    Contingency management (CM) is a strategy that uses positive reinforcement to improve the clinical outcomes of substance abusers in treatment, especially sustained abstinence from drugs of abuse. Further, CM has been adopted to improve methodology and interpretation of outcomes in clinical trials testing new pharmacotherapies and to improve adherence to efficacious medications in substance abuse patients. Thus, CM has proven to be widely useful as a direct therapeutic intervention and as a tool in treatment development.

  15. LiDAR utility for natural resource managers

    Treesearch

    Andrew Thomas Hudak; Jeffrey Scott Evans; Alistair Mattthew Stuart. Smith

    2009-01-01

    Applications of LiDAR remote sensing are exploding, while moving from the research to the operational realm. Increasingly, natural resource managers are recognizing the tremendous utility of LiDAR-derived information to make improved decisions. This review provides a cross-section of studies, many recent, that demonstrate the relevance of LiDAR across a suite of...

  16. Building Maintenance and Utilities Management. Florida Vocational Program Guide.

    ERIC Educational Resources Information Center

    University of South Florida, Tampa. Dept. of Adult and Vocational Education.

    This program guide identifies primary concerns in the organization, operation, and evaluation of a building maintenance and utilities management program. It is designed for local school district and community college administrators, instructors, program advisory committees, and regional coordinating councils. The guide begins with the Dictionary…

  17. 30 years of pharmaceutical cost-utility analyses: growth, diversity and methodological improvement.

    PubMed

    Neumann, Peter J; Fang, Chi-Hui; Cohen, Joshua T

    2009-01-01

    To review and critically evaluate published cost-utility analyses (CUAs) pertaining to pharmaceuticals for the past 3 decades. We examined data from the Tufts Medical Center Cost-Effectiveness Analysis Registry (www.cearegistry.org), which contains detailed information on English-language CUAs and their ratios (in $US, year 2008 values) published in peer-reviewed journals. We summarized study features using descriptive statistics for articles published from 1976 to 2006. Changes in study methodology over time were analysed by trend test. Analysis of ratios was restricted to those published from 2000 to 2006 from studies that correctly discounted future costs and benefits. Factors associated with having a favourable value (defined to be more than the median for all included ratios) were identified by logistic regression. Of 1393 CUAs published through 2006, 640 (45.9%) pertained to pharmaceuticals. The proportion of CUAs that focussed on pharmaceuticals increased from 34% for the period 1990-5 to 47% for the period 2001-5. Investigations with a US perspective accounted for 51% of all CUAs, although this proportion has decreased over time. The UK perspective investigations accounted for nearly 16% of all studies, and this portion has increased over time. About 24% of all CUAs were sponsored by industry, 48% were sponsored by non-industry sources, and 28% did not disclose their funding. Adherence to good methodological practices is roughly similar for studies with industry and non-industry sponsorship. Adherence to these practices has increased over time. Among the 1969 ratios meeting our inclusion criteria, the median value was $US22 000 per QALY. Logistic regression revealed that, while controlling for the intervention category (e.g. pharmaceutical, medical device, screening), ratios were more likely to be favourable if they were from studies sponsored by a pharmaceutical or device manufacturer (OR 1.53; 95% CI 1.07, 2.19). Ratios for pharmaceutical CUAs were less

  18. Evaluation in health: participatory methodology and involvement of municipal managers.

    PubMed

    Almeida, Cristiane Andrea Locatelli de; Tanaka, Oswaldo Yoshimi

    2016-08-04

    To analyze scopes and limits of the use of participatory methodology of evaluation with municipal health managers and administrators. Qualitative research with health policymakers and managers of the Comissão Intergestores Regional (CIR - Regional Interagency Commission) of a health region of the state of Sao Paulo in Brazil. Representatives from seven member cities participated in seven workshops facilitated by the researchers, with the aim of assessing a specific problem of the care line, which would be used as a tracer of the system integrality. The analysis of the collected empirical material was based on the hermeneutic-dialectic methodology and aimed at the evaluation of the applied participatory methodology, according to its capacity of promoting a process of assessment capable to be used as a support for municipal management. With the participatory approach of evaluation, we were able to promote in-depth discussions with the group, especially related to the construction of integral care and to the inclusion of the user's perspective in decision-making, linked to the search for solution to concrete problems of managers. By joint exploration, the possibility of using data from electronic information systems was opened, as well as information coming directly from the users of the services, to enhance discussions and negotiations between partners. The participants were disbelievers of the replication potential of this type of evaluation without the direct monitoring of the academy, given the difficulty of organizing the process in everyday life, already taken by emergency and political issues. Evaluations of programs and services carried out within the Regional Interagency Commission, starting from the local interest and facilitating the involvement of its members by the use of participatory methodologies, can contribute to the construction of integral care. To the extent that the act of evaluating stay invested with greater significance to the local actors

  19. A robust rotorcraft flight control system design methodology utilizing quantitative feedback theory

    NASA Technical Reports Server (NTRS)

    Gorder, Peter James

    1993-01-01

    Rotorcraft flight control systems present design challenges which often exceed those associated with fixed-wing aircraft. First, large variations in the response characteristics of the rotorcraft result from the wide range of airspeeds of typical operation (hover to over 100 kts). Second, the assumption of vehicle rigidity often employed in the design of fixed-wing flight control systems is rarely justified in rotorcraft where rotor degrees of freedom can have a significant impact on the system performance and stability. This research was intended to develop a methodology for the design of robust rotorcraft flight control systems. Quantitative Feedback Theory (QFT) was chosen as the basis for the investigation. Quantitative Feedback Theory is a technique which accounts for variability in the dynamic response of the controlled element in the design robust control systems. It was developed to address a Multiple-Input Single-Output (MISO) design problem, and utilizes two degrees of freedom to satisfy the design criteria. Two techniques were examined for extending the QFT MISO technique to the design of a Multiple-Input-Multiple-Output (MIMO) flight control system (FCS) for a UH-60 Black Hawk Helicopter. In the first, a set of MISO systems, mathematically equivalent to the MIMO system, was determined. QFT was applied to each member of the set simultaneously. In the second, the same set of equivalent MISO systems were analyzed sequentially, with closed loop response information from each loop utilized in subsequent MISO designs. The results of each technique were compared, and the advantages of the second, termed Sequential Loop Closure, were clearly evident.

  20. Planning "and" Sprinting: Use of a Hybrid Project Management Methodology within a CIS Capstone Course

    ERIC Educational Resources Information Center

    Baird, Aaron; Riggins, Frederick J.

    2012-01-01

    An increasing number of information systems projects in industry are managed using hybrid project management methodologies, but this shift in project management methods is not fully represented in our CIS curriculums. CIS capstone courses often include an applied project that is managed with traditional project management methods (plan first,…

  1. Planning "and" Sprinting: Use of a Hybrid Project Management Methodology within a CIS Capstone Course

    ERIC Educational Resources Information Center

    Baird, Aaron; Riggins, Frederick J.

    2012-01-01

    An increasing number of information systems projects in industry are managed using hybrid project management methodologies, but this shift in project management methods is not fully represented in our CIS curriculums. CIS capstone courses often include an applied project that is managed with traditional project management methods (plan first,…

  2. A utility oriented radio resource management algorithm for heterogenous network

    NASA Astrophysics Data System (ADS)

    Wang, Xiaoyan; Dong, Yan; Huang, Zailu

    2007-11-01

    A utility oriented radio resource management algorithm is proposed for broadband nongeostationary satellite network which works in the heterogeneous network environment and provides access services for various customers on the ground. Based on the game theory, the problem for optimizing the network's performance is turned into the problem for maximizing the network's long term utility in the proposed algorithm. With evaluation to the traffic condition and dimensions of Qos for the network at the moment while the access service requirements changing, the influence of this service requirement to the long term utility of the satellite network is audited and then the resource assignment decision can be made according to the rule for maximizing the satellite network's long term utility. The process directed by game theory guaranteed both that the benefit of the network and the requirements of the customers could be considered synthetically. The simulation results demonstrate the effectiveness of the proposed algorithm.

  3. Utilization management in a mixed-payment environment.

    PubMed

    Krohn, R; Broffman, G

    1998-02-01

    Fee-for-service and capitation payment methods create different financial incentives for healthcare providers, and the objectives of utilization management differ under each payment method. These differences can be reconciled, however, by incorporating the strengths of utilization management programs associated with both methods into an overarching program that focuses on the continuum of care. Such a program should be focused on achieving the optimal outcomes for patients by identifying the appropriate level of care, who should provide it, and when and where it should be provided. Essential to this effort is access to comprehensive clinical and financial data through an integrated information system. In addition, financial incentives need to be aligned through such means as risk pools, compensation arrangements tied to achievement of medical management goals, and clearly defined policies and procedures.

  4. Parameter Analysis of Lunar Surface Navigation Utilizing Dilution-of-Precision Methodology With Lunar Orbiters

    NASA Technical Reports Server (NTRS)

    Welch, Bryan W.

    2008-01-01

    With the NASA Vision for Space Exploration focusing on the return of astronauts to the Moon and eventually to Mars, architectures for new navigation concepts must be derived and analyzed. One such concept, developed by the Space Communications Architecture Working Group (SCAWG), is to place a constellation of satellites around the Moon. Previously completed analyses examined the performance of multiple satellite constellations and recommended a constellation oriented as a Walker polar 6/2/1 with a semimajor axis (SMA) of 9250 km. One requirement of the constellations that were examined was that they have continuous access to any location on the lunar surface. In this report, the polar 6/2/1 and polar 8/2/1, with equal SMAs, are examined in greater detail. The dilution-of-precision (DoP) methodology is utilized to examine the effects of longitude surface points, latitude surface points, elevation requirements, and modified failure modes for these two constellations with regard to system availability. Longitude study results show that points along a meridian closely approximate the results of a global set of data points. Latitude study results show that previous assumptions with regard to latitude spacing are adequate to simulate global system availability. Elevation study results show that global system availability curves follow a reverse sigmoid function. Modified failure mode study results show that the benefits of reorienting a failure mode constellation depend on the type of navigation system and the length of the integration period being used.

  5. The Application of Failure Modes and Effects Analysis Methodology to Intrathecal Drug Delivery for Pain Management

    PubMed Central

    Patel, Teresa; Fisher, Stanley P.

    2016-01-01

    Objective This study aimed to utilize failure modes and effects analysis (FMEA) to transform clinical insights into a risk mitigation plan for intrathecal (IT) drug delivery in pain management. Methods The FMEA methodology, which has been used for quality improvement, was adapted to assess risks (i.e., failure modes) associated with IT therapy. Ten experienced pain physicians scored 37 failure modes in the following categories: patient selection for therapy initiation (efficacy and safety concerns), patient safety during IT therapy, and product selection for IT therapy. Participants assigned severity, probability, and detection scores for each failure mode, from which a risk priority number (RPN) was calculated. Failure modes with the highest RPNs (i.e., most problematic) were discussed, and strategies were proposed to mitigate risks. Results Strategic discussions focused on 17 failure modes with the most severe outcomes, the highest probabilities of occurrence, and the most challenging detection. The topic of the highest‐ranked failure mode (RPN = 144) was manufactured monotherapy versus compounded combination products. Addressing failure modes associated with appropriate patient and product selection was predicted to be clinically important for the success of IT therapy. Conclusions The methodology of FMEA offers a systematic approach to prioritizing risks in a complex environment such as IT therapy. Unmet needs and information gaps are highlighted through the process. Risk mitigation and strategic planning to prevent and manage critical failure modes can contribute to therapeutic success. PMID:27477689

  6. The Implications of Healthcare Utilization of Diabetes Disease Management

    DTIC Science & Technology

    2008-06-24

    regression indicate that the overall model significantly predicts of outpatient utilization, R:=.048. R2«j«s.045, F= 19.047. P<.000. This study demonstrates... Regression results indicate that the overall model significantly predicts of outpatient utilization, R2=048, R2adJ=.045, F=19.047, P<.00(f, see...manage patients with diabetes’.’" Standard regression was conducted to determine the accuracy of the independent (HbAlc Testing 2005. 2006 and 2007

  7. Utilizing the PCICS Nursing Guidelines in Managing the CICU Patient.

    PubMed

    Justice, Lindsey; Ellis, Misty; St George-Hyslop, Cecilia; Donnellan, Amy; Trauth, Amiee; Drouillard, Brenda; Watt, Claire; Callow, Louise

    2015-10-01

    The Pediatric Cardiac Intensive Care Society (PCICS) Nursing Guidelines were developed to provide an evidence-based resource for bedside cardiac intensive care unit nursing care. Guideline topics include postoperative care, hemodynamic monitoring, arrhythmia management, and nutrition. These evidence-based care guidelines were presented at the 10th International Meeting of PCICS and have been utilized in the preparation of this article. They can be accessed at http://www.pcics.org/resources/pediatric-neonatal/. Utilization of these guidelines in practice is illustrated for single ventricle stage 1 palliation, Fontan operation, truncus arteriosus, and atrioventricular septal defect. © The Author(s) 2015.

  8. Reference Management Methodologies for Large Structural Models at Kennedy Space Center

    NASA Technical Reports Server (NTRS)

    Jones, Corey; Bingham, Ryan; Schmidt, Rick

    2011-01-01

    There have been many challenges associated with modeling some of NASA KSC's largest structures. Given the size of the welded structures here at KSC, it was critically important to properly organize model struc.ture and carefully manage references. Additionally, because of the amount of hardware to be installed on these structures, it was very important to have a means to coordinate between different design teams and organizations, check for interferences, produce consistent drawings, and allow for simple release processes. Facing these challenges, the modeling team developed a unique reference management methodology and model fidelity methodology. This presentation will describe the techniques and methodologies that were developed for these projects. The attendees will learn about KSC's reference management and model fidelity methodologies for large structures. The attendees will understand the goals of these methodologies. The attendees will appreciate the advantages of developing a reference management methodology.

  9. Utilizing a disease management approach to improve ESRD patient outcomes.

    PubMed

    Anand, Shaan; Nissenson, Allen R

    2002-01-01

    In this era of processes and systems to improve quality, disease management is one methodology to improve care delivery and outcomes for patients with chronic kidney disease (CKD). In most disease management systems a senior renal nurse coordinates all aspects of the patient's care and ensures that the prescribed and necessary care is delivered for both CKD-related and comorbid conditions. The nurse also continually monitors outcomes on quality indicators and key performance measures. These outcome data are then aggregated and analyzed, are compared with local and national benchmarks, and drive the continuous quality improvement (CQI) process. Such a system attempts to centralize the currently fragmented care delivery system, continually improve patient outcomes, and conserve scarce economic resources. Early data suggest a disease management approach may improve both the morbidity and mortality of CKD patients.

  10. 42 CFR 484.230 - Methodology used for the calculation of the low-utilization payment adjustment.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 5 2014-10-01 2014-10-01 false Methodology used for the calculation of the low-utilization payment adjustment. 484.230 Section 484.230 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION HOME HEALTH...

  11. 42 CFR 484.230 - Methodology used for the calculation of the low-utilization payment adjustment.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 5 2013-10-01 2013-10-01 false Methodology used for the calculation of the low-utilization payment adjustment. 484.230 Section 484.230 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION HOME HEALTH...

  12. The cost of energy from utility-owned solar electric systems. A required revenue methodology for ERDA/EPRI evaluations

    NASA Technical Reports Server (NTRS)

    1976-01-01

    This methodology calculates the electric energy busbar cost from a utility-owned solar electric system. This approach is applicable to both publicly- and privately-owned utilities. Busbar cost represents the minimum price per unit of energy consistent with producing system-resultant revenues equal to the sum of system-resultant costs. This equality is expressed in present value terms, where the discount rate used reflects the rate of return required on invested capital. Major input variables describe the output capabilities and capital cost of the energy system, the cash flows required for system operation amd maintenance, and the financial structure and tax environment of the utility.

  13. A methodology to identify stranded generation facilities and estimate stranded costs for Louisiana's electric utility industry

    NASA Astrophysics Data System (ADS)

    Cope, Robert Frank, III

    1998-12-01

    The electric utility industry in the United States is currently experiencing a new and different type of growing pain. It is the pain of having to restructure itself into a competitive business. Many industry experts are trying to explain how the nation as a whole, as well as individual states, will implement restructuring and handle its numerous "transition problems." One significant transition problem for federal and state regulators rests with determining a utility's stranded costs. Stranded generation facilities are assets which would be uneconomic in a competitive environment or costs for assets whose regulated book value is greater than market value. At issue is the methodology which will be used to estimate stranded costs. The two primary methods are known as "Top-Down" and "Bottom-Up." The "Top-Down" approach simply determines the present value of the losses in revenue as the market price for electricity changes over a period of time into the future. The problem with this approach is that it does not take into account technical issues associated with the generation and wheeling of electricity. The "Bottom-Up" approach computes the present value of specific strandable generation facilities and compares the resulting valuations with their historical costs. It is regarded as a detailed and difficult, but more precise, approach to identifying stranded assets and their associated costs. This dissertation develops a "Bottom-Up" quantitative, optimization-based approach to electric power wheeling within the state of Louisiana. It optimally evaluates all production capabilities and coordinates the movement of bulk power through transmission interconnections of competing companies in and around the state. Sensitivity analysis to this approach is performed by varying seasonal consumer demand, electric power imports, and transmission inter-connection cost parameters. Generation facility economic dispatch and transmission interconnection bulk power transfers, specific

  14. Is strategic asset management applicable to small and medium utilities?

    PubMed

    Alegre, Helena

    2010-01-01

    Urban water infrastructures provide essential services to modern societies and represent a major portion of the value of municipal physical assets. Managing these assets rationally is therefore fundamental for the sustainability of the services and to the economy of societies. "Asset Management" (AM) is a modern term for an old practice--assets have always been managed. In recent years, significant evolution occurred in terms of the AM formal approaches, of the monitoring and decision support tools and of the implementation success cases. However, most tools developed are too sophisticated and data seek for small utilities. The European R&D network COST Action C18 ( E-mail: www.costc18.org) identified key research problems related to the management of urban water infrastructures, currently not covered by on-going projects of the European Framework Program. The top 1 topic is "Efficient management of small community". This paper addresses challenges and opportunities for small and medium utilities with regard to infrastructure AM (IAM). To put this into context, the first sections discuss the need for IAM, highlight key recent developments, and present IAM drivers, as well as research and development gaps, priorities and products needed.

  15. Hospital case management and the Utilization Review Committee.

    PubMed

    Orland, Richard A

    2011-01-01

    This article describes the overall regulatory mandate governing the Utilization Review Committee (URC) in the hospital setting. General structure, function, and meeting format of the URC are important considerations. Furthermore, the URC can serve as a vital platform for medical staff leadership and case management practice to use pertinent risk-adjusted data to drive needed change at the organizational, departmental, service line, and physician level. A case history illustrates the importance of these issues. Acute care hospitals. Case management staff, medical advisors, and physician leaders play important roles in driving changes. The URC will become ever-more important in the rapidly accelerating changes, driving heightened accountability on the part of hospitals.

  16. Methodological utility of chemerin as a novel biomarker of immunity and metabolism

    PubMed Central

    Eichelmann, Fabian; Weikert, Cornelia; di Giuseppe, Romina; Biemann, Ronald; Isermann, Berend; Schulze, Matthias B; Boeing, Heiner

    2017-01-01

    Chemerin is a recently discovered adipokine with inflammatory and metabolic actions relevant for chronic disease development. However, evidence from human research on the role of chemerin in chronic disease risk is still lacking. We assessed the reliability of plasma chemerin concentrations measured on two occasions over a 4-month period in 207 apparently healthy participants. In addition, we explored the cross-sectional associations between chemerin and inflammatory biomarkers using Spearman partial correlation and multivariable linear regression analyses. Intra-individual reproducibility of chemerin measurements was assessed by calculating intraclass correlation coefficients (ICCs) and exploration of Bland–Altman plots. Reliability analyses revealed good reproducibility of chemerin measurements (ICC: 0.72 (95%-CI 0.65, 0.78)). Visual inspection of Bland–Altman plots confirmed that the two time point measurements had a high level of agreement. In correlation analyses, chemerin was positively correlated with adiposity measures (body mass index and waist circumference). In addition, independent of adiposity measures, chemerin was correlated with the biomarkers C-reactive protein, fatty acid-binding protein 4 and progranulin (Rho-s ranging from 0.23 to 0.37). In multivariable linear regression analysis, a combination of correlated factors including body mass index, waist circumference, C-reactive protein, progranulin and fatty acid-binding protein-4 explained 28.0% of chemerin concentrations. These findings demonstrate methodological utility of chemerin concentrations in population-based research setting. Human studies are highly warranted in order to provide further insights into the role of chemerin as a biomarker linking immunity and metabolism in relation to chronic disease risk. PMID:28592510

  17. Effective Utilization Management in a Military Treatment Facility

    DTIC Science & Technology

    1999-12-01

    16. Accumulative Average Length of Stay Figure 17. MEPRS Inpatient Summary Data Figure 18. Inpatient Personnel Expenses Figure 19. Inpatient...utilization management efforts have decreased the average length of stay , modified the case mix index, and reduced cost per inpatient bed day. This...system was also used to identify Case Mix Index changes of patients seen at WHMC. The same system provided data to determine Average Length of Stay (ALOS

  18. Increasing the Utility of the Human Resource Management (HRM) Survey.

    DTIC Science & Technology

    1980-03-01

    ADASG 63ft NAVAL POSTGRADUATE SCHOOL MONTEREY CA F/6 /1 INCREASING THE UTILITY OF THE HUMAN RESOUCE MANAGEMENT (NAM) S-ETC(U) MAR 80 F 6 DENGLER7U...REQUIREMENTS----------------------------- 5 D. POTENTIAL RESEARCH ------------------------------ 5 APPENDIX A...HRMC’s and HRMD’s by the Navy Personnel Research and Development Center (NPRDC) located in San Diego, California, which serves as a central data bank

  19. Contemporary management of carotid blowout syndrome utilizing endovascular techniques.

    PubMed

    Manzoor, Nauman F; Rezaee, Rod P; Ray, Abhishek; Wick, Cameron C; Blackham, Kristine; Stepnick, David; Lavertu, Pierre; Zender, Chad A

    2017-02-01

    To illustrate complex interdisciplinary decision making and the utility of modern endovascular techniques in the management of patients with carotid blowout syndrome (CBS). Retrospective chart review. Patients treated with endovascular strategies and/or surgical modalities were included. Control of hemorrhage, neurological, and survival outcomes were studied. Between 2004 and 2014, 33 patients had 38 hemorrhagic events related to head and neck cancer that were managed with endovascular means. Of these, 23 were localized to the external carotid artery (ECA) branches and five localized to the ECA main trunk; nine were related to the common carotid artery (CCA) or internal carotid artery (ICA), and one event was related to the innominate artery. Seven events related to the CCA/ICA or innominate artery were managed with endovascular sacrifice, whereas three cases were managed with a flow-preserving approach (covered stent). Only one patient developed permanent hemiparesis. In two of the three cases where the flow-preserving approach was used, the covered stent eventually became exposed via the overlying soft tissue defect, and definitive management using carotid revascularization or resection was employed to prevent further hemorrhage. In cases of soft tissue necrosis, vascularized tissues were used to cover the great vessels as applicable. The use of modern endovascular approaches for management of acute CBS yields optimal results and should be employed in a coordinated manner by the head and neck surgeon and the neurointerventionalist. 4. Laryngoscope, 2016 127:383-390, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  20. Utilization management in the small group insurance market.

    PubMed

    Spiro, A

    1989-05-01

    Small businesses are the most rapidly growing segment of the economy, providing one half of all jobs in the United States. The health insurance industry must address issues which are unique to this market. The health insurance product for small businesses must have simple administration for the owners and easy access to quality medical care for the employees. Small businesses have been adversely affected by the high cost of health care. Numerous studies have shown that a major factor contributing to the high cost of health care is inappropriate and unnecessary utilization of health care. Until recently, techniques of utilization management have been difficult to adapt to the small group market. The Celtic Life Insurance Company has been using a managed care fee for service arrangement for the past three years. Celtic has been able to tailor a program for small businesses and maintain complete administrative coordination, instead of contracting with a private utilization review company. Our program maintains freedom of choice of providers and easy access to health care, without limiting access to specialists. Cost containment features have assisted insureds in selecting appropriate health care, in the appropriate setting while not interfering with the doctor-patient relationship.

  1. An ontological case base engineering methodology for diabetes management.

    PubMed

    El-Sappagh, Shaker H; El-Masri, Samir; Elmogy, Mohammed; Riad, A M; Saddik, Basema

    2014-08-01

    Ontology engineering covers issues related to ontology development and use. In Case Based Reasoning (CBR) system, ontology plays two main roles; the first as case base and the second as domain ontology. However, the ontology engineering literature does not provide adequate guidance on how to build, evaluate, and maintain ontologies. This paper proposes an ontology engineering methodology to generate case bases in the medical domain. It mainly focuses on the research of case representation in the form of ontology to support the case semantic retrieval and enhance all knowledge intensive CBR processes. A case study on diabetes diagnosis case base will be provided to evaluate the proposed methodology.

  2. Detection of outlier loci and their utility for fisheries management.

    PubMed

    Russello, Michael A; Kirk, Stephanie L; Frazer, Karen K; Askey, Paul J

    2012-01-01

    Genetics-based approaches have informed fisheries management for decades, yet remain challenging to implement within systems involving recently diverged stocks or where gene flow persists. In such cases, genetic markers exhibiting locus-specific ('outlier') effects associated with divergent selection may provide promising alternatives to loci that reflect genome-wide ('neutral') effects for guiding fisheries management. Okanagan Lake kokanee (Oncorhynchus nerka), a fishery of conservation concern, exhibits two sympatric ecotypes adapted to different reproductive environments; however, previous research demonstrated the limited utility of neutral microsatellites for assigning individuals. Here, we investigated the efficacy of an outlier-based approach to fisheries management by screening >11 000 expressed sequence tags for linked microsatellites and conducting genomic scans for kokanee sampled across seven spawning sites. We identified eight outliers among 52 polymorphic loci that detected ecotype-level divergence, whereas there was no evidence of divergence at neutral loci. Outlier loci exhibited the highest self-assignment accuracy to ecotype (92.1%), substantially outperforming 44 neutral loci (71.8%). Results were robust among-sampling years, with assignment and mixed composition estimates for individuals sampled in 2010 mirroring baseline results. Overall, outlier loci constitute promising alternatives for informing fisheries management involving recently diverged stocks, with potential applications for designating management units across a broad range of taxa.

  3. Utilization of lean management principles in the ambulatory clinic setting.

    PubMed

    Casey, Jessica T; Brinton, Thomas S; Gonzalez, Chris M

    2009-03-01

    The principles of 'lean management' have permeated many sectors of today's business world, secondary to the success of the Toyota Production System. This management method enables workers to eliminate mistakes, reduce delays, lower costs, and improve the overall quality of the product or service they deliver. These lean management principles can be applied to health care. Their implementation within the ambulatory care setting is predicated on the continuous identification and elimination of waste within the process. The key concepts of flow time, inventory and throughput are utilized to improve the flow of patients through the clinic, and to identify points that slow this process -- so-called bottlenecks. Nonessential activities are shifted away from bottlenecks (i.e. the physician), and extra work capacity is generated from existing resources, rather than being added. The additional work capacity facilitates a more efficient response to variability, which in turn results in cost savings, more time for the physician to interact with patients, and faster completion of patient visits. Finally, application of the lean management principle of 'just-in-time' management can eliminate excess clinic inventory, better synchronize office supply with patient demand, and reduce costs.

  4. General Risk Analysis Methodological Implications to Explosives Risk Management Systems,

    DTIC Science & Technology

    An investigation sponsored by the National Science Foundation has produced as one of its results a survey and evaluation of risk analysis methodologies...This paper presents some implications of the survey to risk analysis and decision making for explosives hazards such as may ultimately be

  5. Federated and Cloud Enabled Resources for Data Management and Utilization

    NASA Astrophysics Data System (ADS)

    Rankin, R.; Gordon, M.; Potter, R. G.; Satchwill, B.

    2011-12-01

    The emergence of cloud computing over the past three years has led to a paradigm shift in how data can be managed, processed and made accessible. Building on the federated data management system offered through the Canadian Space Science Data Portal (www.cssdp.ca), we demonstrate how heterogeneous and geographically distributed data sets and modeling tools have been integrated to form a virtual data center and computational modeling platform that has services for data processing and visualization embedded within it. We also discuss positive and negative experiences in utilizing Eucalyptus and OpenStack cloud applications, and job scheduling facilitated by Condor and Star Cluster. We summarize our findings by demonstrating use of these technologies in the Cloud Enabled Space Weather Data Assimilation and Modeling Platform CESWP (www.ceswp.ca), which is funded through Canarie's (canarie.ca) Network Enabled Platforms program in Canada.

  6. A methodology to incorporate life cycle analysis and the triple bottom line mechanism for sustainable management of industrial enterprises

    NASA Astrophysics Data System (ADS)

    Wang, Ling; Lin, Li

    2004-02-01

    Since 1970"s, the environmental protection movement has challenged industries to increase their investment in Environmentally Conscious Manufacturing (ECM) techniques and management tools. Social considerations for global citizens and their descendants also motivated the examination on the complex issues of sustainable development beyond the immediate economic impact. Consequently, industrial enterprises have started to understand sustainable development in considering the Triple Bottom Line (TBL): economic prosperity, environmental quality and social justice. For the management, however, a lack of systematic ECM methodologies hinders their effort in planning, evaluating, reporting and auditing of sustainability. To address this critical need, this research develops a framework of a sustainable management system by incorporating a Life Cycle Analysis (LCA) of industrial operations with the TBL mechanism. A TBL metric system with seven sets of indices for the TBL elements and their complex relations is identified for the comprehensive evaluation of a company"s sustainability performance. Utilities of the TBL indices are estimated to represent the views of various stakeholders, including the company, investors, employees and the society at large. Costs of these indices are also captured to reflect the company"s effort in meeting the utilities. An optimization model is formulated to maximize the economic, environmental and social benefits by the company"s effort in developing sustainable strategies. To promote environmental and social consciousness, the methodology can significantly facilitate management decisions by its capabilities of including "non-business" values and external costs that the company has not contemplated before.

  7. A Clustering Methodology of Web Log Data for Learning Management Systems

    ERIC Educational Resources Information Center

    Valsamidis, Stavros; Kontogiannis, Sotirios; Kazanidis, Ioannis; Theodosiou, Theodosios; Karakos, Alexandros

    2012-01-01

    Learning Management Systems (LMS) collect large amounts of data. Data mining techniques can be applied to analyse their web data log files. The instructors may use this data for assessing and measuring their courses. In this respect, we have proposed a methodology for analysing LMS courses and students' activity. This methodology uses a Markov…

  8. A Clustering Methodology of Web Log Data for Learning Management Systems

    ERIC Educational Resources Information Center

    Valsamidis, Stavros; Kontogiannis, Sotirios; Kazanidis, Ioannis; Theodosiou, Theodosios; Karakos, Alexandros

    2012-01-01

    Learning Management Systems (LMS) collect large amounts of data. Data mining techniques can be applied to analyse their web data log files. The instructors may use this data for assessing and measuring their courses. In this respect, we have proposed a methodology for analysing LMS courses and students' activity. This methodology uses a Markov…

  9. 76 FR 54216 - Pacific Fishery Management Council (Council); Work Session To Review Proposed Salmon Methodology...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-31

    ...); Work Session To Review Proposed Salmon Methodology Changes AGENCY: National Marine Fisheries Service... meeting. SUMMARY: The Pacific Fishery Management Council's Salmon Technical Team (STT), Scientific and Statistical Committee (SSC) Salmon Subcommittee, and Model Evaluation Workgroup (MEW) will review...

  10. Assessing and Managing Risks to Information Assurance: A Methodological Approach

    DTIC Science & Technology

    2001-05-01

    Federal Bureau of Investigations FII Federal Information Infrastructure GAO Government Accounting Office GIG Global Information Grid GII Global ...81 TABLE 6: HHM GLOBAL AND SUB-TOPICS SELECTED FOR THE IA METHODOLOGY........................87 TABLE 7: SOURCES OF FAILURE IN THE PUBLIC...declined because they thought the information was a hoax [Christensen, 1999]. There are other cases and each of these cases the military was unable to

  11. Utilizing Radiofrequency Identification Technology to Improve Safety and Management of Blood Bank Supply Chains.

    PubMed

    Coustasse, Alberto; Meadows, Pamela; Hall, Robert S; Hibner, Travis; Deslich, Stacie

    2015-11-01

    The importance of efficiency in the supply chain of perishable products, such as the blood products used in transfusion services, cannot be overstated. Many problems can occur, such as the outdating of products, inventory management issues, patient misidentification, and mistransfusion. The purpose of this article was to identify the benefits and barriers associated with radiofrequency identification (RFID) usage in improving the blood bank supply chain. The methodology for this study was a qualitative literature review following a systematic approach. The review was limited to sources published from 2000 to 2014 in the English language. Sixty-five sources were found, and 56 were used in this research study. According to the finding of the present study, there are numerous benefits and barriers to RFID utilization in blood bank supply chains. RFID technology offers several benefits with regard to blood bank product management, including decreased transfusion errors, reduction of product loss, and more efficient inventory management. Barriers to RFID implementation include the cost associated with system implementation and patient privacy issues. Implementation of an RFID system can be a significant investment. However, when observing the positive impact that such systems may have on transfusion safety and inventory management, the cost associated with RFID systems can easily be justified. RFID in blood bank inventory management is vital to ensuring efficient product inventory management and positive patient outcomes.

  12. Strategic Planning Methodology for Financial Management in the Department of the Navy

    DTIC Science & Technology

    1983-05-24

    STRATEGIC PLANNING METHODOLOGY FOR FINANCIAL MANAGEMENT IN THE DEPARTMENT OF THE NAVY May 24, 1983 Contract Number: N00014-83-C-0016 Prepared for...20376 This document has been approved for public ralaase and sale; its distribution is unlimited. 0 52 TR-83W-035 STRATEGIC PLANNING METHODOLOGY...effective DON-wide strategic planning for financial management. NEED FOR A LEADERSHIP ROLE In the past, the planning unit has functioned primarily in a

  13. Canadian family physician knowledge and attitudes toward laboratory utilization management.

    PubMed

    Thommasen, Amy; Clement, Fiona; Kinniburgh, David W; Lau, Cheryl K; Guo, Maggie; Viczko, Jeannine; Guggisberg, Kelly; Thomas, Roger E; Turin, Tanvir Chowdhury; Wesenberg, James C; Abdullah, Amid; Hnydyk, William S; Naugler, Christopher

    2016-01-01

    Mitigation of unnecessary and redundant laboratory testing is an important quality assurance priority for laboratories and represents an opportunity for cost savings in the health care system. Family physicians represent the largest utilizers of laboratory testing by a large margin. Engagement of family physicians is therefore key to any laboratory utilization management initiatives. Despite this, family physicians have been largely excluded from the planning and implementation of such initiatives. Our purposes were to (1) assess the importance of lab management issues to family physicians, and (2) attempt to define the types of initiatives most acceptable to family physicians. We invited all Alberta family practice residents and practicing physicians to participate in a self-administered online electronic survey. Survey questions addressed the perceived importance of lab misutilization, prevalence of various types of misutilization, acceptability of specific approaches to quality control, and responsibility of various parties to address this issue. Of 162 respondents, 95% considered lab misutilization to be either important or very important. Many physicians placed the responsibility for addressing lab misutilization issues on multiple parties, including patients, but most commonly the ordering physician (97%). Acceptability for common strategies for quality improvement in lab misutilization showed a wide range (35%-98%). These responses could serve as a framework for laboratories to begin discussions on this important topic with primary care groups. Copyright © 2015 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

  14. Utilization of Heat Pump Water Heaters for Load Management

    SciTech Connect

    Boudreaux, Philip R; Jackson, Roderick K; Munk, Jeffrey D; Gehl, Anthony C; Lyne, Christopher T

    2014-01-01

    The Energy Conservation Standards for Residential Water Heaters require residential electric storage water heaters with volumes larger than 55 gallons to have an energy factor greater than 2.0 after April 2015. While this standard will significantly increase the energy efficiency of water heaters, large electric storage water heaters that do not use heat pump technologies may no longer be available. Since utilities utilize conventional large-volume electric storage water heaters for thermal storage in demand response programs, there is a concern that the amended standard will significantly limit demand response capacity. To this end, Oak Ridge National Laboratory partnered with the Tennessee Valley Authority to investigate the load management capability of heat pump water heaters that meet or exceed the forthcoming water heater standard. Energy consumption reduction during peak periods was successfully demonstrated, while still meeting other performance criteria. However, to minimize energy consumption, it is important to design load management strategies that consider the home s hourly hot water demand so that the homeowner has sufficient hot water.

  15. What Is the Proof? A Methodological Review of Studies That Have Utilized Social Stories

    ERIC Educational Resources Information Center

    Leaf, Justin B.; Oppenheim-Leaf, Misty L.; Leaf, Ronald B.; Taubman, Mitchell; McEachin, John; Parker,Tracee; Waks, Andrea B.; Mountjoy, Toby

    2015-01-01

    Social stories are a commonly empirically evaluated and implemented procedure to increase pro-social behaviors and decrease aberrant behaviors for individuals diagnosed with an autism spectrum disorder. Despite their widespread use there have been questions raised to the soundness of the research methodology and the results which have been…

  16. What Is the Proof? A Methodological Review of Studies That Have Utilized Social Stories

    ERIC Educational Resources Information Center

    Leaf, Justin B.; Oppenheim-Leaf, Misty L.; Leaf, Ronald B.; Taubman, Mitchell; McEachin, John; Parker,Tracee; Waks, Andrea B.; Mountjoy, Toby

    2015-01-01

    Social stories are a commonly empirically evaluated and implemented procedure to increase pro-social behaviors and decrease aberrant behaviors for individuals diagnosed with an autism spectrum disorder. Despite their widespread use there have been questions raised to the soundness of the research methodology and the results which have been…

  17. The Future of Integrated Supply Chain Management Utilizing Performance Based Logistics

    DTIC Science & Technology

    2008-04-01

    Defense Acquisition Review Journal 2 the future of integrateD supply chain ManageMent Image designed by Jim Elmore Report Documentation Page Form...00-00-2002 to 00-00-2002 4. TITLE AND SUBTITLE The Future of Integrated Supply Chain Management Utilizing Performance Based Logistics 5a...Defense Acquisition Review Journal the future of integrateD supply chain ManageMent 3 the future of integrateD supply chain ManageMent utiliZing

  18. Availability and Utilization of Opioids for Pain Management: Global Issues

    PubMed Central

    Manjiani, Deepak; Paul, D. Baby; Kunnumpurath, Sreekumar; Kaye, Alan David; Vadivelu, Nalini

    2014-01-01

    Background Pain can significantly influence an individual's health status and can have serious negative consequences: poor nutrition, decreased appetite, abnormal sleep patterns, fatigue, and impairment of daily living activities. Pain can cause psychological impairment and decrease healing and recovery from injuries and illness. A hallmark of many chronic conditions, pain affects more patients' lives than diabetes mellitus, heart disease, and cancer combined. However, many chronic sufferers do not have access to effective pain management for a variety of reasons, including limited access, restrictions, and personal and cultural biases. Methods This review summarizes issues of access, distribution, and cultural bias with regard to opioid agents and seeks to clarify the challenges related to opioid delivery. The considerable negative physical and mental consequences of chronic pain are discussed for the general and palliative care population. Results Opioids are an effective treatment for various intractable painful conditions, but problems in global opioid access for safe and rational use in pain management contribute to unnecessary suffering. These problems persist despite increased understanding in recent years of the pathophysiology of pain. Conclusions Comprehensive guidelines for goal-directed and patient-friendly chronic opiate therapy will potentially enhance the outlook for future chronic pain management. The improvement of pain education in undergraduate and postgraduate training will benefit patients and clinicians. The promise of new medications, along with the utilization of multimodal approaches, has the potential to provide effective pain relief to future generations of sufferers. PMID:24940131

  19. Informing Reactor Aging Management by Extended Risk Methodology

    SciTech Connect

    Unwin, Stephen D.; Lowry, Peter P.; Toyooka, Michael Y.

    2009-07-01

    This is a paper summary to be published in the proceedings of the Winter Meeting of the American Nuclear Society. It describes a method for expanding probabilistic risk assessment models to address issues associated with the management of aging nuclear power plants and the prioritization of materials degradation research.

  20. Pathologists' roles in clinical utilization management. A financing model for managed care.

    PubMed

    Zhao, J J; Liberman, A

    2000-03-01

    In ancillary or laboratory utilization management, the roles of pathologists have not been explored fully in managed care systems. Two possible reasons may account for this: pathologists' potential contributions have not been defined clearly, and effective measurement of and reasonable compensation for the pathologist's contribution remains vague. The responsibilities of pathologists in clinical practice may include clinical pathology and laboratory services (which have long been well-defined and are compensated according to a resource-based relative value system-based coding system), laboratory administration, clinical utilization management, and clinical research. Although laboratory administration services have been compensated with mechanisms such as percentage of total service revenue or fixed salary, the involvement of pathologists seems less today than in the past, owing to increased clinical workload and time constraints in an expanding managed care environment, especially in community hospital settings. The lack of financial incentives or appropriate compensation mechanisms for the services likely accounts for the current situation. Furthermore, the importance of pathologist-driven utilization management in laboratory services lacks recognition among hospital administrators, managed care executives, and pathologists themselves, despite its potential benefits for reducing cost and enhancing quality of care. We propose a financial compensation model for such services and summarize its advantages.

  1. Manpower Planning and Personnel Management Models Based on Utility Theory,

    DTIC Science & Technology

    1980-08-01

    and Morgenstern [1947]. 2.3 Assessment of Utility Functions For decision problems with multiple objectives, multiattribute utility theory provides... multiattribute utility theory and applications. In Multiple Criteria Decision Making, M.K. Starr and M. Zelany (eds.), North Holland, Amsterdam. Fishburn...Princeton University Press, Princeton, NJ. Fishburn, P.C. (1977). Multiattribute utilities in expected utility theory . In Conflicting Objectives in

  2. Frost-Shielding Methodology and Demonstration for Shallow Burial of Water and Sewer Utility Lines.

    DTIC Science & Technology

    1998-06-01

    Research and Engineering Laboratory (CRREL), and the Owens - Corning Specialty and Foam Products Division as partners. Test sites utilizing shielded pipes...predictions and provided valuable guidance for the frost shield design. The industry partner participant in the CPAR project, Owens - Corning Specialty and Foam

  3. Methodology to Assess No Touch Audit Software Using Simulated Building Utility Data

    SciTech Connect

    Cheung, Howard; Braun, James E.; Langner, M. Rois

    2016-10-01

    This report describes a methodology developed for assessing the performance of no touch building audit tools and presents results for an available tool. Building audits are conducted in many commercial buildings to reduce building energy costs and improve building operation. Because the audits typically require significant input obtained by building engineers, they are usually only affordable for larger commercial building owners. In an effort to help small building and business owners gain the benefits of an audit at a lower cost, no touch building audit tools have been developed to remotely analyze a building's energy consumption.

  4. Enhancing the utility of prostascint SPECT scans for patient management.

    PubMed

    Noz, Marilyn E; Chung, Grace; Lee, Benjamin Y; Maguire, Gerald Q; DeWyngaert, J Keith; Doshi, Jay V; Kramer, Elissa L; Murphy-Walcott, Antoinette D; Zeleznik, Michael P; Kwak, Noeun G

    2006-04-01

    This project investigated reducing the artifact content of In-ill ProstaScint SPECT scans for use in treatment planning and management. Forty-one patients who had undergone CT or MRI scans and simultaneous Tc-99m RBC/In-111 ProstaScint SPECT scans were included. SPECT volume sets, reconstructed using Ordered Set-Expectation Maximum (OS-EM) were compared against those reconstructed with standard Filtered Back projection (FBP). Bladder activity in Tc-99m scans was suppressed within an ellipsoidal volume. Tc-99m voxel values were subtracted from the corresponding In-111 after scaling based on peak activity within the descending aorta. The SPECT volume data sets were merged with the CT or MRI scans before and after processing. Volume merging, based both on visual assessment and statistical evaluation, was not affected. Thus iterative reconstruction together with bladder suppression and blood pool subtraction may improve the interpretation and utility of ProstaScint SPECT scans for patient management.

  5. Financial constraints in capacity planning: a national utility regulatory model (NUREG). Volume I of III: methodology. Final report

    SciTech Connect

    Not Available

    1981-10-29

    This report develops and demonstrates the methodology for the National Utility Regulatory (NUREG) Model developed under contract number DEAC-01-79EI-10579. It is accompanied by two supporting volumes. Volume II is a user's guide for operation of the NUREG software. This includes description of the flow of software and data, as well as the formats of all user data files. Finally, Volume III is a software description guide. It briefly describes, and gives a listing of, each program used in NUREG.

  6. WebGIS Platform Adressed to Forest Fire Management Methodologies

    NASA Astrophysics Data System (ADS)

    André Ramos-Simões, Nuno; Neto Paixão, Helena Maria; Granja Martins, Fernando Miguel; Pedras, Celestina; Lança, Rui; Silva, Elisa; Jordán, António; Zavala, Lorena; Soares, Cristina

    2015-04-01

    Forest fires are one of the natural disasters that causes more damages in nature, as well as high material costs, and sometimes, a significant losses in human lives. In summer season, when high temperatures are attained, fire may rapidly progress and destroy vast areas of forest and also rural and urban areas. The forest fires have effect on forest species, forest composition and structure, soil properties and soil capacity for nutrient retention. In order to minimize the negative impact of the forest fires in the environment, many studies have been developed, e.g. Jordán et al (2009), Cerdà & Jordán (2010), and Gonçalves & Vieira (2013). Nowadays, Remote Sensing (RS) and Geographic Information System (GIS) technologies are used as support tools in fire management decisions, namely during the fire, but also before and after. This study presents the development of a user-friendly WebGIS dedicated to share data, maps and provide updated information on forest fire management for stakeholders in Iberia Peninsula. The WebGIS platform was developed with ArcGIS Online, ArcGIS for Desktop; HyperText Markup Language (HTML) and Javascript. This platform has a database that includes spatial and alphanumeric information, such as: origin, burned areas, vegetation change over time, terrain natural slope, land use, soil erosion and fire related hazards. The same database contains also the following relevant information: water sources, forest tracks and traffic ways, lookout posts and urban areas. The aim of this study is to provide the authorities with a tool to assess risk areas and manage more efficiently forest fire hazards, giving more support to their decisions and helping the populations when facing this kind of phenomena.

  7. Sorbent utilization prediction methodology: sulfur control in fluidized-bed combustors

    SciTech Connect

    Fee, D.C.; Wilson, W.I.; Shearer, J.A.; Smith, G.W.; Lenc, J.F.; Fan, L.S.; Myles, K.M.; Johnson, I.

    1980-09-01

    The United States Government has embarked on an ambitious program to develop and commercialize technologies to efficiently extract energy from coal in an environmentally acceptable manner. One of the more promising new technologies for steam and power generation is the fluidized-bed combustion of coal. In this process, coal is burned in a fluidized bed composed mainly of calcined limestone sorbent. The calcium oxide reacts chemically to capture the sulfur dioxide formed during the combustion and to maintain the stack gas sulfur emissions at acceptable levels. The spent sulfur sorbent, containing calcium sulfate, is a dry solid that can be disposed of along with coal ash or potentially used. Other major advantages of fluidized-bed combustion are the reduction in nitrogen oxide emissions because of the relatively low combustion temperatures, the capability of burning wide varieties of fuel, the high carbon combustion efficiencies, and the high heat-transfer coefficients. A key to the widespread commercialization of fluidized-bed technology is the ability to accurately predict the amount of sulfur that will be captured by a given sorbent. This handbook meets this need by providing a simple, yet reliable, user-oriented methodology (the ANL method) that allows performance of a sorbent to be predicted. The methodology is based on only three essential sorbent parameters, each of which can be readily obtained from standardized laboratory tests. These standard tests and the subsequent method of data reduction are described in detail.

  8. Bacterial exopolymer utilization by a harpacticoid copepod: A methodology and results

    SciTech Connect

    Decho, A.W.; Moriarty, D.J.W. )

    1990-07-01

    Exopolymer mucus secretions of bacteria and diatoms are potential foods for benthic animals. These secretions are coincidently ingested by animals during consumption of microbial cells and sediments. The utilization of microbial secretions was investigated with exopolymer derived from a marine bacterium (pseudomonas sp.) from seagrass beds and a harpacticoid copepod Laophonte sp. from the same habitat. A new technique was developed to examine ingestion, absorption, and absorption efficiencies of these bacterial secretions by consumers. Exopolymer mucus (from the bacterium in stationary phase) was labeled with {sup 14}C, collected, purified, and bound onto bacterium-sized beads. The exopolymer slime coating mimicked the coatings associated with many marine bacteria. Results from feeding experiments where the coated beads were mixed with sediment demonstrated that the mucus-exopolymer secretions of bacteria were ingested and utilized by Laophonte sp. Absorption efficiencies, determined directly, were > 80% in the presence of other food resources, indicating that exopolymer is potentially a highly labile C resource for this animal.

  9. Urban water infrastructure asset management - a structured approach in four water utilities.

    PubMed

    Cardoso, M A; Silva, M Santos; Coelho, S T; Almeida, M C; Covas, D I C

    2012-01-01

    Water services are a strategic sector of large social and economic relevance. It is therefore essential that they are managed rationally and efficiently. Advanced water supply and wastewater infrastructure asset management (IAM) is key in achieving adequate levels of service in the future, particularly with regard to reliable and high quality drinking water supply, prevention of urban flooding, efficient use of natural resources and prevention of pollution. This paper presents a methodology for supporting the development of urban water IAM, developed during the AWARE-P project as well as an appraisal of its implementation in four water utilities. Both water supply and wastewater systems were considered. Due to the different contexts and features of the utilities, the main concerns vary from case to case; some problems essentially are related to performance, others to risk. Cost is a common deciding factor. The paper describes the procedure applied, focusing on the diversity of drivers, constraints, benefits and outcomes. It also points out the main challenges and the results obtained through the implementation of a structured procedure for supporting urban water IAM.

  10. Analysis of the definition and utility of personal health records using Q methodology.

    PubMed

    Kim, Jeongeun; Bates, David W

    2011-11-29

    Personal health records (PHRs) remain a relatively new technology and concept in practice even though they have been discussed in the literature for more than 50 years. There is no consensus on the definition of a PHR or PHR system even within the professional societies of health information technology. Our objective was to analyze and classify the opinions of health information professionals regarding the definitions of the PHR. Q methodology was used to explore the concept of the PHR. A total of 50 Q-statements were selected and rated by 45 P-samples consisting of health information professionals. We analyzed the resulting data by using Q methodology-specific software and SPSS. We selected five types of health information professionals' opinions: type I, public interest centered; type II, health information standardization centered; type III, health consumer centered; type IV, health information security centered; and type V, health consumer convenience centered. The Q-statements with the highest levels of agreement were as follows: (1) the PHR is the lifetime record of personal health information, (2) the PHR is the representation of health 2.0, and (3) security is the most important requirement of the PHR. The most disagreed-with Q-statements were (1) the PHR is a paper-based system, and (2) it is most effective to carry the PHR information in USB storage. Health information professionals agree that PHRs should be lifetime records, that they will be useful as more information is stored electronically, and that data security is paramount. To maximize the benefits of PHR, activation strategies should be developed and extended across disciplines and professionals so that patients begin to receive the benefits associate with using PHRs.

  11. Analysis of the Definition and Utility of Personal Health Records Using Q Methodology

    PubMed Central

    Bates, David W

    2011-01-01

    Background Personal health records (PHRs) remain a relatively new technology and concept in practice even though they have been discussed in the literature for more than 50 years. There is no consensus on the definition of a PHR or PHR system even within the professional societies of health information technology. Objective Our objective was to analyze and classify the opinions of health information professionals regarding the definitions of the PHR. Method Q methodology was used to explore the concept of the PHR. A total of 50 Q-statements were selected and rated by 45 P-samples consisting of health information professionals. We analyzed the resulting data by using Q methodology-specific software and SPSS. Result We selected five types of health information professionals’ opinions: type I, public interest centered; type II, health information standardization centered; type III, health consumer centered; type IV, health information security centered; and type V, health consumer convenience centered. The Q-statements with the highest levels of agreement were as follows: (1) the PHR is the lifetime record of personal health information, (2) the PHR is the representation of health 2.0, and (3) security is the most important requirement of the PHR. The most disagreed-with Q-statements were (1) the PHR is a paper-based system, and (2) it is most effective to carry the PHR information in USB storage. Conclusion Health information professionals agree that PHRs should be lifetime records, that they will be useful as more information is stored electronically, and that data security is paramount. To maximize the benefits of PHR, activation strategies should be developed and extended across disciplines and professionals so that patients begin to receive the benefits associate with using PHRs. PMID:22126860

  12. Standard outcome metrics and evaluation methodology for disease management programs. American Healthways and Johns Hopkins Consensus Conference.

    PubMed

    2003-01-01

    Disease management is conceptually recognized as being a significant approach for closing the gaps in care identified by the Institute of Medicine as contributing to poor outcomes from our health care system. That conceptual credibility has been bolstered by the disease management industry through the adoption of an industry-standard definition of disease management and through the development and implementation of disease management accreditation programs by the National Committee for Quality Assurance, Utilization Review Accreditation Commission, and Joint Commission on Accreditation of Healthcare Organizations. The clinical and financial outcomes of disease management programs continue to be suspect, however, due to the lack of an industry standard set of outcomes metrics and a uniform methodology for evaluating those metrics. As a result, the ability to evaluate the effectiveness of any individual program is compromised, and the ability to effectively compare results across programs of different delivery designs is non-existent. To address this issue, American Healthways and Johns Hopkins convened a consensus conference of nearly 150 health care professionals representing health plans, hospitals, practicing physicians (both primary care and specialty), and other health care professionals. The conference purpose was to develop a "first-step" set of metrics and a uniform methodology that could be applied industry-wide to enable meaningful comparisons between programs and to allow evaluation of individual programs whether "homegrown" or "outsourced." The consensus conferees recognized that there were many paths to this objective, but that they had to land on a set of metrics and a methodology that was "doable" in light of today's technology and data availability. The results of their consensus effort follow.

  13. A multiattribute utility analysis of sites nominated for characterization for the first radioactive-waste repository: A decision-aiding methodology

    SciTech Connect

    none,

    1986-05-01

    In December 1984, the Department of Energy (DOE) published draft environmental assessments (EAs) to support the proposed nomination of five sites and the recommendation of three sites for characterization for the first radioactive-waste repository. A chapter common to all the draft EAs (Chapter 7) presented rankings of the five sites against the postclosure and the preclosure technical siting guidelines. To determine which three sites appeared most favorable for recommendation for characterization, three simple quantitative methods were used to aggregate the rankings assigned to each site for the various technical guidelines. In response to numerous comments on the methods, the DOE has undertaken a formal application of one of them (hereafter referred to as the decision-aiding methodology) for the purpose of obtaining a more rigorous evaluation of the nominated sites. The application of the revised methodology is described in this report. The method of analysis is known as multiattribute utility analysis; it is a tool for providing insights as to which sites are preferable and why. The decision-aiding methodology accounts for all the fundamental considerations specified by the siting guidelines and uses as source information the data and evaluations reported or referenced in the EAs. It explicitly addresses the uncertainties and value judgments that are part of all siting problems. Furthermore, all scientific and value judgments are made explicit for the reviewer. An independent review of the application of the decision-aiding methodology has been conducted by the Board on Radioactive Waste Management of the National Academy of Sciences; the comments of the Board are included as an appendix to this report.

  14. The process and utility of classification and regression tree methodology in nursing research

    PubMed Central

    Kuhn, Lisa; Page, Karen; Ward, John; Worrall-Carter, Linda

    2014-01-01

    Aim This paper presents a discussion of classification and regression tree analysis and its utility in nursing research. Background Classification and regression tree analysis is an exploratory research method used to illustrate associations between variables not suited to traditional regression analysis. Complex interactions are demonstrated between covariates and variables of interest in inverted tree diagrams. Design Discussion paper. Data sources English language literature was sourced from eBooks, Medline Complete and CINAHL Plus databases, Google and Google Scholar, hard copy research texts and retrieved reference lists for terms including classification and regression tree* and derivatives and recursive partitioning from 1984–2013. Discussion Classification and regression tree analysis is an important method used to identify previously unknown patterns amongst data. Whilst there are several reasons to embrace this method as a means of exploratory quantitative research, issues regarding quality of data as well as the usefulness and validity of the findings should be considered. Implications for Nursing Research Classification and regression tree analysis is a valuable tool to guide nurses to reduce gaps in the application of evidence to practice. With the ever-expanding availability of data, it is important that nurses understand the utility and limitations of the research method. Conclusion Classification and regression tree analysis is an easily interpreted method for modelling interactions between health-related variables that would otherwise remain obscured. Knowledge is presented graphically, providing insightful understanding of complex and hierarchical relationships in an accessible and useful way to nursing and other health professions. PMID:24237048

  15. Utility of Army Design Methodology in U.S. Coast Guard Counter Narcotic Interdiction Strategy

    DTIC Science & Technology

    2017-06-09

    general actions, and means to solve / manage identified problems . It answers: how do we get from our/the current state to the desired state? In... problems and helps shape an operational approach for solving them (Headquarters Department of the Army 2015, 1-3). The ultimate goal of the design...process is to ensure the CDM (and supporting staff) understands the problem and have developed a well-planned way forward. The most applicable

  16. Constraints Influencing Measurement of the Utilization of Unrestricted Line Officer Financial Management Subspecialists

    DTIC Science & Technology

    1978-03-01

    generated for personnel who were trained and educated in the skills needed for financial management as encompassed by the controllership function. In 1951...measurement of the utilization of unrestricted line officer financial management subspecialists. Tirrell, William Barclay http://hdl.handle.net/10945...18385 Downloaded from NPS Archive: Calhoun CONSTRAINTS INFLUENCING MEASUREMENT OF THE UTILIZATION OF UNRESTRICTED LINE OFFICER FINANCIAL MANAGEMENT

  17. Variables contributing to an excellent customer service management profile within the regulated electric utility industry: A comparison of self-concept with customer satisfaction for customer service management

    SciTech Connect

    Johnson, L.E.

    1991-01-01

    This research sought to address the relationship between self-concept and customer satisfaction: can customer satisfaction with a major electric utility be explained in terms of the self-reported, self-concept of the utility's managers The population to which the results of this study were generalized consisted of customer service managers in public electric utilities across the United States. In order to represent this population, a sample was selected consisting of customer service managers at a midwestern electric utility based in a large metropolitan area. Participants in this study were managers of four direct customer contact service organizations within six geographic division organizations. The methodology included comparisons of these four customer contact service organizations on twelve independent, self-concept variables and six customer satisfaction dependent variables using Analysis of Variance (ANOVA), Scheffe' tests, Chi-Square, and Stepwise multiple regression. The groups were found not to be significantly different and knowledge of the self-concept scores for managers will not increase the ability to predict customer satisfaction over no knowledge of self-concept scores.

  18. Criteria and considerations for preparing atom-probe tomography specimens of nanomaterials utilizing an encapsulation methodology.

    PubMed

    Sun, Zhiyuan; Hazut, Ori; Yerushalmi, Roie; Lauhon, Lincoln J; Seidman, David N

    2017-09-23

    Atom-probe tomography (APT) is a powerful method for characterization of nanomaterials due to its atomic-ppm level detection limit and Angstrom spatial resolution. Sample preparation for nanomaterials is, however, challenging because of their small dimensions and complicated geometries. Nanowires, with their high geometrical aspect ratio and nanowire length, 10 to 100 times their typical diameters, are highly suitable specimens for APT analyses, which can be transferred to silicon microposts using a nanomanipulator for direct APT measurements. This method is, however, prone to poor alignment and a limited field-of-view (FOV). Most importantly, direct implementation of APT with high aspect ratio nanowires may yield a low success rate of ∼30%, due to the high electric fields (10-40 V nm(-1)) associated with APT. While this is acceptable for samples analyzed solely by APT, a low sample yield makes it challenging to perform correlative experiments on the same nanowire specimen, utilizing other sophisticated characterization instruments. Herein, we introduce a general strategy for preparing high-yield APT specimens by encapsulating the nanowires utilizing a conformal atomic-layer deposition (ALD) coating followed by site-specific lift-out using a dual-beam focused-ion beam microscope. The ALD deposited coating forms strong chemical bonds with the Si nanowires yielding a high-quality and robust interface. The evaporation electric fields of the ALD coating and the nanowires are tuned by changing laser energy to obtain a uniform evaporation rate. The strong adhesion of the ALD-coating/nanowire interface and uniform evaporation rate produce a >90% specimen yield, with small concentration of reconstruction artifacts in 3-D. Simultaneously, the field-of-view is enhanced and the surface of the nanowire becomes visible, which makes the study of surface adsorption, segregation and oxidation possible. We utilized ALD-ZnO coated silicon nanowires as an example for

  19. A Multi-Methodology for improving Adelaide's Groundwater Management

    NASA Astrophysics Data System (ADS)

    Batelaan, Okke; Banks, Eddie; Batlle-Aguilar, Jordi; Breciani, Etienne; Cook, Peter; Cranswick, Roger; Smith, Stan; Turnadge, Chris; Partington, Daniel; Post, Vincent; Pool Ramirez, Maria; Werner, Adrian; Xie, Yueqing; Yang, Yuting

    2015-04-01

    Groundwater is a strategic and vital resource in South Australia playing a crucial role in sustaining a healthy environment, as well as supporting industries and economic development. In the Adelaide metropolitan region ten different aquifer units have been identified, extending to more than 500 m below sea level. Although salinity within most of these aquifers is variable, water suitable for commercial, irrigation and/or potable use is predominantly found in the deeper Tertiary aquifers. Groundwater currently contributes only 9000 ML/yr of Adelaide's total water consumption of 216,000 ML, while in the Northern Adelaide Plains 17000 ML/yr is used. However, major industries, market gardeners, golf courses, and local councils are highly dependent on this resource. Despite recent rapid expansion in managed aquifer recharge, and the potential for increased extraction of groundwater, particularly for the commercial and irrigation supplies, little is known about the sources and ages of Adelaide's groundwater. The aim of this study is therefore to provide a robust conceptualisation of Adelaide's groundwater system. The study focuses on three important knowledge gaps: 1. Does groundwater flow from the Adelaide Hills into the sedimentary aquifers on the plains? 2. What is the potential for encroachment of seawater if groundwater extraction increases? 3. How isolated are the different aquifers, or does water leak from one to the other? A multi-tool approach has been used to improve the conceptual understanding of groundwater flow processes; including the installation of new groundwater monitoring wells from the hills to the coast, an extensive groundwater sampling campaign of new and existing groundwater wells for chemistry and environmental tracers analysis, and development of a regional scale numerical model rigorously tested under different scenario conditions. The model allows quantification of otherwise hardly quantifiable quantities such as flow across fault zones and

  20. Influence of Tip Speed Ratio on Wake Flow Characteristics Utilizing Fully Resolved CFD Methodology

    NASA Astrophysics Data System (ADS)

    Salman Siddiqui, M.; Rasheed, Adil; Kvamsdal, Trond; Tabib, Mandar

    2017-05-01

    Dominant flow structures in the wake region behind the turbine employed in the Blind Test campaign [1], [2] is investigated numerically. The effect on the wake configuration at variable operating conditions are studied. The importance of the introduction of turbine tower inside the numerical framework is highlighted. High-fidelity simulations are performed with Multiple Reference Frame (MRF) numerical methodology. A thorough comparison among the cases is presented, and the wake evolution is analyzed at variable stations downstream of the turbine. Streamlines of flow field traveled towards ground adjacent to turbine tower and strongly dependent on the operating tip speed ratio. Wake is composed of tower shadow superimposed by rotor wake. Shadow of the tower varies from x/R=2 until x/R=4 and breaks down into small vortices with the interaction of rotor wake. This study also shows that the wake distribution consists of two zones; inner zone composed of disturbances generated by blade root, nacelle and the tower, and an outer zone consisting of tip vortices.

  1. Resource utilization and outcomes management: opportunities for the entrepreneurial pathologist.

    PubMed

    Vance, R P

    1997-01-01

    Pathologists and laboratory managers are facing an increasingly uncertain place in the emerging managed care marketplace. Among the various opportunities available is outcomes management. The role of benchmarking in outcomes management and the initial steps in developing outcomes management programs are presented.

  2. Micrometeorological Technique for Monitoring of Geological Carbon Capture, Utilization and Storage: Methodology, Workflow and Resources

    NASA Astrophysics Data System (ADS)

    Burba, G. G.; Madsen, R.; Feese, K.

    2013-12-01

    The eddy covariance (EC) method is a micrometeorological technique for direct high-speed measurements of the transport of gases and energy between land or water surfaces and the atmosphere [1]. This method allows for observations of gas transport scales from 20-40 times per second to multiple years, represents gas exchange integrated over a large area, from hundreds of square meters to tens of square kilometres, and corresponds to gas exchange from the entire surface, including canopy, and soil or water layers. Gas fluxes, emission and exchange rates are characterized from single-point in situ measurements using permanent or mobile towers, or moving platforms such as automobiles, helicopters, airplanes, etc. Presently, over 600 eddy covariance stations are in operation in over 120 countries [1]. EC is now recognized as an effective method in regulatory and industrial applications, including CCUS [2-10]. Emerging projects utilize EC to continuously monitor large areas before and after the injections, to locate and quantify leakages where CO2 may escape from the subsurface, to improve storage efficiency, and for other CCUS characterizations [5-10]. Although EC is one of the most direct and defensible micrometeorological techniques measuring gas emission and transport, and complete automated stations and processing are readily available, the method is mathematically complex, and requires careful setup and execution specific to the site and project. With this in mind, step-by-step instructions were created in [1] to introduce a novice to the EC method, and to assist in further understanding of the method through more advanced references. In this presentation we provide brief highlights of the eddy covariance method, its application to geological carbon capture, utilization and storage, key requirements, instrumentation and software, and review educational resources particularly useful for carbon sequestration research. References: [1] Burba G. Eddy Covariance Method

  3. A methodology for decisionmaking in project evaluation in land management planning

    Treesearch

    A. Weintraub

    1978-01-01

    In order to evaluate alternative plans, wildland management planners must consider many objectives, such as timber production, recreational use, and community stability. The method presented utilizes the type of qualitative and intuitive information widely available to wildland management planners, and structures this information into a format suitable for...

  4. Developing and Managing University-Industry Research Collaborations through a Process Methodology/Industrial Sector Approach

    ERIC Educational Resources Information Center

    Philbin, Simon P.

    2010-01-01

    A management framework has been successfully utilized at Imperial College London in the United Kingdom to improve the process for developing and managing university-industry research collaborations. The framework has been part of a systematic approach to increase the level of research contracts from industrial sources, to strengthen the…

  5. Utility of two methodologies in the clinical assessment of oral dryness in postmenopausal women

    PubMed Central

    Chengappa, Rachita Kodandera; Narayanan, Veena S.; Khan, Asim M.; Rakaraddi, Mangala P.; Puttaswamy, Kavitha A.; Puttabuddi, Jaishankar H.

    2016-01-01

    Objective: The aim of this study was to assess the oral dryness in postmenopausal women and to correlate the salivary flow rate determined by sialometry with the clinical oral dryness score (CODS) obtained from Challacombe Scale. To correlate between subjective and objective oral dryness and relationship of salivary flow rate with that of the duration of menopause. Materials and Methods: Sixty postmenopausal women were questioned regarding their oral dryness status and the duration of menopause. Patients complaining of xerostomia formed the case group and rest formed the control group. CODS was assessed based on the 10 features of oral dryness. Unstimulated whole salivary (UWS) flow rate was assessed by sialometry for 5 min. Results: Highly significant negative correlation was observed between UWS and CODS (r = −0.651), low negative correlation was noted between the duration of menopause and UWS flow rates (r = −0.159), and no significant correlation was found between subjective oral dryness with that of UWS flow rates (P = 0.0964). There was no statistically significant difference between case and control group with regard to CODS (P = 0.525). Conclusion: A good correlation of CODS with sialometry scores indicates that CODS can be utilized for semiquantitative assessment of oral dryness. It appears that UWS has poor correlation with duration of menopause. Xerostomia and UWS were not significantly related. PMID:27721638

  6. Managed care enrollee utilization of 911 medical services.

    PubMed

    Dickinson, E T; Verdile, V P; Duncan, T; Bryant, K A

    1999-01-01

    To determine the mechanism by which managed care organization (MCO) enrollees enter the emergency medical services (EMS) system. All enrollees belonging to the region's largest MCO and transported to emergency departments by a paramedic-level municipal EMS system were identified from billing records. Dispatch logs were examined to determine the time and origin of the call to the 911 communication center. Patient care records were used to obtain age, the level of care delivered (advanced or basic life support), and whether the patient received any medications while out of hospital. Hospital admission was also determined. Over a six-month period, 195 enrollees were transported. Three modes of 911 EMS system entry were identified: group I-enrollees who called 911 directly; group II-enrollees who called the MCO triage center, who then called 911 on behalf of the patient; and group III--enrollees who were sent to the MCO health center for evaluation, and subsequently the MCO called 911 to transfer the patient to the hospital. Of the 195 patients transported to the emergency department, the dispositions of 108 (55%) patients were obtained. Group I (n = 109) patients were more likely to be transported in the evening (3 PM to 11 PM), less likely to require advanced life support therapies, and less likely to be admitted to the hospital when compared with groups II (n = 32) and III (n = 54) patients. Group III patients were the most likely to receive advanced life support care and require admission to the hospital. The majority of MCO enrollees called 911 directly, and were most likely to do so during evening hours. Enrollees who called 911 directly (group I) had a trend toward lower acuity, based on the lowest ALS utilization of any group. Those enrollees who most frequently required advanced life support were those who received initial treatment at the MCO center prior to EMS transport. Though EMS system-specific, this type of descriptive analysis is helpful in assisting

  7. The derivation of scenic utility functions and surfaces and their role in landscape management

    Treesearch

    John W. Hamilton; Gregory J. Buhyoff; J. Douglas Wellman

    1979-01-01

    This paper outlines a methodological approach for determining relevant physical landscape features which people use in formulating judgments about scenic utility. This information, coupled with either empirically derived or rationally stipulated regression techniques, may be used to produce scenic utility functions and surfaces. These functions can provide a means for...

  8. Sub-ice shelf sediment geochronology utilizing novel radiocarbon methodology for highly detrital sediments

    NASA Astrophysics Data System (ADS)

    Subt, C.; Yoon, H. I.; Yoo, K. C.; Lee, J. I.; Leventer, A.; Domack, E. W.; Rosenheim, B. E.

    2017-04-01

    Sub-ice shelf sediments near Larsen C ice shelf (LIS-C) show fine-scale rhythmic laminations that could provide a near-continuous seasonal-resolution record of regional ice mass changes. Despite the great potential of these sediments, a dependable Late Quaternary chronology is difficult to generate, rendering the record incomplete. As with many marginal Antarctic sediments, in the absence of preserved carbonate microfossils, the reliability of radiocarbon chronologies depends on presence of high proportions of autochthonous organic carbon with minimized detrital organic carbon. Consequently, acid insoluble organic (AIO) 14C dating works best where high productivity drives high sediment accumulation rates, but can be problematic in condensed sequences with high proportions of detrital organic carbon. Ramped PyrOx 14C dating has progressively been shown to improve upon AIO 14C dates, to the point of matching foraminiferal carbonate 14C dates, through differential thermochemical degradation of organic components within samples. But in highly detrital sediments, proportions of contemporaneously deposited material are too low to fully separate autochthonous organic carbon from detrital carbon in samples large enough to 14C date. We introduce two modifications of the Ramped PyrOx 14C approach applied to highly detrital sediments near LIS-C to maximize accuracy by utilizing ultra-small fractions of the highly detrital AIO material. With minimization of the uncertainty cost, these techniques allow us to generate chronologies for cores that would otherwise go undated, pushing the limits of radiocarbon dating to regions and facies with high proportions of pre-aged detritus. Wider use of these techniques will enable more coordinated a priori coring efforts to constrain regional glacial responses to rapid warming where sediments had previously been thought too difficult to date.

  9. Utilizing Radioisotope Power System Waste Heat for Spacecraft Thermal Management

    NASA Technical Reports Server (NTRS)

    Pantano, David R.; Dottore, Frank; Tobery, E. Wayne; Geng, Steven M.; Schreiber, Jeffrey G.; Palko, Joseph L.

    2005-01-01

    An advantage of using a Radioisotope Power System (RPS) for deep space or planetary surface missions is the readily available waste heat, which can be used for a number of beneficial purposes including: maintaining electronic components within a controlled temperature range, warming propulsion tanks and mobility actuators, and maintaining liquid propellants above their freezing temperature. Previous missions using Radioisotope Thermoelectric Generators (RTGs) dissipated large quantities of waste heat due to the low efficiency of the thermoelectric conversion technology. The next generation RPSs, such as the 110-Watt Stirling Radioisotope Generator (SRG110) will have higher conversion efficiencies, thereby rejecting less waste heat at a lower temperature and may require alternate approaches to transferring waste heat to the spacecraft. RTGs, with efficiencies of 6 to 7 percent, reject their waste heat at the relatively high heat rejection temperature of 200 C. This is an advantage when rejecting heat to space; however, transferring heat to the internal spacecraft components requires a large and heavy radiator heat exchanger. At the same time, sensitive spacecraft instruments must be shielded from the thermal radiation of the RTG. The SRG110, with an efficiency around 22 percent and 50 C nominal housing surface temperature, can readily transfer the available waste heat directly via heat pipes, thermal straps, or fluid loops. The lower temperatures associated with the SRG110 avoid the chances of overheating other scientific components, eliminating the need for thermal shields. This provides the spacecraft designers more flexibility when locating the generator for a specific mission. A common misconception with high-efficiency systems is that there is not enough waste heat for spacecraft thermal management. This paper will dispel this misconception and investigate the use of a high-efficiency SRG110 for spacecraft thermal management and outline potential methods of

  10. Refinement of biodegradation tests methodologies and the proposed utility of new microbial ecology techniques.

    PubMed

    Kowalczyk, Agnieszka; Martin, Timothy James; Price, Oliver Richard; Snape, Jason Richard; van Egmond, Roger Albert; Finnegan, Christopher James; Schäfer, Hendrik; Davenport, Russell James; Bending, Gary Douglas

    2015-01-01

    Society's reliance upon chemicals over the last few decades has led to their increased production, application and release into the environment. Determination of chemical persistence is crucial for risk assessment and management of chemicals. Current established OECD biodegradation guidelines enable testing of chemicals under laboratory conditions but with an incomplete consideration of factors that can impact on chemical persistence in the environment. The suite of OECD biodegradation tests do not characterise microbial inoculum and often provide little insight into pathways of degradation. The present review considers limitations with the current OECD biodegradation tests and highlights novel scientific approaches to chemical fate studies. We demonstrate how the incorporation of molecular microbial ecology methods (i.e., 'omics') may improve the underlying mechanistic understanding of biodegradation processes, and enable better extrapolation of data from laboratory based test systems to the relevant environment, which would potentially improve chemical risk assessment and decision making. We outline future challenges for relevant stakeholders to modernise OECD biodegradation tests and put the 'bio' back into biodegradation.

  11. Disruption of Information Technology Projects: The Reactive Decoupling of Project Management Methodologies

    ERIC Educational Resources Information Center

    Schmitz, Kurt W.

    2013-01-01

    Information Technology projects have migrated toward two dominant Project Management (PM) methodologies. Plan-driven practices provide organizational control through highly structured plans, schedules, and specifications that facilitate oversight by hierarchical bureaucracies. In contrast, agile practices emphasize empowered teams using flexible…

  12. Construction of a Conceptualization of Personal Knowledge within a Knowledge Management Perspective Using Grounded Theory Methodology

    ERIC Educational Resources Information Center

    Straw, Eric M.

    2013-01-01

    The current research used grounded theory methodology (GTM) to construct a conceptualization of personal knowledge within a knowledge management (KM) perspective. The need for the current research was based on the use of just two categories of knowledge, explicit and tacit, within KM literature to explain diverse characteristics of personal…

  13. Disruption of Information Technology Projects: The Reactive Decoupling of Project Management Methodologies

    ERIC Educational Resources Information Center

    Schmitz, Kurt W.

    2013-01-01

    Information Technology projects have migrated toward two dominant Project Management (PM) methodologies. Plan-driven practices provide organizational control through highly structured plans, schedules, and specifications that facilitate oversight by hierarchical bureaucracies. In contrast, agile practices emphasize empowered teams using flexible…

  14. A Methodology to Obtain Learning Effective Laboratories with Learning Management System Integration

    ERIC Educational Resources Information Center

    Ruano, Ildefonso; Gamez, Javier; Dormido, Sebastian; Gomez, Juan

    2016-01-01

    Online laboratories are useful and valuable resources in high education, especially in engineering studies. This work presents a methodology to create effective laboratories for learning that interact with a Learning Management System (LMS) to achieve advanced integration. It is based on pedagogical aspects and considers not only the laboratory…

  15. Construction of a Conceptualization of Personal Knowledge within a Knowledge Management Perspective Using Grounded Theory Methodology

    ERIC Educational Resources Information Center

    Straw, Eric M.

    2013-01-01

    The current research used grounded theory methodology (GTM) to construct a conceptualization of personal knowledge within a knowledge management (KM) perspective. The need for the current research was based on the use of just two categories of knowledge, explicit and tacit, within KM literature to explain diverse characteristics of personal…

  16. Laboratory Test Utilization Management: General Principles and Applications in Hematopathology.

    PubMed

    Reichard, Kaaren K; Wood, Adam J

    2016-03-01

    As the cost of health care continues to rise and reimbursement rates decrease, there is a growing demand and need to cut overall costs, enhance quality of services, and maintain as a top priority the needs and safety of the patient. In this article, we provide an introduction to test utilization and outline a general approach to creating an efficient, cost-effective test utilization strategy. We also present and discuss 2 test utilization algorithms that are evidence-based and may be of clinical utility as we move toward the future of doing the necessary tests at the right time. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. 1980 survey and evaluation of utility conservation, load management, and solar end-use projects. Volume 3: utility load management projects. Final report

    SciTech Connect

    Not Available

    1982-01-01

    The results of the 1980 survey of electric utility-sponsored energy conservation, load management, and end-use solar energy conversion projects are described. The work is an expansion of a previous survey and evaluation and has been jointly sponsored by EPRI and DOE through the Oak Ridge National Laboratory. There are three volumes and a summary document. Each volume presents the results of an extensive survey to determine electric utility involvement in customer-side projects related to the particular technology (i.e., conservation, solar, or load management), selected descriptions of utility projects and results, and first-level technical and economic evaluations.

  18. An evolutionary Bayesian belief network methodology for participatory decision making under uncertainty: an application to groundwater management.

    PubMed

    Farmani, Raziyeh; Henriksen, Hans Jørgen; Savic, Dragan; Butler, David

    2012-07-01

    An integrated participatory approach based on Bayesian belief network (BBN) and evolutionary multiobjective optimization is proposed as an efficient decision-making tool in complex management problems. The proposed methodology incorporates all the available evidence and conflicting objectives to evaluate implications of alternative actions in the decision-making process and suggests best decision pathways under uncertainty. A BBN provides a framework within which the contributions of stakeholders can be taken into account. It allows a range of different factors and their probabilistic relationship to be considered simultaneously. It takes into account uncertainty by assigning probability to those variables whose states are not certain. The integration of BBN with evolutionary multiobjective optimization allows the analysis of tradeoff between different objectives and incorporation and acknowledgement of a broader set of decision goals into the search and decision-making process. The proposed methodology can be used as a decision support tool to model decision-making processes for complex problems. It deals with uncertainties in decision making pertaining to human behavior and checks for consistency of the developed BBN structure and the parameters of the probabilistic relationship by uncovering discrepancies in the decision analysis process (e.g., bias in completeness or redundancy of the model based on a utility function). It generates a set of efficient management options (appropriate combinations of interventions) that balances conflicting objectives. The effectiveness of the proposed methodology is discussed through application to a real case study. It is shown that it successfully identifies any inconsistencies in the developed BBN models and generates large numbers of management options that achieve an optimal tradeoff between different objectives.

  19. United States Environmental Protection Agency: Use of risk assessment and risk management methodologies. Master's thesis

    SciTech Connect

    Lamuro, R.J.

    1992-09-30

    Make a full investigation of the policy implications and appropriate uses of risk assessment and risk management in regulatory programs under various Federal laws to prevent cancer and other chronic health effects which may result from exposure to hazardous substances. This is the primary mission of the Risk Assessment and Management Commission (Risk Commission). The Clean Air Act Amendments of 1990 (CAAA), created the Risk Commission reflecting Congress' concern over agency use of risk assessment and risk management techniques and methodologies to implement federal laws protective of human health. The Risk Commission is to consider: methods for measuring and describing risks of chronic health effects from hazardous substances; methods to reflect uncertainties associated with estimation techniques, and whether it is possible or desirable to develop a consistent risk assessment methodology or a consistent standard of acceptable risk for various federal programs.

  20. Eutrophication assessment and management methodology of multiple pollution sources of a landscape lake in North China.

    PubMed

    Chen, Yanxi; Niu, Zhiguang; Zhang, Hongwei

    2013-06-01

    Landscape lakes in the city suffer high eutrophication risk because of their special characters and functions in the water circulation system. Using a landscape lake HMLA located in Tianjin City, North China, with a mixture of point source (PS) pollution and non-point source (NPS) pollution, we explored the methodology of Fluent and AQUATOX to simulate and predict the state of HMLA, and trophic index was used to assess the eutrophication state. Then, we use water compensation optimization and three scenarios to determine the optimal management methodology. Three scenarios include ecological restoration scenario, best management practices (BMPs) scenario, and a scenario combining both. Our results suggest that the maintenance of a healthy ecosystem with ecoremediation is necessary and the BMPs have a far-reaching effect on water reusing and NPS pollution control. This study has implications for eutrophication control and management under development for urbanization in China.

  1. Case formulation and management using pattern-based formulation (PBF) methodology: clinical case 1.

    PubMed

    Fernando, Irosh; Cohen, Martin

    2014-02-01

    A tool for psychiatric case formulation known as pattern-based formulation (PBF) has been recently introduced. This paper presents an application of this methodology in formulating and managing complex clinical cases. The symptomatology of the clinical presentation has been parsed into individual clinical phenomena and interpreted by selecting explanatory models. The clinical presentation demonstrates how PBF has been used as a clinical tool to guide clinicians' thinking, that takes a structured approach to manage multiple issues using a broad range of management strategies. In doing so, the paper also introduces a number of patterns related to the observed clinical phenomena that can be re-used as explanatory models when formulating other clinical cases. It is expected that this paper will assist clinicians, and particularly trainees, to better understand PBF methodology and apply it to improve their formulation skills.

  2. Towards more sustainable management of European food waste: Methodological approach and numerical application.

    PubMed

    Manfredi, Simone; Cristobal, Jorge

    2016-09-01

    Trying to respond to the latest policy needs, the work presented in this article aims at developing a life-cycle based framework methodology to quantitatively evaluate the environmental and economic sustainability of European food waste management options. The methodology is structured into six steps aimed at defining boundaries and scope of the evaluation, evaluating environmental and economic impacts and identifying best performing options. The methodology is able to accommodate additional assessment criteria, for example the social dimension of sustainability, thus moving towards a comprehensive sustainability assessment framework. A numerical case study is also developed to provide an example of application of the proposed methodology to an average European context. Different options for food waste treatment are compared, including landfilling, composting, anaerobic digestion and incineration. The environmental dimension is evaluated with the software EASETECH, while the economic assessment is conducted based on different indicators expressing the costs associated with food waste management. Results show that the proposed methodology allows for a straightforward identification of the most sustainable options for food waste, thus can provide factual support to decision/policy making. However, it was also observed that results markedly depend on a number of user-defined assumptions, for example on the choice of the indicators to express the environmental and economic performance. © The Author(s) 2016.

  3. The Utilization of Project Management in the Pharmaceutical Industry.

    ERIC Educational Resources Information Center

    Krusko, Diane; Cangemi, Robert R.

    1987-01-01

    A survey of 99 pharmaceutical companies concerning their organization and use of project management techniques for research and development found that the industry is using project management increasingly in a variety of ways for better business planning and operations. (MSE)

  4. Development of a Structured Design and Programming Methodology for Expert Systems Shells Utilizing a Visual Programming Language; Application of Structured Methodology to the MK92 Maintenance Advisor Expert System, Performance Module Prototype.

    DTIC Science & Technology

    1994-09-01

    expert system for the MK92 MOD 2 Fire Control System...methodology for the design and implementation of an expert system in an expert system shell utilizing a visual programming language. Guidelines for the...application of the structured methodology in the Adept expert system shell were develop and these guidelines applied to the Performance module prototype of the MK92 MOD 2 FCS Maintenance Advisor Export

  5. Managing for Biodiversity: Emerging Ideas for the Electric Utility Industry-Summary Statement

    PubMed

    MATTICE; FRASER; RAGONE; DAUGHERTY; WISNIEWSKI

    1996-11-01

    / The conference entitled "Managing for Biodiversity: Emerging Ideas for the Electric Utility Industry" was held in Williamsburg, Virginia, USA, during 19-20 March 1996. This paper provides an overview of the key points, conclusions, and recommendations from both the presentations/papers and the discussions throughout the conference.KEY WORDS: Biodiversity; Partnerships; Utilities; Ecosystem management; Conservation; Electrification

  6. Utilization management in the clinical laboratory: an introduction and overview of the literature.

    PubMed

    Huck, Amelia; Lewandrowski, Kent

    2014-01-01

    There is a broad literature addressing the need for improving utilization management in medical care. Numerous review articles and case studies have described approaches to utilization management challenges in the laboratory. This article will present an overview of the literature on laboratory utilization management and will compile a "toolbox" of strategies that can be used to address specific utilization management initiatives. A clear theme among successful utilization management programs is the need to recruit institutional champions both for the overall utilization management program and for ad hoc assistance with specific utilization challenges. It is important that these individuals represent a cross section of laboratory and clinical specialties and that the group be organized as a committee that has been established by the administrative and physician leadership of the organization. The changing nature of healthcare reimbursement will likely provide increased motivation to control laboratory testing and costs. Clinical pathologists are in a unique position to observe testing behavior patterns, suggest alternatives, implement order entry changes, manage testing algorithms and provide interpretive services for laboratory testing. For these reasons, clinical pathologists have a major opportunity to become institutional leaders in utilization management. © 2013.

  7. Energy management of a university campus utilizing short-term load forecasting with an artificial neural network

    NASA Astrophysics Data System (ADS)

    Palchak, David

    Electrical load forecasting is a tool that has been utilized by distribution designers and operators as a means for resource planning and generation dispatch. The techniques employed in these predictions are proving useful in the growing market of consumer, or end-user, participation in electrical energy consumption. These predictions are based on exogenous variables, such as weather, and time variables, such as day of week and time of day as well as prior energy consumption patterns. The participation of the end-user is a cornerstone of the Smart Grid initiative presented in the Energy Independence and Security Act of 2007, and is being made possible by the emergence of enabling technologies such as advanced metering infrastructure. The optimal application of the data provided by an advanced metering infrastructure is the primary motivation for the work done in this thesis. The methodology for using this data in an energy management scheme that utilizes a short-term load forecast is presented. The objective of this research is to quantify opportunities for a range of energy management and operation cost savings of a university campus through the use of a forecasted daily electrical load profile. The proposed algorithm for short-term load forecasting is optimized for Colorado State University's main campus, and utilizes an artificial neural network that accepts weather and time variables as inputs. The performance of the predicted daily electrical load is evaluated using a number of error measurements that seek to quantify the best application of the forecast. The energy management presented utilizes historical electrical load data from the local service provider to optimize the time of day that electrical loads are being managed. Finally, the utilization of forecasts in the presented energy management scenario is evaluated based on cost and energy savings.

  8. A methodology and supply chain management inspired reference ontology for modeling healthcare teams.

    PubMed

    Kuziemsky, Craig E; Yazdi, Sara

    2011-01-01

    Numerous studies and strategic plans are advocating more team based healthcare delivery that is facilitated by information and communication technologies (ICTs). However before we can design ICTs to support teams we need a solid conceptual model of team processes and a methodology for using such a model in healthcare settings. This paper draws upon success in the supply chain management domain to develop a reference ontology of healthcare teams and a methodology for modeling teams to instantiate the ontology in specific settings. This research can help us understand how teams function and how we can design ICTs to support teams.

  9. Palliative care in the management of lung cancer: analgesic utilization and barriers to optimal pain management.

    PubMed

    Simone, Charles B; Vapiwala, Neha; Hampshire, Margaret K; Metz, James M

    2012-01-01

    Little data exist on assessing pain medication utilization among lung cancer patients or on the reasons they fail to receive optimal analgesic treatment. This study evaluates those reasons and investigates perceived causes of pain among individuals with lung cancer. An institutional review board-approved Internet-based questionnaire was posted on http://www.oncolink.org that included 22 queries evaluating analgesic utilization, pain control, and attitudes regarding analgesics. Between November 2005 and July 2008, 90 respondents with lung malignancies participated. Respondents were Caucasian (89 percent), male (54 percent), and had non-small-cell lung cancer (79 percent), small-cell lung cancer (12 percent), or mesothelioma (9 percent). Respondents underwent surgery (48 percent), chemotherapy (58 percent), and radiotherapy (44 percent). Most respondents (92 percent) reported experiencing pain, with 52 percent attributing pain directly to cancer, 38 percent to cancer treatment, and 67 percent unsure of the primary cause. Among respondents experiencing pain, 33 percent did not use analgesics. Analgesic utilization was less in men (p = 0.050) but did not differ by minority status (p = 0.127), education level (p = 0.37), or lung cancer histology (p = 0.134). Analgesic use was higher in subjects receiving radiotherapy (p = 0.002) and chemotherapy (p = 0.013) but not surgery (p = 0.16). Reasons for not taking analgesics included fear of addiction/dependence (76 percent), healthcare providers not recommending medications (71 percent), and inability to pay for analgesics (56 percent). Participants pursued physical therapy (76 percent) and other complementary modalities (24 percent) for pain control. Many individuals with lung cancer perceive pain from both their disease and their cancer treatment. However, some study respondents did not use analgesics due to concerns of addiction, cost, or their healthcare providers not recommending analgesics. Medicalprofessionals

  10. Resource Guide to Effective Utility Management and Lean

    EPA Pesticide Factsheets

    Water and wastewater utilities are critical to the environmental, economic, and social well being of our nation’s communities, as they work to ensure that the public continues to enjoy the benefits of clean and safe water.

  11. Management and High-rank Utilization of Chemical Information

    NASA Astrophysics Data System (ADS)

    Sasaki, Shinichi

    This is the record of Special Lecture at the 24th Annual Meeting on Information Science and Technology. Firstly, lecturer outlined the production way and a general utilization of database on 13C and H magnetic resonance spectrum, which is produced by his group. In order to make higher the rank of utilization for this kind of factual database, he described three new systems such as CHEMICS, TUTORS and AIPHOS.

  12. Methodology for Knowledge Synthesis of the Management of Vaccination Pain and Needle Fear.

    PubMed

    Taddio, Anna; McMurtry, C Meghan; Shah, Vibhuti; Yoon, Eugene W; Uleryk, Elizabeth; Pillai Riddell, Rebecca; Lang, Eddy; Chambers, Christine T; Noel, Melanie; MacDonald, Noni E

    2015-10-01

    A knowledge synthesis was undertaken to inform the development of a revised and expanded clinical practice guideline about managing vaccination pain in children to include the management of pain across the lifespan and the management of fear in individuals with high levels of needle fear. This manuscript describes the methodological details of the knowledge synthesis and presents the list of included clinical questions, critical and important outcomes, search strategy, and search strategy results. The Grading of Assessments, Recommendations, Development and Evaluation (GRADE) and Cochrane methodologies provided the general framework. The project team voted on clinical questions for inclusion and critically important and important outcomes. A broad search strategy was used to identify relevant randomized-controlled trials and quasi-randomized-controlled trials. Quality of research evidence was assessed using the Cochrane risk of bias tool and quality across studies was assessed using GRADE. Multiple measures of the same construct within studies (eg, observer-rated and parent-rated infant distress) were combined before pooling. The standardized mean difference and 95% confidence intervals (CI) or relative risk and 95% CI was used to express the effects of an intervention. Altogether, 55 clinical questions were selected for inclusion in the knowledge synthesis; 49 pertained to pain management during vaccine injections and 6 pertained to fear management in individuals with high levels of needle fear. Pain, fear, and distress were typically prioritized as critically important outcomes across clinical questions. The search strategy identified 136 relevant studies. This manuscript describes the methodological details of a knowledge synthesis about pain management during vaccination and fear management in individuals with high levels of needle fear. Subsequent manuscripts in this series will present the results for the included questions.

  13. The development of a streamlined, coordinated and sustainable evaluation methodology for a diverse chronic disease management program.

    PubMed

    Berlowitz, David J; Graco, Marnie

    2010-05-01

    The Northern Alliance Hospital Admission Risk Program-Chronic Disease Management comprises 13 services delivering care to those with chronic disease and older people with complex care needs, who are frequent hospital users. To develop and implement a system-wide approach to the evaluation of this existing program. The Northern Clinical Research Centre audited all existing, routinely collected administrative data within the program and then met with each service to develop service specific outcome measures. The evaluators then developed and implemented a system-wide evaluation approach to measure performance in terms of: client profile; access and entry; service efficiency; client outcomes; and hospital demand. Data are collected electronically and more than 80% are derived from existing, administrative datasets, minimising staff and client burden. Additional data include client outcomes and a health related quality of life measure. The preliminary twelve month data suggest that clients have the equivalent of 'fair' or 'poor' self-reported health status (n = 862) and the average health utility scores are significantly (P < 0.05) worse than population control data. These analyses reveal, for the first time, that the Northern Alliance Hospital Admission Risk Program-Chronic Disease Management program is targeting appropriate clients. This methodology will enable many prospective assessments to be performed including; client outcome evaluation, service model comparisons, and cost-utility analyses. This evaluation approach demonstrates the feasibility of a highly coordinated 'whole of system' evaluation. Such an approach may ultimately contribute to the development of evidence-based policy.

  14. Utilizing Project Management Techniques in the Design of Instructional Materials.

    ERIC Educational Resources Information Center

    Murphy, Charles

    1994-01-01

    Discussion of instructional design in large organizations highlights a project management approach. Topics addressed include the role of the instructional designer; project team selection; role of the team members; role of the project manager; focusing on what employees need to know; types of project teams; and monitoring time and responsibility.…

  15. Novel thermal management system design methodology for power lithium-ion battery

    NASA Astrophysics Data System (ADS)

    Nieto, Nerea; Díaz, Luis; Gastelurrutia, Jon; Blanco, Francisco; Ramos, Juan Carlos; Rivas, Alejandro

    2014-12-01

    Battery packs conformed by large format lithium-ion cells are increasingly being adopted in hybrid and pure electric vehicles in order to use the energy more efficiently and for a better environmental performance. Safety and cycle life are two of the main concerns regarding this technology, which are closely related to the cell's operating behavior and temperature asymmetries in the system. Therefore, the temperature of the cells in battery packs needs to be controlled by thermal management systems (TMSs). In the present paper an improved design methodology for developing TMSs is proposed. This methodology involves the development of different mathematical models for heat generation, transmission, and dissipation and their coupling and integration in the battery pack product design methodology in order to improve the overall safety and performance. The methodology is validated by comparing simulation results with laboratory measurements on a single module of the battery pack designed at IK4-IKERLAN for a traction application. The maximum difference between model predictions and experimental temperature data is 2 °C. The models developed have shown potential for use in battery thermal management studies for EV/HEV applications since they allow for scalability with accuracy and reasonable simulation time.

  16. An Implentation Methodology for Integrated Resource Management in Urban Water Planning

    NASA Astrophysics Data System (ADS)

    Ebrahimi, G.; Thurm, B.; Klein, D. R.; Öberg, G.

    2014-12-01

    Urban water management requires innovative and integrative approaches to improve sustainability in cities keeping in touch with science progress. Integrated Resource Management (IRM) is one of these strategies and has been developed to integrate various natural and human resources. However, it is becoming increasingly clear that it is challenging to move from vision to implementation. The aim of this paper is to identify strengths and weaknesses of IRM and analyze if the approach might facilitate implementation of sustainability objectives in the water management field. A literature review was performed on peer-reviewed papers that were identified through Google Scholar search for the term 'Integrated Resource Management'. It was found that IRM has been used in a number of contexts such as urban planning, forestry, and management of waste and livestock. Significant implementation challenges are highlighted in the literature. Based on the lessons learned in many different fields, from forestry to communication sciences, important characteristics of IRM approach were found such as the need for adequate governance and strong leaderships, stakeholder's involvement, the learning process and the critical need of appropriate evaluation criteria. We conclude developing an implementation methodology and presenting several recommendations to implement IRM in urban management. While Integrated Water Resource Management (IWRM) is recognized as a fruitful approach to achieve sustainable water management, this study suggests that a shift toward Integrated Resource Management (IRM) can be beneficial as it is designed to facilitate consideration of the interrelationships between various natural and human resources.

  17. [Evaluation of management capacity in social organizations: an in-process methodological proposal].

    PubMed

    Guimarães, Maria do Carmo Lessa; Santos, Sandra Maria Chaves dos; Melo, Cristina; Sanches Filho, Alvino

    2004-01-01

    A bill for Public Sector Administrative Reform in Brazil introduces administrative strategies based on broad delegation of authority and "a posteriori" demands for results, thereby highlighting the issue of evaluation in public organizations. This article presents a methodological proposal to evaluate management capability in so-called social organizations, a kind of non-government public entity created within this Reform. Drafting of the bill included the definition of an underlying management concept and its dimensions, which oriented the construction of variables, indicators, parameters, and an analytical plan for evaluation. The final remarks include the argument that the conceptual choices and procedural decisions aim to produce an evaluation design that would guarantee the results' reliability and their sensitivity for approaching the phenomenon under evaluation, as well as the methodology's applicability and reproducibility in different contexts.

  18. General Methodologies for Improving Motor Drive Precision in Order to Utilize It as an Embedded Application Sensor

    NASA Astrophysics Data System (ADS)

    Secrest, Caleb W.

    The objectives of this research are to reliably, and non-invasively, extract high quality spatial information from a limited-stroke multi-stage gear train driven by an AC machine using only the sensors necessary for normal AC machine control. In this work, the spatial information will be used to estimate the state of wear of each axis in the gear train. To extract this information, cascaded observer structures are utilized to estimate the load disturbances acting on the AC machine, and then to estimate the spatial errors which produce those disturbances. Further signal processing techniques are then utilized to observe the spatial error information in the spatial domain where the information is most relevant and to extract the systematic spatial errors that reoccur over many operating cycles. In prior art, the intrinsic spatial properties of the AC machine and position sensor feedback limited the quality of the spatial error information that could be extracted using motor drive-based estimation. Furthermore, the limited-stroke of the multi-stage gear train limits the separation of spatial content between the axes of the gear train and limits the extraction of the systematic spatial errors that reoccur over many operating cycles. In this work, methods are developed to reduce and separate machine and sensor contributions to the spatial error information being extracted, and general system design methodologies are investigated to improve the quality of spatial error information that can be extracted within the limited-stroke motion constraints of the multi-stage gear train.

  19. Case Study on Project Risk Management Planning Based on Soft System Methodology

    NASA Astrophysics Data System (ADS)

    Lifang, Xie; Jun, Li

    This paper analyzed the soft system characters of construction projects and the applicability on using Soft System Methodology (SSM) for risk analysis after a brief review of SSM. Taking a hydropower project as an example, it constructed the general frame of project risk management planning (PRMP) and established the Risk Management Planning (RMP) system from the perspective of the interests of co-ordination. This paper provided the ideas and methods for construction RMP under the win-win situation through the practice of SSM.

  20. The Career Management and Utilization of Reserve Component USAWC Graduates.

    ERIC Educational Resources Information Center

    Coleman, Edward R.; And Others

    A study of the Reserve Component officers attendance of the U. S. Army War College (USAWC) Nonresident Course is presented. The areas receiving primary attention are: prerequisites, selection procedures, curriculum, and subsequent utilization. The purpose is to evaluate the current system of achieving a USAWC education. The objective of the study…

  1. The Career Management and Utilization of Reserve Component USAWC Graduates.

    ERIC Educational Resources Information Center

    Coleman, Edward R.; And Others

    A study of the Reserve Component officers attendance of the U. S. Army War College (USAWC) Nonresident Course is presented. The areas receiving primary attention are: prerequisites, selection procedures, curriculum, and subsequent utilization. The purpose is to evaluate the current system of achieving a USAWC education. The objective of the study…

  2. Optimization of polyhydroxybutyrate production utilizing waste water as nutrient source by Botryococcus braunii Kütz using response surface methodology.

    PubMed

    Kavitha, Ganapathy; Kurinjimalar, Chidambaram; Sivakumar, Krishnan; Kaarthik, Muthukumar; Aravind, Rajamani; Palani, Perumal; Rengasamy, Ramasamy

    2016-12-01

    Investigations have been made to optimize various factors including pH, temperature, and substrate for enhanced polyhydroxybutyrate (PHB) production in Botryococcus braunii which serves as a pioneer for production of bioplastic (PHB). Polyhydroxybutyrate is a natural, decomposable polymers accumulated by the microorganism under different nutritional condition. Strain selection was done by staining method using Sudan black and Nile red dye. Using response surface methodology (RSM), three level- three variables Box Behnken design (BBD), the best potential combination of pH (4-11), temperature (30-50°C) and sewage waste water as substrate fed at different concentrations at 20%-100% for maximum PHB production was investigated. Maximum yield (247±0.42mg/L) of PHB dry weight was achieved from the 60% concentration of sewage waste water as a growth medium at pH 7.5 at 40°C. It was well in close agreement with the value predicted by RSM model yield (246± 0.32mg/L). Thus the study shows the production of PHB by B. braunii along with the basic characterization of PHB by using FTIR and TEM analysis. These preliminary studies indicated that PHB can also be produced by B. braunii utilizing waste water. There is no report on the optimization of PHB production in this microalgae have been documented.

  3. Utilization of Gastrointestinal Simulator, an in Vivo Predictive Dissolution Methodology, Coupled with Computational Approach To Forecast Oral Absorption of Dipyridamole.

    PubMed

    Matsui, Kazuki; Tsume, Yasuhiro; Takeuchi, Susumu; Searls, Amanda; Amidon, Gordon L

    2017-03-03

    Weakly basic drugs exhibit a pH-dependent dissolution profile in the gastrointestinal (GI) tract, which makes it difficult to predict their oral absorption profile. The aim of this study was to investigate the utility of the gastrointestinal simulator (GIS), a novel in vivo predictive dissolution (iPD) methodology, in predicting the in vivo behavior of the weakly basic drug dipyridamole when coupled with in silico analysis. The GIS is a multicompartmental dissolution apparatus, which represents physiological gastric emptying in the fasted state. Kinetic parameters for drug dissolution and precipitation were optimized by fitting a curve to the dissolved drug amount-time profiles in the United States Pharmacopeia apparatus II and GIS. Optimized parameters were incorporated into mathematical equations to describe the mass transport kinetics of dipyridamole in the GI tract. By using this in silico model, intraluminal drug concentration-time profile was simulated. The predicted profile of dipyridamole in the duodenal compartment adequately captured observed data. In addition, the plasma concentration-time profile was also predicted using pharmacokinetic parameters following intravenous administration. On the basis of the comparison with observed data, the in silico approach coupled with the GIS successfully predicted in vivo pharmacokinetic profiles. Although further investigations are still required to generalize, these results indicated that incorporating GIS data into mathematical equations improves the predictability of in vivo behavior of weakly basic drugs like dipyridamole.

  4. Utilization of Parenteral Morphine by Application of ATC/DDD Methodology: Retrospective Study in the Referral Teaching Hospital.

    PubMed

    Dragojevic-Simic, Viktorija; Rancic, Nemanja; Stamenkovic, Dusica; Simic, Radoje

    2017-01-01

    Few studies analyzed the pattern of opioid analgesic utilization in hospital settings. The aim of this study was to determine the consumption pattern of parenteral morphine in patients hospitalized in the Serbian referral teaching hospital and to correlate it with utilization at the national and international level. In retrospective study, the required data were extracted from medical records of surgical patients who received parenteral morphine in the 5-year period, from 2011 to 2015. We used the Anatomical Therapeutic Chemical Classification/Defined Daily Doses (DDD) international system for consumption evaluation. While the number of performed surgical procedures in our hospital steadily increased from 2011 to 2015, the number of inpatient bed-days decreased from 2012. However, the consumption of parenteral morphine varied and was not more than 0.867 DDD/100 bed-days in the observed period. Based on the available data, parenteral morphine consumption in our hospital was lower compared with international data. The low level of morphine use in the hospital was in accordance with national data, and compared with other countries, morphine consumption applied for medical indications in Serbia was low. Adequate legal provision to ensure the availability of opioids, better education and training of medical personnel, as well as multidisciplinary approach should enable more rational and individual pain management in the future, not only within the hospitals.

  5. Collision management utilizing CCD and remote sensing technology

    NASA Technical Reports Server (NTRS)

    Mcdaniel, Harvey E., Jr.

    1995-01-01

    With the threat of damage to aerospace systems (space station, shuttle, hypersonic a/c, solar power satellites, loss of life, etc.) from collision with debris (manmade/artificial), there exists an opportunity for the design of a novel system (collision avoidance) to be incorporated into the overall design. While incorporating techniques from ccd and remote sensing technologies, an integrated system utilized in the infrared/visible spectrum for detection, tracking, localization, and maneuvering from doppler shift measurements is achievable. Other analysis such as impact assessment, station keeping, chemical, and optical tracking/fire control solutions are possible through this system. Utilizing modified field programmable gated arrays (software reconfiguring the hardware) the mission and mission effectiveness can be varied. This paper outlines the theoretical operation of a prototype system as it applies to collision avoidance (to be followed up by research).

  6. Sentinel Asia step 2 utilization for disaster management in Malaysia

    NASA Astrophysics Data System (ADS)

    Moslin, S. I.; Wahap, N. A.; Han, O. W.

    2014-02-01

    With the installation of Wideband InterNetworking engineering test and Demonstration Satellite (WINDS) communication system in the National Space Centre, Banting; officially Malaysia is one of the twelve Sentinel Asia Step2 System Regional Servers in the Asia Pacific region. The system will be dedicated to receive and deliver images of disaster struck areas observed by Asia Pacific earth observation satellites by request of the Sentinel Asia members via WINDS satellite or 'Kizuna'. Sentinel Asia is an initiative of collaboration between space agencies and disaster management agencies, applying remote sensing and web-GIS technologies to assist disaster management in Asia Pacific. When a disaster occurred, participating members will make an Emergency Observation Request (EOR) to the Asian Disaster Reduction Centre (ADRC). Subsequently, the Data Provider Node (DPN) will execute the emergency observation using the participating earth observation satellites. The requested images then will be processed and analysed and later it will be uploaded on the Sentinel Asia website to be utilised for disaster management and mitigation by the requestor and any other international agencies related to the disaster. Although the occurrences of large scale natural disasters are statistically seldom in Malaysia, but we can never be sure with the unpredictable earth climate nowadays. This paper will demonstrate the advantage of using Sentinel Asia Step2 for local disaster management. Case study will be from the recent local disaster occurrences. In addition, this paper also will recommend a local disaster management support system by using the Sentinel Asia Step2 facilities in ANGKASA.

  7. Managing an evolution: Deregulation of the electric utility industry

    SciTech Connect

    Skinner, S.K.

    1994-12-31

    The author discusses the emerging competitive situation in the electric power industry as deregulation of electric utilities looms on the horizon. The paper supports this change, and the competition it will bring, but urges caution as changes are instituted, and the regulatory bodies decide how and how much to free, and at what rates. The reason for his urge for caution comes from historical experience of other industries, which were smaller and had less direct impact on every American.

  8. Complex wound management utilizing an artificial dermal matrix.

    PubMed

    Muangman, Pornprom; Engrav, Loren H; Heimbach, David M; Harunari, Nobuyuki; Honari, Shari; Gibran, Nicole S; Klein, Matthew B

    2006-08-01

    The benefits of the Integra Dermal Regeneration Template in the management of extensive burn injuries have been well documented. Integra can reduce donor- and graft-site scarring and has been reported to be capable of vascularizing over small areas of exposed bone and tendon. Given these potential advantages, we have used Integra for a variety of other reconstruction applications. We performed a retrospective review of patients with complex wounds treated with Integra at our burn center. Integra was used in the management of a variety of wounds, including necrotizing fasciitis, extremity degloving injury, meningococcemia, Marjolin ulcer, postburn lip reconstruction, and fourth-degree burns with exposed bone or tendon. Engraftment rates of Integra and autograft were 98% +/- 4% and 97% +/- 4%, respectively. All areas of graft loss healed without need for regrafting. The benefits of Integra in the management of acute burn wounds can be extended to other traumatic and complex wounds.

  9. Mobile healthcare information management utilizing Cloud Computing and Android OS.

    PubMed

    Doukas, Charalampos; Pliakas, Thomas; Maglogiannis, Ilias

    2010-01-01

    Cloud Computing provides functionality for managing information data in a distributed, ubiquitous and pervasive manner supporting several platforms, systems and applications. This work presents the implementation of a mobile system that enables electronic healthcare data storage, update and retrieval using Cloud Computing. The mobile application is developed using Google's Android operating system and provides management of patient health records and medical images (supporting DICOM format and JPEG2000 coding). The developed system has been evaluated using the Amazon's S3 cloud service. This article summarizes the implementation details and presents initial results of the system in practice.

  10. Waste management programmatic environmental impact statement methodology for estimating human health risks

    SciTech Connect

    Bergenback, B.; Blaylock, B.P.; Legg, J.L.

    1995-05-01

    The US Department of Energy (DOE) has produced large quantities of radioactive and hazardous waste during years of nuclear weapons production. As a result, a large number of sites across the DOE Complex have become chemically and/or radiologically contaminated. In 1990, the Secretary of Energy charged the DOE Office of Environmental Restoration and Waste management (EM) with the task of preparing a Programmatic Environmental Impact Statement (PEIS). The PEIS should identify and assess the potential environmental impacts of implementing several integrated Environmental Restoration (ER) and Waste Management (WM) alternatives. The determination and integration of appropriate remediation activities and sound waste management practices is vital for ensuring the diminution of adverse human health impacts during site cleanup and waste management programs. This report documents the PEIS risk assessment methodology used to evaluate human health risks posed by WM activities. The methodology presents a programmatic cradle to grave risk assessment for EM program activities. A unit dose approach is used to estimate risks posed by WM activities and is the subject of this document.

  11. Specification of Energy Assessment Methodologies to Satisfy ISO 50001 Energy Management Standard

    NASA Astrophysics Data System (ADS)

    Kanneganti, Harish

    Energy management has become more crucial for industrial sector as a way to lower their cost of production and in reducing their carbon footprint. Environmental regulations also force the industrial sector to increase the efficiency of their energy usage. Hence industrial sector started relying on energy management consultancies for improvements in energy efficiency. With the development of ISO 50001 standard, the entire energy management took a new dimension involving top level management and getting their commitment on energy efficiency. One of the key requirements of ISO 50001 is to demonstrate continual improvement in their (industry) energy efficiency. The major aim of this work is to develop an energy assessment methodology and reporting format to tailor the needs of ISO 50001. The developed methodology integrates the energy reduction aspect of an energy assessment with the requirements of sections 4.4.3 (Energy Review) to 4.4.6 (Objectives, Targets and Action Plans) in ISO 50001 and thus helping the facilities in easy implementation of ISO 50001.

  12. Utilizing a Simulation Exercise to Illustrate Critical Inventory Management Concepts

    ERIC Educational Resources Information Center

    Umble, Elisabeth; Umble, Michael

    2013-01-01

    Most undergraduate business students simply do not appreciate the elegant mathematical beauty of inventory models. So how does an instructor capture students' interest and keep them engaged in the learning process when teaching inventory management concepts? This paper describes a competitive and energizing in-class simulation game that introduces…

  13. Utilization and environmental management of residues from intensive animal production

    USDA-ARS?s Scientific Manuscript database

    Animal manures are traditional sources of nutrients in agriculture. Under proper management, manures provide nutrients to soil, reducing or eliminating the use of commercial fertilizers, as well as organic carbon that improves soil physical properties and soil health. However, excessive application ...

  14. Clinical utility of sympathetic blockade in cardiovascular disease management.

    PubMed

    Park, Chan Soon; Lee, Hae-Young

    2017-04-01

    A dysregulated sympathetic nervous system is a major factor in the development and progression of cardiovascular disease; thus, understanding the mechanism and function of the sympathetic nervous system and appropriately regulating sympathetic activity to treat various cardiovascular diseases are crucial. Areas covered: This review focused on previous studies in managing hypertension, atrial fibrillation, coronary artery disease, heart failure, and perioperative management with sympathetic blockade. We reviewed both pharmacological and non-pharmacological management. Expert commentary: Chronic sympathetic nervous system activation is related to several cardiovascular diseases mediated by various pathways. Advancement in measuring sympathetic activity makes visualizing noninvasively and evaluating the activation level even in single fibers possible. Evidence suggests that sympathetic blockade still has a role in managing hypertension and controlling the heart rate in atrial fibrillation. For ischemic heart disease, beta-adrenergic receptor antagonists have been considered a milestone drug to control symptoms and prevent long-term adverse effects, although its clinical implication has become less potent in the era of successful revascularization. Owing to pathologic involvement of sympathetic nervous system activation in heart failure progression, sympathetic blockade has proved its value in improving the clinical course of patients with heart failure.

  15. EMERGING TECHNOLOGIES FOR THE MANAGEMENT AND UTILIZATION OF LANDFILL GAS

    EPA Science Inventory

    The report gives information on emerging technologies that are considered to be commercially available (Tier 1), currently undergoing research and development (Tier 2), or considered as potentially applicable (Tier 3) for the management of landfill gas (LFG) emissions or for the ...

  16. Utilizing a Simulation Exercise to Illustrate Critical Inventory Management Concepts

    ERIC Educational Resources Information Center

    Umble, Elisabeth; Umble, Michael

    2013-01-01

    Most undergraduate business students simply do not appreciate the elegant mathematical beauty of inventory models. So how does an instructor capture students' interest and keep them engaged in the learning process when teaching inventory management concepts? This paper describes a competitive and energizing in-class simulation game that introduces…

  17. Utilizing Virtual Teams in a Management Principles Course

    ERIC Educational Resources Information Center

    Olson-Buchanan, Julie B.; Rechner, Paula L.; Sanchez, Rudolph J.; Schmidtke, James M.

    2007-01-01

    Purpose: The purpose of this paper is to describe development of a component in a management principles course to develop university students' virtual team skills. There were several challenges in creating and implementing this new component. The paper aims to describe how these challenges were addressed and discusses outcomes associated with this…

  18. EMERGING TECHNOLOGIES FOR THE MANAGEMENT AND UTILIZATION OF LANDFILL GAS

    EPA Science Inventory

    The report gives information on emerging technologies that are considered to be commercially available (Tier 1), currently undergoing research and development (Tier 2), or considered as potentially applicable (Tier 3) for the management of landfill gas (LFG) emissions or for the ...

  19. Utilizing Virtual Teams in a Management Principles Course

    ERIC Educational Resources Information Center

    Olson-Buchanan, Julie B.; Rechner, Paula L.; Sanchez, Rudolph J.; Schmidtke, James M.

    2007-01-01

    Purpose: The purpose of this paper is to describe development of a component in a management principles course to develop university students' virtual team skills. There were several challenges in creating and implementing this new component. The paper aims to describe how these challenges were addressed and discusses outcomes associated with this…

  20. Impact of fuel fabrication and fuel management technologies on uranium utilization

    SciTech Connect

    Arnsberger, P.L.; Stucker, D.L.

    1994-12-31

    Uranium utilization in commercial pressurized water reactors is a complex function of original NSSS design, utility energy requirements, fuel assembly design, fuel fabrication materials and fuel management optimization. Fuel design and fabrication technologies have reacted to the resulting market forcing functions with a combination of design and material changes. The technologies employed have included ever-increasing fuel discharge burnup, non-parasitic structural materials, burnable absorbers, and fissile material core zoning schemes (both in the axial and radial direction). The result of these technological advances has improved uranium utilization by roughly sixty percent from the infancy days of nuclear power to present fuel management. Fuel management optimization technologies have also been developed in recent years which provide fuel utilization improvements due to core loading pattern optimization. This paper describes the development and impact of technology advances upon uranium utilization in modem pressurized water reactors.

  1. Prognostics and health management design for rotary machinery systems—Reviews, methodology and applications

    NASA Astrophysics Data System (ADS)

    Lee, Jay; Wu, Fangji; Zhao, Wenyu; Ghaffari, Masoud; Liao, Linxia; Siegel, David

    2014-01-01

    Much research has been conducted in prognostics and health management (PHM), an emerging field in mechanical engineering that is gaining interest from both academia and industry. Most of these efforts have been in the area of machinery PHM, resulting in the development of many algorithms for this particular application. The majority of these algorithms concentrate on applications involving common rotary machinery components, such as bearings and gears. Knowledge of this prior work is a necessity for any future research efforts to be conducted; however, there has not been a comprehensive overview that details previous and on-going efforts in PHM. In addition, a systematic method for developing and deploying a PHM system has yet to be established. Such a method would enable rapid customization and integration of PHM systems for diverse applications. To address these gaps, this paper provides a comprehensive review of the PHM field, followed by an introduction of a systematic PHM design methodology, 5S methodology, for converting data to prognostics information. This methodology includes procedures for identifying critical components, as well as tools for selecting the most appropriate algorithms for specific applications. Visualization tools are presented for displaying prognostics information in an appropriate fashion for quick and accurate decision making. Industrial case studies are included in this paper to show how this methodology can help in the design of an effective PHM system.

  2. Quantitative evaluation of geodiversity: development of methodological procedures with application to territorial management

    NASA Astrophysics Data System (ADS)

    Forte, J.; Brilha, J.; Pereira, D.; Nolasco, M.

    2012-04-01

    Although geodiversity is considered the setting for biodiversity, there is still a huge gap in the social recognition of these two concepts. The concept of geodiversity, less developed, is now making its own way as a robust and fundamental idea concerning the abiotic component of nature. From a conservationist point of view, the lack of a broader knowledge concerning the type and spatial variation of geodiversity, as well as its relationship with biodiversity, makes the protection and management of natural or semi-natural areas incomplete. There is a growing need to understand the patterns of geodiversity in different landscapes and to translate this knowledge for territorial management in a practical and effective point of view. This kind of management can also represent an important tool for the development of sustainable tourism, particularly geotourism, which can bring benefits not only for the environment, but also for social and economic purposes. The quantification of geodiversity is an important step in all this process but still few researchers are investing in the development of a proper methodology. The assessment methodologies that were published so far are mainly focused on the evaluation of geomorphological elements, sometimes complemented with information about lithology, soils, hidrology, morphometric variables, climatic surfaces and geosites. This results in very dissimilar areas at very different spatial scales, showing the complexity of the task and the need of further research. This current work aims the development of an effective methodology for the assessment of the maximum elements of geodiversity possible (rocks, minerals, fossils, landforms, soils), based on GIS routines. The main determinant factor for the quantitative assessment is scale, but other factors are also very important, such as the existence of suitable spatial data with sufficient degree of detail. It is expected to attain the proper procedures in order to assess geodiversity

  3. Report: The EPA Should Assess the Utility of the Watch List as a Management Tool

    EPA Pesticide Factsheets

    Report #13-P-0435, September 30, 2013 . The agency runs the risk of maintaining a management tool that does not assist in tracking facilities with long-standing significant violations and has limited transparency and utility to the public.

  4. The Self Diagnosis Method. A new methodology to assess environmental management in sea ports.

    PubMed

    Darbra, R M; Ronza, A; Casal, J; Stojanovic, T A; Wooldridge, C

    2004-03-01

    A methodology has been designed to assess the performance of the environmental management in sea ports. The Self Diagnosis Method, developed by two research teams and about sixty sea ports, allows the comparison of the current environmental situation with that corresponding to previous years and the assessment of the opportunities for improvement. The main objective is to review the management activities and procedures that affect the environment and the way the port authority handles significant environmental aspects. It has been designed as a "first level" tool: it can be applied in approximately six hours by a non-expert user. It is based on the ISO 14001 vocabulary, requirements and structure, and it can be considered as a first step in the voluntary implementation of an environmental management system for port communities.

  5. Methodology for industrial solid waste management: implementation to sludge management in Asturias (Spain).

    PubMed

    Mesa Fernández, José M; Palacios, Henar Morán; Alvarez Cabal, José V; Martínez Huerta, Gemma M

    2014-11-01

    Nowadays, the industry produces an enormous amount of solid waste that has very negative environmental effects. Owing to waste variety and its scattered sites of production, selecting the most proper solid waste treatment is difficult. Simultaneously, social concern about environmental sustainability rises every day and, as a consequence, improvement on waste treatment systems is being demanded. However, when a waste treatment system is being designed, not only environmental but also technical and economic issues should be considered. This article puts forward a methodology to provide industrial factories with an easy way to identify, evaluate and select the most suitable solid waste treatment.

  6. Utilizing patient satisfaction surveys to prepare for Medicaid managed care.

    PubMed

    Fields, T T; Gomez, P S

    2001-02-01

    To prepare for Medicaid managed care, a community health center incorporated the business principle of continuous quality improvement, often used in the private sector to improve customer service, into its planning process. The initial endeavor was to create a patient satisfaction survey that was appropriate for the uniqueness of the community. The survey, taken monthly, resulted in both staff and patients making active improvements in the clinic environment. Staff showed more enthusiasm, and patients were more assertive in their attitudes toward the clinic. The empowerment of the patient to take ownership in the clinic will be coupled with the next step of the formalized plan, that of educating patients on the steps necessary to ensure that their Medicaid managed care facility will be the local community health center.

  7. [Utility of the PET/CT in vulvar cancer management].

    PubMed

    Peiró, V; Chiva, L; González, A; Bratos, R; Alonso, S; Márquez, R; Carballo, N; Alonso-Farto, J C

    2014-01-01

    To describe the clinical impact of PET/CT in the management of patients with vulvar cancer. Retrospective analysis of 13 PET/CT studies with (18)F-FDG (6 staging and 7 suspected recurrence) corresponding to 10 patients diagnosed with vulvar cancer by biopsy, with a mean age of 64.5 years. The preoperative PET/CT study was analyzed qualitatively according to the lesion region. Surgical excision was carried out, covering all the suspected areas according to the PET/CT study. This was compared with the histopathologic analysis. Abnormal vulvar PET/CT uptake was found in 9 out of the 13 studies and invasion of adjacent structures in 5 of them (urethra, perineal, vagina). The inguinal-femoral lymph nodes were considered as affected in 3 studies and one pelvic lymph node was also affected. Four of the studies had extralymphatic involvement: 3 in lung and 1 in ischiorectal fossa. The PET/CT showed a 100% sensitivity for the detection of the vulvar lesion in squamous cell carcinomas and 60% in non-squamous cell ones. There was a false positive result for local invasion due to urine contamination. One of the studies with lung metastases was related to a synchronous breast tumor. All the pathological lymph node levels detected in the PET/CT study were confirmed in the histopathology study. No new lesions were identified by surgery. PET/CT changed the therapeutic management in 8/13 studies (61.5%). PET/CT is postulated as a useful imaging test for the management of vulvar cancer, mainly in the identification of nodal metastases. It may affect both surgical planning and clinical management. Larger series are needed to confirm our findings. Copyright © 2013 Elsevier España, S.L. and SEMNIM. All rights reserved.

  8. Applications of harvesting system simulation to timber management and utilization analyses

    Treesearch

    John E. Baumgras; Chris B. LeDoux

    1990-01-01

    Applications of timber harvesting system simulation to the economic analysis of forest management and wood utilization practices are presented. These applications include estimating thinning revenue by stand age, estimating impacts of minimum merchantable tree diameter on harvesting revenue, and evaluating wood utilization alternatives relative to pulpwood quotas and...

  9. The peregrine falcon in Arizona: Habitat utilization and management recommendations

    USGS Publications Warehouse

    Ellis, D.H.

    1982-01-01

    The peregrine falcon once bred in significant numbers in Arizona. Good documentation is available for specific breeding sites and an additional 20 general locations. This report, based on the published literature, an extensive personal contact survey, an aerial habitat inventory (over 124 hours air time), and ground visits to over 300 locations, provides information on habitat preferences and management practices which can contribute to the bird's survival. In seeking to identify the habitat preferences of the falcon, many site description factors were examined. Those traits which appeared common to most recent Arizona sites (and therefore most useful in evaluating habitat) were: elevation less than 9,000 feet, cliffs tall or very tall, cliffs extensive, topographic relief high, and surface water readily available. All recent sites are in extensive canyon systems or in extensive mountain ranges. Using a habitat evaluation key derived from the traits common to known breeding sites, all cliff regions in Arizona and the Navajo Indian Reservation were flown and evaluated for suitability. Nineteen falcon eyries located in subsequent ground visits were all in areas previously ranked acceptable or better. Many management alternatives are discussed: management of information on breeding sites, habitat preservation, controlling disruptive human activities, and enhancing productivity through the creation of suitable breeding ledges, providing pesticide free prey, or direct reintroductions. Given their privacy (and an increasingly pesticide free environment) the peregrine falcon will likely exist indefinitely in suitable areas across Arizona.

  10. [Methodology of the consensus conference "diagnostic and therapeutic management of urinary tract infection in childhood"].

    PubMed

    Ochoa Sangrador, C

    2007-11-01

    The methodology of the Consensus Conference "Diagnostic and Therapeutic Management of Urinary Tract Infection in Childhood" is presented. The methodology consisted of two phases. In the first phase, a series of documents was drafted, which included an in-depth review of the existing evidence on the diagnosis and treatment of urinary tract infection and of epidemiological data on the etiological and resistance profiles of urinary pathogens in Spain. In the second phase, a multidisciplinary expert panel was convened to evaluate all the documentation and to answer a series of questions and to assign a level of evidence and degree of recommendation to each answer. In this article the search strategies used and their results are described. In addition, the bases for evaluating the efficacy of therapeutic interventions and the validity of the diagnostic tests are presented. Finally, the criteria for hierarchical structuring of the scientific evidence are detailed.

  11. The Validity and Utility of the Positive Presentation Management and Negative Presentation Management Scales for the Revised NEO Personality Inventory

    ERIC Educational Resources Information Center

    Sellbom, Martin; Bagby, R. Michael

    2008-01-01

    Schinka, Kinder, and Kremer developed "validity" scales for the "Revised NEO Personality Inventory" (NEO PI-R; Costa & McCrae) to detect underreporting--the Positive Presentation Management (PPM) Scale and overreporting--the Negative Presentation Management (NPM) Scale. In this investigation, the clinical utility of these…

  12. A knowledge management methodology for the integrated assessment of WWTP configurations during conceptual design.

    PubMed

    Garrido-Baserba, M; Reif, R; Rodriguez-Roda, I; Poch, M

    2012-01-01

    The current complexity involved in wastewater management projects is arising as the XXI century sets new challenges leading towards a more integrated plant design. In this context, the growing number of innovative technologies, stricter legislation and the development of new methodological approaches make it difficult to design appropriate flow schemes for new wastewater projects. Thus, new tools are needed for the wastewater treatment plant (WWTP) conceptual design using integrated assessment methods in order to include different types of objectives at the same time i.e. environmental, economical, technical, and legal. Previous experiences used the decision support system (DSS) methodology to handle the specific issues related to wastewater management, for example, the design of treatment facilities for small communities. However, tools developed for addressing the whole treatment process independently of the plant size, capable of integrating knowledge from many different areas, including both conventional and innovative technologies are not available. Therefore, the aim of this paper is to present and describe an innovative knowledge-based methodology that handles the conceptual design of WWTP process flow-diagrams (PFDs), satisfying a vast number of different criteria. This global approach is based on a hierarchy of decisions that uses the information contained in knowledge bases (KBs) with the aim of automating the generation of suitable WWTP configurations for a specific scenario. Expert interviews, legislation, specialized literature and engineering experience have been integrated within the different KBs, which indeed constitute one of the main highlights of this work. Therefore, the methodology is presented as a valuable tool which provides customized PFD for each specific case, taking into account process unit interactions and the user specified requirements and objectives.

  13. A coupled groundwater-flow-modelling and vulnerability-mapping methodology for karstic terrain management

    NASA Astrophysics Data System (ADS)

    Kavouri, Konstantina P.; Karatzas, George P.; Plagnes, Valérie

    2017-08-01

    A coupled groundwater-flow-modelling and vulnerability-mapping methodology for the management of karst aquifers with spatial variability is developed. The methodology takes into consideration the duality of flow and recharge in karst and introduces a simple method to integrate the effect of temporal storage in the unsaturated zone. In order to investigate the applicability of the developed methodology, simulation results are validated against available field measurement data. The criteria maps from the PaPRIKa vulnerability-mapping method are used to document the groundwater flow model. The FEFLOW model is employed for the simulation of the saturated zone of Palaikastro-Chochlakies karst aquifer, in the island of Crete, Greece, for the hydrological years 2010-2012. The simulated water table reproduces typical karst characteristics, such as steep slopes and preferred drain axes, and is in good agreement with field observations. Selected calculated error indicators—Nash-Sutcliffe efficiency (NSE), root mean squared error (RMSE) and model efficiency (E')—are within acceptable value ranges. Results indicate that different storage processes take place in different parts of the aquifer. The north-central part seems to be more sensitive to diffuse recharge, while the southern part is affected primarily by precipitation events. Sensitivity analysis is performed on the parameters of hydraulic conductivity and specific yield. The methodology is used to estimate the feasibility of artificial aquifer recharge (AAR) at the study area. Based on the developed methodology, guidelines were provided for the selection of the appropriate AAR scenario that has positive impact on the water table.

  14. A coupled groundwater-flow-modelling and vulnerability-mapping methodology for karstic terrain management

    NASA Astrophysics Data System (ADS)

    Kavouri, Konstantina P.; Karatzas, George P.; Plagnes, Valérie

    2017-02-01

    A coupled groundwater-flow-modelling and vulnerability-mapping methodology for the management of karst aquifers with spatial variability is developed. The methodology takes into consideration the duality of flow and recharge in karst and introduces a simple method to integrate the effect of temporal storage in the unsaturated zone. In order to investigate the applicability of the developed methodology, simulation results are validated against available field measurement data. The criteria maps from the PaPRIKa vulnerability-mapping method are used to document the groundwater flow model. The FEFLOW model is employed for the simulation of the saturated zone of Palaikastro-Chochlakies karst aquifer, in the island of Crete, Greece, for the hydrological years 2010-2012. The simulated water table reproduces typical karst characteristics, such as steep slopes and preferred drain axes, and is in good agreement with field observations. Selected calculated error indicators—Nash-Sutcliffe efficiency (NSE), root mean squared error (RMSE) and model efficiency (E')—are within acceptable value ranges. Results indicate that different storage processes take place in different parts of the aquifer. The north-central part seems to be more sensitive to diffuse recharge, while the southern part is affected primarily by precipitation events. Sensitivity analysis is performed on the parameters of hydraulic conductivity and specific yield. The methodology is used to estimate the feasibility of artificial aquifer recharge (AAR) at the study area. Based on the developed methodology, guidelines were provided for the selection of the appropriate AAR scenario that has positive impact on the water table.

  15. DE-CERTS: A Decision Support System for a Comparative Evaluation Method for Risk Management Methodologies and Tools

    DTIC Science & Technology

    1991-09-01

    Patton , Michael Quinn . Qualitative Evaluation Methods . Sage, 1980. Pfleeger, Charles P...the research and indicates directions for further research . 6 II. CERTS: A COMPARATIVE EVALUATION METHOD FOR RISK MANAGDENT METHODOLOGIES AND TOOLS A...A DECISION SUPPORT SYSTEM FOR A COMPARATIVE EVALUATION METHOD FOR RISK MANAGEMENT METHODOLOGIES AND TOOLS by Leonard A. Crump Jr. and James G.

  16. Utility of retrograde ureterocelogram in management of complex ureterocele.

    PubMed

    Arevalo, M K; Prieto, J C; Cost, N; Nuss, G; Brown, B J; Baker, L A

    2017-02-01

    Symptomatic pediatric ureterocele has diverse manifestations, making evidence-based management impractical. Thus, detailed visualization of ureterocele anatomy prior to first surgical incision is invaluable. Retrograde ureterocelogram (RUC) is a simple, underutilized radiologic technique that can be performed during cystoscopy. This study sought to determine whether RUC changes surgical management by more accurately depicting the complex ureteral and ureterocele anatomy, compared with renal ultrasound (US) and voiding cystourethrography (VCUG). Patients who underwent surgical management of ureterocele from 2003 to 2015 were identified; those who received concomitant fluoroscopic RUC were selected for the case series. Data collected included: demographics, pre-operative evaluation, surgical interventions, and outcomes. The RUC images were individually examined, and the anatomic impression compared with previous renal US and VCUG. Novel RUC findings not previously appreciated by the pre-operative evaluation were noted. The RUC was performed by cystoscopically inserting a needle into the ureterocele and injecting contrast retrograde. If indicated, simultaneous PIC (Positioning the Instillation of Contrast) cystography was performed. Of the 43 patients that underwent surgery for suspected ureterocele, 28 underwent cystoscopy + RUC (10 M: 18 F) at a median age of 4.6 months and median follow-up of 37.0 months. All patients had prior US, 25 had prior VCUG, and 20 had prior radionuclide studies. Ureteroceles were either duplex system (n = 21) or single system (n = 7); 17 were ectopic into the bladder neck or urethra; seven were intravesical; and four were pseudoureteroceles. Fourteen patients underwent concomitant transurethral incision of the ureterocele (TUIU); two were deferred for surgery; and 11 received concomitant definitive surgery (e.g., nephrectomy). The RUC illuminated novel aspects of the anatomy in 20 of the 28 patients. No adverse events occurred

  17. 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

  18. Management of climatic heat stress risk in construction: a review of practices, methodologies, and future research.

    PubMed

    Rowlinson, Steve; Yunyanjia, Andrea; Li, Baizhan; Chuanjingju, Carrie

    2014-05-01

    Climatic heat stress leads to accidents on construction sites brought about by a range of human factors emanating from heat induced illness, and fatigue leading to impaired capability, physical and mental. It is an occupational characteristic of construction work in many climates and the authors take the approach of re-engineering the whole safety management system rather than focusing on incremental improvement, which is current management practice in the construction industry. From a scientific viewpoint, climatic heat stress is determined by six key factors: (1) air temperature, (2) humidity, (3) radiant heat, and (4) wind speed indicating the environment, (5) metabolic heat generated by physical activities, and (6) "clothing effect" that moderates the heat exchange between the body and the environment. By making use of existing heat stress indices and heat stress management processes, heat stress risk on construction sites can be managed in three ways: (1) control of environmental heat stress exposure through use of an action-triggering threshold system, (2) control of continuous work time (CWT, referred by maximum allowable exposure duration) with mandatory work-rest regimens, and (3) enabling self-paced working through empowerment of employees. Existing heat stress practices and methodologies are critically reviewed and the authors propose a three-level methodology for an action-triggering, localized, simplified threshold system to facilitate effective decisions by frontline supervisors. The authors point out the need for "regional based" heat stress management practices that reflect unique climatic conditions, working practices and acclimatization propensity by local workers indifferent geographic regions. The authors set out the case for regional, rather than international, standards that account for this uniqueness and which are derived from site-based rather than laboratory-based research. Copyright © 2013 Elsevier Ltd. All rights reserved.

  19. Poor methodological quality and reporting standards of systematic reviews in burn care management.

    PubMed

    Wasiak, Jason; Tyack, Zephanie; Ware, Robert; Goodwin, Nicholas; Faggion, Clovis M

    2016-12-18

    The methodological and reporting quality of burn-specific systematic reviews has not been established. The aim of this study was to evaluate the methodological quality of systematic reviews in burn care management. Computerised searches were performed in Ovid MEDLINE, Ovid EMBASE and The Cochrane Library through to February 2016 for systematic reviews relevant to burn care using medical subject and free-text terms such as 'burn', 'systematic review' or 'meta-analysis'. Additional studies were identified by hand-searching five discipline-specific journals. Two authors independently screened papers, extracted and evaluated methodological quality using the 11-item A Measurement Tool to Assess Systematic Reviews (AMSTAR) tool and reporting quality using the 27-item Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Characteristics of systematic reviews associated with methodological and reporting quality were identified. Descriptive statistics and linear regression identified features associated with improved methodological quality. A total of 60 systematic reviews met the inclusion criteria. Six of the 11 AMSTAR items reporting on 'a priori' design, duplicate study selection, grey literature, included/excluded studies, publication bias and conflict of interest were reported in less than 50% of the systematic reviews. Of the 27 items listed for PRISMA, 13 items reporting on introduction, methods, results and the discussion were addressed in less than 50% of systematic reviews. Multivariable analyses showed that systematic reviews associated with higher methodological or reporting quality incorporated a meta-analysis (AMSTAR regression coefficient 2.1; 95% CI: 1.1, 3.1; PRISMA regression coefficient 6·3; 95% CI: 3·8, 8·7) were published in the Cochrane library (AMSTAR regression coefficient 2·9; 95% CI: 1·6, 4·2; PRISMA regression coefficient 6·1; 95% CI: 3·1, 9·2) and included a randomised control trial (AMSTAR regression

  20. The “Critical” Elements of Illness Management and Recovery: Comparing Methodological Approaches

    PubMed Central

    McGuire, Alan B.; Luther, Lauren; White, Dominique; White, Laura M.; McGrew, John; Salyers, Michelle P.

    2016-01-01

    This study examined three methodological approaches to defining the critical elements of Illness Management and Recovery (IMR), a curriculum-based approach to recovery. Sixty-seven IMR experts rated the criticality of 16 IMR elements on three dimensions: defining, essential, and impactful. Three elements (Recovery Orientation, Goal Setting and Follow-up, and IMR Curriculum) met all criteria for essential and defining and all but the most stringent criteria for impactful. Practitioners should consider competence in these areas as preeminent. The remaining 13 elements met varying criteria for essential and impactful. Findings suggest that criticality is a multifaceted construct, necessitating judgments about model elements across different criticality dimensions. PMID:25425013

  1. Utilization of pheromones in the population management of moth pests.

    PubMed Central

    Cardé, R T

    1976-01-01

    Pheromones are substances emitted by one individual of a species and eliciting a specific response in a second individual of the same species. In moths (Lepidoptera) generally females lure males for mating by emission of a sex attractant pheromone comprised of either one or more components. Since 1966 the identification of the pheromone blends of many moth pests has allowed investigations into the use of these messengers for population manipulation. Pheromone-baited traps may be used both to detect pest presence and to estimate population density, so that conventional control tactics can be employed only as required and timed precisely for maximum effectiveness. Attractant traps also can be utilized for direct population suppression when the traps are deployed at a density effective in reducing mating success sufficiently to achieve control. A third use pattern of pheromones and related compounds is disruption of pheromone communication via atmospheric permeation with synthetic disruptants. The behavioral modifications involved in disruption of communication may include habituation of the normal response sequence (alteration of the pheromone response threshold) and "confusion" (inability of the organism to perceive and orient to the naturally emitted lure). Disruption of communication employing the natural pheromone components as the disruptant has been most successful, although nonattractant behavioral modifiers structurally similar to the pheromone components also may prove useful. Possible future resistance to direct pheromone manipulation may be expected to involve the evolution of behavioral and sensory changes that minimize the informational overlap between the natural pheromone system and the pheromone control technique. PMID:789060

  2. Utilization of market research in managing hospital pharmacy resources.

    PubMed

    Hernandez, L; McNamara, E J

    1984-10-01

    A market research survey of staff physicians and nurses was completed to obtain information on customer preference to be used in making planning and development decisions about the allocation of the pharmacy department's resources. Survey questionnaires were mailed to representative samples of each professional group and included the optimum mix of open-ended and closed-ended questions that would result in the highest response rate. The survey responses identified differences in wants and needs between the nurses and physicians that demonstrate the value of market research. Data obtained from the survey are being used by a staff advisory committee and management to develop departmental goals and objectives that will reduce costs and increase profit margins under the ever-increasing restrictions of prospective reimbursement.

  3. Optimal Energy Management for a Smart Grid using Resource-Aware Utility Maximization

    NASA Astrophysics Data System (ADS)

    Abegaz, Brook W.; Mahajan, Satish M.; Negeri, Ebisa O.

    2016-06-01

    Heterogeneous energy prosumers are aggregated to form a smart grid based energy community managed by a central controller which could maximize their collective energy resource utilization. Using the central controller and distributed energy management systems, various mechanisms that harness the power profile of the energy community are developed for optimal, multi-objective energy management. The proposed mechanisms include resource-aware, multi-variable energy utility maximization objectives, namely: (1) maximizing the net green energy utilization, (2) maximizing the prosumers' level of comfortable, high quality power usage, and (3) maximizing the economic dispatch of energy storage units that minimize the net energy cost of the energy community. Moreover, an optimal energy management solution that combines the three objectives has been implemented by developing novel techniques of optimally flexible (un)certainty projection and appliance based pricing decomposition in an IBM ILOG CPLEX studio. A real-world, per-minute data from an energy community consisting of forty prosumers in Amsterdam, Netherlands is used. Results show that each of the proposed mechanisms yields significant increases in the aggregate energy resource utilization and welfare of prosumers as compared to traditional peak-power reduction methods. Furthermore, the multi-objective, resource-aware utility maximization approach leads to an optimal energy equilibrium and provides a sustainable energy management solution as verified by the Lagrangian method. The proposed resource-aware mechanisms could directly benefit emerging energy communities in the world to attain their energy resource utilization targets.

  4. Clinical utility of pharmacogenomics in the management of hepatitis C

    PubMed Central

    Trinks, Julieta; Hulaniuk, María Laura; Redal, María Ana; Flichman, Diego

    2014-01-01

    Hepatitis C virus (HCV) was identified for the first time more than 20 years ago. Since then, several studies have highlighted the complicated aspects of this viral infection in relation to its worldwide prevalence, its clinical presentation, and its therapeutic response. Recently, two landmark scientific breakthroughs have moved us closer to the successful eradication of chronic HCV infection. First, response rates in treatment-naïve patients and in prior non-responders to pegylated-interferon-α and ribavirin therapy are increasing as a direct consequence of the development of direct-acting antiviral drugs. Secondly, the discovery of single-nucleotide polymorphisms near the interleukin 28B gene significantly related to spontaneous and treatment-induced HCV clearance represents a milestone in the HCV therapeutic landscape. The implementation of this pharmacogenomics finding as a routine test for HCV-infected patients has enhanced our understanding of viral pathogenesis, has encouraged the design of ground-breaking antiviral treatment regimens, and has become useful for pretreatment decision making. Nowadays, interleukin 28B genotyping is considered to be a key diagnostic tool for the management of HCV-infected patients and will maintain its significance for new combination treatment schemes using direct-acting antiviral agents and even in interferon-free regimens. Such pharmacogenomics insights represent a challenge to clinicians, researchers, and health administrators to transform this information into knowledge with the aim of elaborating safer and more effective therapeutic strategies specifically designed for each patient. In conclusion, the individualization of treatment regimens for patients with hepatitis C, that may lead to a universal cure in future years, is becoming a reality due to recent developments in biomarker and genomic medicine. In light of these advances, we review the scientific evidence and clinical implications of recent findings related to

  5. Clinical utility of pharmacogenomics in the management of hepatitis C.

    PubMed

    Trinks, Julieta; Hulaniuk, María Laura; Redal, María Ana; Flichman, Diego

    2014-01-01

    Hepatitis C virus (HCV) was identified for the first time more than 20 years ago. Since then, several studies have highlighted the complicated aspects of this viral infection in relation to its worldwide prevalence, its clinical presentation, and its therapeutic response. Recently, two landmark scientific breakthroughs have moved us closer to the successful eradication of chronic HCV infection. First, response rates in treatment-naïve patients and in prior non-responders to pegylated-interferon-α and ribavirin therapy are increasing as a direct consequence of the development of direct-acting antiviral drugs. Secondly, the discovery of single-nucleotide polymorphisms near the interleukin 28B gene significantly related to spontaneous and treatment-induced HCV clearance represents a milestone in the HCV therapeutic landscape. The implementation of this pharmacogenomics finding as a routine test for HCV-infected patients has enhanced our understanding of viral pathogenesis, has encouraged the design of ground-breaking antiviral treatment regimens, and has become useful for pretreatment decision making. Nowadays, interleukin 28B genotyping is considered to be a key diagnostic tool for the management of HCV-infected patients and will maintain its significance for new combination treatment schemes using direct-acting antiviral agents and even in interferon-free regimens. Such pharmacogenomics insights represent a challenge to clinicians, researchers, and health administrators to transform this information into knowledge with the aim of elaborating safer and more effective therapeutic strategies specifically designed for each patient. In conclusion, the individualization of treatment regimens for patients with hepatitis C, that may lead to a universal cure in future years, is becoming a reality due to recent developments in biomarker and genomic medicine. In light of these advances, we review the scientific evidence and clinical implications of recent findings related to

  6. A Retention Assessment Process: Utilizing Total Quality Management Principles and Focus Groups

    ERIC Educational Resources Information Center

    Codjoe, Henry M.; Helms, Marilyn M.

    2005-01-01

    Retaining students is a critical topic in higher education. Methodologies abound to gather attrition data as well as key variables important to retention. Using the theories of total quality management and focus groups, this case study gathers and reports data from current college students. Key results, suggestions for replication, and areas for…

  7. A Retention Assessment Process: Utilizing Total Quality Management Principles and Focus Groups

    ERIC Educational Resources Information Center

    Codjoe, Henry M.; Helms, Marilyn M.

    2005-01-01

    Retaining students is a critical topic in higher education. Methodologies abound to gather attrition data as well as key variables important to retention. Using the theories of total quality management and focus groups, this case study gathers and reports data from current college students. Key results, suggestions for replication, and areas for…

  8. Integrating fisheries approaches and household utility models for improved resource management

    PubMed Central

    Milner-Gulland, E. J.

    2011-01-01

    Natural resource management is littered with cases of overexploitation and ineffectual management, leading to loss of both biodiversity and human welfare. Disciplinary boundaries stifle the search for solutions to these issues. Here, I combine the approach of management strategy evaluation, widely applied in fisheries, with household utility models from the conservation and development literature, to produce an integrated framework for evaluating the effectiveness of competing management strategies for harvested resources against a range of performance metrics. I demonstrate the strengths of this approach with a simple model, and use it to examine the effect of manager ignorance of household decisions on resource management effectiveness, and an allocation tradeoff between monitoring resource stocks to reduce observation uncertainty and monitoring users to improve compliance. I show that this integrated framework enables management assessments to consider household utility as a direct metric for system performance, and that although utility and resource stock conservation metrics are well aligned, harvest yield is a poor proxy for both, because it is a product of household allocation decisions between alternate livelihood options, rather than an end in itself. This approach has potential far beyond single-species harvesting in situations where managers are in full control; I show that the integrated approach enables a range of management intervention options to be evaluated within the same framework. PMID:21205895

  9. Centralized care management support for "high utilizers" in primary care practices at an academic medical center.

    PubMed

    Williams, Brent C; Paik, Jamie L; Haley, Laura L; Grammatico, Gina M

    2014-01-01

    Although evidence of effectiveness is limited, care management based outside primary care practices or hospitals is receiving increased attention. The University of Michigan (UM) Complex Care Management Program (CCMP) provides care management for uninsured and underinsured, high-utilizing patients in multiple primary care practices. To inform development of optimal care management models, we describe the CCMP model and characteristics and health care utilization patterns of its patients. Of a consecutive series of 49 patients enrolled at CCMP in 2011, the mean (SD) age was 48 (+/- 14); 23 (47%) were women; and 29 (59%) were White. Twenty-eight (57%) had two or more chronic medical conditions, 39 (80%) had one or more psychiatric condition, 28 (57%) had a substance abuse disorder, and 11 (22%) were homeless. Through phone, e-mail, and face-to-face contact with patients and primary care providers (PCPs), care managers coordinated health and social services and facilitated access to medical and mental health care. Patients had a mean (SD) number of hospitalizations and emergency room (ER) visits in 6 months prior to enrollment of2.2 (2.5) and 4.2 (4.3), respectively, with a nonstatistically significant decrease in hospitalizations, hospital days, and emergency room visits in 6 months following enrollment in CCMP. Centralized care management support for primary care practices engages high-utilizing patients with complex medical and behavioral conditions in care management that would be difficult to provide through individual practices and may decrease health care utilization by these patients.

  10. Ergonomics program management in Tucuruí Hydropower Plant using TPM methodology.

    PubMed

    Santos, R M; Sassi, A C; Sá, B M; Miguez, S A; Pardauil, A A

    2012-01-01

    This paper aims to present the benefits achieved in the ergonomics process management with the use of the TPM methodology (Total Productive Maintenance) in Tucuruí Hydropower Plant. The methodology is aligned with the corporate guidelines, moreover with the Strategic Planning of the company, it is represented in the TPM Pillars including the Health Pillar in which is inserted the ergonomics process. The results of the ergonomic actions demonstrated a 12% reduction over the absenteeism rate due to musculoskeletal disorders, solving 77,0% of ergonomic non-conformities, what favored the rise of the Organizational Climate in 44,8%, impacting on the overall performance of the company. Awards confirmed the success of the work by the achievement of the Award for TPM Excellence in 2001, Award for Excellence in Consistent TPM Commitment in 2009 and more recently the Special Award for TPM Achievement, 2010. The determination of the high rank administration and workers, allied with the involvement/dynamism of Pillars, has assured the success of this management practice in Tucuruí Hydropower Plant.

  11. [Activity-based costing methodology to manage resources in intensive care units].

    PubMed

    Alvear V, Sandra; Canteros G, Jorge; Jara M, Juan; Rodríguez C, Patricia

    2013-11-01

    An accurate estimation of resources use by individual patients is crucial in hospital management. To measure financial costs of health care actions in intensive care units of two public regional hospitals in Chile. Prospective follow up of 716 patients admitted to two intensive care units during 2011. The financial costs of health care activities was calculated using the Activity-Based Costing methodology. The main activities recorded were procedures and treatments, monitoring, response to patient needs, patient maintenance and coordination. Activity-Based Costs, including human resources and assorted indirect costs correspond to 81 to 88% of costs per disease in one hospital and 69 to 80% in the other. The costs associated to procedures and treatments are the most significant and are approximately $100,000 (Chilean pesos) per day of hospitalization. The second most significant cost corresponds to coordination activities, which fluctuates between $86,000 and 122,000 (Chilean pesos). There are significant differences in resources use between the two hospitals studied. Therefore cost estimation methodologies should be incorporated in the management of these clinical services.

  12. Utilizing Radioisotope Power System Waste Heat for Spacecraft Thermal Management

    NASA Technical Reports Server (NTRS)

    Pantano, David R.; Dottore, Frank; Geng, Steven M.; Schrieber, Jeffrey G.; Tobery, E. Wayne; Palko, Joseph L.

    2005-01-01

    One of the advantages of using a Radioisotope Power System (RPS) for deep space or planetary surface missions is the readily available waste heat, which can be used to maintain electronic components within a controlled temperature range, to warm propulsion tanks and mobility actuators, and to gasify liquid propellants. Previous missions using Radioisotope Thermoelectric Generators (RTGs) dissipated a very large quantity of waste heat due to the relatively low efficiency of the thermoelectric conversion technology. The next generation RPSs, such as the 110-watt Stirling Radioisotope Generator (SRG110) will have much higher conversion efficiencies than their predecessors and therefore may require alternate approaches to transferring waste heat to the spacecraft. RTGs, with efficiencies of approx. 6 to 7% and 200 C housing surface temperatures, would need to use large and heavy radiator heat exchangers to transfer the waste heat to the internal spacecraft components. At the same time, sensitive spacecraft instruments must be shielded from the thermal radiation by using the heat exchangers or additional shields. The SRG110, with an efficiency around 22% and 50 C nominal housing surface temperature, can use the available waste heat more efficiently by more direct heat transfer methods such as heat pipes, thermal straps, or fluid loops. The lower temperatures allow the SRG110 much more flexibility to the spacecraft designers in configuring the generator without concern of overheating nearby scientific instruments, thereby eliminating the need for thermal shields. This paper will investigate using a high efficiency SRG110 for spacecraft thermal management and outline potential methods in several conceptual missions (Lunar Rover, Mars Rover, and Titan Lander) to illustrate the advantages with regard to ease of assembly, less complex interfaces, and overall mass savings.

  13. Effects of Home Energy Management Systems on Distribution Utilities and Feeders Under Various Market Structures: Preprint

    SciTech Connect

    Ruth, Mark; Pratt, Annabelle; Lunacek, Monte; Mittal, Saurabh; Wu, Hongyu; Jones, Wesley

    2015-07-17

    The combination of distributed energy resources (DER) and retail tariff structures to provide benefits to both utility consumers and the utilities is poorly understood. To improve understanding, an Integrated Energy System Model (IESM) is being developed to simulate the physical and economic aspects of DER technologies, the buildings where they reside, and feeders servicing them. The IESM was used to simulate 20 houses with home energy management systems on a single feeder under a time of use tariff to estimate economic and physical impacts on both the households and the distribution utilities. HEMS reduce consumers’ electric bills by precooling houses in the hours before peak electricity pricing. Household savings are greater than the reduction utility net revenue indicating that HEMS can provide a societal benefit providing tariffs are structured so that utilities remain solvent. Utilization of HEMS reduce peak loads during high price hours but shifts it to hours with off-peak and shoulder prices and resulting in a higher peak load.

  14. Effectiveness of the Nursing Methodology in Pain Management after Major Ambulatory Surgery.

    PubMed

    Porras-González, María Helena; Barón-López, Francisco Javier; García-Luque, María José; Morales-Gil, Isabel María

    2015-08-01

    Patients undergoing a surgical intervention for the first time are unfamiliar with the perioperative context, and they usually have no knowledge of postoperative pain management. In the preoperative circuit, there is no time to educate the patient in these terms. The professional profile of nurses allows this need to be addressed, and provides a regulated language to evaluate their effectiveness. This study evaluates the effectiveness of nursing counseling during a preoperative consultation for the management of postoperative pain and its effects on patient satisfaction at hospital discharge. This quasi-experimental study assesses the efficacy of preoperative nursing intervention in two groups, control (n = 185) and intervention (n = 195). Those in the intervention group attended a preoperative session during which they received information from nursing staff and took part in activities to learn about postoperative pain management and the perioperative circuit. Control group patients underwent the standard preoperative protocol. Data were compiled from January to December 2009. Statistically significant differences existed between the two groups regarding postoperative pain (visual analogue scale >3, 20.5% versus 11.5%; p = .023), patient satisfaction (87.1% versus 78.7%; p = .041), and surgical wound complications (13.9% versus 5.5%; p = .010). The results confirm the benefits of applying the nursing methodology in preoperative clinics. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  15. Utility of endoscopic therapy in the management of Boerhaave syndrome

    PubMed Central

    Dickinson, K. J.; Buttar, N.; Wong Kee Song, L. M.; Gostout, C. J.; Cassivi, S. D.; Allen, M. S.; Nichols, F. C.; Shen, K. R.; Wigle, D. A.; Blackmon, S. H.

    2016-01-01

    Background/aims: The optimal intervention for Boerhaave perforation has not been determined. Options include surgical repair with/without a pedicled muscle flap, T tube placement, esophageal resection or diversion, or an endoscopic approach. All management strategies require adequate drainage and nutritional support. Our aim was to evaluate outcomes following Boerhaave perforation treated with surgery, endoscopic therapy, or both. Patients and methods: We performed a 10-year review of our prospectively maintained databases of adult patients with Boerhaave perforations. We documented clinical presentation, extent of injury, primary intervention, “salvage” treatment (any treatment for persistent leak), and outcome. Results were analyzed using the Fisher’s exact and Kruskal – Wallis tests. Results: Between October 2004 and October 2014, 235 patients presented with esophageal leak/fistula with 17 Boerhaave perforations. Median age was 68 years. Median length of perforation was 1.25 cm (range 0.8 – 5 cm). Four patients presented with systemic sepsis (two treated with palliative stent and two surgically). Primary endotherapy was performed for eight (50 %) and primary surgery for eight (50 %) patients. Two endotherapy patients required multiple stents. Median stent duration was 61 days (range 56 – 76). “Salvage” intervention was required in 2/8 (25 %) endotherapy patients and 1/8 (13 %) surgery patient (stent). All patients healed without resection/reconstruction. There were no deaths in the surgically treated group and two in the endotherapy group (stented with palliative intent due to poor systemic condition). Readmission within 30 days occurred in 3/6 of alive endotherapy patients (50 %) and 0/8 surgery patients. Re-intervention within 30 days was required for one endotherapy patient. Conclusion: Endoscopic repair of Boerhaave perforations can be useful in carefully selected patients without evidence of systemic sepsis

  16. Application of performance indicators in water utilities management--a case-study in Portugal.

    PubMed

    Marques, R C; Monteiro, A J

    2001-01-01

    This paper presents some issues concerning water supply systems assessment through performance indicators, based upon research work recently carried out in Portugal about water utilities. A proposal of 50 performance indicators divided into five different groups is presented here, namely structural indicators, operational indicators, water and service quality indicators, personnel indicators and economic indicators. These indicators were associated with a hierarchical structure of knowledge or development according to different levels: basic level, development level and strategic level. The performance indicators, structure, their implementation and assessment methodology and examples of some indicators, use concerning the characterisation or assessment of a water utility are also presented in the paper.

  17. Interpolation of extensive routine water pollution monitoring datasets: methodology and discussion of implications for aquifer management.

    PubMed

    Yuval, Yuval; Rimon, Yaara; Graber, Ellen R; Furman, Alex

    2014-08-01

    A large fraction of the fresh water available for human use is stored in groundwater aquifers. Since human activities such as mining, agriculture, industry and urbanisation often result in incursion of various pollutants to groundwater, routine monitoring of water quality is an indispensable component of judicious aquifer management. Unfortunately, groundwater pollution monitoring is expensive and usually cannot cover an aquifer with the spatial resolution necessary for making adequate management decisions. Interpolation of monitoring data is thus an important tool for supplementing monitoring observations. However, interpolating routine groundwater pollution data poses a special problem due to the nature of the observations. The data from a producing aquifer usually includes many zero pollution concentration values from the clean parts of the aquifer but may span a wide range of values (up to a few orders of magnitude) in the polluted areas. This manuscript presents a methodology that can cope with such datasets and use them to produce maps that present the pollution plumes but also delineates the clean areas that are fit for production. A method for assessing the quality of mapping in a way which is suitable to the data's dynamic range of values is also presented. A local variant of inverse distance weighting is employed to interpolate the data. Inclusion zones around the interpolation points ensure that only relevant observations contribute to each interpolated concentration. Using inclusion zones improves the accuracy of the mapping but results in interpolation grid points which are not assigned a value. The inherent trade-off between the interpolation accuracy and coverage is demonstrated using both circular and elliptical inclusion zones. A leave-one-out cross testing is used to assess and compare the performance of the interpolations. The methodology is demonstrated using groundwater pollution monitoring data from the coastal aquifer along the Israeli

  18. Methodology to Estimate the Quantity, Composition, and Management of Construction and Demolition Debris in the United States

    EPA Science Inventory

    This report, Methodology to Estimate the Quantity, Composition and Management of Construction and Demolition Debris in the US, was developed to expand access to data on CDD in the US and to support research on CDD and sustainable materials management. Since past US EPA CDD estima...

  19. Classroom Management Strategies to Address the Needs of Sudanese Refugee Learners: Support Document--Methodology and Literature Review

    ERIC Educational Resources Information Center

    Burgoyne, Ursula; Hull, Oksana

    2007-01-01

    This document presents the methodology and literature review for the research report "Classroom Management Strategies to Address the Needs of Sudanese Refugee Learners" (ED499673), which examined the extent to which English language, literacy and numeracy teachers used classroom management strategies to meet the needs of adult Sudanese…

  20. Methodology to Estimate the Quantity, Composition, and Management of Construction and Demolition Debris in the United States

    EPA Science Inventory

    This report, Methodology to Estimate the Quantity, Composition and Management of Construction and Demolition Debris in the US, was developed to expand access to data on CDD in the US and to support research on CDD and sustainable materials management. Since past US EPA CDD estima...

  1. Utilization management in radiology, part 1: rationale, history, and current status.

    PubMed

    Duszak, Richard; Berlin, Jonathan W

    2012-10-01

    Previous growth in the utilization of medical imaging has led to numerous efforts to reduce associated spending. Although these have historically been directed toward unit cost reductions, recent interest has emerged by various stakeholders in curbing inappropriate utilization. Radiology benefits managers have widespread market penetration and have been promoted largely by the payer community as effective mechanisms to curb increases in imaging volume. The provider community has tended to favor real-time order entry decision support systems. These have demonstrated comparable effectiveness to radiology benefits managers in early projects but currently have only limited market penetration. In this first of a two-part series, the rationale for the development of utilization management programs will be discussed and their history and current status reviewed.

  2. Thermal disposal of waste containing nanomaterials: first investigations on a methodology for risk management

    NASA Astrophysics Data System (ADS)

    Ounoughene, G.; LeBihan, O.; Debray, B.; Chivas-Joly, C.; Longuet, C.; Joubert, A.; Lopez-Cuesta, J.-M.; Le Coq, L.

    2017-06-01

    Considering the wide use and production of NMs since last two decades, these trendy nanomaterials (NMs) are expected to end up in thermal disposal and waste incineration plants (WIP). It seems relevant to assess the risks related to the thermal disposal and incineration of waste containing NMs (WCNMs). The objective of this work is to present a first approach to develop a preliminary methodology for risk management in order (1) to give insights on nanosafety of exposed operators and on potential environmental risks related to the incineration and thermal disposal of WCNMs, and (2) to eventually support decision-makers and incineration plant managers. Therefore, the main challenge is to find (a) key parameter(s) which would govern the decision related to risk management of NMs thermal disposal. On the one hand, we focused on the relevant literature studies about experimental works on incineration of NMs. On the other hand, we conducted an introductory discussion with a group of experts. The review of this literature highlights that the nano-object’s nanostructure destruction appears as a relevant indicator of the risks related to the NMs incineration. As a consequence, we defined a “temperature of nanostructure destruction” (TND) which would be the temperature from which the nanostructure will be destroyed. This parameter has been assumed to be a consistent indicator to develop a preliminary methodology. If the combustion chamber temperature is higher than the TND of the NM (or if they are close to each other), then the nanostructure will be destroyed and no risks related to NMs remain. If the TND of the NMs is higher than the combustion chamber temperature, then the nanostructure will not be destroyed and risks related to NMs have to be considered. As a result, five groups of NMs have been identified. WCNMs including carbonic NMs appear to be in good position to be destroyed safely in WIP. On the other hand, based on this criterion, there would be no

  3. Physician organization care management capabilities associated with effective inpatient utilization management: a fuzzy set qualitative comparative analysis.

    PubMed

    Sheehy, Thomas J; Thygeson, N Marcus

    2014-12-03

    We studied the relationship between physician organization (PO) care management capabilities and inpatient utilization in order to identify PO characteristics or capabilities associated with low inpatient bed-days per thousand. We used fuzzy-set qualitative comparative analysis (fsQCA) to conduct an exploratory comparative case series study. Data about PO capabilities were collected using structured interviews with medical directors at fourteen California POs that are delegated to provide inpatient utilization management (UM) for HMO members of a California health plan. Health plan acute hospital claims from 2011 were extracted from a reporting data warehouse and used to calculate inpatient utilization statistics. Supplementary analyses were conducted using Fisher's Exact Test and Student's T-test. POs with low inpatient bed-days per thousand minimized length of stay and surgical admissions by actively engaging in concurrent review, discharge planning, and surgical prior authorization, and by contracting directly with hospitalists to provide UM-related services. Disease and case management were associated with lower medical admissions and readmissions, respectively, but not lower bed-days per thousand. Care management methods focused on managing length of stay and elective surgical admissions are associated with low bed-days per thousand in high-risk California POs delegated for inpatient UM. Reducing medical admissions alone is insufficient to achieve low bed-days per thousand. California POs with high bed-days per thousand are not applying care management best practices.

  4. A methodological framework to assess the carbon balance of tropical managed forests.

    PubMed

    Piponiot, Camille; Cabon, Antoine; Descroix, Laurent; Dourdain, Aurélie; Mazzei, Lucas; Ouliac, Benjamin; Rutishauser, Ervan; Sist, Plinio; Hérault, Bruno

    2016-12-01

    Managed forests are a major component of tropical landscapes. Production forests as designated by national forest services cover up to 400 million ha, i.e. half of the forested area in the humid tropics. Forest management thus plays a major role in the global carbon budget, but with a lack of unified method to estimate carbon fluxes from tropical managed forests. In this study we propose a new time- and spatially-explicit methodology to estimate the above-ground carbon budget of selective logging at regional scale. The yearly balance of a logging unit, i.e. the elementary management unit of a forest estate, is modelled by aggregating three sub-models encompassing (i) emissions from extracted wood, (ii) emissions from logging damage and deforested areas and (iii) carbon storage from post-logging recovery. Models are parametrised and uncertainties are propagated through a MCMC algorithm. As a case study, we used 38 years of National Forest Inventories in French Guiana, northeastern Amazonia, to estimate the above-ground carbon balance (i.e. the net carbon exchange with the atmosphere) of selectively logged forests. Over this period, the net carbon balance of selective logging in the French Guianan Permanent Forest Estate is estimated to be comprised between 0.12 and 1.33 Tg C, with a median value of 0.64 Tg C. Uncertainties over the model could be diminished by improving the accuracy of both logging damage and large woody necromass decay submodels. We propose an innovating carbon accounting framework relying upon basic logging statistics. This flexible tool allows carbon budget of tropical managed forests to be estimated in a wide range of tropical regions.

  5. A multiobjective discrete stochastic optimization approach to shared aquifer management: Methodology and application

    NASA Astrophysics Data System (ADS)

    Siegfried, Tobias; Kinzelbach, Wolfgang

    2006-02-01

    Negative effects from groundwater mining are observed globally. They threaten future supply locally. Especially in semiarid to arid regions, where aquifers are the sole freshwater resource, this is problematic and can lead to an excessive rise of provision costs. Proper resource management in such environments is crucial. In many instances, however, aquifers are common property resources. In such cases and depending on resource characteristics and the nature of competing uses, their management is inherently multiobjective, and benefits from cooperative management are likely to be substantial. This paper presents a methodology for the determination of optimal, cooperative allocation policies in multiobjective aquifer management problems. Our model couples a finite difference aquifer model with an economic model that accounts for water provision costs. Discounted temporal installation and pumping and conveyance costs determine the vector-valued objective function. Each of the objectives characterizes the individual present costs over a given time horizon that the corresponding decision makers wish to minimize. Constraint handling is implemented by the option of moving wells. A multiobjective evolutionary algorithm is coupled to the management model so as to approximate cooperative tradeoff policies on the Pareto surface. These solutions can be ranked against existing, noncooperative status quo strategies. Consequently, the simulation-optimization model is applied to the northwest Sahara aquifer system which is used noncooperatively as a resource by Algeria, Tunisia, and Libya. We find that significant capital gains can be achieved by the establishment of intelligent pump scheduling. Since each country could benefit, a strong incentive toward the implementation of such cooperative strategies exists.

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

    NASA Astrophysics Data System (ADS)

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

    2014-12-01

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

  7. Transition to managed care impacts health care service utilization by children insured by Medicaid.

    PubMed

    Bollinger, Mary Elizabeth; Smith, Sheila Weiss; LoCasale, Robert; Blaisdell, Carol

    2007-11-01

    Purpose. To evaluate the impact of transition to managed care from fee for service on asthma service utilization among Maryland Medicaid insured children. Methods. Healthcare claims from 1997-2000 for children with asthma insured by Maryland Medicaid were extracted and analyzed. Results. Between 1997-2000, inhaled corticosteroid use increased as a proportion of all asthma medications. Outpatient asthma visits increased from 4.2% to 5.9% of all outpatient claims as both asthma-related hospitalizations and emergency department visits decreased. Conclusions. Restructuring of Maryland Medicaid for children from fee for service to managed care was associated with improvement in asthma-related healthcare utilization claims.

  8. Strategic planning in electric utilities: Using wind technologies as risk management tools

    SciTech Connect

    Hoff, T E; Parsons, B

    1996-06-01

    This paper highlights research investigating the ownership of renewable energy technologies to mitigate risks faced by the electric utility industry. Renewable energy technology attributes of fuel costs, environmental costs, lead time, modularity, and investment reversibility are discussed. Incorporating some of these attributes into an economic evaluation is illustrated using a municipal utility`s decision to invest in either wind generation or natural gas based generation. The research concludes that wind and other modular renewable energy technologies, such as photovoltaics, have the potential to provide decision makers with physical risk-management investments.

  9. Electronic managed care: the utilization of information technology in a managed care environment.

    PubMed

    Kiel, Joan M

    2003-01-01

    Health care managers must use information technology in managed care negotiations with all players in the managed care model-employers, managed care organizations, providers, and patients. Information technology effectuates these negotiations, provides a value added to all those involved in terms of efficiency and communication, and helps managers remain within regulations. This article describes each phase of the managed care model and how information technology is used. It also provides an operational overview of how to integrate the technology into health care settings.

  10. Linking outcomes management and practice improvement. Structured care methodologies: evolution and use in patient care delivery.

    PubMed

    Cole, L; Houston, S

    1999-01-01

    Structured care methodologies are tools that provide a comprehensive approach to patient care delivery. These tools have evolved in their application and purpose over the years. In many situations, multiple tools are needed to obtain the best outcomes for a patient. The presence of a SCM does not preclude clinical judgment. On the contrary, the fundamental purpose of any SCM is to assist practitioners in implementing practice patterns associated with good clinical judgment, research-based interventions, and improved patient outcomes. These tools support smooth operation and appropriate use of resources, establish a means of patient management across the continuum of care, facilitate collaboration among disciplines, reflect patient outcomes, and provide outcomes data. Data from SCMs permit benchmarking, comparison of pre-implementation and post-implementation outcomes, development of action plans for quality enhancement, identification of high-risk patients, identification of issues and problems in the system that require interventions, and the development of research protocols and studies. Structured care methodology development and implementation can be challenging, rewarding, and at times frustrating. When used appropriately, these tools can have a major impact on the standardization of care and the achievement of desired outcomes. However, individual patient needs may supersede adherence to a tool. The challenge then becomes one of balancing the unique needs of each patient and appropriate use of SCMs. Change comes slowly, but persistence pays off.

  11. Interpolation of extensive routine water pollution monitoring datasets: methodology and discussion of implications for aquifer management

    NASA Astrophysics Data System (ADS)

    Yuval; Rimon, Y.; Graber, E. R.; Furman, A.

    2013-07-01

    A large fraction of the fresh water available for human use is stored in groundwater aquifers. Since human activities such as mining, agriculture, industry and urbanization often result in incursion of various pollutants to groundwater, routine monitoring of water quality is an indispensable component of judicious aquifer management. Unfortunately, groundwater pollution monitoring is expensive and usually cannot cover an aquifer with the spatial resolution necessary for making adequate management decisions. Interpolation of monitoring data between points is thus an important tool for supplementing measured data. However, interpolating routine groundwater pollution data poses a special problem due to the nature of the observations. The data from a producing aquifer usually includes many zero pollution concentration values from the clean parts of the aquifer but may span a wide range (up to a few orders of magnitude) of values in the polluted areas. This manuscript presents a methodology that can cope with such datasets and use them to produce maps that present the pollution plumes but also delineates the clean areas that are fit for production. A method for assessing the quality of mapping in a way which is suitable to the data's dynamic range of values is also presented. Local variant of inverse distance weighting is employed to interpolate the data. Inclusion zones around the interpolation points ensure that only relevant observations contribute to each interpolated concentration. Using inclusion zones improves the accuracy of the mapping but results in interpolation grid points which are not assigned a value. That inherent trade-off between the interpolation accuracy and coverage is demonstrated using both circular and elliptical inclusion zones. A leave-one-out cross testing is used to assess and compare the performance of the interpolations. The methodology is demonstrated using groundwater pollution monitoring data from the Coastal aquifer along the Israeli

  12. Cost Reductions for Wastewater Treatment Utilizing Water Management at Holston Army Ammunition Plant

    DTIC Science & Technology

    1976-05-01

    HOLSTON ARMY AMMUNITION PLANT DARCOM INTERN TRAINING CENTER MAY 1976 .:15914414 Report DARCOM-ITC-02-;08-76-201 COST REDUCTIONS FOR WASTEWATER...TREATIMENT UTILIZING WATER MANAGEMENT AT HOLSTON ARMY AMMUNITION PLANT Dennis J. Kravec Product/Production Graduate Engineering Program DARCOM Intern...number) This ?study examines the cost reductions obtained by using water management te6hniques at Holston Army Ammunition Plant . It compares the

  13. Addressing methodological challenges in implementing the nursing home pain management algorithm randomized controlled trial

    PubMed Central

    Ersek, Mary; Polissar, Nayak; Du Pen, Anna; Jablonski, Anita; Herr, Keela; Neradilek, Moni B

    2015-01-01

    Background Unrelieved pain among nursing home (NH) residents is a well-documented problem. Attempts have been made to enhance pain management for older adults, including those in NHs. Several evidence-based clinical guidelines have been published to assist providers in assessing and managing acute and chronic pain in older adults. Despite the proliferation and dissemination of these practice guidelines, research has shown that intensive systems-level implementation strategies are necessary to change clinical practice and patient outcomes within a health-care setting. One promising approach is the embedding of guidelines into explicit protocols and algorithms to enhance decision making. Purpose The goal of the article is to describe several issues that arose in the design and conduct of a study that compared the effectiveness of pain management algorithms coupled with a comprehensive adoption program versus the effectiveness of education alone in improving evidence-based pain assessment and management practices, decreasing pain and depressive symptoms, and enhancing mobility among NH residents. Methods The study used a cluster-randomized controlled trial (RCT) design in which the individual NH was the unit of randomization. The Roger's Diffusion of Innovations theory provided the framework for the intervention. Outcome measures were surrogate-reported usual pain, self-reported usual and worst pain, and self-reported pain-related interference with activities, depression, and mobility. Results The final sample consisted of 485 NH residents from 27 NHs. The investigators were able to use a staggered enrollment strategy to recruit and retain facilities. The adaptive randomization procedures were successful in balancing intervention and control sites on key NH characteristics. Several strategies were successfully implemented to enhance the adoption of the algorithm. Limitations/Lessons The investigators encountered several methodological challenges that were inherent to

  14. Effects of aircraft noise on the equilibrium of airport residents: Testing and utilization of a new methodology

    NASA Technical Reports Server (NTRS)

    Francois, J.

    1981-01-01

    The focus of the investigation is centered around two main themes: an analysis of the effects of aircraft noise on the psychological and physiological equilibrium of airport residents; and an analysis of the sources of variability of sensitivity to noise. The methodology used is presented. Nine statistical tables are included, along with a set of conclusions.

  15. Statistical Techniques Utilized in Analyzing PISA and TIMSS Data in Science Education from 1996 to 2013: A Methodological Review

    ERIC Educational Resources Information Center

    Liou, Pey-Yan; Hung, Yi-Chen

    2015-01-01

    We conducted a methodological review of articles using the Programme for International Student Assessment (PISA) or Trends in International Mathematics and Science Study (TIMSS) data published by the SSCI-indexed science education journals, such as the "International Journal of Science and Mathematics Education," the "International…

  16. Statistical Techniques Utilized in Analyzing PISA and TIMSS Data in Science Education from 1996 to 2013: A Methodological Review

    ERIC Educational Resources Information Center

    Liou, Pey-Yan; Hung, Yi-Chen

    2015-01-01

    We conducted a methodological review of articles using the Programme for International Student Assessment (PISA) or Trends in International Mathematics and Science Study (TIMSS) data published by the SSCI-indexed science education journals, such as the "International Journal of Science and Mathematics Education," the "International…

  17. Root Source Analysis/ValuStream[Trade Mark] - A Methodology for Identifying and Managing Risks

    NASA Technical Reports Server (NTRS)

    Brown, Richard Lee

    2008-01-01

    Root Source Analysis (RoSA) is a systems engineering methodology that has been developed at NASA over the past five years. It is designed to reduce costs, schedule, and technical risks by systematically examining critical assumptions and the state of the knowledge needed to bring to fruition the products that satisfy mission-driven requirements, as defined for each element of the Work (or Product) Breakdown Structure (WBS or PBS). This methodology is sometimes referred to as the ValuStream method, as inherent in the process is the linking and prioritizing of uncertainties arising from knowledge shortfalls directly to the customer's mission driven requirements. RoSA and ValuStream are synonymous terms. RoSA is not simply an alternate or improved method for identifying risks. It represents a paradigm shift. The emphasis is placed on identifying very specific knowledge shortfalls and assumptions that are the root sources of the risk (the why), rather than on assessing the WBS product(s) themselves (the what). In so doing RoSA looks forward to anticipate, identify, and prioritize knowledge shortfalls and assumptions that are likely to create significant uncertainties/ risks (as compared to Root Cause Analysis, which is most often used to look back to discover what was not known, or was assumed, that caused the failure). Experience indicates that RoSA, with its primary focus on assumptions and the state of the underlying knowledge needed to define, design, build, verify, and operate the products, can identify critical risks that historically have been missed by the usual approaches (i.e., design review process and classical risk identification methods). Further, the methodology answers four critical questions for decision makers and risk managers: 1. What s been included? 2. What's been left out? 3. How has it been validated? 4. Has the real source of the uncertainty/ risk been identified, i.e., is the perceived problem the real problem? Users of the RoSA methodology

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

    SciTech Connect

    Howard, J.H.

    1993-01-15

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

  19. Managing for biodiversity: Emerging ideas for the electric utility industry—summary statement

    NASA Astrophysics Data System (ADS)

    Mattice, Jack; Fraser, Myra; Ragone, Stephen; Daugherty, David; Wisniewski, Joe

    1996-11-01

    The conference entitled “Managing for Biodiversity: Emerging Ideas for the Electric Utility Industry” was held in Williamsburg, Virginia, USA, during 19 20 March 1996. This paper provides an overview of the key points, conclusions, and recommendations from both the presentations/papers and the discussions throughout the conference.

  20. Management support services to the Office of Utility Technologies. Final technical report

    SciTech Connect

    Not Available

    1993-12-16

    The Office of Utility Technologies works cooperatively with industry and the utility sector to realize the market potential for energy efficiency and renewable energy technologies. Under this contract, BNF has provided management support services for OUT R&D activities for the following Program offices: (1) Office of Energy Management; (2) Office of Solar Energy Conversion; (3) Office of Renewable Energy Conversion; and (4) Deputy Assistant Secretary. During the period between 4/17/91 and 9/17/93, BNF furnished the necessary personnel, equipment, materials, facilities and travel required to provide management support services for each of the above Program Offices. From 9/18/93 to 12/17/93, BNF has been involved in closeout activities, including final product deliverables. Research efforts that have been supported in these Program Offices are: (1) for Energy Management -- Advanced Utility Concepts Division; Utility Systems Division; Integrated Planning; (2) for Solar Energy Conversion -- Photovoltaics Division; Solar Thermal and Biomass Power Division; (3) for Renewable Energy Conversion -- Geothermal Division; Wind, Hydroelectric and Ocean Systems Division; (4) for the Deputy Assistant Secretary -- support as required by the Supporting Staff. This final report contains summaries of the work accomplished for each of the Program Offices listed above.

  1. Primary cardiac lymphoma: utility of multimodality imaging in diagnosis and management.

    PubMed

    Mato, Anthony R; Morgans, Alicia K; Roullet, Michele R; Bagg, Adam; Glatstein, Eli; Litt, Harold I; Downs, Lisa H; Chong, Elise A; Olson, Erin R; Andreadis, Charalambos; Schuster, Stephen J

    2007-12-01

    Primary cardiac lymphoma (PCL) is an extremely rare disease defined as a lymphoma strictly confined to the heart or pericardium without dissemination. We present the case of an 82 yr old male with newly diagnosed PCL and two years of subsequent follow up. This report highlights the utility of a multimodality imaging approach in the diagnosis and management of PCL.

  2. Identifying wood utilization options for ecosystem management : summary of a national research project

    Treesearch

    K. E. Skog; R. J. Barbour; J. E. Baumgras; A. Clark

    1997-01-01

    Using an ecosystem approach to forest management will change silvicultural practices, thus requiring utilization options to provide revenue and to help offset the costs of the silviculture treatments. The Forest Service, university cooperators, and several industry mills in the southern, western, and northeastern United States have been involved in a national...

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

    DTIC Science & Technology

    1991-09-01

    single utilization rate should be specified. Simulation models were developed and information about current practices was gathered. I am indebted to many...Current Capacity Study Reports.........10 4. Emerging Management Philosophies ... 13 5. Simulation and Modeling ................15 Discussion... MODEL ........................ 21 BUFFERED BASELINE MODEL ...............24 REDUCED VARIABILITY MODEL .............24 CONSTRAINED MODEL

  4. Distributed File System Utilities to Manage Large DatasetsVersion 0.5

    SciTech Connect

    2014-05-21

    FileUtils provides a suite of tools to manage large datasets typically created by large parallel MPI applications. They are written in C and use standard POSIX I/Ocalls. The current suite consists of tools to copy, compare, remove, and list. The tools provide dramatic speedup over existing Linux tools, which often run as a single process.

  5. Privatized Management in Urban Public Housing: A Comparative Analysis of Social Service Availability, Utilization, and Satisfaction

    ERIC Educational Resources Information Center

    Bowie, Stan L.

    2004-01-01

    This article presents the results of a study that assessed the effect of privatized management on social service availability, utilization, and resident satisfaction in public housing communities. The respondents were heads of household who lived in public housing "projects" in Miami, Florida -- more than 90 percent of whom were African…

  6. An outcomes analysis approach to utilization management: quality assessment of appropriateness of specialty referrals.

    PubMed

    Warren, B H

    1994-01-01

    This report illustrates some methods by which to identify, guide, and develop acceptable levels of expected outcomes, defined as the validity or appropriateness of specialty referrals or procedures, through utilization management case studies and interventions. Outcomes variables may be used as standardized ongoing measures of cost-effectiveness and quality of health care services, focusing on appropriateness of utilization of specialty resources and health care technology. Community, regional, and national standards for such measures are currently being developed and evaluated for assessing the appropriateness of the use of health care technology. These standards for desired or expected outcomes need to become an integral part of utilization management as well as quality assessment and improvement, and are very helpful tools for developing specific interventions to be used for improving upon and documenting the cost-effective delivery of care within health services organizations.

  7. Identification of stakeholder perspectives on future flood management in the Rhine basin using Q methodology

    NASA Astrophysics Data System (ADS)

    Raadgever, G. T.; Mostert, E.; van de Giesen, N. C.

    2008-08-01

    This article identifies different stakeholder perspectives on future flood management in the downstream parts of the Rhine basin in Germany and The Netherlands. The perspectives were identified using Q methodology, which proved to be a good, but time-intensive, method for eliciting and analyzing stakeholder perspectives in a structured and unbiased way. Three shared perspectives were found: A) "Anticipation and institutions", B) "Space for flooding" and C) "Knowledge and engineering". These three perspectives share a central concern for the provision of safety against flooding, but disagree on the expected autonomous developments and the preferred measures. In perspective A, the expected climate change and economic growth call for fast action. To deal with the increasing flood risk, mostly institutional measures are proposed, such as the development of a stronger basin commission. In perspective B, an increasing spatial pressure on the river area is expected, and the proposed measures are focused on mitigating damage, e.g., through controlled flooding and compartmentalization. In perspective C, the role of expert knowledge and technological improvements is emphasized. Preferred strategies include strengthening the dikes and differentiation of safety standards. An overview of stakeholder perspectives can be useful in natural resources management for 1) setting the research agenda, 2) identifying differences in values and interests that need to be discussed, 3) creating awareness among a broad range of stakeholders, and 4) developing scenarios.

  8. Redesigning service delivery for hypertensive patients: a methodological guideline to improve the management of chronic diseases.

    PubMed

    Ippolito, Adelaide; Cannavacciuolo, Lorella; Ponsiglione, Cristina; De Luca, Nicola; Iaccarino, Guido; Illario, Maddalena

    2014-04-01

    Best care is not necessarily the most expensive, but the most appropriate, and prevention is the most powerful tool to promote health. A novel approach might envision the reduction of hospital admittance (thus meeting a requirement from long term condition patients: they would rather not being hospitalized!) and the enforcement of peripheral (both on the territory and at home) assistance. In this direction, experiences of reshaping new service deliveries towards an integrated disease management, namely clinical pathways, can be observed in Europe and in different parts of the world. Aim of this paper is to provide a methodological guideline to support the management in planning clinical pathways, also outlining the main barriers limiting the process. In particular, we present the results of planning a clinical pathway at the Centre for Hypertension of the Federico II University Hospital (Naples, Italy). The case study showed that the introduction of a similar service impacts on the organisation of the structure. An analysis of organizational processes "as are" and the re-design of processes "to be" are necessary to integrate the clinical pathway into the actual activities.

  9. Kidney transplant patients' attitudes towards self-management support: A Q-methodological study.

    PubMed

    Grijpma, J W; Tielen, M; van Staa, A L; Maasdam, L; van Gelder, T; Berger, S P; Busschbach, J J; Betjes, M G H; Weimar, W; Massey, E K

    2016-05-01

    Kidney transplant recipients face many self-management challenges. We aimed to identify profiles of attitudes towards self-management support (SMS) shortly after kidney transplantation. Profiles were generated using Q-methodology: In face-to-face interviews participants rank-ordered opinion statements on aspects of SMS according to agreement. Socio-demographic and medical characteristics were assessed using a questionnaire. By-person factor analysis was used to analyze the rankings and qualitative data was used to support choice of profiles. The resulting factors represent clusters of patients with similar attitudes towards SMS. Forty-three patients (mean age=56; 77% male) participated. Four profiles were identified: (A) transplant-focused and obedient; (B) holistic and collaborative; (C) life-focused and self-determined; and (D) was bipolar. The positive pole (D+) minimalizing and disengaged and the negative pole (D-) coping-focused and needy represent opposing viewpoints within the same profile. Socio-demographic and medical characteristics were not related to profile membership. Each profile represents a specific attitude on post-transplant life, responsibility for health and decision-making, SMS needs, and preferences for SMS. Patients vary in their attitude, needs and preferences for SMS indicating the necessity of providing personalized support after kidney transplantation. Health professionals should explore patients' SMS needs and adapt support accordingly. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  10. A methodological framework for hydromorphological assessment, analysis and monitoring (IDRAIM) aimed at promoting integrated river management

    NASA Astrophysics Data System (ADS)

    Rinaldi, M.; Surian, N.; Comiti, F.; Bussettini, M.

    2015-12-01

    A methodological framework for hydromorphological assessment, analysis and monitoring (named IDRAIM) has been developed with the specific aim of supporting the management of river processes by integrating the objectives of ecological quality and flood risk mitigation. The framework builds on existing and up-to-date geomorphological concepts and approaches and has been tested on several Italian streams. The framework includes the following four phases: (1) catchment-wide characterization of the fluvial system; (2) evolutionary trajectory reconstruction and assessment of current river conditions; (3) description of future trends of channel evolution; and (4) identification of management options. The framework provides specific consideration of the temporal context, in terms of reconstructing the trajectory of past channel evolution as a basis for interpreting present river conditions and future trends. A series of specific tools has been developed for the assessment of river conditions, in terms of morphological quality and channel dynamics. These include: the Morphological Quality Index (MQI), the Morphological Dynamics Index (MDI), the Event Dynamics Classification (EDC), and the river morphodynamic corridors (MC and EMC). The monitoring of morphological parameters and indicators, alongside the assessment of future scenarios of channel evolution provides knowledge for the identification, planning and prioritization of actions for enhancing morphological quality and risk mitigation.

  11. Redesigning Service Delivery for Hypertensive Patients: A Methodological Guideline to Improve the Management of Chronic Diseases

    PubMed Central

    Ippolito, Adelaide; Cannavacciuolo, Lorella; Ponsiglione, Cristina; De Luca, Nicola; Iaccarino, Guido; Illario, Maddalena

    2014-01-01

    Best care is not necessarily the most expensive, but the most appropriate, and prevention is the most powerful tool to promote health. A novel approach might envision the reduction of hospital admittance (thus meeting a requirement from long term condition patients: they would rather not being hospitalized!) and the enforcement of peripheral (both on the territory and at home) assistance. In this direction, experiences of reshaping new service deliveries towards an integrated disease management, namely clinical pathways, can be observed in Europe and in different parts of the world. Aim of this paper is to provide a methodological guideline to support the management in planning clinical pathways, also outlining the main barriers limiting the process. In particular, we present the results of planning a clinical pathway at the Centre for Hypertension of the Federico II University Hospital (Naples, Italy). The case study showed that the introduction of a similar service impacts on the organisation of the structure. An analysis of organizational processes “as are” and the re-design of processes “to be” are necessary to integrate the clinical pathway into the actual activities. PMID:24809028

  12. A comparison of costs associated with utility management options for dry active waste

    SciTech Connect

    Hornibrook, C.

    1995-12-31

    The economics of low level waste management is receiving more attention today than ever before. This is due to four factors: (1) the increases in the cost of processing of these wastes; (2) increases in the cost of disposal; (3) the addition of storage costs for those without access to disposal; and (4) the increasing competitive nature of the electric generation industry. These pressures are forcing the industry to update it`s evaluation of the mix of processing that will afford it the best long term economics and minimize it`s risks for unforeseen costs. Whether disposal is available or not, all utilities face the same challenge of minimizing the costs associated with the management of these wastes. There are a number of variables that will impact how a utility manages their wastes but the problem is the uncertainty of what will actually happen, i.e., will disposal be available, when and at what cost. Using the EPRI-developed WASTECOST: DAW code, this paper explores a variety of LLW management options available to utilities. Along with providing the costs and benefits, other technical considerations which play an important part in the management of these wastes are also addressed.

  13. Changing Management of the Patent Ductus Arteriosus: Effect on Neonatal Outcomes and Resource Utilization.

    PubMed

    Chock, Valerie Y; Goel, Veena V; Palma, Jonathan P; Luh, Thomas M; Wang, Nichole A; Gaskari, Shabnam; Punn, Rajesh; Silverman, Norman H; Benitz, William E

    2017-04-04

    Objective This historical cohort study investigated how a shift toward a more conservative approach of awaiting spontaneous closure of the patent ductus arteriosus (PDA) in preterm infants has affected neonatal outcomes and resource utilization. Methods We retrospectively studied very low birth weight infants diagnosed with a PDA by echocardiogram (ECHO) in 2006-2008 (era 1), when medical or surgical PDA management was emphasized, to those born in 2010-2012 (era 2) when conservative PDA management was encouraged. Multiple regression analyses adjusted for gestational age were performed to assess differences in clinical outcomes and resource utilization between eras. Results More infants in era 2 (35/89, 39%) compared with era 1 (22/120, 18%) had conservative PDA management (p < 0.01). Despite no difference in surgical ligation rate, infants in era 2 had ligation later (median 24 vs. 8 days, p < 0.0001). There was no difference in clinical outcomes between eras, while number of ECHOs per patient was the only resource measure that increased in era 2 (median 3 vs. 2 ECHOs, p = 0.003). Conclusion In an era of more conservative PDA management, no increase in adverse clinical outcomes or significant change in resource utilization was found. Conservative PDA management may be a safe alternative for preterm infants.

  14. Transforming public utility commissions in the new regulatory environment: Some issues and ideas for managing change

    SciTech Connect

    Wirick, D.W.; Davis, V.W.; Burns, R.E.; Jones, D.N.

    1996-07-01

    In the face of sweeping changes in utility markets and regulatory practices, public utility commissions are being forced to change in fundamental ways--to substantially transform themselves rather than to make only incremental changes in their operations. Managing this process of radical change is complicated by the fact that for the foreseeable future some portions of utility markets (e.g., water utilities) will function much as they have before. Some envision commissions in the future that are more externally focussed, that rely more on dispute resolution than adjudicatory proceedings, that concentrate on identifying and understanding competitive markets, that are more automated, and that are more likely to question old assumptions and definitions. This report identifies the considerations commissions might apply for identifying what mix of skills or fields of experise should compromise the technical staff. Factors are also identified which point towards a sectoral arrangement of staff and those factors which point toward a functional approach.

  15. Methodological approach for the assessment, protection, promotion and management of geoheritage

    NASA Astrophysics Data System (ADS)

    Reynard, E.; Perret, A.; Grangier, L.; Kozlik, L.

    2012-04-01

    During the last decade, within the framework of the Working group on geomorphosites of the International Association of Geomorphologists (IAG), a set of methods for the assessment of geomorphological heritage have been developed. All are based on assessment criteria, more or less quantitative, sometimes grouped in generic categories (intrinsic values, additional values, use values, etc.) (see Reynard, 2009 for a review). Most of these methods may be used with numeric scores, allowing the "calculation" of a site's value and the classification of geomorphosites according to their values. More recently, methodological improvements have been made in other domains of geomorphosite studies, such as cartography, the education to geoheritage, the evaluation of public needs, and the evaluation of geotourist products. The analytical framework we propose here aims at covering all the stages of what we could name "the integrative management of geomorphosites", from the selection of important sites to the evaluation of geotourist and educational activities by the users. The work is divided into two phases: assessment; and management. The first phase is divided in two stages: the selection of potential geomorphosites; and the assessment of these sites by using a specific method developed in Lausanne (Reynard et al., 2007). The management phase is also divided in two stages: the elaboration of a management strategy (with the creation of geotourist and educational products and the elaboration of a conservation strategy); and the evaluation of the scientific work by the users. The proposed analytical framework is tested in the Hérens Valley (Switzerland). The valley ranges from 500 m to 4357 m ASL and is rich in terms of mountain landforms (periglacial and glacial landforms, gravitational deposits, fluvial and torrential landforms). It is representative for landscape reconstructions since the end of the Last Glacial Maximum (LGM). The valley has also a rich ecological and cultural

  16. A decision-support methodology for assessing the sustainability of natural risk management strategies in urban areas

    NASA Astrophysics Data System (ADS)

    Edjossan-Sossou, A. M.; Deck, O.; Heib, M. Al; Verdel, T.

    2014-12-01

    This paper attempts to provide a decision support framework that can help risk managers in urban areas to improve their decision-making processes related to sustainable management. Currently, risk management strategies should no longer be selected based primarily on economic and technical insight. Managers must address the sustainability of risk management by assessing the impacts of their decisions on the sustainable development of a given territory. These assessments require tools that allow ex ante comparisons of the effectiveness and the likely economic, social and ecological impacts of the alternative management strategies. Therefore, this paper reports a methodological and operational framework, which aims to incorporate sustainability principles in a particular decision by taking all the dimensions that affect sustainability into account. This paper is divided into two main parts: one on the theoretical aspects of the proposed methodology and the other on its application to a flood risks management case in a municipality located in Meurthe-et-Moselle county (France). The results of the case study have shown how the methodology can be suitable for determining the most sustainable decision.

  17. Managing water utility financial risks through third-party index insurance contracts

    NASA Astrophysics Data System (ADS)

    Zeff, Harrison B.; Characklis, Gregory W.

    2013-08-01

    As developing new supply capacity has become increasingly expensive and difficult to permit (i.e., regulatory approval), utilities have become more reliant on temporary demand management programs, such as outdoor water use restrictions, for ensuring reliability during drought. However, a significant fraction of water utility income is often derived from the volumetric sale of water, and such restrictions can lead to substantial revenue losses. Given that many utilities set prices at levels commensurate with recovering costs, these revenue losses can leave them financially vulnerable to budgetary shortfalls. This work explores approaches for mitigating drought-related revenue losses through the use of third-party financial insurance contracts based on streamflow indices. Two different types of contracts are developed, and their efficacy is compared against two more traditional forms of financial hedging used by water utilities: Drought surcharges and contingency funds (i.e., self-insurance). Strategies involving each of these approaches, as well as their use in combination, are applied under conditions facing the water utility serving Durham, North Carolina. A multireservoir model provides information on the scale and timing of droughts, and the financial effects of these events are simulated using detailed data derived from utility billing records. Results suggest that third-party index insurance contracts, either independently or in combination with more traditional hedging tools, can provide an effective means of reducing a utility's financial vulnerability to drought.

  18. Use of Ill-Informed Multiple Attribute Utility Theory for Deciding Which of Two Management Information Systems to Purchase

    DTIC Science & Technology

    1990-05-01

    Processing Equipment (ADPE) Systems. It uses Multi Attribute Utility Theory ( MAUT ) with poorly understood utility functions and probabilities. Linear...most appropriate here was Multiple Attribute Utility Theory ( MAUT ) with incomplete knowledge of probabilities and utility values (hereafter referred to...USAAVSCOM JAD TECHNICAL MEMORANDUM TM-90-F-2 0 N Lq USE OF ILL-INFORMED MULTIPLE 1 ATTRIBUTE UTILITY THEORY FOR DECIDING WHICH OF TWO MANAGEMENT <E

  19. Lbs Augmented Reality Assistive System for Utilities Infrastructure Management Through Galileo and Egnos

    NASA Astrophysics Data System (ADS)

    Stylianidis, E.; Valaria, E.; Smagas, K.; Pagani, A.; Henriques, J.; Garca, A.; Jimeno, E.; Carrillo, I.; Patias, P.; Georgiadis, C.; Kounoudes, A.; Michail, K.

    2016-06-01

    There is a continuous and increasing demand for solutions, both software and hardware-based, that are able to productively handle underground utilities geospatial data. Innovative approaches that are based on the use of the European GNSS, Galileo and EGNOS, sensor technologies and LBS, are able to monitor, document and manage utility infrastructures' data with an intuitive 3D augmented visualisation and navigation/positioning technology. A software and hardware-based system called LARA, currently under develop- ment through a H2020 co-funded project, aims at meeting that demand. The concept of LARA is to integrate the different innovative components of existing technologies in order to design and develop an integrated navigation/positioning and information system which coordinates GNSS, AR, 3D GIS and geodatabases on a mobile platform for monitoring, documenting and managing utility infrastruc- tures on-site. The LARA system will guide utility field workers to locate the working area by helping them see beneath the ground, rendering the complexity of the 3D models of the underground grid such as water, gas and electricity. The capacity and benefits of LARA are scheduled to be tested in two case studies located in Greece and the United Kingdom with various underground utilities. The paper aspires to present the first results from this initiative. The project leading to this application has received funding from the European GNSS Agency under the European Union's Horizon 2020 research and innovation programme under grant agreement No 641460.

  20. Definition of a methodology for the management of geological heritage. An application to the Azores archipelago (Portugal)

    NASA Astrophysics Data System (ADS)

    Lima, Eva; Nunes, João; Brilha, José; Calado, Helena

    2013-04-01

    The conservation of the geological heritage requires the support of appropriate policies, which should be the result of the integration of nature conservation, environmental and land-use planning, and environmental education perspectives. There are several papers about inventory methodologies for geological heritage and its scientific, educational and tourism uses (e.g. Cendrero, 2000, Lago et al., 2000; Brilha, 2005; Carcavilla et al., 2007). However, management methodologies for geological heritage are still poorly developed. They should be included in environmental and land-use planning and nature conservation policies, in order to support a holistic approach to natural heritage. This gap is explained by the fact that geoconservation is a new geoscience still needed of more basic scientific research, like any other geoscience (Henriques et al., 2011). It is necessary to establish protocols and mechanisms for the conservation and management of geological heritage. This is a complex type of management because it needs to address not only the fragile natural features to preserve but also legal, economic, cultural, educational and recreational aspects. In addition, a management methodology should ensure the geosites conservation, the local development and the dissemination of the geological heritage (Carcavilla et al., 2007). This work is part of a PhD project aiming to contribute to fill this gap that exists in the geoconservation domain, specifically in terms of establishing an appropriate methodology for the management of geological heritage, taking into account the natural diversity of geosites and the variety of natural and anthropic threats. The proposed methodology will be applied to the geological heritage of the Azores archipelago, which management acquires particular importance and urgency after the decision of the Regional Government to create the Azores Geopark and its application to the European and Global Geoparks Networks. Acknowledgment This work is

  1. The validity and utility of the positive presentation management and negative presentation management scales for the Revised NEO Personality Inventory.

    PubMed

    Sellbom, Martin; Bagby, R Michael

    2008-06-01

    Schinka, Kinder, and Kremer developed "validity" scales for the Revised NEO Personality Inventory (NEO PI-R; Costa & McCrae) to detect underreporting-the Positive Presentation Management (PPM) Scale and overreporting-the Negative Presentation Management (NPM) Scale. In this investigation, the clinical utility of these scales was examined using the established validity scales from the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher et al.) as the referent. The sample was composed of 370 psychiatric patients who completed the NEO PI-R and the MMPI-2 as part of a routine evaluation. Results indicated that response distortion compromised the utility of the NEO PI-R domain scales. Moreover, the PPM and NPM scales and an NPM-PPM index significantly differentiated invalid under-and overreporting groups from a valid responding group. The PPM and NPM-PPM index were adequate in classifying under- and overreporters, respectively.

  2. A kinetic study of ferrocenium cation decomposition utilizing an integrated electrochemical methodology composed of cyclic voltammetry and amperometry.

    PubMed

    Singh, Archana; Chowdhury, Debarati Roy; Paul, Amit

    2014-11-21

    A novel, easy, quick, and inexpensive integrated electrochemical methodology composed of cyclic voltammetry and amperometry has been developed for the determination of the kinetic stability of higher oxidation states for inorganic complexes. In this study, ferrocene and its derivatives have been used as model systems and the corresponding ferrocenium cations were generated in situ during the electrochemical experiments to determine their kinetic stabilities. The study found that the ferrocenium cations decompose following the first-order kinetics at 27 ± 3 °C in the presence of ambient oxygen and water. The half-lives of the ferrocenium, carboxylate ferrocenium, and decamethyl ferrocenium cations were found to be 1.27 × 10(3), 1.52 × 10(3), and ≫11.0 × 10(3) s, respectively, in acetonitrile solvent having a 0.5 M tetrabutylammonium hexafluorophosphate electrolyte. These results are in agreement with the previous reports, i.e. the ferrocenium cation is unstable whereas the decamethyl ferrocenium cation has superior stability. The new methodology has been established by performing various experiments using different concentrations of ferrocene, variable scan rates in cyclic voltammetry, different time periods for amperometry, and in situ spectroelectrochemical experiments.

  3. Variation in practice patterns and resource utilization surrounding management of intussusception at freestanding Children's Hospitals.

    PubMed

    Rice-Townsend, Samuel; Chen, Catherine; Barnes, Jeff N; Rangel, Shawn J

    2013-01-01

    To characterize variation in practice patterns and resource utilization associated with the management of intussusception at Children's Hospitals. A retrospective cohort study (1/1/09-6/30/11) of 27 Children's Hospitals participating in the Pediatric Health Information System database was performed. Hospitals were compared with regard to their rates of operative management following attempted enema reduction, prophylactic antibiotic utilization, same-day discharge for those successfully managed non-operatively, 48-h readmission rates, and case-related cost and charges. 2544 patients were identified (median: 93 cases/center) with a median age of 17 months. The rate of operation following attempted enema reduction varied significantly across hospitals (overall rate: 21.1%: range: 11%-62.8%; p<0.0001). For patients managed non-operatively, significant variability was found for prophylactic antibiotic utilization (overall rate: 23.3%; range: 1.4%-93.2%; p<0.0001), same-day discharge (overall rate: 15.2%; range: 0%-83.8%; p<0.0001), readmission rates (overall rate: 17.5%; range: 5.3%-32.1%; p<0.0001), treatment-related costs (overall median: $2490; range: $829-$5905; p<0.0001), and charges (overall median: $6350; range: $2497-$10,306; p<0.0001). Variability in costs and charges was even greater when analyzing all patients (operative and non-operative) with intussusception (overall cost median: $2865; range: $1574-$6763; p<0.0001; overall charge median: $7110; range: $3544-$22,097; p<0.0001). Significant variation in practice patterns and resource utilization exists between Children's Hospitals in the management of intussusception. Prospective analysis of practice variation and appropriately risk-adjusted outcomes through a collaborative quality-improvement platform could accelerate the dissemination of best-practice guidelines for optimizing cost-effective care. Copyright © 2013 Elsevier Inc. All rights reserved.

  4. A decision methodology for the evaluation of mixed low-level radioactive waste management options for DOE sites

    SciTech Connect

    Bassi, J.; Abashian, M.S.; Chakraborti, S.; Devarakonda, M.; Djordjevic, S.M.

    1993-03-01

    Currently, many DOE sites are developing site-specific solutions to manage their mixed low-level wastes. These site-specific MLLW programs often result in duplication of efforts between the different sites, and consequently, inefficient use of DOE system resources. A nationally integrated program for MLLW eliminates unnecessary duplication of effort, but requires a comprehensive analysis of waste management options to ensure that all site issues are addressed. A methodology for comprehensive analysis of the complete DOE MLLW system is being developed by DOE-HQ to establish an integrated and standardized solution for managing MLLW. To be effective, the comprehensive systems analysis must consider all aspects of MLLW management from cradle-to-grave (i.e. from MLLW generation to disposal). The results of the analysis will include recommendations for alternative management options for the complete DOE MLLW system based on various components such as effectiveness, cost, health and safety risks, and the probability of regulatory acceptance for an option. Because of the diverse nature of these various components and the associated difficulties in comparing between them, a decision methodology is being developed that will integrate the above components into a single evaluation scheme for performing relative comparisons between different MLLW management options. The remainder of this paper provides an overview of the roles and responsibilities of the various participants of the DOE MLLW Program, and discusses in detail the components involved in the development of the decision methodology for a comprehensive systems analysis.

  5. Thru-life impacts of driver aggression, climate, cabin thermal management, and battery thermal management on battery electric vehicle utility

    NASA Astrophysics Data System (ADS)

    Neubauer, Jeremy; Wood, Eric

    2014-08-01

    Battery electric vehicles (BEVs) offer the potential to reduce both oil imports and greenhouse gas emissions, but have a limited utility that is affected by driver aggression and effects of climate-both directly on battery temperature and indirectly through the loads of cabin and battery thermal management systems. Utility is further affected as the battery wears through life in response to travel patterns, climate, and other factors. In this paper we apply the National Renewable Energy Laboratory's Battery Lifetime Analysis and Simulation Tool for Vehicles (BLAST-V) to examine the sensitivity of BEV utility to driver aggression and climate effects over the life of the vehicle. We find the primary challenge to cold-climate BEV operation to be inefficient cabin heating systems, and to hot-climate BEV operation to be high peak on-road battery temperatures and excessive battery degradation. Active cooling systems appear necessary to manage peak battery temperatures of aggressive, hot-climate drivers, which can then be employed to maximize thru-life vehicle utility.

  6. Watershed influence on fluvial ecosystems: an integrated methodology for river water quality management.

    PubMed

    Carone, Maria T; Simoniello, Tiziana; Manfreda, Salvatore; Caricato, Gaetano

    2009-05-01

    The EU Water Framework Directive 2000/60 (Integrated River Basin Management for Europe) establishes the importance of preserving water quality through policies applied at watershed level given the strong links existing among ecological, hydrological, and hydrogeological systems. Therefore, monitoring campaigns of river water quality should be planned with multidisciplinary approaches starting from a landscape perspective. In this paper, the effects of the basin hydrology on the river water quality and, in particular, the impacts caused by the runoff production coming from agricultural areas are investigated. The fluvial segments receiving consistent amount of pollutant loads (due to the runoff routing over agricultural areas) are assumed more critical in terms of water quality and thus, they require more accurate controls. Starting from this perspective, to evaluate the runoff productions coming from agricultural areas, we applied a semi-distributed hydrological model that adopts satellite data, pedological and morphological information for the watershed description. Then, the river segments receiving critical amount of runoff loads from the surrounding cultivated areas were identified. Finally, in order to validate the approach, water quality for critical and non critical segment was investigated seasonally, by using river macroinvertebrates as indicators of water quality because of their effectiveness in preserving in time a memory of pollution events. Biomonitoring data showed that river water quality strongly decreases in correspondence of fluvial segments receiving critical amount of runoff coming from agricultural areas. The results highlight the usefulness of such a methodology to plan monitoring campaigns specifically devoted to non-point pollution sources and suggest the possibility to use this approach for water quality management and for planning river restoration policies.

  7. Developing a methodology for identifying action zones to protect and manage groundwater well fields

    NASA Astrophysics Data System (ADS)

    Bellier, Sandra; Viennot, Pascal; Ledoux, Emmanuel; Schott, Celine

    2013-04-01

    Implementation of a long term action plan to manage and protect well fields is a complex and very expensive process. In this context, the relevance and efficiency of such action plans on water quality should be evaluated. The objective of this study is to set up a methodology to identify relevant actions zones in which environmental changes may significantly impact the quantity or quality of pumped water. In the Seine-et-Marne department (France), under French environmental laws three sectors integrating numerous well-field pumping in Champigny's limestone aquifer are considered as priority. This aquifer, located at south-east of Paris, supplies more than one million people with drinking water. Catchments areas of these abstractions are very large (2000 km2) and their intrinsic vulnerability was established by a simple parametric approach that does not permit to consider the complexity of hydrosystem. Consequently, a methodology based on a distributed modeling of the process of the aquifer was developed. The basin is modeled using the hydrogeological model MODCOU, developed in MINES ParisTech since the 1980s. It simulates surface and groundwater flow in aquifer systems and allows to represent the local characteristics of the hydrosystem (aquifers communicating by leakage, rivers infiltration, supply from sinkholes and locally perched or dewatering aquifers). The model was calibrated by matching simulated river discharge hydrographs and piezometric heads with observed ones since the 1970s. Thanks to this modelling tool, a methodology based on the transfer of a theoretical tracer through the hydrosystem from the ground surface to the outlets was implemented to evaluate the spatial distribution of the contribution areas at contrasted, wet or dry recharge periods. The results show that the surface of areas contributing to supply most catchments is lower than 300 km2 and the major contributory zones are located along rivers. This finding illustrates the importance of

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

    SciTech Connect

    Schweitzer, M.

    1991-01-01

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

  9. Herbicide-Resistant Crops: Utilities and Limitations for Herbicide-Resistant Weed Management

    PubMed Central

    2010-01-01

    Since 1996, genetically modified herbicide-resistant (HR) crops, particularly glyphosate-resistant (GR) crops, have transformed the tactics that corn, soybean, and cotton growers use to manage weeds. The use of GR crops continues to grow, but weeds are adapting to the common practice of using only glyphosate to control weeds. Growers using only a single mode of action to manage weeds need to change to a more diverse array of herbicidal, mechanical, and cultural practices to maintain the effectiveness of glyphosate. Unfortunately, the introduction of GR crops and the high initial efficacy of glyphosate often lead to a decline in the use of other herbicide options and less investment by industry to discover new herbicide active ingredients. With some exceptions, most growers can still manage their weed problems with currently available selective and HR crop-enabled herbicides. However, current crop management systems are in jeopardy given the pace at which weed populations are evolving glyphosate resistance. New HR crop technologies will expand the utility of currently available herbicides and enable new interim solutions for growers to manage HR weeds, but will not replace the long-term need to diversify weed management tactics and discover herbicides with new modes of action. This paper reviews the strengths and weaknesses of anticipated weed management options and the best management practices that growers need to implement in HR crops to maximize the long-term benefits of current technologies and reduce weed shifts to difficult-to-control and HR weeds. PMID:20586458

  10. Herbicide-resistant crops: utilities and limitations for herbicide-resistant weed management.

    PubMed

    Green, Jerry M; Owen, Micheal D K

    2011-06-08

    Since 1996, genetically modified herbicide-resistant (HR) crops, particularly glyphosate-resistant (GR) crops, have transformed the tactics that corn, soybean, and cotton growers use to manage weeds. The use of GR crops continues to grow, but weeds are adapting to the common practice of using only glyphosate to control weeds. Growers using only a single mode of action to manage weeds need to change to a more diverse array of herbicidal, mechanical, and cultural practices to maintain the effectiveness of glyphosate. Unfortunately, the introduction of GR crops and the high initial efficacy of glyphosate often lead to a decline in the use of other herbicide options and less investment by industry to discover new herbicide active ingredients. With some exceptions, most growers can still manage their weed problems with currently available selective and HR crop-enabled herbicides. However, current crop management systems are in jeopardy given the pace at which weed populations are evolving glyphosate resistance. New HR crop technologies will expand the utility of currently available herbicides and enable new interim solutions for growers to manage HR weeds, but will not replace the long-term need to diversify weed management tactics and discover herbicides with new modes of action. This paper reviews the strengths and weaknesses of anticipated weed management options and the best management practices that growers need to implement in HR crops to maximize the long-term benefits of current technologies and reduce weed shifts to difficult-to-control and HR weeds.

  11. Methane emissions from domestic waste management facilities in Jordan--applicability of IPCC methodology.

    PubMed

    Abdulla, F A; al-Ghazzawi, Z D

    2000-02-01

    In this paper, methane emissions from municipal wastewater treatment plants and municipal solid waste (MSW) landfills in Jordan for 1994 have been estimated using the methodology developed by the Intergovernmental Panel on Climate Change (IPCC). For this purpose, the 14 domestic wastewater treatment plants in the country were surveyed. Generation rates and characterization of MSW components as well as dumping and landfilling practices were surveyed in order to estimate 1994 CH4 emissions from these sites. Locally available waste statistics were used in cases where those of the IPCC guidelines were not representative of Jordan's statistics. Methane emissions from domestic wastewater in Jordan were estimated at 4.66 gigagrams (Gg). Total 1994 CH4 emissions from MSW management facilities in Jordan are estimated at 371.76 Gg--351.12 Gg (94.45%) from sanitary landfills, 19.83 Gg (5.33%) from MSW open dumps, and 0.81 Gg (0.22%) from raw sewage-water dumping ponds. Uncertainties associated with these estimations are presented.

  12. Methane Emissions from Domestic Waste Management Facilities in Jordan-Applicability of IPCC Methodology.

    PubMed

    Abdulla, Fayez A; Al-Ghazzawi, Ziad D

    2000-02-01

    In this paper, methane emissions from municipal wastewater treatment plants and municipal solid waste (MSW) landfills in Jordan for 1994 have been estimated using the methodology developed by the Intergovernmental Panel on Climate Change (IPCC). For this purpose, the 14 domestic wastewater treatment plants in the country were surveyed. Generation rates and characterization of MSW components as well as dumping and landfilling practices were surveyed in order to estimate 1994 CH4 emissions from these sites. Locally available waste statistics were used in cases where those of the IPCC guidelines were not representative of Jordan's statistics. Methane emissions from domestic wastewater in Jordan were estimated at 4.66 gigagrams (Gg). Total 1994 CH4 emissions from MSW management facilities in Jordan are estimated at 371.76 Gg-351.12 Gg (94.45%) from sanitary landfills, 19.83 Gg (5.33%) from MSW open dumps, and 0.81 Gg (0.22%) from raw sewage-water dumping ponds. Uncertainties associated with these estimations are presented.

  13. The Spillover Effects of Medicare Managed Care: Medicare Advantage and Hospital Utilization

    PubMed Central

    Baicker, Katherine; Chernew, Michael; Robbins, Jacob

    2013-01-01

    More than a quarter of Medicare beneficiaries are enrolled in Medicare Advantage, which was created in large part to improve the efficiency of health care delivery by promoting competition among private managed care plans. This paper explores the spillover effects of the Medicare Advantage program on the traditional Medicare program and other patients, taking advantage of changes in Medicare Advantage payment policy to isolate exogenous increases in Medicare Advantage enrollment and trace out the effects of greater managed care penetration on hospital utilization and spending throughout the health care system. We find that when more seniors enroll in Medicare managed care, hospital costs decline for all seniors and for commercially insured younger populations. Greater managed care penetration is not associated with fewer hospitalizations, but is associated with lower costs and shorter stays per hospitalization. These spillovers are substantial – offsetting more than 10% of increased payments to Medicare Advantage plans. PMID:24308880

  14. Capital Requirements Estimating Model (CREMOD) for electric utilities. Volume I. Methodology description, model, description, and guide to model applications. [For each year up to 1990

    SciTech Connect

    Collins, D E; Gammon, J; Shaw, M L

    1980-01-01

    The Capital Requirements Estimating Model for the Electric Utilities (CREMOD) is a system of programs and data files used to estimate the capital requirements of the electric utility industry for each year between the current one and 1990. CREMOD disaggregates new electric plant capacity levels from the Mid-term Energy Forecasting System (MEFS) Integrating Model solution over time using actual projected commissioning dates. It computes the effect on aggregate capital requirements of dispersal of new plant and capital expenditures over relatively long construction lead times on aggregate capital requirements for each year. Finally, it incorporates the effects of real escalation in the electric utility construction industry on these requirements and computes the necessary transmission and distribution expenditures. This model was used in estimating the capital requirements of the electric utility sector. These results were used in compilation of the aggregate capital requirements for the financing of energy development as published in the 1978 Annual Report to Congress. This volume, Vol. I, explains CREMOD's methodology, functions, and applications.

  15. Cluster randomized trials utilizing primary care electronic health records: methodological issues in design, conduct, and analysis (eCRT Study).

    PubMed

    Gulliford, Martin C; van Staa, Tjeerd P; McDermott, Lisa; McCann, Gerard; Charlton, Judith; Dregan, Alex

    2014-06-11

    There is growing interest in conducting clinical and cluster randomized trials through electronic health records. This paper reports on the methodological issues identified during the implementation of two cluster randomized trials using the electronic health records of the Clinical Practice Research Datalink (CPRD). Two trials were completed in primary care: one aimed to reduce inappropriate antibiotic prescribing for acute respiratory infection; the other aimed to increase physician adherence with secondary prevention interventions after first stroke. The paper draws on documentary records and trial datasets to report on the methodological experience with respect to research ethics and research governance approval, general practice recruitment and allocation, sample size calculation and power, intervention implementation, and trial analysis. We obtained research governance approvals from more than 150 primary care organizations in England, Wales, and Scotland. There were 104 CPRD general practices recruited to the antibiotic trial and 106 to the stroke trial, with the target number of practices being recruited within six months. Interventions were installed into practice information systems remotely over the internet. The mean number of participants per practice was 5,588 in the antibiotic trial and 110 in the stroke trial, with the coefficient of variation of practice sizes being 0.53 and 0.56 respectively. Outcome measures showed substantial correlations between the 12 months before, and after intervention, with coefficients ranging from 0.42 for diastolic blood pressure to 0.91 for proportion of consultations with antibiotics prescribed, defining practice and participant eligibility for analysis requires careful consideration. Cluster randomized trials may be performed efficiently in large samples from UK general practices using the electronic health records of a primary care database. The geographical dispersal of trial sites presents a difficulty for

  16. [Methodology for construction of a panel of indicators for monitoring and evaluation of unified health system (SUS) management].

    PubMed

    Tamaki, Edson Mamoru; Tanaka, Oswaldo Yoshimi; Felisberto, Eronildo; Alves, Cinthia Kalyne de Almeida; Drumond Junior, Marcos; Bezerra, Luciana Caroline de Albuquerque; Calvo, Maria Cristina Marino; Miranda, Alcides Silva de

    2012-04-01

    This study sought to develop methodology for the construction of a Panel for the Monitoring and Evaluation of Management of the Unified Health System (SUS). The participative process used in addition to the systematization conducted made it possible to identify an effective strategy for building management tools in partnership with researchers, academic institutions and managers of the SUS. The final systematization of the Panel selected indicators for the management of the SUS in terms of Demand, Inputs, Processes, Outputs and Outcomes in order to provide a simple, versatile and useful tool for evaluation at any level of management and more transparent and easier communication with all stakeholders in decision-making. Taking the management of the SUS as the scope of these processes and practices in all normative aspects enabled dialog between systemic theories and those which consider the centrality of the social actor in the decision-making process.

  17. Platform development for merging various information sources for water management: methodological, technical and operational aspects

    NASA Astrophysics Data System (ADS)

    Galvao, Diogo

    2013-04-01

    As a result of various economic, social and environmental factors, we can all experience the increase in importance of water resources at a global scale. As a consequence, we can also notice the increasing need of methods and systems capable of efficiently managing and combining the rich and heterogeneous data available that concerns, directly or indirectly, these water resources, such as in-situ monitoring station data, Earth Observation images and measurements, Meteorological modeling forecasts and Hydrological modeling. Under the scope of the MyWater project, we developed a water management system capable of satisfying just such needs, under a flexible platform capable of accommodating future challenges, not only in terms of sources of data but also on applicable models to extract information from it. From a methodological point of view, the MyWater platform obtains data from distinct sources, and in distinct formats, be they Satellite images or meteorological model forecasts, transforms and combines them in ways that allow them to be fed to a variety of hydrological models (such as MOHID Land, SIMGRO, etc…), which themselves can also be combined, using such approaches as those advocated by the OpenMI standard, to extract information in an automated and time efficient manner. Such an approach brings its own deal of challenges, and further research was developed under this project on the best ways to combine such data and on novel approaches to hydrological modeling (like the PriceXD model). From a technical point of view, the MyWater platform is structured according to a classical SOA architecture, with a flexible object oriented modular backend service responsible for all the model process management and data treatment, while the information extracted can be interacted with using a variety of frontends, from a web portal, including also a desktop client, down to mobile phone and tablet applications. From an operational point of view, a user can not only see

  18. Role playing games: a methodology to acquire knowledge for integrated wastewater infrastructures management in a river basin scale.

    PubMed

    Prat, P; Aulinas, M; Turon, C; Comas, J; Poch, M

    2009-01-01

    Current management of sanitation infrastructures (sewer systems, wastewater treatment plant, receiving water, bypasses, deposits, etc) is not fulfilling the objectives of up to date legislation, to achieve a good ecological and chemical status of water bodies through integrated management. These made it necessary to develop new methodologies that help decision makers to improve the management in order to achieve that status. Decision Support Systems (DSS) based on Multi-Agent System (MAS) paradigm are promising tools to improve the integrated management. When all the different agents involved interact, new important knowledge emerges. This knowledge can be used to build better DSS and improve wastewater infrastructures management achieving the objectives planned by legislation. The paper describes a methodology to acquire this knowledge through a Role Playing Game (RPG). First of all there is an introduction about the wastewater problems, a definition of RPG, and the relation between RPG and MAS. Then it is explained how the RPG was built with two examples of game sessions and results. The paper finishes with a discussion about the uses of this methodology and future work.

  19. Medicaid Managed Care and the Health Care Utilization of Foster Children.

    PubMed

    Palmer, Makayla; Marton, James; Yelowitz, Aaron; Talbert, Jeffery

    2017-01-01

    A recent trend in state Medicaid programs is the transition of vulnerable populations into Medicaid managed care (MMC) who were initially carved out of such coverage, such as foster children or those with disabilities. The purpose of this article is to evaluate the impact of the transition of foster children from fee-for-service Medicaid coverage to MMC coverage on outpatient health care utilization. There is very little empirical evidence on the impact of managed care on the health care utilization of foster children because of the recent timing of these transitions as well as challenges associated with finding data sets large enough to contain a sufficient number of foster children for such analysis. Using administrative Medicaid data from Kentucky, we use retrospective difference-in-differences analysis to compare the outpatient utilization of foster children transitioned to MMC in one region of the state with foster children in the rest of the state who remained in fee-for-service coverage. We find that the transition to MMC led to a 4 percentage point reduction in the probability of having any monthly outpatient utilization. We also estimate that MMC leads to a reduction in outpatient spending.

  20. Operationalization of the UFuRT methodology for usability analysis in the clinical research data management domain.

    PubMed

    Nahm, Meredith; Zhang, Jiajie

    2009-04-01

    Data management software applications specifically designed for the clinical research environment are increasingly available from commercial vendors and open-source communities, however, general-purpose spreadsheets remain widely employed in clinical research data management (CRDM). The suitability of spreadsheets for this use is controversial, and no formal comparative usability evaluations have been performed. We report on an application of the UFuRT (user, function, representation, and task (analyses) methodology to create a domain-specific process for usability evaluation. We demonstrate this process in an evaluation of differences in usability between a spreadsheet program (Microsoft Excel) and a commercially available clinical research data management system (Phase Forward Clintrial). Through this domain-specific operationalization of UFuRT methodology, we successfully identified usability differences and quantified task and cost differences, while differentiating these from socio-technical aspects. UFuRT can be generalized to other domains.

  1. Operationalization of the UFuRT Methodology for Usability Analysis in the Clinical Research Data Management Domain

    PubMed Central

    Nahm, Meredith; Zhang, Jiajie

    2009-01-01

    Data management software applications specifically designed for the clinical research environment are increasingly available from commercial vendors and open-source communities, however, general-purpose spreadsheets remain widely employed in clinical research data management (CRDM). Spreadsheet suitability for this use is controversial, and no formal comparative usability evaluations have been performed. We report on an application of the UFuRT (User, Function, Representation, and Task (analyses)) methodology to create a domain-specific process for usability evaluation. We demonstrate this process in an evaluation of differences in usability between a spreadsheet program (Microsoft® Excel) and a commercially available clinical research data management system (CDMS) (Phase Forward Clintrial™). Through this domain-specific operationalization of UFuRT methodology, we successfully identified usability differences and quantified task and cost differences, while delineating these from socio-technical aspects. UFuRT can similarly be generalized to other domains. PMID:19026765

  2. Methodology To Define Drought Management Scenarios Based On Accumulated Future Projections Of Risk

    NASA Astrophysics Data System (ADS)

    Haro-Monteagudo, David; Solera-Solera, Abel; Andreu-Álvarez, Joaquín

    2014-05-01

    Drought is a serious threat to many water resources systems in the world. Especially to those in which the equilibrium between resources availability and water uses is very fragile, making that deviation below normality compromises the capacity of the system to cope with all the demands and environmental requirements. Since droughts are not isolated events but instead they develop through time in what could be considered a creeping behavior, it is very difficult to determine when an episode starts and how long will it last. Because this is a major concern for water managers and society in general, scientific research has strived to develop indices that allow evaluating the risk of a drought event occurrence. These indices often have as basis previous and current state variables of the system that combined between them supply decision making responsible with an indication of the risk of being in a situation of drought, normally through the definition of a drought scenario situation. While this way of proceeding has found to be effective in many systems, there are cases in which indicators systems fail to define the appropriate on-going drought scenario early enough to start measures that allowed to minimize the possible impacts. This is the case, for example, of systems with high seasonal precipitation variability. The use of risk assessment models to evaluate future possible states of the system becomes handy in cases like the previous one, although they are not limited to such systems. We present a method to refine the drought scenario definition within a water resources system. To implement this methodology, we use a risk assessment model generalized to water resources systems based in the stochastic generation of multiple possible future streamflows generation and the simulation of the system from a Monte-Carlo approach. We do this assessment every month of the year up to the end of the hydrologic year that normally corresponds with the end of the irrigation

  3. Effect of diabetic case management intervention on health service utilization in Korea.

    PubMed

    Shin, Soon Ae; Kim, Hyeongsu; Lee, Kunsei; Lin, Vivian; Liu, George

    2015-12-01

    This study is to estimate the effectiveness of a diabetic case management programme on health-care service utilization. The study population included 6007 as the intervention group and 956,766 as the control group. As the indicators of health-care service utilization, numbers of medical ambulatory consultations, days of medication prescribed and medical expenses for one year were used, and we analysed the claim data of the health insurance from 2005 to 2007. The study population was classified into three subgroups based on the number of medical ambulatory consultations per year before this intervention. In the under-serviced subgroup, the intervention group showed a significant increase in the number of consultations (3.2), days of prescribed medication (66.4) and medical expenses (287,900 KRW) compared with the control group. Conversely, in the over-serviced subgroup, the intervention group showed a less decrease days of prescribed medication (1.6) compared with the control group. This showed that the case management programme led the intervention group to optimize their utilization of health-care services by subgroups. It is necessary to evaluate the appropriateness of health-care usage and clinical outcome to show the direct effectiveness of the case management programme by subgroups.

  4. Energy and water quality management systems for water utility's operations: a review.

    PubMed

    Cherchi, Carla; Badruzzaman, Mohammad; Oppenheimer, Joan; Bros, Christopher M; Jacangelo, Joseph G

    2015-04-15

    Holistic management of water and energy resources is critical for water utilities facing increasing energy prices, water supply shortage and stringent regulatory requirements. In the early 1990s, the concept of an integrated Energy and Water Quality Management System (EWQMS) was developed as an operational optimization framework for solving water quality, water supply and energy management problems simultaneously. Approximately twenty water utilities have implemented an EWQMS by interfacing commercial or in-house software optimization programs with existing control systems. For utilities with an installed EWQMS, operating cost savings of 8-15% have been reported due to higher use of cheaper tariff periods and better operating efficiencies, resulting in the reduction in energy consumption of ∼6-9%. This review provides the current state-of-knowledge on EWQMS typical structural features and operational strategies and benefits and drawbacks are analyzed. The review also highlights the challenges encountered during installation and implementation of EWQMS and identifies the knowledge gaps that should motivate new research efforts.

  5. Impact of Disease Management on Utilization and Adherence With Drugs and Tests

    PubMed Central

    Thiebaud, Patrick; Demand, Michael; Wolf, Scott A.; Alipuria, Linda L.; Ye, Qin; Gutierrez, Peter R.

    2008-01-01

    OBJECTIVE—The purpose of this study was to evaluate the effect of telephonic care management within a diabetes disease management program on adherence to treatment with hypoglycemic agents, ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), statins, and recommended laboratory tests in a Medicaid population. RESEARCH DESIGN AND METHODS—A total of 2,598 patients with diabetes enrolled for at least 2 years in Florida: A Healthy State (FAHS), a large Medicaid disease management program, who received individualized telephonic care management were selected if they were eligible for at least 12 months before and 12 months after beginning care management. Patients were matched one-to-one on all baseline characteristics to 2,598 control patients. The impact of care management on utilization and adherence rates for diabetes-related medications and tests was analyzed with the difference-in-difference estimator. RESULTS—Changes in utilization were evaluated separately for those who were characterized as adherent to treatment at baseline (“users”) and those who were not (“nonusers”). Both groups achieved significant improvement in adherence between baseline and follow-up. Nonusers increased their overall hypoglycemic use by 0.7 script (P < 0.001), by 0.7 script for ACEIs and statins (both P < 0.001), by 0.8 test for A1C (P < 0.001), and by 0.7 test for lipids (P < 0.001). Users increased hypoglycemic use by 1.5 scripts (P < 0.001) and insulin use by 0.9 script (P < 0.001). CONCLUSIONS—The FAHS telephonic care management intervention effectively induced Medicaid patients with diabetes to begin treatment and improved adherence to oral hypoglycemic agents and recommended tests. It also substantially improved adherence among baseline insulin users. PMID:18523144

  6. The utility of computed tomography in the management of fever and neutropenia in pediatric oncology.

    PubMed

    Rao, Avani D; Sugar, Elizabeth A; Barrett, Neil; Mahesh, Mahadevappa; Arceci, Robert J

    2015-10-01

    Despite the frequent use and radiation exposure of computed tomography (CT) scans, there is little information on patterns of CT use and their utility in the management of pediatric patients with fever and neutropenia (FN). We examined the contribution of either the commonly employed pan-CT (multiple anatomical locations) or targeted CT (single location) scanning to identify possible infectious etiologies in this challenging clinical scenario. Procedure Pediatric patients with an underlying malignancy admitted for fever (temperature ≥ 38.3 °C) and an absolute neutrophil count <500 cells/μL from 2003-2009 were included. Risk factors associated with utilization, results, and effects on clinical management of CT scans were identified. Results Charts for 635 admissions for FN from 263 patients were reviewed. Overall, 139 (22%) admissions (93 individuals) had at least one scan. Of 188 scans, 103 (55%) were pan-scans. Changes in management were most strongly associated with the identification of evidence consistent with infection (OR = 12.64, 95% CI: 5.05-31.60, P < 0.001). Seventy-eight (41%) of all CT scans led to a change in clinical management, most commonly relating to use of antibiotic (N = 41, 53%) or antifungal/antiviral medications (N = 33, 42%). The odds of a change in clinical management did not differ for those receiving a pan-scan compared to those receiving a targeted scan (OR = 1.23; 95% CI, 0.61-2.46; P = 0.57). Conclusions When CT is clinically indicated, it is important for clinicians to strongly consider utilizing a targeted scan to reduce radiation exposure to patients as well as to decrease costs without compromising care. © 2015 Wiley Periodicals, Inc.

  7. Methodology for phase selection of a weak basic drug candidate, utilizing kinetic solubility profiles in bio-relevant media.

    PubMed

    Furukawa, Shuntaro; Zhao, Chenhua; Ohki, Yasuhiro

    2010-02-01

    We aimed to develop a phase selection methodology for a weak basic active pharmaceutical ingredient (API) that would require less than 10mg of the API and monitor the real-time kinetic solubility of the API in two bio-relevant media. Three sets of kinetic solubility measurements were conducted for free form I and the disulfate salt of an API (compound A) in order to determine the better API phase for further development of the compound. Tests consisted of solid API dissolution in both simulated gastric fluid (SGF) and fasted-state intestinal fluid (FaSSIF), and precipitation kinetics by injection of liquid state API into FaSSIF. All dissolution tests were conducted above the saturated concentrations in order to determine the compounds' thermodynamic and kinetic solubility to trace the API's phase transitions during dissolution. The pharmacokinetic profiles of compound A following oral administration of two API phases were evaluated in dogs. Results of the three sets of kinetic solubility measurements showed different kinetic solubility profiles for the two API phases under gastrointestinal conditions, indicating that the disulfate salt is preferred over free form I due to its superior kinetic solubility profile. This conclusion is consistent with the bioavailability results obtained in dogs. Copyright (c) 2009 Elsevier B.V. All rights reserved.

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

    SciTech Connect

    Eto, J.

    1996-12-01

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

  9. Configuration Data Management (CDM) on a Shoestring Identifying & Utilizing an Existing Configuration & Data Management Infrastructure

    SciTech Connect

    VANN, J.M.

    2000-08-24

    The spreading need for and use of configuration and data management (CDM) standards has highlighted a number of challenges to the companies that need to implement those standards. For companies and organizations that are new to CDM or have limited CDM capabilities, one of the major dilemmas faced is identifying how and where to start. In many cases there is a need to contend with a legacy of poorly identified items and information and an immature or non-existent CDM infrastructure (processes, procedures, people, and information systems). To the company management and CDM professional this poses a seemingly insurmountable task of putting in place a CDM infrastructure that provides the needed benefits while keeping within an acceptable cost and schedule. This paper deals with initially establishing the CDM infrastructure using the tools that a company already has available. The paper identifies features of common software applications that can be used to implement CDM principles.

  10. Utilizing an Energy Management System with Distributed Resources to Manage Critical Loads and Reduce Energy Costs

    DTIC Science & Technology

    2014-09-01

    Systems with Electric Power Systems,” IEEE std 1547.4–2011, IEEE , 2011. [3] Department of the Navy, “Department of the Navy’s Energy Program for...Providing Improved Power Quality in Microgrids,” IEEE Industry Applications Magazine , pp. 34–43, September– October 2014. [27] A. Julian, N. Peck...and G. Oriti, “ Power electronics enabled energy management systems,” in Proceedings of IEEE Applied Power Electronics Conference, Long Beach, CA

  11. Thermal management of closed computer modules utilizing high density circuitry. [in Airborne Information Management System

    NASA Technical Reports Server (NTRS)

    Hoadley, A. W.; Porter, A. J.

    1990-01-01

    This paper presents data on a preliminary analysis of the thermal dynamic characteristics of the Airborne Information Management System (AIMS), which is a continuing design project at NASA Dryden. The analysis established the methods which will be applied to the actual AIMS boards as they become available. The paper also describes the AIMS liquid cooling system design and presents a thermodynamic computer model of the AIMS cooling system, together with an experimental validation of this model.

  12. Thermal management of closed computer modules utilizing high density circuitry. [in Airborne Information Management System

    NASA Technical Reports Server (NTRS)

    Hoadley, A. W.; Porter, A. J.

    1990-01-01

    This paper presents data on a preliminary analysis of the thermal dynamic characteristics of the Airborne Information Management System (AIMS), which is a continuing design project at NASA Dryden. The analysis established the methods which will be applied to the actual AIMS boards as they become available. The paper also describes the AIMS liquid cooling system design and presents a thermodynamic computer model of the AIMS cooling system, together with an experimental validation of this model.

  13. Outer Banks Climate - Utilizing NASA Earth Observations to Establish a Methodology for Assessing Coastal Change in North Carolina

    NASA Astrophysics Data System (ADS)

    Vaughan, M. A.; Morgan, K.; Doddridge, D.; Norman, D.; Burns, C.; Collins, C.; Warren, J.

    2010-12-01

    North Carolina’s dynamic and ever changing coastal region, defined by the Outer Banks and nearby estuarine systems, is especially vulnerable to the effects of climate change. In addition to the shoreline transformations resultant from erosion and the natural processes of land subsistence, this coastal zone is experiencing increased effects of global climate change. Accelerated rates of rising temperatures in recent years have contributed to thermal expansion, melting ice and thus, a rising sea level that is especially stressful for these low lying coastal regions. Current trends in human behavior are predicted to only accelerate the process of climate change, making the future of this region all the more uncertain. With higher temperatures and added water volume, more frequent and intense storms can be expected to make landfall on or near the North Carolina coast that present hazards threatening entire communities. This study first applied remote sensing tools and techniques to delineate an accurate shoreline envelope. Then, through examination of Landsat imagery taken before and after named storms, observation of images at nine year intervals, and a process of acquiring NDVI values, short and long term vegetative differences were identified. Models based on historical data were also produced with the intention of forecasting future sea level rise along North Carolina’s estuary and coastal shorelines; a particular focus on sea level changes surrounding hurricane episodes corresponds to rates discerned in existing studies. This project will provide a methodology using NASA satellite instrumentation to analyze and delineation shoreline change and measure erosion. Including vegetation loss, sea level rise and the effects of natural and anthropogenic climate change in the study will supplement explanations of current shoreline loss, highest risk areas, and forecasts of future impacts. This information will assist officials in their strategic planning and policy

  14. Using Q Methodology to Explore Leadership: The Role of the School Business Manager

    ERIC Educational Resources Information Center

    Woods, Charlotte Emma

    2011-01-01

    This article is primarily methodological but has dual aims. First, it makes a case for Q methodology as an effective and so far little exploited means of capturing, comparing and contrasting individual perspectives on a specific question in the field of educational leadership. In common with other research approaches designed to uncover the…

  15. Ultra-Structure database design methodology for managing systems biology data and analyses.

    PubMed

    Maier, Christopher W; Long, Jeffrey G; Hemminger, Bradley M; Giddings, Morgan C

    2009-08-19

    Modern, high-throughput biological experiments generate copious, heterogeneous, interconnected data sets. Research is dynamic, with frequently changing protocols, techniques, instruments, and file formats. Because of these factors, systems designed to manage and integrate modern biological data sets often end up as large, unwieldy databases that become difficult to maintain or evolve. The novel rule-based approach of the Ultra-Structure design methodology presents a potential solution to this problem. By representing both data and processes as formal rules within a database, an Ultra-Structure system constitutes a flexible framework that enables users to explicitly store domain knowledge in both a machine- and human-readable form. End users themselves can change the system's capabilities without programmer intervention, simply by altering database contents; no computer code or schemas need be modified. This provides flexibility in adapting to change, and allows integration of disparate, heterogenous data sets within a small core set of database tables, facilitating joint analysis and visualization without becoming unwieldy. Here, we examine the application of Ultra-Structure to our ongoing research program for the integration of large proteomic and genomic data sets (proteogenomic mapping). We transitioned our proteogenomic mapping information system from a traditional entity-relationship design to one based on Ultra-Structure. Our system integrates tandem mass spectrum data, genomic annotation sets, and spectrum/peptide mappings, all within a small, general framework implemented within a standard relational database system. General software procedures driven by user-modifiable rules can perform tasks such as logical deduction and location-based computations. The system is not tied specifically to proteogenomic research, but is rather designed to accommodate virtually any kind of biological research. We find Ultra-Structure offers substantial benefits for

  16. Ultra-Structure database design methodology for managing systems biology data and analyses

    PubMed Central

    Maier, Christopher W; Long, Jeffrey G; Hemminger, Bradley M; Giddings, Morgan C

    2009-01-01

    Background Modern, high-throughput biological experiments generate copious, heterogeneous, interconnected data sets. Research is dynamic, with frequently changing protocols, techniques, instruments, and file formats. Because of these factors, systems designed to manage and integrate modern biological data sets often end up as large, unwieldy databases that become difficult to maintain or evolve. The novel rule-based approach of the Ultra-Structure design methodology presents a potential solution to this problem. By representing both data and processes as formal rules within a database, an Ultra-Structure system constitutes a flexible framework that enables users to explicitly store domain knowledge in both a machine- and human-readable form. End users themselves can change the system's capabilities without programmer intervention, simply by altering database contents; no computer code or schemas need be modified. This provides flexibility in adapting to change, and allows integration of disparate, heterogenous data sets within a small core set of database tables, facilitating joint analysis and visualization without becoming unwieldy. Here, we examine the application of Ultra-Structure to our ongoing research program for the integration of large proteomic and genomic data sets (proteogenomic mapping). Results We transitioned our proteogenomic mapping information system from a traditional entity-relationship design to one based on Ultra-Structure. Our system integrates tandem mass spectrum data, genomic annotation sets, and spectrum/peptide mappings, all within a small, general framework implemented within a standard relational database system. General software procedures driven by user-modifiable rules can perform tasks such as logical deduction and location-based computations. The system is not tied specifically to proteogenomic research, but is rather designed to accommodate virtually any kind of biological research. Conclusion We find Ultra-Structure offers

  17. Barriers to Innovation in Urban Wastewater Utilities: Attitudes of Managers in California.

    PubMed

    Kiparsky, Michael; Thompson, Barton H; Binz, Christian; Sedlak, David L; Tummers, Lars; Truffer, Bernhard

    2016-06-01

    In many regions of the world, urban water systems will need to transition into fundamentally different forms to address current stressors and meet impending challenges-faster innovation will need to be part of these transitions. To assess the innovation deficit in urban water organizations and to identify means for supporting innovation, we surveyed wastewater utility managers in California. Our results reveal insights about the attitudes towards innovation among decision makers, and how perceptions at the level of individual managers might create disincentives for experimentation. Although managers reported feeling relatively unhindered organizationally, they also spend less time on innovation than they feel they should. The most frequently reported barriers to innovation included cost and financing; risk and risk aversion; and regulatory compliance. Considering these results in the context of prior research on innovation systems, we conclude that collective action may be required to address underinvestment in innovation.

  18. Commentary: Exploiting the overlap: using utilization management to reduce medical malpractice.

    PubMed

    Dulworth, Sherrie

    2003-01-01

    This report presents a practical way in which hospitals can reduce medical malpractice exposure that is related to omissions and delays in care. We illustrate our approach using the results of a risk/medical management study performed at an acute-care hospital. Traditional risk management (RM) often focuses retrospectively on adverse events and may miss opportunities to prevent errors related to omissions and delays in care. Close-to-real-time utilization management (UM) activity offers ready potential to improve quality and reduce medical malpractice--but only if UM can work synergistically with RM. It is our conclusion that hospitals can implement systematic processes to identify and intervene in patterns of omissions and delays and improve the communication and synergy among stakeholders and thereby improve patient safety and reduce their medical malpractice risks.

  19. Barriers to Innovation in Urban Wastewater Utilities: Attitudes of Managers in California

    NASA Astrophysics Data System (ADS)

    Kiparsky, Michael; Thompson, Barton H.; Binz, Christian; Sedlak, David L.; Tummers, Lars; Truffer, Bernhard

    2016-06-01

    In many regions of the world, urban water systems will need to transition into fundamentally different forms to address current stressors and meet impending challenges—faster innovation will need to be part of these transitions. To assess the innovation deficit in urban water organizations and to identify means for supporting innovation, we surveyed wastewater utility managers in California. Our results reveal insights about the attitudes towards innovation among decision makers, and how perceptions at the level of individual managers might create disincentives for experimentation. Although managers reported feeling relatively unhindered organizationally, they also spend less time on innovation than they feel they should. The most frequently reported barriers to innovation included cost and financing; risk and risk aversion; and regulatory compliance. Considering these results in the context of prior research on innovation systems, we conclude that collective action may be required to address underinvestment in innovation.

  20. An analysis of case management--the efficient utility of human resources, but to what end?

    PubMed

    Jones, A

    1995-05-01

    Case management has been credited as a modality to reduce the lengths of hospital admission and to utilize human resources more effectively. The approach concentrates on the process of delivering care to constantly improve the productivity levels of health care practitioners. The United Kingdom government policy is certainly progressing towards cost-containment and cost-effective service delivery. However, it needs to be considered if the culture of nursing would be able to adopt the strategy. Firstly, it needs to be questioned if nurses have the managerial and financial acuity to successfully perform the role. Secondly, the adoption of case management may potentially negate the value of some aspects of professionally skilled nursing care which has little cost-benefit analysis but provides the true essence of nursing. With a further advancement of cost-centered care, case management may become the anti-thesis of an inherently caring profession.

  1. Integrating Systems Health Management with Adaptive Controls for a Utility-Scale Wind Turbine

    NASA Technical Reports Server (NTRS)

    Frost, Susan A.; Goebel, Kai; Trinh, Khanh V.; Balas, Mark J.; Frost, Alan M.

    2011-01-01

    Increasing turbine up-time and reducing maintenance costs are key technology drivers for wind turbine operators. Components within wind turbines are subject to considerable stresses due to unpredictable environmental conditions resulting from rapidly changing local dynamics. Systems health management has the aim to assess the state-of-health of components within a wind turbine, to estimate remaining life, and to aid in autonomous decision-making to minimize damage. Advanced adaptive controls can provide the mechanism to enable optimized operations that also provide the enabling technology for Systems Health Management goals. The work reported herein explores the integration of condition monitoring of wind turbine blades with contingency management and adaptive controls. Results are demonstrated using a high fidelity simulator of a utility-scale wind turbine.

  2. Is control through utilization a cost effective Prosopis juliflora management strategy?

    PubMed

    Wakie, Tewodros T; Hoag, Dana; Evangelista, Paul H; Luizza, Matthew; Laituri, Melinda

    2016-03-01

    The invasive tree Prosopis juliflora is known to cause negative impacts on invaded ranges. High P. juliflora eradication costs have swayed developing countries to follow a new and less expensive approach known as control through utilization. However, the net benefits of this new approach have not been thoroughly evaluated. Our objective was to assess the economic feasibility of selected P. juliflora eradication and utilization approaches that are currently practiced in one of the severely affected developing countries, Ethiopia. The selected approaches include converting P. juliflora infested lands into irrigated farms (conversion), charcoal production, and seed flour production. We estimate the costs and revenues of the selected P. juliflora eradication and utilization approaches by interviewing 19 enterprise owners. We assess the economic feasibility of the enterprises by performing enterprise, break-even, investment, sensitivity, and risk analyses. Our results show that conversion to irrigated cotton is economically profitable, with Net Present Value (NPV) of 5234 US$/ha over 10 years and an interest rate of 10% per year. Conversion greatly reduces the spread of P. juliflora on farmlands. Managing P. juliflora infested lands for charcoal production with a four-year harvest cycle is profitable, with NPV of 805 US$/ha. However, the production process needs vigilant regulation to protect native plants from exploitation and caution should be taken to prevent charcoal production sites from becoming potential seed sources. Though flour from P. juliflora pods can reduce invasions by destroying viable seeds, flour enterprises in Ethiopia are unprofitable. Conversion and charcoal production can be undertaken with small investment costs, while flour production requires high investment costs. Introducing new changes in the production and management steps of P. juliflora flour might be considered to make the enterprise profitable. Our study shows that control

  3. Resource utilization after introduction of a standardized clinical assessment and management plan.

    PubMed

    Friedman, Kevin G; Rathod, Rahul H; Farias, Michael; Graham, Dionne; Powell, Andrew J; Fulton, David R; Newburger, Jane W; Colan, Steven D; Jenkins, Kathy J; Lock, James E

    2010-01-01

    A Standardized Clinical Assessment and Management Plan (SCAMP) is a novel quality improvement initiative that standardizes the assessment and management of all patients who carry a predefined diagnosis. Based on periodic review of systemically collected data the SCAMP is designed to be modified to improve its own algorithm. One of the objectives of a SCAMP is to identify and reduce resource utilization and patient care costs. We retrospectively reviewed resource utilization in the first 93 arterial switch operation (ASO) SCAMP patients and 186 age-matched control ASO patients. We compared diagnostic and laboratory testing obtained at the initial SCAMP clinic visit and control patient visits. To evaluate the effect of the SCAMP over time, the number of clinic visits per patient year and echocardiograms per patient year in historical control ASO patients were compared to the projected rates for ASO SCAMP participants. Cardiac magnetic resonance imaging (MRI), stress echocardiogram, and lipid profile utilization were higher in the initial SCAMP clinic visit group than in age-matched control patients. Total echocardiogram and lung scan usage were similar. Chest X-ray and exercise stress testing were obtained less in SCAMP patients. ASO SCAMP patients are projected to have 0.5 clinic visits and 0.5 echocardiograms per year. Historical control patients had more clinic visits (1.2 vs. 0.5 visits/patient year, P<.01) and a higher echocardiogram rate (0.92 vs. 0.5 echocardiograms/patient year, P<.01) Implementation of a SCAMP may initially lead to increased resource utilization, but over time resource utilization is projected to decrease.

  4. Can a chronic disease management pulmonary rehabilitation program for COPD reduce acute rural hospital utilization?

    PubMed

    Rasekaba, T M; Williams, E; Hsu-Hage, B

    2009-01-01

    Chronic obstructive pulmonary disease (COPD) imposes a costly burden on healthcare. Pulmonary rehabilitation (PR) is the best practice to better manage COPD to improve patient outcomes and reduce acute hospital care utilization. To evaluate the impact of a once-weekly, eight-week multidisciplinary PR program as an integral part of the COPD chronic disease management (CDM) Program at Kyabram District Health Services. The study compared two cohorts of COPD patients: CDM-PR Cohort (4-8 weeks) and Opt-out Cohort (0-3 weeks) between February 2006 and March 2007. The CDM-PR Program involved multidisciplinary patient education and group exercise training. Nonparametric statistical tests were used to compare acute hospital care utilization 12 months before and after the introduction of CDM-PR. The number of patients involved in the CDM-PR Cohort was 29 (n = 29), and that in the Opt-out Cohort was 24 (n = 24). The CDM-PR Cohort showed significant reductions in cumulative acute hospital care utilization indicators (95% emergency department presentations, 95% inpatient admissions, 99% length of stay; effect sizes = 0.62-0.66, P < 0.001) 12 months after the introduction of the CDM Program; in contrast, changes in the cumulative indicators were statistically insignificant for the Opt-out Cohort (emergency department presentations decreased by 5%, inpatient admissions decreased by 12%, length of stay increased by 30%; effect size = 0.14-0.40, P > 0.05). Total costs associated with the hospital care utilization decreased from $130,000 to $7,500 for the CDM-PR Cohort and increased from $77,700 to $101,200 for the Opt-out Cohort. Participation in the CDM-PR for COPD patients can significantly reduce acute hospital care utilization and associated costs in a small rural health service.

  5. Estimation of the intrinsic maximum substrate utilization rate using batch reactors with denitrifying biofilm: a proposed methodology.

    PubMed

    Rabah, Fahid K J; Dahab, Mohamed F; Zhang, Tian C

    2007-08-01

    A method for estimation of the maximum substrate utilization rate (q(max)) using batch reactors with denitrification biofilm was introduced and compared with the traditional method of using batch reactors with suspended growth for q(max) estimation. The values of q(max) obtained from the suspended-growth reactors (0.69 to 0.71 g N/g volatile suspended solids [VSS] x d) and from the attached-biomass reactors (0.74 to 0.85 g N/g VSS x d) are similar and within the range of the values reported in the literature (0.23 to 2.88 g N/g VSS x d). Therefore, the intrinsic kinetic parameter, q(max), can be obtained using attached-growth batch reactors, if the effectiveness factor, eta, is approximately equal to 1 and the bulk concentration of the rate-limiting substrate, C, is much higher than the half-velocity constant, K(S). The attached-growth batch reactor method is unique, because the biomass used in the batch tests is the same as that present in the parent reactor under investigation.

  6. Evaluation and Reduction of Machine Difference in Press Working with Utilization of Dedicated Die Support Structure and Numerical Methodologies

    NASA Astrophysics Data System (ADS)

    Ohashi, Takahiro

    2011-05-01

    In this study, support structures of a die for press working are discussed to solve the machine difference problems amongst presses. The developed multi-point die support structures are not only utilized for adjusting elastic deformation of a die, but also for in-process sensing of the behavior of a die. The structures have multiple support cells between a die and the slide of a press machine. The cell, known as `a support unit,' has the strain gauges attached on its side, and works in both ways as a kind of spring and a load and displacement sensor. The cell contacts on the die with a ball-contact, therefore it transmits only the vertical force at each support point. The isolation of a momentum and horizontal load at each support point contributes for a simple numerical model; it helps us to know the practical boundary condition at the points under an actual production. In addition, the momentum and horizontal forces at the points are useless for press working; the isolation of these forces contributes to reduce a jolt and related machine differences. The horizontal distribution of support units is changed to reduce elastic deformation of a die; it contributes to reduce a jolt, alignment errors of a die and geometrical errors of a product. The validity of those adjustments are confirmed with evaluating a product shape of a deep drawing and measuring jolts between upper and lower stamping dies. Furthermore, die deformation in a process is analyzed with using elastic FE analysis with actual bearing loads compiled from each support unit.

  7. Utilizing Combined Methodologies to Define the Role of Plasma Membrane Delivery During Axon Branching and Neuronal Morphogenesis.

    PubMed

    Winkle, Cortney C; Hanlin, Christopher C; Gupton, Stephanie L

    2016-03-16

    During neural development, growing axons extend to multiple synaptic partners by elaborating axonal branches. Axon branching is promoted by extracellular guidance cues like netrin-1 and results in dramatic increases to the surface area of the axonal plasma membrane. Netrin-1-dependent axon branching likely involves temporal and spatial control of plasma membrane expansion, the components of which are supplied through exocytic vesicle fusion. These fusion events are preceded by formation of SNARE complexes, comprising a v-SNARE, such as VAMP2 (vesicle-associated membrane protein 2), and plasma membrane t-SNAREs, syntaxin-1 and SNAP25 (synaptosomal-associated protein 25). Detailed herein isa multi-pronged approach used to examine the role of SNARE mediated exocytosis in axon branching. The strength of the combined approach is data acquisition at a range of spatial and temporal resolutions, spanning from the dynamics of single vesicle fusion events in individual neurons to SNARE complex formation and axon branching in populations of cultured neurons. This protocol takes advantage of established biochemical approaches to assay levels of endogenous SNARE complexes and Total Internal Reflection Fluorescence (TIRF) microscopy of cortical neurons expressing VAMP2 tagged with a pH-sensitive GFP (VAMP2-pHlourin) to identify netrin-1 dependent changes in exocytic activity in individual neurons. To elucidate the timing of netrin-1-dependent branching, time-lapse differential interference contrast (DIC) microscopy of single neurons over the order of hours is utilized. Fixed cell immunofluorescence paired with botulinum neurotoxins that cleave SNARE machinery and block exocytosis demonstrates that netrin-1 dependent axon branching requires SNARE-mediated exocytic activity.

  8. Utilizing Combined Methodologies to Define the Role of Plasma Membrane Delivery During Axon Branching and Neuronal Morphogenesis

    PubMed Central

    Winkle, Cortney C.; Hanlin, Christopher C.; Gupton, Stephanie L.

    2016-01-01

    During neural development, growing axons extend to multiple synaptic partners by elaborating axonal branches. Axon branching is promoted by extracellular guidance cues like netrin-1 and results in dramatic increases to the surface area of the axonal plasma membrane. Netrin-1-dependent axon branching likely involves temporal and spatial control of plasma membrane expansion, the components of which are supplied through exocytic vesicle fusion. These fusion events are preceded by formation of SNARE complexes, comprising a v-SNARE, such as VAMP2 (vesicle-associated membrane protein 2), and plasma membrane t-SNAREs, syntaxin-1 and SNAP25 (synaptosomal-associated protein 25). Detailed herein is a multi-pronged approach used to examine the role of SNARE mediated exocytosis in axon branching. The strength of the combined approach is data acquisition at a range of spatial and temporal resolutions, spanning from the dynamics of single vesicle fusion events in individual neurons to SNARE complex formation and axon branching in populations of cultured neurons. This protocol takes advantage of established biochemical approaches to assay levels of endogenous SNARE complexes and Total Internal Reflection Fluorescence (TIRF) microscopy of cortical neurons expressing VAMP2 tagged with a pH-sensitive GFP (VAMP2-pHlourin) to identify netrin-1 dependent changes in exocytic activity in individual neurons. To elucidate the timing of netrin-1-dependent branching, time-lapse differential interference contrast (DIC) microscopy of single neurons over the order of hours is utilized. Fixed cell immunofluorescence paired with botulinum neurotoxins that cleave SNARE machinery and block exocytosis demonstrates that netrin-1 dependent axon branching requires SNARE-mediated exocytic activity. PMID:27023471

  9. Integrated EAP/Managed Behavioral Health Plan Utilization by Persons with Substance Use Disorders

    PubMed Central

    Levy Merrick, Elizabeth S.; Hodgkin, Dominic; Hiatt, Deirdre; Horgan, Constance M.; Greenfield, Shelly F.; McCann, Bernard

    2011-01-01

    New federal parity and health reform legislation, promising increased behavioral health care access and a focus on prevention, has heightened interest in employee assistance programs (EAPs). This study investigated service utilization by persons with a primary substance use disorder (SUD) diagnosis in a managed behavioral healthcare organization's integrated EAP/managed behavioral health care product (N=1,158). In 2004, 25.0% of clients used the EAP first for new treatment episodes. After initial EAP utilization, 44.4% received no additional formal services through the plan and 40.4% received regular outpatient services. Overall, outpatient care, intensive outpatient/day treatment, and inpatient/residential detoxification were most common. About half of clients had co-occurring psychiatric diagnoses. Mental health service utilization was extensive. Findings suggest that for service users with primary SUD diagnoses in an integrated EAP/MBHC product, the EAP benefit plays a key role at the front end of treatment and is often only one component of treatment episodes. PMID:21185684

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

    NASA Astrophysics Data System (ADS)

    Bock, Mark Joseph

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

  11. Variable Resource Utilization in the Prenatal and Postnatal Management of Isolated Hydronephrosis.

    PubMed

    Dy, Geolani W; Ellison, Jonathan S; Fu, Benjamin C; Holt, Sarah K; Gore, John L; Merguerian, Paul A

    2017-10-01

    To characterize contemporary resource utilization and medical outcomes for infants with antenatal hydronephrosis and their mothers from a national claims database. We hypothesize that management of isolated hydronephrosis (IHN) varies widely, with decreased imaging following the 2010 Society for Fetal Urology Consensus Statement. Using MarketScan claims from 2007 to 2013, we identified infants 0-12 months of age with hydronephrosis and linked mothers. Those with urologic diagnoses more specific than hydronephrosis, additional urologic comorbidities, or postnatal surgeries were excluded. Resource utilization including prenatal and postnatal imaging, laboratory studies, hospital admissions, and medical outcomes within the first year was captured. Demographics, maternal characteristics, utilization measures, and outcomes were compared across imaging intensity groups based on number of postnatal ultrasounds received using bivariate analysis. Among 801,919 mother-child pairs, 8610 infants (1.1%) had hydronephrosis or a related diagnosis. A total of 5876 (68.2%) met inclusion criteria for IHN. Patients underwent a mean 5.3 ± 3.5 prenatal and 2.1 ± 1.3 postnatal ultrasounds before age 1. Imaging practices were unchanged following the Society for Fetal Urology consensus statement. Antenatal hydronephrosis prevalence in an insured population is consistent with published ranges. Prenatal imaging in IHN is variable and potentially excessive. Future study into the efficacy of evidence-based pathways in reducing excess utilization is warranted. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Management of old landfills by utilizing forest and energy industry waste flows.

    PubMed

    Niutanen, Ville; Korhonen, Jouni

    2002-05-01

    The lack of landfill capacity, forthcoming EU waste disposal and landfill management legislation and the use of non-renewable and energy intensive natural resources for the end-treatment of old landfills increase pressures to develop new landfill management methods. This paper considers a method for the end-management of old landfills in Finland, which is based on the utilization of forest and paper industry waste flows, wastes from paper recycling (de-inking) and wastes from forest industry energy production. Fibre clay wastes from paper mills, de-inking sludges from de-inking of recovered waste paper and incineration ash from forest industry power plants serve to substitute the use of natural clay for the building of landfill structures for closed landfills. Arguably, this method is preferable to existing practices of natural clay use for landfill building, because it (1) substitutes non-renewable natural clay, (2) consumes less energy and generates less CO2 emissions than the use of natural clay, and (3) eliminates considerable amounts of wastes from paper production, paper consumption and from forest industry energy production. Some difficulties in the application of the method are considered and the waste flow utilization is incorporated into a local forest industry recycling network.

  13. Development of an integrated methodology for the sustainable environmental and socio-economic management of river ecosystems.

    PubMed

    Koundouri, P; Ker Rault, P; Pergamalis, V; Skianis, V; Souliotis, I

    2016-01-01

    The development of the Water Framework Directive aimed to establish an integrated framework of water management at European level. This framework revolves around inland surface waters, transitional waters, coastal waters and ground waters. In the process of achieving the environment and ecological objectives set from the Directive, the role of economics is put in the core of the water management. An important feature of the Directive is the recovery of total economic cost of water services by all users. The total cost of water services can be disaggregated into environmental, financial and resource costs. Another important aspect of the directive is the identification of major drivers and pressures in each River Basin District. We describe a methodology that is aiming to achieve sustainable and environmental and socioeconomic management of freshwater ecosystem services. The Ecosystem Services Approach is in the core of the suggested methodology for the implementation of a more sustainable and efficient water management. This approach consists of the following three steps: (i) socio-economic characterization of the River Basin area, (ii) assessment of the current recovery of water use cost, and (iii) identification and suggestion of appropriate programs of measures for sustainable water management over space and time. This methodology is consistent with a) the economic principles adopted explicitly by the Water Framework Directive (WFD), b) the three-step WFD implementation approach adopted in the WATECO document, c) the Ecosystem Services Approach to valuing freshwater goods and services to humans. Furthermore, we analyze how the effects of multiple stressors and socio-economic development can be quantified in the context of freshwater resources management. We also attempt to estimate the value of four ecosystem services using the benefit transfer approach for the Anglian River Basin, which showed the significance of such services.

  14. Flash memory management system and method utilizing multiple block list windows

    NASA Technical Reports Server (NTRS)

    Chow, James (Inventor); Gender, Thomas K. (Inventor)

    2005-01-01

    The present invention provides a flash memory management system and method with increased performance. The flash memory management system provides the ability to efficiently manage and allocate flash memory use in a way that improves reliability and longevity, while maintaining good performance levels. The flash memory management system includes a free block mechanism, a disk maintenance mechanism, and a bad block detection mechanism. The free block mechanism provides efficient sorting of free blocks to facilitate selecting low use blocks for writing. The disk maintenance mechanism provides for the ability to efficiently clean flash memory blocks during processor idle times. The bad block detection mechanism provides the ability to better detect when a block of flash memory is likely to go bad. The flash status mechanism stores information in fast access memory that describes the content and status of the data in the flash disk. The new bank detection mechanism provides the ability to automatically detect when new banks of flash memory are added to the system. Together, these mechanisms provide a flash memory management system that can improve the operational efficiency of systems that utilize flash memory.

  15. Characteristics associated with home- and community-based service utilization for Medicare managed care consumers.

    PubMed

    Alkema, Gretchen E; Reyes, Judy Y; Wilber, Kathleen H

    2006-04-01

    We identified the types of home- and community-based services (HCBS) that high-risk older adults in Medicare managed care used, and we examined participant characteristics associated with service use in six areas: overall service use, four specific categories of HCBS, and referrals to insured medical services. We used service data from the Care Advocate Demonstration Program, a telephone-based care-management intervention that linked chronically ill older adults to HCBS. Two hundred and twenty-four high-risk older adults who were enrolled in a southern California-based Medicare managed care plan received an assessment, service referrals, and 12 months of telephone follow-up by master's level social service professionals. We used logistic regression to estimate the odds of using the HCBS categories and medical services. Results indicated that characteristics associated with service use varied extensively, depending on the service. Age, gender, social support, living situation, education, specific functional impairments, heart conditions, and sensory impairments at baseline significantly predicted utilization in the six different service models. Policy implications include the importance of individualized care-management assessments that direct targeted referrals to appropriate services. Findings support the need for individualized care-management assessment and service planning, suggesting that a "one size fits all" approach to HCBS will not meet the varied needs of diverse consumers.

  16. Improvement of the health technology management process of the public Health Service in Morelos using the Six Sigma methodology.

    PubMed

    Becerril-Alquicira, A; Ortiz-Posadas, M R

    2010-01-01

    The purpose of this study was to make a proposal to improve the management process of the health technology within the Health Service at Morelos State, México, using the five stages of Six Sigma methodology: Definition, Measurement, Analysis, Improvement and Control. Up to date these five steps have been executed resulting in a set of proposals to improve the current health technology management process. This will allow the establishment of a medical equipment control program that impacts the three levels of Health Care Service in Morelos State in Mexico.

  17. Do Italian Companies Manage Work-Related Stress Effectively? A Process Evaluation in Implementing the INAIL Methodology.

    PubMed

    Di Tecco, Cristina; Ronchetti, Matteo; Ghelli, Monica; Russo, Simone; Persechino, Benedetta; Iavicoli, Sergio

    2015-01-01

    Studies on Intervention Process Evaluation are attracting growing attention in the literature on interventions linked to stress and the wellbeing of workers. There is evidence that some elements relating to the process and content of an intervention may have a decisive role in implementing it by facilitating or hindering the effectiveness of the results. This study aimed to provide a process evaluation on interventions to assess and manage risks related to work-related stress using a methodological path offered by INAIL. The final sample is composed of 124 companies participating to an interview on aspects relating to each phase of the INAIL methodological path put in place to implement the intervention. INAIL methodology has been defined as useful in the process of assessing and managing the risks related to work-related stress. Some factors related to the process (e.g., implementation of a preliminary phase, workers' involvement, and use of external consultants) showed a role in significant differences that emerged in the levels of risk, particularly in relation to findings from the preliminary assessment. Main findings provide information on the key aspects of process and content that are useful in implementing an intervention for assessing and managing risks related to work-related stress.

  18. Cost-Utility Analysis: Sartorius Flap versus Negative Pressure Therapy for Infected Vascular Groin Graft Managment

    PubMed Central

    Macarios, David; Griffin, Leah; Kosowski, Tomasz; Pyfer, Bryan J.; Offodile, Anaeze C.; Driscoll, Daniel; Maddali, Sirish; Attwood, John

    2015-01-01

    Background: Sartorius flap coverage and adjunctive negative pressure wound therapy (NPWT) have been described in managing infected vascular groin grafts with varying cost and clinical success. We performed a cost–utility analysis comparing sartorius flap with NPWT in managing an infected vascular groin graft. Methods: A literature review compiling outcomes for sartorius flap and NPWT interventions was conducted from peer-reviewed journals in MEDLINE (PubMed) and EMBASE. Utility scores were derived from expert opinion and used to estimate quality-adjusted life years (QALYs). Medicare current procedure terminology and diagnosis-related groups codes were used to assess the costs for successful graft salvage with the associated complications. Incremental cost-effectiveness was assessed at $50,000/QALY, and both univariate and probabilistic sensitivity analyses were conducted to assess robustness of the conclusions. Results: Thirty-two studies were used pooling 384 patients (234 sartorius flaps and 150 NPWT). NPWT had better clinical outcomes (86.7% success rate, 0.9% minor complication rate, and 13.3% major complication rate) than sartorius flap (81.6% success rate, 8.0% minor complication rate, and 18.4% major complication rate). NPWT was less costly ($12,366 versus $23,516) and slightly more effective (12.06 QALY versus 12.05 QALY) compared with sartorius flap. Sensitivity analyses confirmed the robustness of the base case findings; NPWT was either cost-effective at $50,000/QALY or dominated sartorius flap in 81.6% of all probabilistic sensitivity analyses. Conclusion: In our cost–utility analysis, use of adjunctive NPWT, along with debridement and antibiotic treatment, for managing infected vascular groin graft wounds was found to be a more cost-effective option when compared with sartorius flaps. PMID:26893991

  19. Cost-Utility Analysis: Sartorius Flap versus Negative Pressure Therapy for Infected Vascular Groin Graft Managment.

    PubMed

    Chatterjee, Abhishek; Macarios, David; Griffin, Leah; Kosowski, Tomasz; Pyfer, Bryan J; Offodile, Anaeze C; Driscoll, Daniel; Maddali, Sirish; Attwood, John

    2015-11-01

    Sartorius flap coverage and adjunctive negative pressure wound therapy (NPWT) have been described in managing infected vascular groin grafts with varying cost and clinical success. We performed a cost-utility analysis comparing sartorius flap with NPWT in managing an infected vascular groin graft. A literature review compiling outcomes for sartorius flap and NPWT interventions was conducted from peer-reviewed journals in MEDLINE (PubMed) and EMBASE. Utility scores were derived from expert opinion and used to estimate quality-adjusted life years (QALYs). Medicare current procedure terminology and diagnosis-related groups codes were used to assess the costs for successful graft salvage with the associated complications. Incremental cost-effectiveness was assessed at $50,000/QALY, and both univariate and probabilistic sensitivity analyses were conducted to assess robustness of the conclusions. Thirty-two studies were used pooling 384 patients (234 sartorius flaps and 150 NPWT). NPWT had better clinical outcomes (86.7% success rate, 0.9% minor complication rate, and 13.3% major complication rate) than sartorius flap (81.6% success rate, 8.0% minor complication rate, and 18.4% major complication rate). NPWT was less costly ($12,366 versus $23,516) and slightly more effective (12.06 QALY versus 12.05 QALY) compared with sartorius flap. Sensitivity analyses confirmed the robustness of the base case findings; NPWT was either cost-effective at $50,000/QALY or dominated sartorius flap in 81.6% of all probabilistic sensitivity analyses. In our cost-utility analysis, use of adjunctive NPWT, along with debridement and antibiotic treatment, for managing infected vascular groin graft wounds was found to be a more cost-effective option when compared with sartorius flaps.

  20. Advances in management and utilization of invasive water hyacinth (Eichhornia crassipes) in aquatic ecosystems - a review.

    PubMed

    Yan, Shao-Hua; Song, Wei; Guo, Jun-Yao

    2017-03-01

    The objective of this review is to provide a concise summary of literature in the Chinese language since late 1970s and focuses on recent development in global scenarios. This work will replenish the FAO summary of water hyacinth utilization from 1917 to 1979 and review ecological and socioeconomic impacts of the water hyacinth from 1980 to 2010. This review also discusses the debate on whether the growth of the water hyacinth is a problem, a challenge or an opportunity. Literature suggested that integrated technologies and good management may be an effective solution and the perception of water hyacinth could change from that of a notorious aquatic weed to a valuable resource, including its utilization as a biological agent for the application in bioremediation for removing excess nutrients from eutrophic water bodies at low cost. Key aspects on system integration and innovation may focus on low-cost and efficient equipment and the creation of value-added goods from water hyacinth biomass. In the socioeconomic and ecological domain of global development, all the successful and sustainable management inputs for the water hyacinth must generate some sort of social and economic benefit simultaneously, as well as benefiting the ecosystem. Potential challenges exist in linkages between the management of water hyacinth on the large scale to the sustainable development of agriculture based on recycling nutrients, bio-energy production or silage and feed production. Further research and development may focus on more detailed biology of water hyacinth related with its utilization, cost-benefit analysis of middle to large-scale application of the technologies and innovation of the equipment used for harvesting and dehydrating the plant.

  1. Diabetes Mellitus and Infection: An Evaluation of Hospital Utilization and Management Costs in the United States

    PubMed Central

    Korbel, Lindsey; Spencer, John David

    2014-01-01

    Aims The objective of this study is to evaluate the number of diabetics that seek medical treatment in emergency departments or require hospitalization for infection management in the United States. This study also assesses the socioeconomic impact of inpatient infection management among diabetics. Methods We accessed the Healthcare Cost and Utilization Project’s Nationwide Emergency Department Sample database and the Nationwide Inpatient Sample database to perform a retrospective analysis on diabetics presenting to the emergency department or hospitalized for infection management from 2006-2011. Results Emergency Department Since 2006, nearly 10 million diabetics were annually evaluated in the emergency department. Infection was the primary reason for presentation in 10% of these visits. Among those visits, urinary tract infection was the most common infection, accounting for over 30% of emergency department encounters for infections. Other common infections included sepsis, skin and soft tissue infections, and pneumonia. Diabetics were more than twice as likely to be hospitalized for infection management than patients without diabetes. Hospitalization Since 2006, nearly 6 million diabetics were annually hospitalized. 8-12% of these patients were hospitalized for infection management. In 2011, the inpatient care provided to patients with DM and infection was responsible for over $48 billion dollars in aggregate hospital charges. Conclusions Diabetics commonly present to the emergency department and require hospitalization for infection management. The care provided to diabetics for infection management has a large economic impact on the United States healthcare system. More efforts are needed to develop cost-effective strategies for the prevention of infection in patients with diabetes. PMID:25488325

  2. Critical aortic stenosis and acute ascending aortic penetrating ulcer managed utilizing transapical TAVR and TEVAR.

    PubMed

    Allen, Keith B; Davis, J Russell; Cohen, David J

    2015-10-01

    Thoracic endovascular aortic repair (TEVAR) of acute ascending aortic pathology is feasible; however, the unique features of this aortic segment in addition to access challenges restricts its use to a select, high-risk subset of patients. With the advent of TAVR, large device delivery using transapical access has become a well-defined technique. We report a patient with critical aortic stenosis and an acute ascending aortic penetrating ulcer with tamponade managed successfully utilizing transapical TAVR and TEVAR. To our knowledge, this is the first reported case of a hybrid single-stage TAVR and ascending aortic TEVAR using transapical access.

  3. What Ambulatory Care Managers Need to Know About Examination Room Utilization Measurement and Analysis.

    PubMed

    Klarich, Mark J; Rea, Ronald W; Lal, Tarun Mohan; Garcia, Angel L; Steffens, Fay L

    2016-01-01

    Demand for ambulatory care visits is projected to increase 22% between 2008 and 2025. Given this growth, ambulatory care managers need to proactively plan for efficient use of scarce resources (ie, space, equipment, and staff). One important component of ambulatory care space (the number of examination rooms) is dependent on multiple factors, including variation in demand, hours of operation, scheduling, and staff. The authors (1) outline common data collection methods, (2) highlight analysis and reporting considerations for examination room utilization, and (3) provide a strategic framework for short- and long-term decision making for facility design or renovation.

  4. Removal of uranium and priority pollutant metals from Fernald Environmental Management Project wastewater utilizing potassium ferrate

    SciTech Connect

    Hampshire, L.H. . Fernald Environmental Management Project); Potts, M.E. )

    1992-01-30

    A side-by-side treatment comparison between calcium hydroxide and TRU/Clear {reg sign} 4'', a potassium ferrate based wastewater treatment chemical, was performed in a process wastewater and stormwater treatment facility. Results from the full-scale plant testing demonstrated that potassium ferrate could achieve the same treatment levels as calcium hydroxide while generating 55% less sludge than the calcium hydroxide treatment. The testing also showed that utilization of potassium ferrate would minimize the volume of sludge generated and assist in the reduction of total waste management costs associated with storage, monitoring, transportation, and final disposition of generated sludge.

  5. Removal of uranium and priority pollutant metals from Fernald Environmental Management Project wastewater utilizing potassium ferrate

    SciTech Connect

    Hampshire, L.H.; Potts, M.E.

    1992-01-30

    A side-by-side treatment comparison between calcium hydroxide and TRU/Clear {reg_sign} ``4``, a potassium ferrate based wastewater treatment chemical, was performed in a process wastewater and stormwater treatment facility. Results from the full-scale plant testing demonstrated that potassium ferrate could achieve the same treatment levels as calcium hydroxide while generating 55% less sludge than the calcium hydroxide treatment. The testing also showed that utilization of potassium ferrate would minimize the volume of sludge generated and assist in the reduction of total waste management costs associated with storage, monitoring, transportation, and final disposition of generated sludge.

  6. Zonal management of multi-purposes groundwater utilization based on water quality and impact on the aquifer.

    PubMed

    Liang, Ching-Ping; Jang, Cheng-Shin; Chen, Ching-Fang; Chen, Jui-Sheng

    2016-07-01

    Groundwater is widely used for drinking, irrigation, and aquaculture in the Pingtung Plain, Southwestern Taiwan. The overexploitation and poor quality of groundwater in some areas of the Pingtung Plain pose great challenges for the safe use and sustainable management of groundwater resources. Thus, establishing an effective management plan for multi-purpose groundwater utilization in the Pingtung Plain is imperative. Considerations of the quality of the groundwater and potential impact on the aquifer of groundwater exploitation are paramount to multi-purpose groundwater utilization management. This study proposes a zonal management plan for the multi-purpose use of groundwater in the Pingtung Plain. The zonal management plan is developed by considering the spatial variability of the groundwater quality and the impact on the aquifer, which is defined as the ratio of the actual groundwater extraction rate to transmissivity. A geostatistical Kriging approach is used to spatially delineate the safe zones based on the water quality standards applied in the three groundwater utilization sectors. Suitable zones for the impact on the aquifer are then spatially determined. The evaluation results showing the safe water quality zones for the three types of utilization demands and suitable zones for the impact on aquifer are integrated to create a zonal management map for multi-purpose groundwater utilization which can help government administrators to establish a water resource management strategy for safe and sustainable use of groundwater to meet multi-purpose groundwater utilization requirements in the Pingtung Plain.

  7. Partnerships between utilities and small-scale providers: Delegated management in Kisumu, Kenya

    NASA Astrophysics Data System (ADS)

    Schwartz, Klaas; Sanga, Anthony

    Increasingly, partnerships between small-scale providers and formal utilities are being promoted as an alternative model of infrastructure development and service provision. This paper analyzes the potential of such a model for bridging the gap in service provision in peri-urban areas. The model, which this article focuses on, is the delegated management model, which has been implemented in Kisumu, Kenya. In this model a formal utility entered into contracts with multiple small-scale providers to distribute water to an informal settlement. In this arrangement, the water utility sells bulk water to the small-scale providers and these then distribute the water to an area covering about 120 connections for each provider. The research finds that the arrangement in Kisumu has met with mixed results. On the one hand, the arrangement led to considerable service expansion and to service improvements for those not connected to the network. Also, the formal utility benefited from the fact that they generated additional revenue by selling bulk water to the small-scale providers. The arrangement has also generated employment for those working for the small-scale providers. On the other hand, experiences so far, show that some challenges need to be addressed before the partnership arrangement becomes truly sustainable. For some providers corruption seems to be a problem as funds have been misappropriated. Also, the utility has not upheld the agreement to transfer all ‘old connections’ to the small-scale providers. A particularly worrying feature is that in low-income areas of Nyalenda, the customers of kiosks run by the small-scale providers pay three times more for their water than households who have an in-house connection.

  8. Environmental auditing: Capabilities and management utility of recreation impact monitoring programs

    USGS Publications Warehouse

    Marion, J.L.

    1995-01-01

    A recreation impact monitoring system was developed and applied in 1984?1986 and in 1991 to all backcountry river-accessed campsites within Delaware Water Gap National Recreation Area, Pennsylvania and New Jersey. Results suggest that actions implemented by park managers in response to problems identified by the initial survey were highly effective in reducing resource degradation caused by camping. In particular, the elimination of some designated campsites and installation of anchored firegrates reduced the total area of disturbance by 50%. Firegrate installation provided a focal point that increased the concentration of camping activities, allowing peripheral areas to recover. As suggested by predictive models, additional resource degradation caused by increased camping intensities is more than offset by improvements in the condition of areas where use is eliminated. The capabilities and management utility of recreation impact monitoring programs, illustrated by the Delaware Water Gap monitoring program, are also presented and discussed.

  9. Utility of Functional Hemodynamics and Echocardiography to Aid Diagnosis and Management of Shock.

    PubMed

    McGee, William T; Raghunathan, Karthik; Adler, Adam C

    2015-12-01

    The utility of functional hemodynamics and bedside ultrasonography is increasingly recognized as advantageous for both improved diagnosis and management of shock states. In contrast to conventional "static" measures, "dynamic" hemodynamic measures and bedside imaging modalities enhance pathophysiology-based comprehensive understanding of shock states and the response to therapy. The current editions of major textbooks in the primary specialties--in which clinicians routinely encounter patients in shock--including surgery, anesthesia, emergency medicine, and internal medicine continue to incorporate traditional (conventional) descriptions of shock that use well-described (but potentially misleading) intravascular pressures to classify shock states. Reliance on such intravascular pressure measurements is not as helpful as newer "dynamic" functional measures including ultrasonography to both better assess volume responsiveness and biventricular cardiac function. This review thus emphasizes the application of current functional hemodynamics and ultrasonography to the diagnosis and management of shock as a contrast to conventional "static" pressure-based measures.

  10. Clinical Utility of Viral Load in Management of Cytomegalovirus Infection after Solid Organ Transplantation

    PubMed Central

    2013-01-01

    SUMMARY The negative impact of cytomegalovirus (CMV) infection on transplant outcomes warrants efforts toward improving its prevention, diagnosis, and treatment. During the last 2 decades, significant breakthroughs in diagnostic virology have facilitated remarkable improvements in CMV disease management. During this period, CMV nucleic acid amplification testing (NAT) evolved to become one of the most commonly performed tests in clinical virology laboratories. NAT provides a means for rapid and sensitive diagnosis of CMV infection in transplant recipients. Viral quantification also introduced several principles of CMV disease management. Specifically, viral load has been utilized (i) for prognostication of CMV disease, (ii) to guide preemptive therapy, (iii) to assess the efficacy of antiviral treatment, (iv) to guide the duration of treatment, and (v) to indicate the risk of clinical relapse or antiviral drug resistance. However, there remain important limitations that require further optimization, including the interassay variability in viral load reporting, which has limited the generation of standardized viral load thresholds for various clinical indications. The recent introduction of an international reference standard should advance the major goal of uniform viral load reporting and interpretation. However, it has also become apparent that other aspects of NAT should be standardized, including sample selection, nucleic acid extraction, amplification, detection, and calibration, among others. This review article synthesizes the vast amount of information on CMV NAT and provides a timely review of the clinical utility of viral load testing in the management of CMV in solid organ transplant recipients. Current limitations are highlighted, and avenues for further research are suggested to optimize the clinical application of NAT in the management of CMV after transplantation. PMID:24092851

  11. A PDA study management tool (SMT) utilizing wireless broadband and full DICOM viewing capability

    NASA Astrophysics Data System (ADS)

    Documet, Jorge; Liu, Brent; Zhou, Zheng; Huang, H. K.; Documet, Luis

    2007-03-01

    During the last 4 years IPI (Image Processing and Informatics) Laboratory has been developing a web-based Study Management Tool (SMT) application that allows Radiologists, Film librarians and PACS-related (Picture Archiving and Communication System) users to dynamically and remotely perform Query/Retrieve operations in a PACS network. The users utilizing a regular PDA (Personal Digital Assistant) can remotely query a PACS archive to distribute any study to an existing DICOM (Digital Imaging and Communications in Medicine) node. This application which has proven to be convenient to manage the Study Workflow [1, 2] has been extended to include a DICOM viewing capability in the PDA. With this new feature, users can take a quick view of DICOM images providing them mobility and convenience at the same time. In addition, we are extending this application to Metropolitan-Area Wireless Broadband Networks. This feature requires Smart Phones that are capable of working as a PDA and have access to Broadband Wireless Services. With the extended application to wireless broadband technology and the preview of DICOM images, the Study Management Tool becomes an even more powerful tool for clinical workflow management.

  12. Dose-response effects for disease management programs on hospital utilization in Illinois Medicaid.

    PubMed

    Berg, Gregory D; Donnelly, Shawn; Miller, Mary; Medina, Wendie; Warnick, Kathleen

    2012-12-01

    The objective of this study is to estimate a dose-response impact of disease management contacts on inpatient admissions. Multivariate regression analysis of panel data was used to test the hypothesis that increased disease management contacts lower the odds of an inpatient admission. Subjects were 40,452 members of Illinois' noninstitutionalized Medicaid-only aged, blind, or disabled population diagnosed with asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes, and/or heart failure. All members are also in the state's Illinois Health Connect program, a medical home strategy in place for most of the 2.4 million Illinois Medicaid beneficiaries. The statistical measure is the odds ratio, which is a measure of association between the monthly inpatient admission indicator and the number of contacts (doses) a member has had for each particular disease management intervention. Statistically significant contacts are between 8 and 12 for heart failure, between 4 and 12 contacts for diabetes, and between 8 and 13 contacts for asthma. Total inpatient savings during the study period is estimated to be $12.4 million. This study shows the dose-response pattern of inpatient utilization improvements through the number of disease management contacts.

  13. Utility of the advanced chronic kidney disease patient management tools: case studies.

    PubMed

    Patwardhan, Meenal B; Matchar, David B; Samsa, Gregory P; Haley, William E

    2008-01-01

    Appropriate management of advanced chronic kidney disease (CKD) delays or limits its progression. The Advanced CKD Patient Management Toolkit was developed using a process-improvement technique to assist patient management and address CKD-specific management issues. We pilot tested the toolkit in 2 community nephrology practices, assessed the utility of individual tools, and evaluated the impact on conformance to an advanced CKD guideline through patient chart abstraction. Tool use was distinct in the 2 sites and depended on the site champion's involvement, the extent of process reconfiguration demanded by a tool, and its perceived value. Baseline conformance varied across guideline recommendations (averaged 54%). Posttrial conformance increased in all clinical areas (averaged 59%). Valuable features of the toolkit in real-world settings were its ability to: facilitate tool selection, direct implementation efforts in response to a baseline performance audit, and allow selection of tool versions and customizing them. Our results suggest that systematically created, multifaceted, and customizable tools can promote guideline conformance.

  14. Utility of Laboratory Diagnosis for Confirmation of the Syndromic Case Management in Married Indian Women with Vaginal Discharge

    PubMed Central

    Aggarwal, Prabhav; Bhattar, Sonali; Sahani, Satyendra Kumar; Bhalla, Preena

    2016-01-01

    Objective WHO and NACO recommend treatment of STIs/RTIs on the basis syndromic case management (SCM), even without laboratory confirmation, which may lead to over-treatment. Thus, this study was conducted to evaluate the utility of laboratory diagnosis for confirmation of patients with vaginal discharge diagnosed on the basis of SCM. Methodology 234 married women in reproductive age group, diagnosed as having vaginal discharge syndrome were included. Normal saline wet-mount slide preparations were made for detection of motile trichomonads. Gram stained smear were prepared and scored as per classification developed by Nugent. The presence of pseudohyphae and/or budding yeast cells was considered diagnostic of candidal infection. VDRL, TPHA and HIV testing were also done as per protocol. Results The median age of the study population was 34 years. Most common cause was bacterial vaginosis (positive= 21.4%, 95% CI= 16.6–27.1%; intermediate score= 17.5%, 95% CI= 13.2–22.9%), followed by candidiasis (13.7%, 95% CI= 98–18.7%) and trichomoniasis (0.4%, 95% CI= 0–2.6%). No etiological diagnosis for vaginal discharge could be established in approximately half of the women. Only two women were HIV positive; one was reactive by VDRL and TPHA tests. Conclusion Our study highlights the possible lacunae in SCM. Large number of patients may be over-treated if only syndromic management is followed, with financial, medical and social implications. Thus we recommend, the treatment maybe initiated on the basis of SCM, but it is essential that laboratory diagnosis is sought for and the treatment modified accordingly. PMID:27833516

  15. Four perspectives on self-management support by nurses for people with chronic conditions: a Q-methodological study.

    PubMed

    van Hooft, Susanne M; Dwarswaard, Jolanda; Jedeloo, Susan; Bal, Roland; van Staa, AnneLoes

    2015-01-01

    Self-management support is a major task of nurses in chronic care. Several conceptualizations on what self-management support encompasses are described in the literature. However, nurses' attitudes and perceptions related to self-management support are not known. To reveal distinctive perspectives of nurses toward self-management support in chronic care. A Q-methodological study was conducted in which nurses rank-ordered 37 statements on self-management support. Thereafter they motivated their ranking in semi-structured interviews. A purposive sample of 49 Dutch nurses with a variety of educational levels, age, and from different healthcare settings was invited by e-mail to participate in the study. Thirty-nine nurses (aged 21-54 years) eventually participated. The nurses worked in the following settings: hospital (n=11, 28%), home-care (n=14, 36%), mental health care (n=7, 17%), elderly care (n=6, 15%) and general practice (n=1, 3%). Four distinct perspectives on the goals for self-management support were identified: the Coach, the Clinician, the Gatekeeper and the Educator perspective. The Coach nurse focuses on the patient's daily life activities, whereas the nurses of the Clinician type aim to achieve adherence to treatment. The goal of self-management support from the Gatekeeper perspective is to reduce health care costs. Finally, the Educator nurse focuses on instructing patients in managing the illness. The changing role of chronic patients with regard to self-management asks for a new understanding of nurses' supportive tasks. Nurses appear to have dissimilar perceptions of what self-management support entails. These distinct perceptions reflect different patient realities and demand that nurses are capable of reflexivity and sensitivity to patient needs. Different perspectives toward self-management support also call for diverse competencies and consequently, also for adaptation of educational nursing programs. Copyright © 2014 Elsevier Ltd. All rights

  16. Applying the Collective Causal Mapping Methodology to Operations Management Curriculum Development

    ERIC Educational Resources Information Center

    Hays, Julie M.; Bouzdine-Chameeva, Tatiana; Goldstein, Susan Meyer; Hill, Arthur V.; Scavarda, Annibal José

    2007-01-01

    Although the field of operations management has come a long way since its beginnings in scientific management, the field still appears somewhat amorphous and unstructured to many. Introductory operations management textbooks usually include a number of largely disjointed topics, which leave many students (and their instructors) without a coherent…

  17. On Methodological and Technological Challenges for Proactive Health Management in Smart Homes.

    PubMed

    Wolf, Klaus-Hendrik; Dehling, Tobias; Haux, Reinhold; Sick, Bernhard; Sunyaev, Ali; Tomforde, Sven

    2017-01-01

    Health management in smart homes has advanced during the last years. With proactive health management in such environments further progress for health prevention and care is to be expected. Challenges for proactive health management in three areas are summarized and briefly discussed: pattern recognition and machine learning, information privacy and user-oriented design, and sensor-enhanced health information systems architectures.

  18. Applying the Collective Causal Mapping Methodology to Operations Management Curriculum Development

    ERIC Educational Resources Information Center

    Hays, Julie M.; Bouzdine-Chameeva, Tatiana; Goldstein, Susan Meyer; Hill, Arthur V.; Scavarda, Annibal José

    2007-01-01

    Although the field of operations management has come a long way since its beginnings in scientific management, the field still appears somewhat amorphous and unstructured to many. Introductory operations management textbooks usually include a number of largely disjointed topics, which leave many students (and their instructors) without a coherent…

  19. Longitudinal analysis on utilization of medical document management system in a hospital with EPR implementation.

    PubMed

    Kuwata, Shigeki; Yamada, Hitomi; Park, Keunsik

    2011-01-01

    Document management systems (DMS) have widespread in major hospitals in Japan as a platform to digitize the paper-based records being out of coverage by EPR. This study aimed to examine longitudinal trends of actual use of DMS in a hospital in which EPR had been in operation, which would be conducive to planning the further information management system in the hospital. Degrees of utilization of electronic documents and templates with DMS were analyzed based on data extracted from a university-affiliated hospital with EPR. As a result, it was found that the number of electronic documents as well as scanned documents circulating at the hospital tended to increase. The result indicated that replacement of paper-based documents with electronic documents did not occur. Therefore it was anticipated that the need for DMS would continue to increase in the hospital. The methods used this study to analyze the trend of DMS utilization would be applicable to other hospitals with with a variety of DMS implementation, such as electronic storage by scanning documents or paper preservation that is compatible with EPR.

  20. Integrated employee assistance program/managed behavioral health plan utilization by persons with substance use disorders.

    PubMed

    Merrick, Elizabeth S Levy; Hodgkin, Dominic; Hiatt, Deirdre; Horgan, Constance M; Greenfield, Shelly F; McCann, Bernard

    2011-04-01

    New federal parity and health reform legislation, promising increased behavioral health care access and a focus on prevention, has heightened interest in employee assistance programs (EAPs). This study investigated service utilization by persons with a primary substance use disorder (SUD) diagnosis in a managed behavioral health care (MBHC) organization's integrated EAP/MBHC product (N = 1,158). In 2004, 25.0% of clients used the EAP first for new treatment episodes. After initial EAP utilization, 44.4% received no additional formal services through the plan, and 40.4% received regular outpatient services. Overall, outpatient care, intensive outpatient/day treatment, and inpatient/residential detoxification were most common. About half of the clients had co-occurring psychiatric diagnoses. Mental health service utilization was extensive. Findings suggest that for service users with primary SUD diagnoses in an integrated EAP/MBHC product, the EAP benefit plays a key role at the front end of treatment and is often only one component of treatment episodes.

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

    NASA Astrophysics Data System (ADS)

    Adzanu, Steve Kwaku

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

  2. How to assess solid waste management in armed conflicts? A new methodology applied to the Gaza Strip, Palestine.

    PubMed

    Caniato, Marco; Vaccari, Mentore

    2014-09-01

    We have developed a new methodology for assessing solid waste management in a situation of armed conflict. This methodology is composed of six phases with specific activities, and suggested methods and tools. The collection, haulage, and disposal of waste in low- and middle-income countries is so complicated and expensive task for municipalities, owing to several challenges involved, that some waste is left in illegal dumps. Armed conflicts bring further constraints, such as instability, the sudden increase in violence, and difficulty in supplying equipment and spare parts: planning is very difficult and several projects aimed at improving the situation have failed. The methodology was validated in the Gaza Strip, where the geopolitical situation heavily affects natural resources. We collected information in a holistic way, crosschecked, and discussed it with local experts, practitioners, and authorities. We estimated that in 2011 only 1300 tonne day(-1) were transported to the three disposal sites, out of a production exceeding 1700. Recycling was very limited, while the composting capacity was 3.5 tonnes day(-1), but increasing. We carefully assessed system elements and their interaction. We identified the challenges, and developed possible solutions to increase system effectiveness and robustness. The case study demonstrated that our methodology is flexible and adaptable to the context, thus it could be applied in other areas to improve the humanitarian response in similar situations. © The Author(s) 2014.

  3. Variability in blood and blood component utilization as assessed by an anesthesia information management system.

    PubMed

    Frank, Steven M; Savage, Will J; Rothschild, Jim A; Rivers, Richard J; Ness, Paul M; Paul, Sharon L; Ulatowski, John A

    2012-07-01

    Data can be collected for various purposes with anesthesia information management systems. The authors describe methods for using data acquired from an anesthesia information management system to assess intraoperative utilization of blood and blood components. Over an 18-month period, data were collected on 48,086 surgical patients at a tertiary care academic medical center. All data were acquired with an automated anesthesia recordkeeping system. Detailed reports were generated for blood and blood component utilization according to surgical service and surgical procedure, and for individual surgeons and anesthesiologists. Transfusion hemoglobin trigger and target concentrations were compared among surgical services and procedures, and between individual medical providers. For all patients given erythrocytes, the mean transfusion hemoglobin trigger was 8.4 ± 1.5, and the target was 10.2 ± 1.5 g/dl. Variation was significant among surgical services (trigger range: 7.5 ± 1.2-9.5 ± 1.1, P = 0.0001; target range: 9.1 ± 1.2-11.3 ± 1.4 g/dl, P = 0.002), surgeons (trigger range: 7.2 ± 0.7-9.8 ± 1.0, P = 0.001; target range: 8.8 ± 0.9-11.8 ± 1.3 g/dl, P = 0.001), and anesthesiologists (trigger range: 7.2 ± 0.8-9.6 ± 1.2, P = 0.001; target range: 9.0 ± 0.9-11.7 ± 1.3 g/dl, P = 0.0004). The use of erythrocyte salvage, fresh frozen plasma, and platelets varied threefold to fourfold among individual surgeons compared with their peers performing the same surgical procedure. The use of data acquired from an anesthesia information management system allowed a detailed analysis of blood component utilization, which revealed significant variation among surgical services and surgical procedures, and among individual anesthesiologists and surgeons compared with their peers. Incorporating these methods of data acquisition and analysis into a blood management program could reduce unnecessary transfusions, an outcome that may increase patient safety and reduce costs.

  4. Using the Agile Development Methodology and Applying Best Practice Project Management Processes

    DTIC Science & Technology

    2014-12-01

    CONTRAST TO WATERFALL DEVELOPMENT METHODOLOGY ..........................................................................................7 E. CHAPTER...Figure 3. Scrum Model (from N-Axis Software Technologies 2010) ..............................6 Figure 4. Waterfall Model (from Waterfall Model 2014...executed between 2002 and 2010. It depicts the success rates of projects executing the Waterfall model versus those implementing Agile. The second

  5. Data Management inside the Library: Assessing Electronic Resources Data Using the Data Asset Framework Methodology

    ERIC Educational Resources Information Center

    Ogier, Andi; Hall, Monena; Bailey, Annette; Stovall, Connie

    2014-01-01

    Rapidly growing within academic libraries, library data services have often been focused on assessing research trends and building partnerships outside the library. There are distinct benefits, however, to using data audit methodologies created for these external assessments of researcher practices inside the library as well. In this article, we…

  6. Data Management inside the Library: Assessing Electronic Resources Data Using the Data Asset Framework Methodology

    ERIC Educational Resources Information Center

    Ogier, Andi; Hall, Monena; Bailey, Annette; Stovall, Connie

    2014-01-01

    Rapidly growing within academic libraries, library data services have often been focused on assessing research trends and building partnerships outside the library. There are distinct benefits, however, to using data audit methodologies created for these external assessments of researcher practices inside the library as well. In this article, we…

  7. Database Design Methodology and Database Management System for Computer-Aided Structural Design Optimization.

    DTIC Science & Technology

    1984-12-01

    1983). Several researchers Lillehagen and Dokkar (1982), Grabowski, Eigener and Ranch (1978), and Eberlein and Wedekind (1982) have worked on database...Proceedings of International Federation of Information Processing. pp. 335-366. Eberlein, W. and Wedekind , H., 1982, "A Methodology for Embedding Design

  8. Outpatient utilization by infants auto-assigned to Medicaid managed care plans.

    PubMed

    Zickafoose, Joseph S; Cohn, Lisa M; Clark, Sarah J

    2014-04-01

    To test the hypothesis that infants auto-assigned to a Medicaid managed care plan would have lower primary care and higher emergency department (ED) utilization compared to infants with a chosen plan. Retrospective cohort study. Medicaid administrative data were used to identify all children 0-3 months of age at enrollment in Michigan Medicaid managed care in 2005-2008 with 18-months of subsequent enrollment. Medicaid encounter and state immunization registry data were then acquired. Auto-assigned infants were compared versus chosen plan infants on: (1) well-child visits (WCVs); (2) immunizations; (3) acute office visits; and (4) ED visits. Chi squared and rank-sum tests and logistic and negative binomial regression were used in bivariate and multivariable analyses for dichotomous and count data, respectively. 18% of infants were auto-assigned. Auto-assigned infants were less likely to meet goal number of WCVs in 18-months of managed care enrollment (32 vs. 53%, p < 0.001) and to be up-to-date on immunizations at 12 months of age (75 vs. 85%, p < 0.001). Auto-assigned infants had fewer acute office visits (median: 4 vs. 5, p < 0.001) but were only slightly more likely to have 2 or more ED visits (51 vs. 46%, p < 0.001) in 18-months of enrollment. All results were significant in multivariable analyses. Auto-assigned infants were less likely to use preventive and acute primary care but only slightly more likely to use emergency care. Future work is needed to understand mechanisms of differences in utilization, but auto-assigned children may represent a target group for efforts to promote pediatric preventive care in Medicaid.

  9. Outpatient Utilization by Infants Auto-assigned to Medicaid Managed Care Plans

    PubMed Central

    Cohn, Lisa M.; Clark, Sarah J.

    2013-01-01

    To test the hypothesis that infants auto-assigned to a Medicaid managed care plan would have lower primary care and higher emergency department (ED) utilization compared to infants with a chosen plan. Retrospective cohort study. Medicaid administrative data were used to identify all children 0–3 months of age at enrollment in Michigan Medicaid managed care in 2005–2008 with 18-months of subsequent enrollment. Medicaid encounter and state immunization registry data were then acquired. Auto-assigned infants were compared versus chosen plan infants on: (1) well-child visits (WCVs); (2) immunizations; (3) acute office visits; and (4) ED visits. Chi squared and rank-sum tests and logistic and negative binomial regression were used in bivariate and multivariable analyses for dichotomous and count data, respectively. 18 % of infants were auto-assigned. Auto-assigned infants were less likely to meet goal number of WCVs in 18-months of managed care enrollment (32 vs. 53 %, p < 0.001) and to be up-to-date on immunizations at 12 months of age (75 vs. 85 %, p < 0.001). Auto-assigned infants had fewer acute office visits (median: 4 vs. 5, p < 0.001) but were only slightly more likely to have 2 or more ED visits (51 vs. 46 %, p < 0.001) in 18-months of enrollment. All results were significant in multivariable analyses. Auto-assigned infants were less likely to use preventive and acute primary care but only slightly more likely to use emergency care. Future work is needed to understand mechanisms of differences in utilization, but auto-assigned children may represent a target group for efforts to promote pediatric preventive care in Medicaid. PMID:23775252

  10. The utility of geographic information systems (GIS) in rapid epidemiological assessments following weather-related disasters: methodological issues based on the Tropical Storm Allison Experience.

    PubMed

    Waring, Stephen; Zakos-Feliberti, Anna; Wood, Robert; Stone, Matthew; Padgett, Paige; Arafat, Raouf

    2005-01-01

    Flooding is the most common natural disaster worldwide, and is the leading cause of weather-related deaths in the United States. Tropical storm Allison hit landfall near Galveston, Texas on June 5, 2001, causing the most severe flood-related damage ever recorded in the Houston metropolitan area. This devastating storm dumped 37 in of rain in 24h on parts of the city, killing 22 people and causing more than $5 billion in damage. The main goal of the public health response to tropical storm Allison was to rapidly evaluate the immediate health needs of the community. Geographical information system (GIS) technology was instrumental to the timeliness of this effort. We conducted a rapid needs assessment in the areas most affected by flooding using modified cluster sampling facilitated by GIS methodology. Of the 420 households participating in the survey, we found a significant increase in illness (OR, 5.1; 95% CI, 2.7-9.4), injuries (OR, 4.8; 95% CI, 1.9-12.8), and immediate health needs (OR, 3.3; 95% CI, 1.7-6.1) among persons living in flooded homes compared to non-flooded homes. There were 60 households reporting serious damage, 24 of which were outside the 500-year flood plain. We also obtained reliable estimates of the extent of damage and household needs to help guide relief efforts. These findings underscore the usefulness of rapid needs assessment as a tool to identify actual health threats and to facilitate delivery of resources to those with the greatest and most immediate need. Our ability to swiftly plan and implement a rapid needs assessment over a large geographical region within 1 week following the damage would not have been possible without the utilization of GIS methodology and the availability of skilled personnel and timely data resources.

  11. Resource utilization for non-operative cervical radiculopathy: Management by surgeons versus non-surgeons.

    PubMed

    Chung, Sophie H; Bohl, Daniel D; Paul, Jonathan T; Rihn, Jeffrey A; Harrop, James S; Ghogawala, Zoher; Hilibrand, Alan S; Grauer, Jonathan N

    2017-07-01

    To compare the estimated resource utilization for non-operative treatment of cervical radiculopathy if managed by surgeons versus non-surgeons. A Cervical Spine Research Society-sponsored survey was administered at a national spine surgery conference to surgeons and non-surgeons, as classified above. The survey asked questions regarding resource utilization and perceived costs for the "average patient" with cervical radiculopathy managed non-operatively. Resource utilization and perceived costs were compared between surgeon and non-surgeon participants, and between private practice and academic and/or hybrid groups that combine academic and private practices. In total, 101 of the 125 conference attendees participated in the survey (return rate 80.8%, of which 60% were surgeons). Surgeon and non-surgeon estimates for duration of non-operative care did not differ (3.3 versus 4.2 months, p=0.071). Estimates also did not differ for estimated number of physical therapy visits (10.5 versus 10.5, p=0.983), cervical injections (1.4 versus 1.7, p=0.272), chiropractic visits (3.1 versus 3.7, p=0.583), or perceived days off from work (14.9 versus 16.3, p=0.816). The only difference identified was that surgeon estimates of the number of physician visits while providing non-operative care were lower than non-surgeon estimates (3.2 versus 4.0, p=0.018). In terms of estimated costs, surgeon and non-surgeon were mostly similar (only difference being that surgeon estimates for the total cost of physician visits per patient were lower than non-surgeon estimates ($382 versus $579, p=0.007). Surgeon estimates for the percent of their patients that go on to receive surgery within 6 months were higher than non-surgeon estimates (28.6% versus 18.8%, p=0.018). Similarly, surgeon estimates for the percent of their patients to go on to receive surgery within 2 years were higher than non-surgeon estimates (37.8% versus 24.8%, p=0.013). Academic/hybrid and private practice group resource

  12. The utilization and management of plant resources in rural areas of the Limpopo Province, South Africa

    PubMed Central

    2013-01-01

    Background Most rural people in the Limpopo Province depend on plant resources to meet their livelihood needs. However, there is insufficient recorded information regarding their use and management. The current study therefore was carried out in selected villages of the Limpopo Province, to close this knowledge gap. Methods Information was collected from 60 people residing in two villages, using a semi-structured questionnaire, supplemented with field observations. Results A total of 47 wild plant species (95% indigenous and 5% exotics) from 27 families, mostly from the Fabaceae (17%), Anacardiaceae (9%), and Combretaceae (9%) were documented. These species were used primarily for firewood (40%), food (36%) and medicine (29%). Significantly used species included Sclerocarya birrea (85%), Combretum kraussii (35%) and Harpephyllum caffrum (35%). Local traditional rules and regulations including taboos, social beliefs and fines are in place to aid in the management of communal resources. However, a significant number (67%) of participants mentioned that they were not pleased with these rules and regulations. Conclusion The current study concluded that plant resources still play an important role in the surveyed rural areas of the Limpopo Province. Furthermore, for sustainable utilization and long-term conservation of plants in these areas the government should assist communities in the management of their plant resources. PMID:23590903

  13. The utilization and management of plant resources in rural areas of the Limpopo Province, South Africa.

    PubMed

    Rasethe, Marula T; Semenya, Sebua S; Potgieter, Martin J; Maroyi, Alfred

    2013-04-16

    Most rural people in the Limpopo Province depend on plant resources to meet their livelihood needs. However, there is insufficient recorded information regarding their use and management. The current study therefore was carried out in selected villages of the Limpopo Province, to close this knowledge gap. Information was collected from 60 people residing in two villages, using a semi-structured questionnaire, supplemented with field observations. A total of 47 wild plant species (95% indigenous and 5% exotics) from 27 families, mostly from the Fabaceae (17%), Anacardiaceae (9%), and Combretaceae (9%) were documented. These species were used primarily for firewood (40%), food (36%) and medicine (29%). Significantly used species included Sclerocarya birrea (85%), Combretum kraussii (35%) and Harpephyllum caffrum (35%). Local traditional rules and regulations including taboos, social beliefs and fines are in place to aid in the management of communal resources. However, a significant number (67%) of participants mentioned that they were not pleased with these rules and regulations. The current study concluded that plant resources still play an important role in the surveyed rural areas of the Limpopo Province. Furthermore, for sustainable utilization and long-term conservation of plants in these areas the government should assist communities in the management of their plant resources.

  14. Utilization of remotely-sensed data in the management of inland wetlands

    NASA Technical Reports Server (NTRS)

    Carter, V.; Smith, D. G.

    1973-01-01

    The author has identified the following significant results. ERTS-1 data and aerial photography are proving to be a useful tool for the inventory and management of inland wetlands. Two examples of the application of remotely-sensed data to specific wetland management needs or requirements are discussed. Studies of the Great Dismal Swamp are utilizing ERTS-1 imagery and color IR photography in: (1) study area selection; (2) field inspection; (3) vegetation mapping; (4) identification of drainage characteristics and moisture regime; (5) location of intensive study areas; and (6) detection of change. Thematic extractions of ERTS-1 data made using the United States Geological Survey's Autographic Theme Extraction System are aiding analyses of swamp hydrologic regime and providing information pertinent to quick recognition and inventory of wetlands from ERTS-1. DCP'S in south Florida wetlands provide near-real time data for water resources managers. Data relayed by satellite can be entered into models to provide predictive data and water storage information for long-term and short-term decision making.

  15. Diabetes management: utilizing community health workers in a Hawaiian/Samoan population.

    PubMed

    Beckham, Sheila; Bradley, Stephen; Washburn, Anuenue; Taumua, Tusi

    2008-05-01

    Although not widely utilized, community health workers (CHWs) have been shown to enhance diabetes education and management efforts among racial/ethnic minority populations. To examine the effectiveness of CHWs on diabetes management among a population with primarily Native Hawaiian and Samoan ethnic minority participants with HbA1c greater than 10%. Descriptive study comparing HbA1c readings of participants with diabetes with and without CHW intervention. Of 116 eligible participants, 74% were either Native Hawaiian or Samoan. The mean baseline HbA1c for all eligible participants was 10.9+/-0.8%. The 80 participants who completed CHW intervention had a 2.2+/-1.8% (p.<.01, compared with baseline) mean reduction in HbA1c, compared with a 0.2+/-1.5% reduction for those without CHW intervention. Community health workers had a positive impact on diabetes management defined in terms of improved HbA1c amongst this predominantly Native Hawaiian and Samoan population.

  16. Interventions to improve diabetes self-management: utility and relevance for practice.

    PubMed

    Leeman, Jennifer

    2006-01-01

    The purpose of this study was to review publications of research on diabetes self-management interventions and assess whether the interventions are relevant for practice. A content analysis was performed on research reports published between 1993 and 2004 of interventions designed to improve patients' diabetes self-management. Information was abstracted relevant to the intervention's generalizability to other settings and its compatibility and feasibility in practice. Publications included only limited information relevant to an intervention's generalizability across populations and settings. Many of the interventions tested were not designed to be compatible with the realities of current practice or to be delivered in the settings in which most diabetes care is provided. Many of the interventions were very complex, requiring multiple delivery modes and contacts, proactive scheduling, and coordination across disciplines. In view of the prevalence of diabetes, it is critical that effective self-management interventions be adopted and implemented. Interventions need to be designed so that their findings have greater relevance and utility for practice and can be generalized across practice settings.

  17. Cost-utility of a disease management program for patients with asthma.

    PubMed

    Steuten, Lotte; Palmer, Stephen; Vrijhoef, Bert; van Merode, Frits; Spreeuwenberg, Cor; Severens, Hans

    2007-01-01

    The long-term cost-utility of a disease management program (DMP) for adults with asthma was assessed compared to usual care. A DMP for patients with asthma has been developed and implemented in the region of Maastricht (The Netherlands). By integrating care, the program aims to continuously improve quality of care within existing budgets. A clinical trial was performed over a period of 15 months to collect data on costs and effects of the program and usual care. These data were used to inform a probabilistic decision-analytic model to estimate the 5-year impact of the program beyond follow-up. A societal perspective was adopted, with outcomes assessed in terms of costs per quality-adjusted life-year (QALY). The DMP is associated with a gain in QALYs compared to usual care (2.7+/-.2 versus 3.4+/-.8), at lower costs (3,302+/-314 euro versus 2,973+/-304 euro), thus leading to dominance. The probability that disease management is the more cost-effective strategy is 76 percent at a societal willingness to pay (WTP) for an additional QALY of 0 euro, reaching 95 percent probability at a WTP of 1,000 euro per additional QALY. Organizing health care according to the principles of disease management for adults with asthma has a high probability of being cost-effective and is associated with a gain in QALYs at lower costs.

  18. Management of End-Stage Ankle Arthritis: Cost-Utility Analysis Using Direct and Indirect Costs.

    PubMed

    Nwachukwu, Benedict U; McLawhorn, Alexander S; Simon, Matthew S; Hamid, Kamran S; Demetracopoulos, Constantine A; Deland, Jonathan T; Ellis, Scott J

    2015-07-15

    Total ankle replacement and ankle fusion are costly but clinically effective treatments for ankle arthritis. Prior cost-effectiveness analyses for the management of ankle arthritis have been limited by a lack of consideration of indirect costs and nonoperative management. The purpose of this study was to compare the cost-effectiveness of operative and nonoperative treatments for ankle arthritis with inclusion of direct and indirect costs in the analysis. Markov model analysis was conducted from a health-systems perspective with use of direct costs and from a societal perspective with use of direct and indirect costs. Costs were derived from the 2012 Nationwide Inpatient Sample (NIS) and expressed in 2013 U.S. dollars; effectiveness was expressed in quality-adjusted life years (QALYs). Model transition probabilities were derived from the available literature. The principal outcome measure was the incremental cost-effectiveness ratio (ICER). In the direct-cost analysis for the base case, total ankle replacement was associated with an ICER of $14,500/QALY compared with nonoperative management. When indirect costs were included, total ankle replacement was both more effective and resulted in $5900 and $800 in lifetime cost savings compared with the lifetime costs following nonoperative management and ankle fusion, respectively. At a $100,000/QALY threshold, surgical management of ankle arthritis was preferred for patients younger than ninety-six years and total ankle replacement was increasingly more cost-effective in younger patients. Total ankle replacement, ankle fusion, and nonoperative management were the preferred strategy in 83%, 12%, and 5% of the analyses, respectively; however, our model was sensitive to patient age, the direct costs of total ankle replacement, the failure rate of total ankle replacement, and the probability of arthritis after ankle fusion. Compared with nonoperative treatment for the management of end-stage ankle arthritis, total ankle

  19. Situational Methodology as Multifaceted Pedagogical Tool of Influence on the Formation of Socio-Ethical Values of Future Managers-Economists in Higher Schools of Ukraine and Germany

    ERIC Educational Resources Information Center

    Sikaliuk, Anzhela

    2014-01-01

    The role and importance of situational methodology as one of the pedagogical tools of influence on the formation of socio-ethical values of future managers in higher schools of Ukraine and Germany have been theoretically substantiated. The possibilities of situational methodology influence on the formation of socio-ethical values of…

  20. Situational Methodology as Multifaceted Pedagogical Tool of Influence on the Formation of Socio-Ethical Values of Future Managers-Economists in Higher Schools of Ukraine and Germany

    ERIC Educational Resources Information Center

    Sikaliuk, Anzhela

    2014-01-01

    The role and importance of situational methodology as one of the pedagogical tools of influence on the formation of socio-ethical values of future managers in higher schools of Ukraine and Germany have been theoretically substantiated. The possibilities of situational methodology influence on the formation of socio-ethical values of…

  1. Sandia National Laboratories performance assessment methodology for long-term environmental programs : the history of nuclear waste management.

    SciTech Connect

    Marietta, Melvin Gary; Anderson, D. Richard; Bonano, Evaristo J.; Meacham, Paul Gregory

    2011-11-01

    Sandia National Laboratories (SNL) is the world leader in the development of the detailed science underpinning the application of a probabilistic risk assessment methodology, referred to in this report as performance assessment (PA), for (1) understanding and forecasting the long-term behavior of a radioactive waste disposal system, (2) estimating the ability of the disposal system and its various components to isolate the waste, (3) developing regulations, (4) implementing programs to estimate the safety that the system can afford to individuals and to the environment, and (5) demonstrating compliance with the attendant regulatory requirements. This report documents the evolution of the SNL PA methodology from inception in the mid-1970s, summarizing major SNL PA applications including: the Subseabed Disposal Project PAs for high-level radioactive waste; the Waste Isolation Pilot Plant PAs for disposal of defense transuranic waste; the Yucca Mountain Project total system PAs for deep geologic disposal of spent nuclear fuel and high-level radioactive waste; PAs for the Greater Confinement Borehole Disposal boreholes at the Nevada National Security Site; and PA evaluations for disposal of high-level wastes and Department of Energy spent nuclear fuels stored at Idaho National Laboratory. In addition, the report summarizes smaller PA programs for long-term cover systems implemented for the Monticello, Utah, mill-tailings repository; a PA for the SNL Mixed Waste Landfill in support of environmental restoration; PA support for radioactive waste management efforts in Egypt, Iraq, and Taiwan; and, most recently, PAs for analysis of alternative high-level radioactive waste disposal strategies including repositories deep borehole disposal and geologic repositories in shale and granite. Finally, this report summarizes the extension of the PA methodology for radioactive waste disposal toward development of an enhanced PA system for carbon sequestration and storage systems

  2. Cost Utility Analysis of Percutaneous Adhesiolysis in Managing Pain of Post-lumbar Surgery Syndrome and Lumbar Central Spinal Stenosis.

    PubMed

    Manchikanti, Laxmaiah; Helm, Standiford; Pampati, Vidyasagar; Racz, Gabor B

    2015-06-01

    The increase in the number of interventions for the management of chronic pain and associated escalation of healthcare costs has captured the attention of health policymakers, in no small part due to the lack of documentation of efficacy, cost-effectiveness, or cost utility analysis. A recent cost utility analysis of caudal epidural injections in managing chronic low back pain of various pathologies showed a high cost utility with improvement in quality of life years, competitive with various other modalities of treatments. However, there are no analyses derived from high-quality controlled studies related to the cost utility of percutaneous adhesiolysis in the treatment of post-lumbar surgery syndrome or lumbar central spinal stenosis. This analysis is based on 2 previously published controlled studies. To assess the cost utility of percutaneous adhesiolysis procedures in managing chronic low back and lower extremity pain secondary to post-lumbar surgery syndrome and lumbar central spinal stenosis. A private, specialty referral interventional pain management center in the United States. Two controlled studies were conducted assessing the clinical effectiveness of percutaneous adhesiolysis for post-lumbar surgery syndrome and lumbar central spinal stenosis in an interventional pain management setting utilizing contemporary interventional pain management practices. A cost utility analysis was performed with direct payment data for a total of 130 patients in treatment groups over a 2-year period. Various outcome measures were included with significant improvement, defined as at least 50% improvement with reduction in pain and disability status. The results of 2 controlled studies of low back pain with 60 and 70 patients and a 2-year follow-up with the actual reimbursement data showed cost utility for 1 year of quality-adjusted life year (QALY) of USD $2,652 for post-lumbar surgery syndrome and USD $2,649 for lumbar central spinal stenosis. The results of this

  3. Towards Accelerated Aging Methodologies and Health Management of Power MOSFETs (Technical Brief)

    NASA Technical Reports Server (NTRS)

    Celaya, Jose R.; Patil, Nishad; Saha, Sankalita; Wysocki, Phil; Goebel, Kai

    2009-01-01

    Understanding aging mechanisms of electronic components is of extreme importance in the aerospace domain where they are part of numerous critical subsystems including avionics. In particular, power MOSFETs are of special interest as they are involved in high voltage switching circuits such as drivers for electrical motors. With increased use of electronics in aircraft control, it becomes more important to understand the degradation of these components in aircraft specific environments. In this paper, we present an accelerated aging methodology for power MOSFETs that subject the devices to indirect thermal overstress during high voltage switching. During this accelerated aging process, two major modes of failure were observed - latch-up and die attach degradation. In this paper we present the details of our aging methodology along with details of experiments and analysis of the results.

  4. Creation of a System of Systems Portfolio Management and Technology Selection Methodology

    DTIC Science & Technology

    2010-05-01

    traditional Ao, defined at the fleet level and computed as the average of squadron or unit level Ao. In this fashion , a clear definition of Am for...the SMM to incorporate a Performance Level Monitoring ( PLM ) methodology. The PLM is being developed to understand if the performance will satisfy...changing existing capabilities within a MP. Performance Level Monitoring Explained The PLM strives to apply a modified TPM type approach to a SoS

  5. Review of LCA studies of solid waste management systems – Part II: Methodological guidance for a better practice

    SciTech Connect

    Laurent, Alexis; Clavreul, Julie; Bernstad, Anna; Bakas, Ioannis; Niero, Monia; Gentil, Emmanuel; Christensen, Thomas H.; Hauschild, Michael Z.

    2014-03-01

    Highlights: • We perform a critical review of 222 LCA studies of solid waste management systems. • We analyse the past LCA practice against the ISO standard and ILCD Handbook guidance. • Malpractices exist in many methodological aspects with large variations among studies. • Many of these aspects are important for the reliability of the results. • We provide detailed recommendations to practitioners of waste management LCAs. - Abstract: Life cycle assessment (LCA) is increasingly used in waste management to identify strategies that prevent or minimise negative impacts on ecosystems, human health or natural resources. However, the quality of the provided support to decision- and policy-makers is strongly dependent on a proper conduct of the LCA. How has LCA been applied until now? Are there any inconsistencies in the past practice? To answer these questions, we draw on a critical review of 222 published LCA studies of solid waste management systems. We analyse the past practice against the ISO standard requirements and the ILCD Handbook guidelines for each major step within the goal definition, scope definition, inventory analysis, impact assessment, and interpretation phases of the methodology. Results show that malpractices exist in several aspects of the LCA with large differences across studies. Examples are a frequent neglect of the goal definition, a frequent lack of transparency and precision in the definition of the scope of the study, e.g. an unclear delimitation of the system boundaries, a truncated impact coverage, difficulties in capturing influential local specificities such as representative waste compositions into the inventory, and a frequent lack of essential sensitivity and uncertainty analyses. Many of these aspects are important for the reliability of the results. For each of them, we therefore provide detailed recommendations to practitioners of waste management LCAs.

  6. Savanna burning methodology for fire management and emissions reduction: a critical review of influencing factors.

    PubMed

    Maraseni, Tek Narayan; Reardon-Smith, Kathryn; Griffiths, Greg; Apan, Armando

    2016-12-01

    Savanna fire is a major source of global greenhouse gas (GHG) emissions. In Australia, savanna fire contributes about 3% of annual GHG emissions reportable to the Kyoto Protocol. In order to reduce GHG emissions from savanna burning, the Australian government has developed and approved a Kyoto compliant savanna controlled burning methodology-the first legal instrument of this kind at a global level-under its Emission Reduction Fund. However, this approved methodology is currently only applicable to nine vegetation fuel types across northern parts of Australia in areas which receive on average over 600 mm rainfall annually, covering only 15.4% of the total land area in Australia. Savanna ecosystems extend across a large proportion of mainland Australia. This paper provides a critical review of ten key factors that need to be considered in developing a savanna burning methodology applicable to the other parts of Australia. It will also inform discussion in other countries intent on developing similar emissions reduction strategies.

  7. Primary radiotherapy for nonsurgically managed Stage I endometrial cancer: Utilization and impact of brachytherapy.

    PubMed

    Gill, Beant S; Chapman, Bhavana V; Hansen, Karyn J; Sukumvanich, Paniti; Beriwal, Sushil

    2015-01-01

    The National Cancer Data Base (NCDB) was analyzed to evaluate practice patterns and the impact of radiotherapy modalities for endometrial cancer treated with primary radiotherapy. The NCDB was queried for Stage I endometrioid adenocarcinoma patients treated with primary radiotherapy without surgery from 1998 to 2006. Brachytherapy (BT) utilization factors were established using multivariable logistic regression. Log-rank and Cox proportional hazards modeling were used to assess variables impacting survival. A total of 853 patients were analyzed: 23.7%, 31.3%, and 45.0% received BT alone, external beam radiotherapy (EBRT) and BT, or EBRT alone. The BT utilization ranged from 40.5% to 51.9% over time (p=0.70). Lower utilization was associated with advanced age (≥80 years: odds ratio [OR] 0.43, 95% confidence interval [CI] 0.28-0.65, p<0.01) and facilities with volume in the bottom quartile (OR 0.44, 95% CI 0.30-0.66, p<0.01). Utilization was higher among patients living more than 30 miles from the facilities (OR 2.14, 95%CI 1.35-3.42, p<0.01). With 36-month median followup, unadjusted median survivals for EBRT dose of 30Gy or lower, EBRT dose higher than 30Gy, BT, and EBRT+BT were 12.6, 31.1, 44.6, and 57.1 months (p<0.01). After correcting for other factors, higher risk of mortality was seen with EBRT dose of 30Gy or lower (hazard ratio [HR]2.75, 95% CI 1.66-4.55, p<0.01) and EBRT dose higher than 30Gy (HR 1.43, 95% CI 1.07-1.91, p=0.02) compared with EBRT+BT. No difference was seen using BT alone (HR 1.29, 95% CI 0.92-1.79, p=0.14). BT utilization for nonsurgically managed endometrial cancer remains low with most patients receiving EBRT alone. Despite concerns of overtreatment in a population with competing causes of death, BT appears to improve survival. Copyright © 2015 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

  8. Utilization of Interventional Techniques in Managing Chronic Pain In Medicare Population from 2000 to 2014: An Analysis of Patterns of Utilization.

    PubMed

    Manchikanti, Laxmaiah; Pampati, Vidyasagar; Hirsch, Joshua A

    2016-05-01

    The increase in the utilization of various techniques in managing chronic pain, including interventional techniques, is a major concern for policy-makers and the public at large. Consequently, multiple regulations have been instituted to reduce health care expenditures in general and expenditures related to interventional techniques in particular. Previous investigations have shown significant increases of utilization of interventional techniques across the board with minor decreases noted in 2007, 2010, 2012 and 2013. To assess the patterns of utilization of interventional techniques in chronic pain management in the fee-for-service (FFS) Medicare population. Analysis of utilization patterns of interventional techniques from 2000 to 2014 in Fee-for-Services (FFS) Medicare beneficiaries in managing chronic pain. The analyzed data was derived from the Centers for Medicare and Medicaid Services (CMS) Physician/Supplier Procedure Summary Master Data from 2000 to 2014. The analysis of data from 2000 to 2014 in FFS Medicare beneficiaries showed overall utilization of interventional techniques increasing at a rate of 153% and an annual average growth rate of 6.9% per 100,000 Medicare population with increase in services of 242%. This showed a 3% decrease per 100,000 Medicare population, compared to the data from 2000 through 2013, even though services increased by 6% due to the increase in the number of Medicare recipients in the FFS beneficiary group. The overall increases in epidural and adhesiolysis procedures were 165% with a rate of 96% per 100,000 Medicare population with an average annual increase of 4.9%. Facet joint interventions and sacroiliac joint blocks increased at a rate of 313% per 100,000 population with an annual average increase of 10.7%. Disc procedures and other types of nerve blocks increased at a much lesser pace than epidural and adhesiolysis procedures or facet joint interventions with an increase of 54% per 100,000 Medicare population and annual

  9. A computer modeling methodology and tool for assessing design concepts for the Space Station Data Management System

    NASA Technical Reports Server (NTRS)

    Jones, W. R.

    1986-01-01

    A computer modeling tool is being developed to assess candidate designs for the Space Station Data Management System (DMS). The DMS is to be a complex distributed computer system including the processor, storage devices, local area networks, and software that will support all processing functions onboard the Space Station. The modeling tool will allow a candidate design for the DMS, or for other subsystems that use the DMS, to be evaluated in terms of parameters. The tool and its associated modeling methodology are intended for use by DMS and subsystem designers to perform tradeoff analyses between design concepts using varied architectures and technologies.

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

    NASA Astrophysics Data System (ADS)

    McDonald, Betsy

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

  11. [Guidelines for the diagnosis and management of thyroid disease and their utility].

    PubMed

    Hashimoto, Koshi; Mori, Masatomo

    2012-11-01

    Thyroid dysfunction is a common disorder in daily clinical practice, however due to unspecific and diverse symptoms of the disease, it is sometimes hard to make a definite diagnosis. Japan thyroid association (JTA) published 'Guideline for the diagnosis of thyroid disease, 2010' and it is open to the public on the JTA website(http : //www.japanthyroid.jp/doctor/ guideline/japanese.html). English version of the guideline is also available. JTA also published 'Guideline for the management of subclinical hypothyroidism 2008' and 'Guideline for the diagnosis of thyroid storm, version 2'. The latter in English version has been published in Thyroid(http : //www.ncbi.nlm.nih.gov/pubmed/22494618). The utility of these guidelines is discussed.

  12. The impact of cancer incidence and stage on optimal utilization of radiotherapy: Methodology of a population based analysis by the ESTRO-HERO project.

    PubMed

    Borras, Josep M; Barton, Michael; Grau, Cai; Corral, Julieta; Verhoeven, Rob; Lemmens, Valery; van Eycken, Liesbet; Henau, Kris; Primic-Zakelj, Maja; Strojan, Primoz; Trojanowski, Maciej; Dyzmann-Sroka, Agnieszka; Kubiak, Anna; Gasparotto, Chiara; Defourny, Noemie; Malicki, Julian; Dunscombe, Peter; Coffey, Mary; Lievens, Yolande

    2015-07-01

    The impact of differences in the distribution of major cancer sites and stages at diagnosis among 4 European countries on the optimal utilization proportion (OUP) of patients who should receive external beam radiotherapy was assessed within the framework of the ESTRO-HERO project. Data from Australian Collaboration for Cancer Outcomes Research and Evaluation (CCORE) were used. Population based stages at diagnosis from the cancer registries of Belgium, Slovenia, the Greater Poland region of Poland, and The Netherlands were used to assess the OUP for each country. A sensitivity analysis was carried out. The overall OUP by country varied from the lowest of 48.3% in Australia to the highest of 53.4% in Poland; among European countries the variation was limited to 3%. Cancer site specific OUPs showed differences according to the variability in stage at diagnosis across countries. The most important impact on the OUP by country was due to changes in relative frequency of tumours rather than stage at diagnosis. This methodology can be adapted using European data, thus facilitating the planning of resources required to cope with the demand for radiotherapy in Europe, taking into account the national variability in cancer incidence. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  13. Understanding the economic burden of heart failure in China: impact on disease management and resource utilization.

    PubMed

    Huang, Jun; Yin, Hongjun; Zhang, Milun; Ni, Qian; Xuan, Jianwei

    2017-05-01

    This study has two objectives: (1) to examine healthcare resource utilization in heart failure (HF) patients; and (2) to examine the treatment costs associated with HF in China. The data used in this study was from the 2014 national insurance database sponsored by the China Health Insurance Research Association (CHIRA), that covers national urban employees and residents. ICD-10 codes and keywords indicating heart failure diagnoses were used to identify patients with heart failure. Drug utilization, hospital visits, re-admission, and treatment costs in different service categories were examined. A total of 7,847 patients were included in this analysis, of which 1,157 patients had a 1-year complete follow-up period. In total, 48.16% of patients received the combination treatment of angiotensin-converting-enzyme inhibitor (ACEI)/angiotensin II receptor blockers (ARB) and beta-blockers (BB); and 22.87% of patients received the combination treatment of ACEI/ARB, beta-blockers and Mineralocorticoid receptor antagonists (MRAs). The annual treatment cost per patient with HF diagnosis was RMB 28,974, of which 66% was for inpatient care. The cost on HF medications accounted for 8.2% of annual cost. Treatment cost was much higher in provincial-level municipalities than that of prefecture-level and other cities. Hospitalization is a major driver of HF treatment cost. Compared to the requirements in international treatment guidelines, HF standard of care medication treatment was under-utilized among HF patients in China. The high re-admission rate among Chinese patients indicates that the management of HF needs to be improved. The percentage of GDP spent on treating HF patients was much lower than that in the developed countries.

  14. Healthcare utilization and cost of Stevens-Johnson syndrome and toxic epidermal necrolysis management in Thailand

    PubMed Central

    Dilokthornsakul, P; Sawangjit, R; Inprasong, C; Chunhasewee, S; Rattanapan, P; Thoopputra, T; Chaiyakunapruk, N

    2016-01-01

    Background: Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are life-threatening dermatologic conditions. Although, the incidence of SJS/TEN in Thailand is high, information on cost of care for SJS/TEN is limited. This study aims to estimate healthcare resource utilization and cost of SJS/TEN in Thailand, using hospital perspective. Methods: A retrospective study using an electronic health database from a university-affiliated hospital in Thailand was undertaken. Patients admitted with SJS/TEN from 2002 to 2007 were included. Direct medical cost was estimated by the cost-to-charge ratio. Cost was converted to 2013 value by consumer price index, and converted to $US using 31 Baht/1 $US. The healthcare resource utilization was also estimated. Results: A total of 157 patients were included with average age of 45.3±23.0 years. About 146 patients (93.0%) were diagnosed as SJS and the remaining (7.0%) were diagnosed as TEN. Most of the patients (83.4%) were treated with systemic corticosteroids. Overall, mortality rate was 8.3%, while the average length of stay (LOS) was 10.1±13.2 days. The average cost of managing SJS/TEN for all patients was $1,064±$2,558. The average cost for SJS patients was $1,019±$2,601 while that for TEN patients was $1,660±$1,887. Conclusions: Healthcare resource utilization and cost of care for SJS/TEN in Thailand were tremendous. The findings are important for policy makers to allocate healthcare resources and develop strategies to prevent SJS/TEN which could decrease length of stay and cost of care. PMID:27089110

  15. Healthcare utilization and cost of Stevens-Johnson syndrome and toxic epidermal necrolysis management in Thailand.

    PubMed

    Dilokthornsakul, P; Sawangjit, R; Inprasong, C; Chunhasewee, S; Rattanapan, P; Thoopputra, T; Chaiyakunapruk, N

    2016-01-01

    Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are life-threatening dermatologic conditions. Although, the incidence of SJS/TEN in Thailand is high, information on cost of care for SJS/TEN is limited. This study aims to estimate healthcare resource utilization and cost of SJS/TEN in Thailand, using hospital perspective. A retrospective study using an electronic health database from a university-affiliated hospital in Thailand was undertaken. Patients admitted with SJS/TEN from 2002 to 2007 were included. Direct medical cost was estimated by the cost-to-charge ratio. Cost was converted to 2013 value by consumer price index, and converted to $US using 31 Baht/ 1 $US. The healthcare resource utilization was also estimated. A total of 157 patients were included with average age of 45.3±23.0 years. About 146 patients (93.0%) were diagnosed as SJS and the remaining (7.0%) were diagnosed as TEN. Most of the patients (83.4%) were treated with systemic corticosteroids. Overall, mortality rate was 8.3%, while the average length of stay (LOS) was 10.1±13.2 days. The average cost of managing SJS/TEN for all patients was $1,064±$2,558. The average cost for SJS patients was $1,019±$2,601 while that for TEN patients was $1,660±$1,887. Healthcare resource utilization and cost of care for SJS/TEN in Thailand were tremendous. The findings are important for policy makers to allocate healthcare resources and develop strategies to prevent SJS/TEN which could decrease length of stay and cost of care.

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

    SciTech Connect

    Chen, T.; Yu, O.S.

    1997-10-01

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

  17. Alternatives for management of wastes generated by the formerly utilized sites remedial action program and supplement

    SciTech Connect

    Gilbert, T.L.; Peterson, J.M.; Vocke, R.W.; Alexander, J.K.

    1983-03-01

    Alternatives for disposal or stabilization of the wastes generated by the US Department of Energy's Formerly Utilized Sites Remedial Action Program (FUSRAP) are identified and compared, with emphasis on the long-term aspects. These wastes consist of soil material and rubble containing trace amounts of radionuclides. A detailed pathway analysis for the dose to the maximally exposed individual is carried out using an adaptation of the natural analogue method. Comparisons of the different alternatives, based on the results of the pathway analysis and qualitative cost considerations, indicate that, if the hazard is such that the wastes must be removed and disposed of rather than stabilized in place, disposal by immediate dispersal is preferable to containment, and containment followed by slow planned dispersal is preferable to containment without dispersal. The Supplement presents refinements of work that was reported at the 1982 International Decommissioning Symposium. The new material consists of revisions of the estimates of the predicted potential dose to the maximally exposed individual and a more detailed comparative assessment of the radiological impacts of alternatives for management of wastes generated by the US Department of Energy's Formerly Utilized Sites Remedial Action Program (FUSRAP).

  18. Minimal support technology and in situ resource utilization for risk management of planetary spaceflight missions

    NASA Astrophysics Data System (ADS)

    Murphy, K.; Rygalov, V.; Johnson, S.

    All artificial systems and components in space degrade at higher rates than on Earth depending in part on environmental conditions design approach assembly technologies and the materials used This degradation involves not only the hardware and software systems but the humans that interact with those systems All technological functions and systems can be expressed through functional dependence Function sim ERU RUIS ISR DR where newline ERU Efficiency Rate of Environmental Resources Utilization newline RUIS Resource Utilization Infra-Structure ISR In Situ Resources newline DR Degradation Rate The limited resources of spaceflight and open space for autonomous missions require a high reliability approaching 100 for system functioning and operation and must minimize the rate of any system degradation To date only a continuous human presence with a system in the spaceflight environment can absolutely mitigate those degradations This mitigation is based on environmental amelioration for both the technology systems as repair data and spare parts and the humans as exercise and psychological support Such maintenance requires huge infrastructures including research and development complexes and management agencies which currently cannot move beyond the Earth When considering what is required to move manned spaceflight from near Earth stations to remote locations such as Mars what are the minimal technologies and infrastructures necessary for autonomous restoration of a degrading system in space In

  19. Effects of Home Energy Management Systems on Distribution Utilities and Feeders Under Various Market Structure; NREL (National Renewable Energy Laboratory)

    SciTech Connect

    Ruth, M.; Pratt, A.; Lunacek, M.; Mittal, S.; Wu, H.; Jones, W.

    2015-06-15

    The combination of distributed energy resources (DER) and retail tariff structures to provide benefits to both utility consumers and the utilities is not well understood. To improve understanding, an Integrated Energy System Model (IESM) is being developed to simulate the physical and economic aspects of DER technologies, the buildings where they reside, and feeders servicing them. The IESM was used to simulate 20 houses with home energy management systems on a single feeder under a time-of-use (TOU) tariff to estimate economic and physical impacts on both the households and the distribution utilities. Home energy management systems (HEMS) reduce consumers’ electric bills by precooling houses in the hours before peak electricity pricing. Utilization of HEMS reduce peak loads during high price hours but shifts it to hours with off-peak and shoulder prices, resulting in a higher peak load. used to simulate 20 houses with home energy management systems on a single feeder under a time-of-use (TOU) tariff to estimate economic and physical impacts on both the households and the distribution utilities. Home energy management systems (HEMS) reduce consumers’ electric bills by precooling houses in the hours before peak electricity pricing. Utilization of HEMS reduce peak loads during high price hours but shifts it to hours with off-peak and shoulder prices, resulting in a higher peak load.

  20. Squaring the Project Management Circle: Updating the Cost, Schedule, and Performance Methodology

    DTIC Science & Technology

    2016-04-30

    the weapons systems the DoD produces are the best in the world. Cost, schedule, and performance were sufficient for the management of simple...change (Sargut & McGrath, 2011). By their very nature, cost, schedule, and performance are metrics, and as metrics, become predictors . However, it is...context of the system development. Project Success Cost, schedule, and performance are both a management tool as well as a predictor of success

  1. Dose–response effects for depression and Schizophrenia management on hospital utilization in Illinois Medicaid: a multivariate regression analysis

    PubMed Central

    2014-01-01

    Background The prevalence of schizophrenia and depression in the United States is far higher among Medicaid recipients than in the general population. Individuals suffering from mental illness, including schizophrenia and depression, also have higher rates of emergency department utilization, which is costly and may not generate the positive health outcomes desired. Disease management programs strive to help individuals suffering from chronic illnesses better manage their condition(s) and seek health care in the appropriate settings. The objective of this manuscript is to estimate a dose–response impact on hospital inpatient and emergency room utilizations for any reason by Medicaid recipients with depression or schizophrenia who received disease management contacts. Methods Multivariate regression analysis of panel data taken from administrative claims was conducted to test the hypothesis that increased contacts lower the likelihood of all-cause inpatient admissions and emergency room visits. Subjects included 6,274 members of Illinois’ non-institutionalized Medicaid-only aged, blind or disabled population diagnosed with depression or schizophrenia. The statistical measure is the odds ratio. The odds ratio association is between the monthly utilization indicators and the number of contacts (doses) a member had for each particular disease management intervention. Results Higher numbers of intervention contacts for Medicaid recipients diagnosed with depression or schizophrenia were associated with statistically significant reductions in all-cause inpatient admissions and emergency room utilizations. Conclusions There is a high correlation between depression and schizophrenia disease management contacts and lowered all-cause hospital inpatient and emergency room utilizations. PMID:24989717

  2. Dose-response effects for depression and Schizophrenia management on hospital utilization in Illinois Medicaid: a multivariate regression analysis.

    PubMed

    Berg, Gregory D; Donnelly, Shawn; Warnick, Kathleen; Medina, Wendie; Miller, Mary

    2014-07-03

    The prevalence of schizophrenia and depression in the United States is far higher among Medicaid recipients than in the general population. Individuals suffering from mental illness, including schizophrenia and depression, also have higher rates of emergency department utilization, which is costly and may not generate the positive health outcomes desired. Disease management programs strive to help individuals suffering from chronic illnesses better manage their condition(s) and seek health care in the appropriate settings. The objective of this manuscript is to estimate a dose-response impact on hospital inpatient and emergency room utilizations for any reason by Medicaid recipients with depression or schizophrenia who received disease management contacts. Multivariate regression analysis of panel data taken from administrative claims was conducted to test the hypothesis that increased contacts lower the likelihood of all-cause inpatient admissions and emergency room visits. Subjects included 6,274 members of Illinois' non-institutionalized Medicaid-only aged, blind or disabled population diagnosed with depression or schizophrenia. The statistical measure is the odds ratio. The odds ratio association is between the monthly utilization indicators and the number of contacts (doses) a member had for each particular disease management intervention. Higher numbers of intervention contacts for Medicaid recipients diagnosed with depression or schizophrenia were associated with statistically significant reductions in all-cause inpatient admissions and emergency room utilizations. There is a high correlation between depression and schizophrenia disease management contacts and lowered all-cause hospital inpatient and emergency room utilizations.

  3. Utilization of specific and non-specific peptide interactions with inorganic nanomaterials on the surface of bacteriophage M13: Methodologies towards phage supported bi-functional materials

    NASA Astrophysics Data System (ADS)

    Avery, Kendra Nicole

    the phage with a negative charge on which nanomaterials can be supported. Metal salt precursors reduced in the presence of WT M13 are studied in this chapter. Metal salt precursors of Fe, Co, Ru, Rh and Pd seem to be the most effective at coating the surface of the phage based on the positively charged metal-aquo complexes formed in water, which are attracted to the negative pVIII region. Other types of reactions are explored with WT phage as a scaffold such as conversion chemistry in a polyol solvent to access several intermetallic phases as well as co-precipitation reactions to access ternary oxides. Chapter 4 focuses on combining research from chapter 2 and chapter 3 to create a bi-functional material that utilizes both specific and non-specific peptide interactions with inorganic materials on the surface of M13 to attach two different types of nanomaterials. The example provided here is a magnetically recoverable hydrogenation catalyst made up of a pVIII region coated with rhodium nanoparticles held in place by non-specific peptide interactions and a pIII region attached to iron oxide nanoparticles via specific peptide interactions. This is the first example in the literature of a commercially available pIII bioengineered M13 bacteriophage forming a bi-functional material. This research provides a methodology to design and build single and multi-component materials on the surface of bacteriophage M13 without the necessity for additional bioengineering and library characterization. The simplicity of use will make the technique available to a wider variety of researchers in the materials science community.

  4. Improved methodology to assess modification and completion of landfill gas management in the aftercare period

    SciTech Connect

    Morris, Jeremy W.F.; Crest, Marion; Barlaz, Morton A.; Spokas, Kurt A.; Akerman, Anna; Yuan, Lei

    2012-12-15

    Highlights: Black-Right-Pointing-Pointer Performance-based evaluation of landfill gas control system. Black-Right-Pointing-Pointer Analytical framework to evaluate transition from active to passive gas control. Black-Right-Pointing-Pointer Focus on cover oxidation as an alternative means of passive gas control. Black-Right-Pointing-Pointer Integrates research on long-term landfill behavior with practical guidance. - Abstract: Municipal solid waste landfills represent the dominant option for waste disposal in many parts of the world. While some countries have greatly reduced their reliance on landfills, there remain thousands of landfills that require aftercare. The development of cost-effective strategies for landfill aftercare is in society's interest to protect human health and the environment and to prevent the emergence of landfills with exhausted aftercare funding. The Evaluation of Post-Closure Care (EPCC) methodology is a performance-based approach in which landfill performance is assessed in four modules including leachate, gas, groundwater, and final cover. In the methodology, the objective is to evaluate landfill performance to determine when aftercare monitoring and maintenance can be reduced or possibly eliminated. This study presents an improved gas module for the methodology. While the original version of the module focused narrowly on regulatory requirements for control of methane migration, the improved gas module also considers best available control technology for landfill gas in terms of greenhouse gas emissions, air quality, and emissions of odoriferous compounds. The improved module emphasizes the reduction or elimination of fugitive methane by considering the methane oxidation capacity of the cover system. The module also allows for the installation of biologically active covers or other features designed to enhance methane oxidation. A methane emissions model, CALMIM, was used to assist with an assessment of the methane oxidation capacity of

  5. BPMN, Toolsets, and Methodology: A Case Study of Business Process Management in Higher Education

    NASA Astrophysics Data System (ADS)

    Barn, Balbir S.; Oussena, Samia

    This chapter describes ongoing action research which is exploring the use of BPMN and a specific toolset - Intalio Designer to capture the “as is” essential process model of part of an overarching large business process within higher education. The chapter contends that understanding the efficacy of the BPMN notation and the notational elements to use is not enough. Instead, the effectiveness of a notation is determined by the notation, the toolset that is being used, and methodological consideration. The chapter presents some of the challenges that are faced in attempting to develop computation independent models in BPMN using toolsets such as Intalio Designer™.

  6. An innovative thermal management concept of waste heat utilization in space

    SciTech Connect

    Choi, M.K.

    1995-12-31

    This paper presents an innovative thermal management concept that utilizes the waste heat of electronics to meet both the heater power budget and the thermal requirements of the Far Ultraviolet Spectroscopic Explorer (FUSE) payload during the phase-B study at NASA Goddard Space Flight Center. The phase-B study included trade studies of different orbits. This paper is concerned with the highly elliptical orbit. The total heat dissipation of the electronics is 177.4 W, all at the mid-section of a 3.9-m tall graphite epoxy structure. The innovative thermal management concept uses constant conductance heat pipes to transport the waste heat to interior cold plates which radiate to the structure and aft end of the baffle tubes. It provides uniform temperature to the structure. Variable conductance heat pipes transport the excess waste heat to external radiators to maintain the structure at a constant temperature. This design minimizes the heater power for the graphite epoxy structure and reduces the heater power for the mirrors. The total heater power required at Sun angles in the 45{degree} to 105{degree} range is 58.5 W at a 45{degree} sun angle, 46 W at 90{degree} and 30.4 W at 105{degree}. The optical performance of the payload is optimum at these sun angles. It also provides temperature stability to the structure during science observation at sun angles of 20{degree} to 45{degree} and 105{degree} to 137{degree} when no heater power is available.

  7. A risk-based approach to management of leachables utilizing statistical analysis of extractables.

    PubMed

    Stults, Cheryl L M; Mikl, Jaromir; Whelehan, Oliver; Morrical, Bradley; Duffield, William; Nagao, Lee M

    2015-04-01

    To incorporate quality by design concepts into the management of leachables, an emphasis is often put on understanding the extractable profile for the materials of construction for manufacturing disposables, container-closure, or delivery systems. Component manufacturing processes may also impact the extractable profile. An approach was developed to (1) identify critical components that may be sources of leachables, (2) enable an understanding of manufacturing process factors that affect extractable profiles, (3) determine if quantitative models can be developed that predict the effect of those key factors, and (4) evaluate the practical impact of the key factors on the product. A risk evaluation for an inhalation product identified injection molding as a key process. Designed experiments were performed to evaluate the impact of molding process parameters on the extractable profile from an ABS inhaler component. Statistical analysis of the resulting GC chromatographic profiles identified processing factors that were correlated with peak levels in the extractable profiles. The combination of statistically significant molding process parameters was different for different types of extractable compounds. ANOVA models were used to obtain optimal process settings and predict extractable levels for a selected number of compounds. The proposed paradigm may be applied to evaluate the impact of material composition and processing parameters on extractable profiles and utilized to manage product leachables early in the development process and throughout the product lifecycle.

  8. Utilization of Geotextile Tube for Sandy and Muddy Coastal Management: A Review

    PubMed Central

    Lee, Siew Cheng; Hashim, Roslan; Motamedi, Shervin; Song, Ki-Il

    2014-01-01

    Threats to beaches have accelerated the coastal destruction. In recent decades, geotextile tubes were used around the world to prevent coastal erosion, to encourage beach nourishment, and to assist mangrove rehabilitation. However, the applications of geotextile tube in sandy and muddy coasts have different concerns as the geological settings are different. Applications of geotextile tubes in sandy beaches were mainly to prevent coastline from further erosion and to nourish the beach. However, for the muddy coasts, mangrove rehabilitation and conservation were additional concerns in coastal management schemes. The mangrove forests are natural barriers which can be found on the muddy coasts of many tropical countries. In this paper, the viability of geotextile tubes in sandy and muddy beaches was analysed. The advantages and disadvantages of the utilization of geotextile tubes in coastal management were discussed based on the experiences from the tropical countries such as Mexico, Malaysia, and Thailand. From the case studies, impressive improvements in coastal restoration after installation of geotextile tubes were shown. Based on the discussion, several recommendations to improve the application of geotextile tubes were suggested in this paper. PMID:24955408

  9. From Physician to Consumer: The Effectiveness of Strategies to Manage Health Care Utilization

    PubMed Central

    Flynn, Kathryn E.; Smith, Maureen A.; Davis, Margaret K.

    2006-01-01

    Many strategies are commonly used to influence physician behavior in managed care organizations. This review examines the effectiveness of three mechanisms to influence physician behavior: financial incentives directed at providers or patients, policies/procedures for managing care, and the selection/education of both providers and patients. We reach three conclusions. First, all health care systems use financial incentives, but these mechanisms are shifting away from financial incentives directed at the physician to those directed at the consumer. Second, heavily procedural strategies such as utilization review and gatekeeping show some evidence of effectiveness but are highly unpopular due to their restrictions on physician and patient choice. Third, a future system built on consumer choice is contradicted by mechanisms that rely solely on narrow networks of providers or the education of physicians. If patients become the new locus of decision-making in health care, provider-focused mechanisms to influence physician behavior will not disappear but are likely to decline in importance. PMID:12508705

  10. Utilization of geotextile tube for sandy and muddy coastal management: a review.

    PubMed

    Lee, Siew Cheng; Hashim, Roslan; Motamedi, Shervin; Song, Ki-Il

    2014-01-01

    Threats to beaches have accelerated the coastal destruction. In recent decades, geotextile tubes were used around the world to prevent coastal erosion, to encourage beach nourishment, and to assist mangrove rehabilitation. However, the applications of geotextile tube in sandy and muddy coasts have different concerns as the geological settings are different. Applications of geotextile tubes in sandy beaches were mainly to prevent coastline from further erosion and to nourish the beach. However, for the muddy coasts, mangrove rehabilitation and conservation were additional concerns in coastal management schemes. The mangrove forests are natural barriers which can be found on the muddy coasts of many tropical countries. In this paper, the viability of geotextile tubes in sandy and muddy beaches was analysed. The advantages and disadvantages of the utilization of geotextile tubes in coastal management were discussed based on the experiences from the tropical countries such as Mexico, Malaysia, and Thailand. From the case studies, impressive improvements in coastal restoration after installation of geotextile tubes were shown. Based on the discussion, several recommendations to improve the application of geotextile tubes were suggested in this paper.

  11. Utilization and management of maternal and child health funds in rural Nepal.

    PubMed

    Morrison, Joanna; Thapa, Rita; Sen, Aman; Neupane, Rishi; Borghi, Jo; Tumbahangphe, Kirti Man; Osrin, David; Manandhar, Dharma; Costello, Anthony

    2010-01-01

    Maternal and neonatal mortality rates are highest in the poorest countries, and financial barriers impede access to health care. Community loan funds can increase access to cash in rural areas, thereby reducing delays in care seeking. As part of a participatory intervention in rural Nepal, community women's groups initiated and managed local funds. We explore the factors affecting utilization and management of these funds and the role of the funds in the success of the women's group intervention. We conducted a qualitative study using focus group discussions, group interviews and unstructured observations. Funds may increase access to care for members of trusted 'insider' families adjudged as able to repay loans. Sustainability and sufficiency of funds was a concern but funds increased women's independence and enabled timely care seeking. Conversely, the perceived necessity to contribute may have deterred poorer women. While funds were integral to group success and increased women's autonomy, they may not be the most effective way of supporting the poorest, as the risk pool is too small to allow for repayment default.

  12. Utility of ambulatory blood pressure monitoring for the management of hypertension.

    PubMed

    Campbell, Patrick T; White, William B

    2017-07-01

    Hypertension is a leading cause of cardiovascular morbidity and mortality, affecting nearly 80 million individuals in the United States alone. Accurate measurement of blood pressure (BP) is the crucial first step to reduce the associated cardiovascular risk of hypertension. For decades, clinicians have relied on office BP measurements for the diagnosis and subsequent management of hypertension. However, it has been clearly demonstrated that ambulatory BP measurements are a better predictor of cardiovascular risk and can provide clinicians with important additional information to improve BP control and reduce cardiovascular risk. This article reviews the available data and provides clinical insights into the use of ambulatory BP monitoring for the management of hypertension. Ambulatory BP monitoring is uniquely capable of identifying patients with white-coat hypertension (WCH), masked hypertension and abnormal nocturnal BP profiles. Recently, ambulatory BP data have demonstrated the negative impact of WCH on right ventricular function, a greater prevalence of masked hypertension than previously recognized and the detrimental impact of nocturnal hypertension even in controlled hypertension. Ambulatory BP monitoring provides clinicians with the most comprehensive evaluation of hypertension and the ability to define individual BP phenotypes. Hence, these out-of-office measurements can be utilized to improve hypertension control, translating into a reduction of cardiovascular events.

  13. Modeling strategy to identify patients with primary immunodeficiency utilizing risk management and outcome measurement.

    PubMed

    Modell, Vicki; Quinn, Jessica; Ginsberg, Grant; Gladue, Ron; Orange, Jordan; Modell, Fred

    2017-02-21

    This study seeks to generate analytic insights into risk management and probability of an identifiable primary immunodeficiency defect. The Jeffrey Modell Centers Network database, Jeffrey Modell Foundation's 10 Warning Signs, the 4 Stages of Testing Algorithm, physician-reported clinical outcomes, programs of physician education and public awareness, the SPIRIT® Analyzer, and newborn screening, taken together, generates P values of less than 0.05%. This indicates that the data results do not occur by chance, and that there is a better than 95% probability that the data are valid. The objectives are to improve patients' quality of life, while generating significant reduction of costs. The advances of the world's experts aligned with these JMF programs can generate analytic insights as to risk management and probability of an identifiable primary immunodeficiency defect. This strategy reduces the uncertainties related to primary immunodeficiency risks, as we can screen, test, identify, and treat undiagnosed patients. We can also address regional differences and prevalence, age, gender, treatment modalities, and sites of care, as well as economic benefits. These tools support high net benefits, substantial financial savings, and significant reduction of costs. All stakeholders, including patients, clinicians, pharmaceutical companies, third party payers, and government healthcare agencies, must address the earliest possible precise diagnosis, appropriate intervention and treatment, as well as stringent control of healthcare costs through risk assessment and outcome measurement. An affected patient is entitled to nothing less, and stakeholders are responsible to utilize tools currently available. Implementation offers a significant challenge to the entire primary immunodeficiency community.

  14. Application of a new methodology for coastal multi-hazard-assessment & management on the state of Karnataka, India.

    PubMed

    Rosendahl Appelquist, Lars; Balstrøm, Thomas

    2015-04-01

    This paper presents the application of a new methodology for coastal multi-hazard assessment & management under a changing global climate on the state of Karnataka, India. The recently published methodology termed the Coastal Hazard Wheel (CHW) is designed for local, regional and national hazard screening in areas with limited data availability, and covers the hazards of ecosystem disruption, gradual inundation, salt water intrusion, erosion and flooding. The application makes use of published geophysical data and remote sensing information and is showcasing how the CHW framework can be applied at a scale relevant for regional planning purposes. It uses a GIS approach to develop regional and sub-regional hazard maps as well as to produce relevant hazard risk data, and includes a discussion of uncertainties, limitations and management perspectives. The hazard assessment shows that 61 percent of Karnataka's coastline has a high or very high inherent hazard of erosion, making erosion the most prevalent coastal hazard. The hazards of flooding and salt water intrusion are also relatively widespread as 39 percent of Karnataka's coastline has a high or very high inherent hazard for both of these hazard types. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

  15. Utility of Early MRI in the Diagnosis and Management of Acute Spontaneous Intracerebral Hemorrhage

    PubMed Central

    Wijman, Christine A.C.; Venkatasubramanian, Chitra; Bruins, Sara; Fischbein, Nancy; Schwartz, Neil

    2010-01-01

    Background The optimal diagnostic evaluation for spontaneous intracerebral hemorrhage (ICH) remains controversial. In this retrospective study, we assessed the utility of early magnetic resonance imaging (MRI) in ICH diagnosis and management. Methods Eighty-nine (72%) of 123 patients with spontaneous ICH underwent a brain CT and MRI within 30 days of ICH onset. Seventy patients with a mean age of 62 ± 15 years were included. A stroke neurologist and a general neurologist, each blinded to the final diagnosis, independently reviewed the admission data and the initial head CT and then assigned a presumed ICH cause under 1 of 9 categories. ICH cause was potentially modified after subsequent MRI review. The final ‘gold standard’ ICH etiology was determined after review of the complete medical record by an independent investigator. Change in diagnostic category and confidence and the potential impact on patient management were systematically recorded. Results Mean time to MRI was 3 ± 5 days. Final ICH diagnosis was hypertension or cerebral amyloid angiopathy (CAA) in 50% of patients. After MRI review the stroke neurologist changed diagnostic category in 14%, diagnostic confidence in an additional 23% and management in 20%, and the general neurologist did so in 19, 21 and 21% of patients, respectively. MRI yield was highest in ICH secondary to ischemic stroke, CAA, vascular malformations and neoplasms, and did not differ by age, history of hypertension, hematoma location or the presence of intraventricular hemorrhage. Conclusions The results of this study suggest potential additive clinical benefit of early MRI in patients with spontaneous ICH. PMID:20733299

  16. Methodology for the nuclear design validation of an Alternate Emergency Management Centre (CAGE)

    NASA Astrophysics Data System (ADS)

    Hueso, César; Fabbri, Marco; de la Fuente, Cristina; Janés, Albert; Massuet, Joan; Zamora, Imanol; Gasca, Cristina; Hernández, Héctor; Vega, J. Ángel

    2017-09-01

    The methodology is devised by coupling different codes. The study of weather conditions as part of the data of the site will determine the relative concentrations of radionuclides in the air using ARCON96. The activity in the air is characterized depending on the source and release sequence specified in NUREG-1465 by RADTRAD code, which provides results of the inner cloud source term contribution. Known activities, energy spectra are inferred using ORIGEN-S, which are used as input for the models of the outer cloud, filters and containment generated with MCNP5. The sum of the different contributions must meet the conditions of habitability specified by the CSN (Spanish Nuclear Regulatory Body) (TEDE <50 mSv and equivalent dose to the thyroid <500 mSv within 30 days following the accident doses) so that the dose is optimized by varying parameters such as CAGE location, flow filtering need for recirculation, thicknesses and compositions of the walls, etc. The results for the most penalizing area meet the established criteria, and therefore the CAGE building design based on the methodology presented is radiologically validated.

  17. Decision-making in crisis: Applying a healthcare triage methodology to business continuity management.

    PubMed

    Moore, Bethany; Bone, Eric A

    2017-01-01

    The concept of triage in healthcare has been around for centuries and continues to be applied today so that scarce resources are allocated according to need. A business impact analysis (BIA) is a form of triage in that it identifies which processes are most critical, which to address first and how to allocate limited resources. On its own, however, the BIA provides only a roadmap of the impacts and interdependencies of an event. When disaster strikes, organisational decision-makers often face difficult decisions with regard to allocating limited resources between multiple 'mission-critical' functions. Applying the concept of triage to business continuity provides those decision-makers navigating a rapidly evolving and unpredictable event with a path that protects the fundamental priorities of the organisation. A business triage methodology aids decision-makers in times of crisis by providing a simplified framework for decision-making based on objective, evidence-based criteria, which is universally accepted and understood. When disaster strikes, the survival of the organisation depends on critical decision-making and quick actions to stabilise the incident. This paper argues that organisations need to supplement BIA processes with a decision-making triage methodology that can be quickly applied during the chaos of an actual event.

  18. Implementation and evaluation of a pharmacist-led hypertension management service in primary care: outcomes and methodological challenges

    PubMed Central

    2016-01-01

    Background: Suboptimal utilisation of pharmacotherapy, non-adherence to prescribed treatment, and a lack of monitoring all contribute to poor blood (BP) pressure control in patients with hypertension. Objective: The objective of this study was to evaluate the implementation of a pharmacist-led hypertension management service in terms of processes, outcomes, and methodological challenges. Method: A prospective, controlled study was undertaken within the Australian primary care setting. Community pharmacists were recruited to one of three study groups: Group A (Control – usual care), Group B (Intervention), or Group C (Short Intervention). Pharmacists in Groups B and C delivered a service comprising screening and monitoring of BP, as well as addressing poor BP control through therapeutic adjustment and adherence strategies. Pharmacists in Group C delivered the shortened version of the service. Results: Significant changes to key outcome measures were observed in Group C: reduction in systolic and diastolic BPs at the 3-month visit (P<0.01 and P<0.01, respectively), improvement in medication adherence scores (P=0.01), and a slight improvement in quality of life (EQ-5D-3L Index) scores (P=0.91). There were no significant changes in Group B (the full intervention), and no differences in comparison to Group A (usual care). Pharmacists fed-back that patient recruitment was a key barrier to service implementation, highlighting the methodological implications of screening. Conclusion: A collaborative, pharmacist-led hypertension management service can help monitor BP, improve medication adherence, and optimise therapy in a step-wise approach. However, blood pressure screening can effect behaviour change in patients, presenting methodological challenges in the evaluation of services in this context. PMID:27382427

  19. Experimental evaluation of the sensitivity to fuel utilization and air management on a 100 kW SOFC system

    NASA Astrophysics Data System (ADS)

    Santarelli, M.; Leone, P.; Calì, M.; Orsello, G.

    The tubular SOFC generator CHP-100, built by Siemens Power Generation (SPG) Stationary Fuel Cells (SFC), is running at the Gas Turbine Technologies (GTT) in Torino (Italy), in the framework of the EOS Project. The nominal load of the generator ensures a produced electric power of around 105 kW e ac and around 60 kW t of thermal power at 250 °C to be used for the custom tailored HVAC system. Several experimental sessions have been scheduled on the generator; the aim is to characterize the operation through the analysis of some global performance index and the detailed control of the operation of the different bundles of the whole stack. All the scheduled tests have been performed by applying the methodology of design of experiment; the main obtained results show the effect of the change of the analysed operating factors in terms of distribution of voltage and temperature over the stack. Fuel consumption tests give information about the sensitivity of the voltage and temperature distribution along the single bundles. On the other hand, since the generator is an air cooled system, the results of the tests on the air stoichs have been used to analyze the generator thermal management (temperature distribution and profiles) and its effect on the polarization. The sensitivity analysis of the local voltage to the overall fuel consumption modifications can be used as a powerful procedure to deduce the local distribution of fuel utilization (FU) along the single bundles: in fact, through a model obtained by deriving the polarization curve respect to FU, it is possible to link the distribution of voltage sensitivities to FC to the distribution of the local FU. The FU distribution will be shown as non-uniform, and this affects the local voltage and temperatures, causing a high warming effect in some rows of the generator. Therefore, a discussion around the effectiveness of the thermal regulation made by the air stoichs, in order to reduce the non-uniform distribution of

  20. Implementation and Methodology of a Multidisciplinary Disease-State-Management Program for Comprehensive Diabetes Care

    PubMed Central

    Antoline, Catherine; Kramer, Amy; Roth, Mark

    2011-01-01

    Introduction: Before the implementation of a multidisciplinary disease-state-management program in the Kaiser Permanente Ohio Region, the primary care physician (PCP) worked with a registered nurse care manager (RNCM) and a clinical pharmacist with the degree of PharmD to control diabetes mellitus (DM). This occurred through PCP referral when patients required a higher level of care than could be achieved during initial PCP office visits and subsequent follow-up visits. However, not all PCPs consistently initiated referrals, and as patients in need of referral were typically identified through office visits, those without routine appointments were often missed. This practice translated into suboptimal 2008 comprehensive DM care Healthcare Effectiveness Data and Information Set (HEDIS) scores. Methods: A quality-improvement disease-management committee convened for design and implementation of a multidisciplinary DM disease-state-management program, as well as oversight and analysis of the new process. This regional intervention required many members of the health care team to obtain additional education about comprehensive DM care, adopt new work flows, and learn to use tools for evaluating patient care gaps. Results: Within one year, this regional multidisciplinary intervention resulted in improvements in blood pressure, lipid levels, and glycemic control as indicated by 2009 comprehensive DM-care HEDIS scores. Discussion: Main contributors to the success of the program included executive support and sponsorship, the leadership of the oversight committee, systematic identification and assignment of patients, the blood-pressure service run by licensed practical nurses, continuous education efforts, dedicated panel-management time, use of a multidisciplinary team, and expanding treatment of the diabetic patient beyond glucose control to include blood pressure and lipid management. PMID:21505617

  1. Exploring the cost-utility of stratified primary care management for low back pain compared with current best practice within risk-defined subgroups.

    PubMed

    Whitehurst, David G T; Bryan, Stirling; Lewis, Martyn; Hill, Jonathan; Hay, Elaine M

    2012-11-01

    Stratified management for low back pain according to patients' prognosis and matched care pathways has been shown to be an effective treatment approach in primary care. The aim of this within-trial study was to determine the economic implications of providing such an intervention, compared with non-stratified current best practice, within specific risk-defined subgroups (low-risk, medium-risk and high-risk). Within a cost-utility framework, the base-case analysis estimated the incremental healthcare cost per additional quality-adjusted life year (QALY), using the EQ-5D to generate QALYs, for each risk-defined subgroup. Uncertainty was explored with cost-utility planes and acceptability curves. Sensitivity analyses were performed to consider alternative costing methodologies, including the assessment of societal loss relating to work absence and the incorporation of generic (ie, non-back pain) healthcare utilisation. The stratified management approach was a cost-effective treatment strategy compared with current best practice within each risk-defined subgroup, exhibiting dominance (greater benefit and lower costs) for medium-risk patients and acceptable incremental cost to utility ratios for low-risk and high-risk patients. The likelihood that stratified care provides a cost-effective use of resources exceeds 90% at willingness-to-pay thresholds of £4000 (≈ 4500; $6500) per additional QALY for the medium-risk and high-risk groups. Patients receiving stratified care also reported fewer back pain-related days off work in all three subgroups. Compared with current best practice, stratified primary care management for low back pain provides a highly cost-effective use of resources across all risk-defined subgroups.

  2. Exploring the cost–utility of stratified primary care management for low back pain compared with current best practice within risk-defined subgroups

    PubMed Central

    Whitehurst, David G T; Bryan, Stirling; Lewis, Martyn; Hill, Jonathan; Hay, Elaine M

    2012-01-01

    Objectives Stratified management for low back pain according to patients' prognosis and matched care pathways has been shown to be an effective treatment approach in primary care. The aim of this within-trial study was to determine the economic implications of providing such an intervention, compared with non-stratified current best practice, within specific risk-defined subgroups (low-risk, medium-risk and high-risk). Methods Within a cost–utility framework, the base-case analysis estimated the incremental healthcare cost per additional quality-adjusted life year (QALY), using the EQ-5D to generate QALYs, for each risk-defined subgroup. Uncertainty was explored with cost–utility planes and acceptability curves. Sensitivity analyses were performed to consider alternative costing methodologies, including the assessment of societal loss relating to work absence and the incorporation of generic (ie, non-back pain) healthcare utilisation. Results The stratified management approach was a cost-effective treatment strategy compared with current best practice within each risk-defined subgroup, exhibiting dominance (greater benefit and lower costs) for medium-risk patients and acceptable incremental cost to utility ratios for low-risk and high-risk patients. The likelihood that stratified care provides a cost-effective use of resources exceeds 90% at willingness-to-pay thresholds of £4000 (≈ 4500; $6500) per additional QALY for the medium-risk and high-risk groups. Patients receiving stratified care also reported fewer back pain-related days off work in all three subgroups. Conclusions Compared with current best practice, stratified primary care management for low back pain provides a highly cost-effective use of resources across all risk-defined subgroups. PMID:22492783

  3. Methodology for Analyzing and Developing Information Management Infrastructure to Support Telerehabilitation

    PubMed Central

    Saptono, Andi; Schein, Richard M.; Parmanto, Bambang; Fairman, Andrea

    2009-01-01

    The proliferation of advanced technologies led researchers within the Rehabilitation Engineering Research Center on Telerehabilitation (RERC-TR) to devise an integrated infrastructure for clinical services using the University of Pittsburgh (PITT) model. This model describes five required characteristics for a telerehabilitation (TR) infrastructure: openness, extensibility, scalability, cost-effectiveness, and security. The infrastructure is to deliver clinical services over distance to improve access to health services for people living in underserved or remote areas. The methodological approach to design, develop, and employ this infrastructure is explained and detailed for the remote wheelchair prescription project, a research task within the RERC-TR. The availability of this specific clinical service and personnel outside of metropolitan areas is limited due to the lack of specialty expertise and access to resources. The infrastructure is used to deliver expertise in wheeled mobility and seating through teleconsultation to remote clinics, and has been successfully deployed to five rural clinics in Western Pennsylvania. PMID:25945161

  4. Methodology for analyzing and developing information management infrastructure to support telerehabilitation.

    PubMed

    Saptono, Andi; Schein, Richard M; Parmanto, Bambang; Fairman, Andrea

    2009-01-01

    The proliferation of advanced technologies led researchers within the Rehabilitation Engineering Research Center on Telerehabilitation (RERC-TR) to devise an integrated infrastructure for clinical services using the University of Pittsburgh (PITT) model. This model describes five required characteristics for a telerehabilitation (TR) infrastructure: openness, extensibility, scalability, cost-effectiveness, and security. The infrastructure is to deliver clinical services over distance to improve access to health services for people living in underserved or remote areas. The methodological approach to design, develop, and employ this infrastructure is explained and detailed for the remote wheelchair prescription project, a research task within the RERC-TR. The availability of this specific clinical service and personnel outside of metropolitan areas is limited due to the lack of specialty expertise and access to resources. The infrastructure is used to deliver expertise in wheeled mobility and seating through teleconsultation to remote clinics, and has been successfully deployed to five rural clinics in Western Pennsylvania.

  5. A Proposed Methodology to Assess the Quality of Public Use Management in Protected Areas

    NASA Astrophysics Data System (ADS)

    Muñoz-Santos, Maria; Benayas, Javier

    2012-07-01

    In recent years, the goal of nature preservation has faced, almost worldwide, an increase in the number of visitors who are interested in experiencing protected areas resources, landscapes and stories. Spain is a good example of this process. The rapidly increasing numbers of visitors have prompted administrations and managers to offer and develop a broad network of facilities and programs in order to provide these visitors with information, knowledge and recreation. But, are we doing it the best way? This research focuses on developing and applying a new instrument for evaluating the quality of visitor management in parks. Different areas are analyzed with this instrument (78 semi-quantitative indicators): planning and management capacity (planning, funding, human resources), monitoring, reception, information, interpretation, environmental education, training, participation and volunteer's programs. Thus, we attempt to gain a general impression of the development of the existing management model, detecting strengths and weaknesses. Although Spain's National Parks constituted the specific context within which to develop the evaluation instrument, the design thereof is intended to provide a valid, robust and flexible method for application to any system, network or set of protected areas in other countries. This paper presents the instrument developed, some results obtained following its application to Spanish National parks, along with a discussion on the limits and validity thereof.

  6. A Methodology for Building Faculty Support for the United Nations Principles for Responsible Management Education

    ERIC Educational Resources Information Center

    Maloni, Michael J.; Smith, Shane D.; Napshin, Stuart

    2012-01-01

    Evidence from extant literature indicates that faculty support is a critical driver for implementing the United Nations Principles for Responsible Management Education (PRME), particularly for schools pursuing an advanced, cross-disciplinary level of sustainability integration. However, there is limited existing research offering insight into how…

  7. Environmental and socio-economic methodologies and solutions towards integrated water resources management.

    PubMed

    Friesen, Jan; Rodriguez Sinobas, Leonor; Foglia, Laura; Ludwig, Ralf

    2017-03-01

    Semi-arid regions are facing the challenge of managing water resources under conditions of increasing scarcity and drought. These are recently pressured by the impact of climate change favoring the shifting from using surface water to groundwater without taking sustainability issues into account. Likewise, water scarcity raises the competition for water among users, increasing the risk of social conflicts, as the availability of fresh water in sufficient quality and quantity is already one of the major factors limiting socio-economic development. In terms of hydrology, semi-arid regions are characterized by very complex hydro- and hydrogeological systems. The complexity of the water cycle contrasts strongly with the poor data availability, (1) which limits the number of analysis techniques and methods available to researchers, (2) limits the accuracy of models and predictions, and (3) consequently challenges the capabilities to develop appropriate management measures to mitigate or adapt the environment to scarcity and drought conditions. Integrated water resources management is a holistic approach to focus on both environmental as well as on socio-economic factors influencing water availability and supply. The management approaches and solutions adopted, e.g. in form of decision support for specific water resources systems, are often highly specific for individual case studies. Copyright © 2016 Elsevier B.V. All rights reserved.

  8. A Methodology for Building Faculty Support for the United Nations Principles for Responsible Management Education

    ERIC Educational Resources Information Center

    Maloni, Michael J.; Smith, Shane D.; Napshin, Stuart

    2012-01-01

    Evidence from extant literature indicates that faculty support is a critical driver for implementing the United Nations Principles for Responsible Management Education (PRME), particularly for schools pursuing an advanced, cross-disciplinary level of sustainability integration. However, there is limited existing research offering insight into how…

  9. Assessment of management approaches in a public water utility: A case study of the Namibia water corporation (NAMWATER)

    NASA Astrophysics Data System (ADS)

    Ndokosho, Johnson; Hoko, Zvikomborero; Makurira, Hodson

    More than 90% of urban water supply and sanitation services in developing countries are provided by public organizations. However, public provision of services has been inherently inefficient. As a result a number of initiatives have emerged in recent years with a common goal to improve service delivery. In Namibia, the water sector reform resulted in the creation of a public utility called the Namibia Water Corporation (NAMWATER) which is responsible for bulk water supply countrywide. Since its inception in 1998, NAMWATER has been experiencing poor financial performance. This paper presents the findings of a case study that compared the management approaches of NAMWATER to the New Public Management (NPM) paradigm. The focus of the NPM approach is for the public water sector to mirror private sector methods of management so that public utilities can accrue the benefits of effectiveness, efficiency and flexibility often associated with private sector. The study tools used were a combination of literature review, interviews and questionnaires. It was found out that NAMWATER has a high degree of autonomy in its operations, albeit government approved tariffs and sourcing of external financing. The utility reports to government annually to account for results. The utility embraces a notion of good corporate culture and adheres to sound management practices. NAMWATER demonstrated a strong market-orientation indicated by the outsourcing of non-core functions but benchmarking was poorly done. NAMWATER’s customer-orientation is poor as evidenced by the lack of customer care facilities. NAMWATER’s senior management delegated operational authority to lower management to facilitate flexibility and eliminate bottlenecks. The lower management is in turn held accountable for performance by the senior management. There are no robust methods of ensuring sufficient accountability indicated by absence of performance contracts or service level agreements. It was concluded that

  10. Health Utility Outcomes in Patients Undergoing Medical Management for Chronic Rhinosinusitis – A Prospective Multi-Institutional Study

    PubMed Central

    Luk, Lauren J.; Steele, Toby O.; Mace, Jess C.; Soler, Zachary M.; Rudmik, Luke; Smith, Timothy L.

    2015-01-01

    Background A health utility value represents an individual’s preference for living in a specific health state and is used in cost-utility analyses. This study investigates the impact of continuing medical therapy on health utility outcomes in patients with chronic rhinosinusitis (CRS). Methods The Medical Outcomes Study Short Form-6D (SF-6D) was administered to patients prospectively enrolled in a longitudinal study examining treatment outcomes for CRS. Patients were prescribed robust, initial medical therapy and then elected to continue with medical therapy (n=40) or undergo endoscopic sinus surgery (ESS), followed by medical therapy (n=152). Patients observed through treatment crossover to ESS were also evaluated (n=20). Health utility values (SF-6D) were generated at baseline, 6-months, and 12-months follow-up for both cohorts and evaluated using repeated measures ANOVA. Results Treatment crossover patients were found to have a significantly higher prevalence of previous sinus surgery compared to medical management (χ2=6.91; p=0.009) and surgical intervention (χ2=8.11; p=0.004) subgroups. Mean baseline utility value for the medical therapy cohort was significantly better compared to the ESS cohort (0.76[0.12] versus 0.70[0.15]; p=0.023). Significant improvement in health utility was reported in the ESS cohort (F(2)=37.69; p<0.001), while values remained stable, without significant improvement, in both the medical therapy cohort (F(2)=0.03; p=0.967) and treatment crossover cohort (F(2)=2.36; p=0.115). Conclusions Patients electing continued medical management report better baseline health utility compared to patients electing ESS. Patients electing ESS demonstrate significant improvement in health utility while those electing continued medical management demonstrate stable health utility over 12 months. PMID:26140502

  11. Lean management in health care: definition, concepts, methodology and effects reported (systematic review protocol)

    PubMed Central

    2014-01-01

    Background Lean is a set of operating philosophies and methods that help create a maximum value for patients by reducing waste and waits. It emphasizes the consideration of the customer’s needs, employee involvement and continuous improvement. Research on the application and implementation of lean principles in health care has been limited. Methods This is a protocol for a systematic review, following the Cochrane Effective Practice and Organisation of Care (EPOC) methodology. The review aims to document, catalogue and synthesize the existing literature on the effects of lean implementation in health care settings especially the potential effects on professional practice and health care outcomes. We have developed a Medline keyword search strategy, and this focused strategy will be translated into other databases. All search strategies will be provided in the review. The method proposed by the Cochrane EPOC group regarding randomized study designs, non-randomised controlled trials controlled before and after studies and interrupted time series will be followed. In addition, we will also include cohort, case–control studies, and relevant non-comparative publications such as case reports. We will categorize and analyse the review findings according to the study design employed, the study quality (low- versus high-quality studies) and the reported types of implementation in the primary studies. We will present the results of studies in a tabular form. Discussion Overall, the systematic review aims to identify, assess and synthesize the evidence to underpin the implementation of lean activities in health care settings as defined in this protocol. As a result, the review will provide an evidence base for the effectiveness of lean and implementation methodologies reported in health care. Systematic review registration PROSPERO CRD42014008853 PMID:25238974

  12. Lean management in health care: definition, concepts, methodology and effects reported (systematic review protocol).

    PubMed

    Lawal, Adegboyega K; Rotter, Thomas; Kinsman, Leigh; Sari, Nazmi; Harrison, Liz; Jeffery, Cathy; Kutz, Mareike; Khan, Mohammad F; Flynn, Rachel

    2014-09-19

    Lean is a set of operating philosophies and methods that help create a maximum value for patients by reducing waste and waits. It emphasizes the consideration of the customer's needs, employee involvement and continuous improvement. Research on the application and implementation of lean principles in health care has been limited. This is a protocol for a systematic review, following the Cochrane Effective Practice and Organisation of Care (EPOC) methodology. The review aims to document, catalogue and synthesize the existing literature on the effects of lean implementation in health care settings especially the potential effects on professional practice and health care outcomes. We have developed a Medline keyword search strategy, and this focused strategy will be translated into other databases. All search strategies will be provided in the review. The method proposed by the Cochrane EPOC group regarding randomized study designs, non-randomised controlled trials controlled before and after studies and interrupted time series will be followed. In addition, we will also include cohort, case-control studies, and relevant non-comparative publications such as case reports. We will categorize and analyse the review findings according to the study design employed, the study quality (low- versus high-quality studies) and the reported types of implementation in the primary studies. We will present the results of studies in a tabular form. Overall, the systematic review aims to identify, assess and synthesize the evidence to underpin the implementation of lean activities in health care settings as defined in this protocol. As a result, the review will provide an evidence base for the effectiveness of lean and implementation methodologies reported in health care. PROSPERO CRD42014008853.

  13. The effect of disease management on utilization of services by race/ethnicity: evidence from the Florida Medicaid program.

    PubMed

    Kominski, Gerald F; Morisky, Donald E; Afifi, Abdelmonem A; Kotlerman, Jenny B

    2008-03-01

    To measure possible racial/ethnic differences in a Florida disease management (DM) program on utilization of selected healthcare services for 4 chronic illnesses. Pre-post comparison of utilization among 15,275 high-risk beneficiaries enrolled in DM in the Florida Medicaid program between October 2001 and October 2003. Two-part regression analyses of the effect of DM on annualized inpatient days, emergency department (ED) visits, and outpatient visits, controlling for relevant covariates. Annualized rates were used to adjust for differences in length of program enrollment. Disease management patients in the postperiod had significantly lower annual rates of inpatient days, ED visits, and outpatient visits across most racial/ethnic groups. Disease management reduced utilization by a similar absolute amount in each racial/ethnic group. However, baseline disparities in utilization of inpatient days were not reduced by the DM program. Disease management has a similar effect across different racial/ethnic groups but may not ameliorate important baseline disparities. Evaluations of DM programs should account for baseline disparities in utilization and examine whether those disparities can be reduced through DM.

  14. Efficient management and promotion of utilization of the video information acquired by observation

    NASA Astrophysics Data System (ADS)

    Kitayama, T.; Tanaka, K.; Shimabukuro, R.; Hase, H.; Ogido, M.; Nakamura, M.; Saito, H.; Hanafusa, Y.; Sonoda, A.

    2012-12-01

    In Japan Agency for Marine-Earth Science and Technology (JAMSTEC), the deep sea videos are made from the research by JAMSTEC submersibles in 1982, and the information on the huge deep-sea that will reach more 4,000 dives (ca. 24,700 tapes) by the present are opened to public via the Internet since 2002. The deep-sea videos is important because the time variation of deep-sea environment with difficult investigation and collection and growth of the living thing in extreme environment can be checked. Moreover, with development of video technique, the advanced analysis of an investigation image is attained. For grasp of deep sea environment, especially the utility value of the image is high. In JAMSTEC's Data Research Center for Marine-Earth Sciences (DrC), collection of the video are obtained by dive investigation of JAMSTEC, preservation, quality control, and open to public are performed. It is our big subject that the huge video information which utility value has expanded managed efficiently and promotion of use. In this announcement, the present measure is introduced about these subjects . The videos recorded on a tape or various media onboard are collected, and the backup and encoding for preventing the loss and degradation are performed. The video inside of a hard disk has the large file size. Then, we use the Linear Tape File System (LTFS) which attracts attention with image management engineering these days. Cost does not start compared with the usual disk backup, but correspondence years can also save the video data for a long time, and the operatively of a file is not different from a disk. The video that carried out the transcode to offer is archived by disk storage, and offer according to a use is possible for it. For the promotion of utilization of the video, the video public presentation system was reformed completely from November, 2011 to "JAMSTEC E-library of Deep Sea Images (http:// www.godac.jamstec.go.jp/jedi/)" This new system has preparing

  15. Psychosocial and nonclinical factors predicting hospital utilization in patients of a chronic disease management program: a prospective observational study.

    PubMed

    Tran, Mark W; Weiland, Tracey J; Phillips, Georgina A

    2015-01-01

    Psychosocial factors such as marital status (odds ratio, 3.52; 95% confidence interval, 1.43-8.69; P = .006) and nonclinical factors such as outpatient nonattendances (odds ratio, 2.52; 95% confidence interval, 1.22-5.23; P = .013) and referrals made (odds ratio, 1.20; 95% confidence interval, 1.06-1.35; P = .003) predict hospital utilization for patients in a chronic disease management program. Along with optimizing patients' clinical condition by prescribed medical guidelines and supporting patient self-management, addressing psychosocial and nonclinical issues are important in attempting to avoid hospital utilization for people with chronic illnesses.

  16. The Affordable Care Act, health care reform, prescription drug formularies and utilization management tools.

    PubMed

    Ung, Brian L; Mullins, C Daniel

    2015-01-01

    The U.S. Patient Protection and Affordable Care Act (hence, Affordable Care Act, or ACA) was signed into law on March 23, 2010. Goals of the ACA include decreasing the number of uninsured people, controlling cost and spending on health care, increasing the quality of care provided, and increasing insurance coverage benefits. This manuscript focuses on how the ACA affects pharmacy benefit managers and consumers when they have prescriptions dispensed. PBMs use formularies and utilization control tools to steer drug usage toward cost-effective and efficacious agents. A logic model was developed to explain the effects of the new legislation. The model draws from peer-reviewed and gray literature commentary about current and future U.S. healthcare reform. Outcomes were identified as desired and undesired effects, and expected unintended consequences. The ACA extends health insurance benefits to almost 32 million people and provides financial assistance to those up to 400% of the poverty level. Increased access to care leads to a similar increase in overall health care demand and usage. This short-term increase is projected to decrease downstream spending on disease treatment and stunt the continued growth of health care costs, but may unintentionally exacerbate the current primary care physician shortage. The ACA eliminates limitations on insurance and increases the scope of benefits. Online health care insurance exchanges give patients a central location with multiple insurance options. Problems with prescription drug affordability and control utilization tools used by PBMs were not addressed by the ACA. Improving communication within the U.S. healthcare system either by innovative health care delivery models or increased usage of health information technology will help alleviate problems of health care spending and affordability.

  17. Triage of the autistic spectrum child utilizing the congruence of case management concepts and Orem's Nursing Theories.

    PubMed

    Oliver, Catherine J

    2003-01-01

    The purpose of this project was to design and implement a case management framework for the benefit of children diagnosed with an autistic spectrum disorder (ASD). The process consisted of selecting two children exhibiting symptoms of an ASD and managing them across a continuum of care. Methodological structure was derived from case management standards of practice and Orem's Nursing Theories. Although some objectives sustained a slight delay because of variances, findings revealed successful outcomes based on progression toward measurable case management goals. The children were directed to appropriate school placements and habilitative therapies in an efficient manner. Their parents received support and education related to special needs children. The process yielded assurance that Orem's Nursing Theories and case management concepts articulate seamlessly within nursing care boundaries.

  18. Utilization of Local Law Enforcement Aerial Resources in Consequence Management (CM) Response

    SciTech Connect

    Wasiolek, Piotr T.; Malchow, Russell L.

    2013-03-12

    During the past decade the U.S. Department of Homeland Security (DHS) was instrumental in enhancing the nation’s ability to detect and prevent a radiological or nuclear attack in the highest risk cities. Under the DHS Securing the Cities initiative, nearly 13,000 personnel in the New York City region have been trained in preventive radiological and nuclear detection operations, and nearly 8,500 pieces of radiological detection equipment have been funded. As part of the preventive radiological/nuclear detection (PRND) mission, several cities have received funding to purchase commercial aerial radiation detection systems. In 2008, the U.S. Department of Energy, National Nuclear Security Administration Aerial Measuring System (AMS) program started providing Mobile Aerial Radiological Surveillance (MARS) training to such assets, resulting in over 150 HAZMAT teams’ officers and pilots from 10 law enforcement organizations and fire departments being trained in the aerial radiation detection. From the beginning, the MARS training course covered both the PRND and consequence management (CM) missions. Even if the law enforcement main focus is PRND, their aerial assets can be utilized in the collection of initial radiation data for post-event radiological CM response. Based on over 50 years of AMS operational experience and information collected during MARS training, this presentation will focus on the concepts of CM response using aerial assets as well as utilizing law enforcement/fire department aerial assets in CM. Also discussed will be the need for establishing closer relationships between local jurisdictions’ aerial radiation detection capabilities and state and local radiation control program directors, radiological health department managers, etc. During radiological events these individuals may become primary experts/advisers to Incident Commanders for radiological emergency response, especially in the early stages of a response. The knowledge of the existence

  19. Legionella and risk management in hospitals-A bibliographic research methodology for people responsible for built environment and facility management.

    PubMed

    Leiblein, Thomas W; Tucker, Matthew; Ashall, Mal; Lee, Susanne B; Gollnisch, Carsten; Hofer, Susanne

    2016-11-01

    An ongoing research project investigates the roles and duties of persons responsible for the built environment with respect to risk management of water systems and Legionella prevention from a facility management's perspective. Our literature review provides an approach for selecting and analysing abstracts of initially 177 journal articles, subjected to certain topic-specific inclusion and exclusion criteria. Different decision strategies of either logic 'yes/no', Boolean operators 'OR' or 'AND' and decisions for single counts or cumulative counts of the identified three principal keywords 'Legionella', 'hospital' and 'water', were completed. A final list of ten principal reference articles from 29 journals was compiled. It suggests that the interconnected perspective of water systems, Legionella and hospitals seems to be underrepresented in the field of the built environment and facility management. The term 'stakeholder', which would refer to decision-makers, was not found more than once. Our result is a useful summary of established sources of information on environmental Legionella research. The results can be helpful for those new to the topic.

  20. Integrated national energy planning and management: methodology and application to Sri Lanka. World Bank technical paper

    SciTech Connect

    Munasinghe, M.; Meier, P.

    1988-01-01

    Given the importance of energy in modern economies, the first part of the volume is devoted to examining some of the key conceptual and analytical tools available for energy-policy analysis and planning. Policy tools and institutional frameworks that will facilitate better energy management are also discussed. Energy-policy analysis is explained, while effective energy management techniques are discussed to achieve desirable national objectives, using a selected set of policies and policy instruments. In the second part of the volume, the actual application of the principles set out earlier is explained through a case study of Sri Lanka. The monograph integrates the many aspects of the short-term programs already begun with the options for the medium to long term, and ends with the outline of a long-term strategy for Sri Lanka.